Bacterial meningitis in children in southern Ghana

East Afr Med J. 1994 Feb;71(2):113-7.


One hundred and three children (1% of seriously ill children referred to the Korle Bu Teaching Hospital in Accra) were admitted with bacterial meningitis over a 17 month period. 43 of these children had been ill for more than 4 days before arrival at our centre. The main causative organisms were S. pneumoniae (47.9%), Neisseria meningitides (38.4%) and Haemophilus influenzae (9.6%). All bacterial isolates were highly sensitive to ceftriaxone. Resistance to penicillin and chloramphenicol was however present in 5-17% of isolates. All cerebrospinal fluid samples were sterilised within 48 hours of antibiotic treatment. Case fatality rate was 22% with the majority of deaths occurring within hours of admission and closely related to S. pneumoniae infection. Neurological complications occurred in 22%; mild diarrhoea in 33% and secondary fever in 14.8% of survivors. No significant difference was noted among the three treatment regimens of ceftriaxone alone, penicillin plus chloramphenicol, and ceftriaxone alone for 48 hours followed by penicillin/chloramphenicol combination. Our overall outcome would have been better if patients had been started on appropriate antibiotic treatment within the earlier hours of the infection. Furthermore, the latter generation cephalosporins, including ceftriaxone, must be given consideration as antibiotics of first choice world wide.

PIP: Between November, 1991, and March, 1993, in Accra, Ghana, physicians admitted 103 children, 2 months to 12 years old, to the Korle Bu Teaching Hospital with suspected bacterial meningitis. They constituted 1.04% of all children presenting at the emergency rooms. Late referral to the hospital was likely responsible for the high case fatality rate within the 1st 24 hours of admission (59.1% of all deaths). 42.7% of all cases presented more than 96 hours after the onset of symptoms. 7 children died immediately after admission, allowing physicians no time to begin antibiotic treatment. The overall case fatality rate was 21.4%. Streptococcus pneumonia was isolated from the cerebrospinal fluid (CSF) in 53.8% of the early deaths and 55% of all 73 mortality cases from which bacteria were isolated. Leading causative organisms were $. pneumoniae (47.9%), Neisseria meningitides (38.4%), and Hemophilus influenza (9.6%). All bacterial isolates were sensitive to ceftriaxone. 5-17% of all isolates were resistant to penicillin and chloramphenicol. No bacteria were isolated in the CSF of any children within 48 hours of antibiotic treatment. The leading complications and sequelae of the 81 survivors were mild diarrhea (33%), neurological complications (22%), and secondary fever (14.8%). Even though the chloramphenicol/penicillin treatment regimen had the highest survivor outcome results (43%), its results were not significantly different than those of ceftriaxone alone for 48 hours followed by chloramphenicol/penicillin and ceftriaxone alone (24% and 20%, respectively; p =.6). These results suggest that health workers at less than optimum health facilities should administer the 1st dose of ceftriaxone to children suspected of having meningitis before transferring them to a tertiary facility for further management. This should greatly reduce case fatalities and sequelae. Health workers worldwide, even those in malaria endemic areas, should consider meningitis as a significant cause of fever.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anti-Bacterial Agents / therapeutic use
  • Child
  • Child, Preschool
  • Drug Resistance, Microbial
  • Female
  • Ghana / epidemiology
  • Hospitalization
  • Humans
  • Infant
  • Male
  • Meningitis, Haemophilus / cerebrospinal fluid
  • Meningitis, Haemophilus / drug therapy
  • Meningitis, Haemophilus / epidemiology*
  • Meningitis, Haemophilus / microbiology
  • Meningitis, Meningococcal / cerebrospinal fluid
  • Meningitis, Meningococcal / drug therapy
  • Meningitis, Meningococcal / epidemiology*
  • Meningitis, Meningococcal / microbiology
  • Meningitis, Pneumococcal / cerebrospinal fluid
  • Meningitis, Pneumococcal / drug therapy
  • Meningitis, Pneumococcal / epidemiology*
  • Meningitis, Pneumococcal / microbiology
  • Microbial Sensitivity Tests
  • Population Surveillance*
  • Survival Rate
  • Time Factors
  • Treatment Outcome


  • Anti-Bacterial Agents