IV.6) HOSPITAL OUTCOME
Table 7: Distribution of complications found during
admission
|
Complication
|
|
Number
|
Percentage(%)
|
|
Respiratorydistress
|
|
9
|
20.9
|
|
Anemia
|
|
7
|
16.3
|
|
Brain abcess
|
|
6
|
14.0
|
|
Status epilepticus
|
|
5
|
11.6
|
|
Dehydration
|
|
5
|
11.6
|
|
Motor deficit
|
|
4
|
9.3
|
|
Intracranial hypertension
|
|
4
|
9.3
|
|
Hydrocephalus
Others (strabismus,
retardation)
|
psychomotor
|
4
2
|
9.3
4.7
|
|
Cerebral empyema
|
|
2
|
4.7
|
Most of the patients with bacterial meningitis developed
respiratory distress in the course of admission with a percentage of 20.9 %,
followed by anemia with a percentage of 16.3 %. Brainabscess also being an
important complication in meningitis was present at 14.0%.
44
Table 8: Distribution of patients according to outcome
during admission
Outcome Number Percentage(%)
Cured 41 97.6
Death 1 2.4
Total 42 100
Most patients admitted for meningitis 41 were cured at 95.3 %
and among those, 25 had complications at 61.0 %.
We recorded 1 death, and 1 patient went against medical
advice.
45
Table 9: Distribution of patients according to sequelae
at time of discharge
Sequelae Number Percentage(%)
Hydrocephalus 4 9.3
Tetraparesis 2 4.3
Hemiparesis 1 2.3
Facial paralysis 1 2.3
Psychomotorregression 1 2.3
Hydrocephalus was the most frequent sequelae at time of
discharged at 9.3 % of all the complications found.
46
Table 10: Distribution of patients according to
treatment recieved for sequalae
|
Sequelae
|
N(%)
|
Treatment
|
N
|
|
Hydrocephalus
|
4(9.3)
|
Neurosurgery
|
2
|
|
Tetraparesis
|
2(4.3)
|
Physiotherapy
|
1
|
|
Hemiparesis
|
1(2.3)
|
-
|
|
|
Facial paralysis
|
1(2.3)
|
-
|
|
|
Psychomotorregression
|
1(2.3)
|
Physiotherapy
|
1
|
Among the patients withsequelae, 2 undergone surgery and 2
undergone physiotherapy.
47
CHAPITRE FIVE
DISCUSSION
Our main objective was to identify the common pathogens that
cause bacterial meningitis in children at the Pediatric unit in YGOPH and to
describe their hospital outcome. At the end of our study, we were able to
identify these pathogens causing bacterial meningitis in children and described
the hospital outcome.
V.1) INCIDENCE
A total number of 43 patients were admitted at the general
pediatric unit for bacterial meningitis with biological confirmation from the
1st of January 2014 till the 31st of December 2018 giving an incidence of 0.3
%. This incidence is similar to that of Shingoh et al in Japan that had an
incidence of 0.37 %[63] .Our incidence for bacterial
meningitis is far lower than what Nguefack et al had in 2014 in YGOPH where
bacterial meningitis was 1.54 % of the total admissions in the general
pediatric unit[3].This large difference could be explained
first by the problem of lost files from the archives .Secondly , the difference
could be explained by the vaccination programme in Cameroon which was
introduced since 1976, became operational in all the regions in 1982 and covers
children from 0-11 months of age against infectious diseases[73]
. In that same line, in a study done at YGOPH in 2016, there was
vaccination completeness in children aged from 0-11 months at 96.3 %
[73]. Koko et al in Libreville, Gabon also had a higher
incidence of 1.2 % [65], thus our incidence tends to be much
lower than most incidences of bacterial meningitis in Africa and even for those
in developed countries; 0.70% in Finland in 2014[62].
V.2) SOCIODEMOGRAPHIC CHARACTERISTICS
The average age in our study was 22.4 months, with most
patients admitted for bacterial meningitis being less than 12 months of age.
These are similar to Nguefack et al who had more patients with 2 months - 1
year of age [3]. Similar results were observed with Mohammed
in Al-Ramadi with more patients being less than 1 year of age, but our results
are contradictory to those of Campagne who had instead less patients of
bacterial meningitis with less than 1 year of age [33][
64].Fayyaz also had less patients of less than 1 year of age
[70].
48
The sex ratio was 0.79 in our study. There was a predominance
of female sex admissions of 56 %.This result is similar to that of Almuneef et
al in Saudi Arabia which had 36 females over 34
males[59].Contradictory result is gotten from Sile et al who
had a sex ratio of 1.65 with a predominance in male sex in Garoua Provincial
hospital[67] , also with Franck - Briggs who had male
predominance of 58 in Nigeria[57].Otero et al had in Columbia
a predominance in the male sex of 61.4 %[72] .Thus any
predominance of either sex varies with each study.
There was more direct entry in YGOPH than referral in our
study with 60.5 %. This result can be explained by the fact that YGOPH is a
tertiary and a reference hospital which has the capacity to take care of
emergencies.Therefore, patients will prefer to start consultations directly in
such settings especially as they consider some symptoms as a sign of
fatality.
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