Sequelae due to bacterial meningitis among African children: a systematic literature review

Abstract

Background: African children have some of the highest rates of bacterial meningitis in the world. Bacterial meningitis in Africa is associated with high case fatality and frequent neuropsychological sequelae. The objective of this study is to present a comprehensive review of data on bacterial meningitis sequelae in children from the African continent.

Methods: We conducted a systematic literature search to identify studies from Africa focusing on children aged between 1 month to 15 years with laboratory-confirmed bacterial meningitis. We extracted data on neuropsychological sequelae (hearing loss, vision loss, cognitive delay, speech/language disorder, behavioural problems, motor delay/impairment, and seizures) and mortality, by pathogen.

Results: A total of 37 articles were included in the final analysis representing 21 African countries and 6,029 children with confirmed meningitis. In these studies, nearly one fifth of bacterial meningitis survivors experienced in-hospital sequelae (median = 18%, interquartile range (IQR) = 13% to 27%). About a quarter of children surviving pneumococcal meningitis and Haemophilus influenzae type b (Hib) meningitis had neuropsychological sequelae by the time of hospital discharge, a risk higher than in meningococcal meningitis cases (median = 7%). The highest in-hospital case fatality ratios observed were for pneumococcal meningitis (median = 35%) and Hib meningitis (median = 25%) compared to meningococcal meningitis (median = 4%). The 10 post-discharge studies of children surviving bacterial meningitis were of varying quality. In these studies, 10% of children followed-up post discharge died (range = 0% to 18%) and a quarter of survivors had neuropsychological sequelae (range = 3% to 47%) during an average follow-up period of 3 to 60 months.

Conclusion: Bacterial meningitis in Africa is associated with high mortality and risk of neuropsychological sequelae. Pneumococcal and Hib meningitis kill approximately one third of affected children and cause clinically evident sequelae in a quarter of survivors prior to hospital discharge. The three leading causes of bacterial meningitis are vaccine preventable, and routine use of conjugate vaccines could provide substantial health and economic benefits through the prevention of childhood meningitis cases, deaths and disability.

Figure 1

Citations found through literature search.

Figure 2

Number of articles included in review by country and region.

Figure 3

Box plots of proportion of survivors with in-hospital sequelae. This figure presents box plots of the range of estimates for any in-hospital neuropsychological sequelae by pathogen and for all causes of confirmed bacterial meningitis (CBM) combined. The upper border of the shaded box is the value of the 75th percentile and the lower border of the shaded box is the 25th percentile, and these two values define the interquartile range (IQR). The vertical 'whiskers' represent the values 1.5 IQRs above the 75th percentile and 1.5 IQRs below the 25th percentile. Any data points that are beyond the whiskers appear as outliers (dots). The median estimate for each group is represented by the horizontal line within the shaded box and the number above the horizontal line. Spn = Streptococcus pneumoniae, Hib = Haemophilus influenzae type b, Nm = Neiserria meningitidis

Figure 4

Box plots of in-hospital case fatality ratios. Spn = Streptococcus pneumoniae, Hib = Haemophilus influenzae type b, Nm = Neiserria meningitidis