title: Mortality and neurodevelopmental outcomes of acute bacterial meningitis in children aged <5 years in Pakistan.
abstract: OBJECTIVE
  Significant neurodevelopmental sequelae are known to occur after acute bacterial meningitis (ABM). This study determined the burden of such sequelae in Pakistani children aged <5 years to guide policies for Haemophilus influenzae type b (Hib) and pneumococcal vaccination.
  
  
  METHODS
  Cases of ABM were recruited from hospital-based surveillance and assigned to 1 of 3 etiologic groups (Hib, Streptococcus pneumoniae, or unknown etiology). Two age-matched controls were recruited for each case. Six months after enrollment, each case underwent neurologic history and examination, neurodevelopmental evaluation, and neurophysiological hearing test. Controls were assessed in parallel.
  
  
  RESULTS
  Of 188 cases, 64 (34%) died. Mortality among subgroups were 7 (27%), 14 (28%), and 43 (39%) for Hib, Streptococcus pneumoniae, and unknown etiology, respectively. Eighty cases and 160 controls completed the assessments. Sequelae among cases included developmental delay (37%), motor deficit (31%), hearing impairment (18.5%), epilepsy (14%), and vision impairment (14%). Sequelae were higher after pneumococcal meningitis (19, 73%) compared with Hib meningitis (8, 53%). Compared with controls, cases were at significantly higher risk for all sequelae (P < .0001).
  
  
  CONCLUSIONS
  ABM causes a substantial long-term burden of poor neurodevelopmental outcomes. Hib and pneumococcal vaccines are very effective interventions to prevent meningitis and its disabling sequelae.
authors.affiliation: Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan.
authors.forename: Asif Raza
authors.initials: AR
authors.lastname: Khowaja
authors.forename: Syed
authors.initials: S
authors.lastname: Mohiuddin
authors.forename: Adam L
authors.initials: AL
authors.lastname: Cohen
authors.forename: Ahmed
authors.initials: A
authors.lastname: Khalid
authors.forename: Usma
authors.initials: U
authors.lastname: Mehmood
authors.forename: Farnaz
authors.initials: F
authors.lastname: Naqvi
authors.forename: Nargis
authors.initials: N
authors.lastname: Asad
authors.forename: Khatidja
authors.initials: K
authors.lastname: Pardhan
authors.forename: Kim
authors.initials: K
authors.lastname: Mulholland
authors.forename: Rana
authors.initials: R
authors.lastname: Hajjeh
authors.forename: Anita K M
authors.initials: AK
authors.lastname: Zaidi
authors.forename: Saad
authors.initials: S
authors.lastname: Shafqat
mesh_terms: D016022:Case-Control Studies; D002658:Developmental Disabilities / Q000453:epidemiology*; D005260:Female; D006320:Hearing Tests; D006801:Humans; D007223:Infant; D008297:Male; D016920:Meningitis, Bacterial / Q000401:mortality*; D008586:Meningitis, Pneumococcal / Q000401:mortality; D009422:Nervous System Diseases / Q000453:epidemiology*; D010154:Pakistan / Q000453:epidemiology; D011379:Prognosis; D013296:Streptococcus pneumoniae; D015996:Survival Rate