Risk factors for death and severe sequelae in Malawian children with bacterial meningitis, 1997-2010.
BACKGROUND
Acute bacterial meningitis (ABM) causes significant death and disability in children worldwide, with HIV recognized as an established risk factor for infection and negative outcomes. However, additional major risk factors for death and disability in pediatric ABM remain unclear.


METHODS
We conducted a retrospective analysis of case data from 3 departmental studies of ABM involving 1784 children <15 years old who attended Queen Elizabeth Central Hospital in Blantyre, Malawi during 1997 to 2010. Univariate and multivariate logistic regression models were used to estimate the effects of HIV seropositivity, impaired consciousness and causative organism on death and severe sequelae.


RESULTS
Impaired consciousness or coma at the time of admission was strongly associated with death (coma: odds ratio [OR] = 14.4, 95% confidence interval [CI]: 9.42, 22.1) and severe sequelae (Coma: OR = 3.27, 95% CI: 2.02, 5.29) in multivariate logistic regression models. HIV seropositivity was significantly associated with increased odds of death (OR = 1.65, 95% CI: 1.20, 2.26) but not with developing severe sequelae (OR = 0.88, 95% CI: 0.56, 1.38). After adjustment, infection with Salmonella spp. was associated with increased odds of death (OR = 2.11, 95% CI: 1.06, 4.08) and pneumococcal meningitis was associated with increased odds of severe sequelae (OR = 1.84, 95% CI: 1.03, 3.29).


CONCLUSIONS
Impaired consciousness and HIV infection increased the odds of death from ABM in Malawian children. Use of pneumococcal conjugate vaccine could greatly reduce the burden of ABM in Malawi.
Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA. dmccorm4@uthsc.edu
David W
DW
McCormick
Mark L
ML
Wilson
Limangeni
L
Mankhambo
Ajib
A
Phiri
Yamikani
Y
Chimalizeni
Kondwani
K
Kawaza
Brigitte
B
Denis
Enitan D
ED
Carrol
Elizabeth M
EM
Molyneux
D000293:Adolescent; D000704:Analysis of Variance; D002648:Child; D002675:Child, Preschool; D003128:Coma / Q000453:epidemiology / Q000382:microbiology; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000382:microbiology; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008295:Malawi / Q000453:epidemiology; D008297:Male; D016920:Meningitis, Bacterial / Q000134:cerebrospinal fluid / Q000453:epidemiology* / Q000382:microbiology / Q000473:pathology*; D009752:Nutritional Status; D016017:Odds Ratio; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome