SEQUELLES NEUROLOGIQUES CHEZ DES ENFANTS ATTEINTS D\'UNE MENINGITE PURULENTE DANS UN CENTRE TERTIAIRE A LAGOS (NIGERIA)

NEUROLOGICAL SEQUELAE IN CHILDREN WITH PYOGENIC MENINGITIS IN A TERTIARY CENTRE IN LAGOS (NIGERIA ABSTRACT Background: Neurological sequelae following childhood bacterial meningitis are common particularly in the presence of delayed diagnosis and treatment. The latter is commonplace with meningitis in developing countries like Nigeria but information on the incidence and prevalence rates of consequent neurological sequelae is rare. Objective: We herein document the prevalence of such sequelae in children following admission for pyogenic meningitis and describe associated risk factors. Methods: We retrospectively reviewed forty-nine children managed for acute pyogenic meningitis at the Lagos University Teaching Hospital (LUTH) over a 10-year period. Information on biodata, clinical features, pre–admission treatment, investigation results, treatment, and duration of hospitalization were extracted from their case records and analysed. Results: Thirty-two (65.3%) of these children had obvious neurological sequelae. These included neuro-motor disorders (31%), hydrocephalus (28%), hearing disorders (25%), speech and language problems (25%), recurrent seizures (22%), mental retardation (22%), visual defects (19%) and behavioural problems (3%). All ages were affected but more commonly infants. Sequelae occurred in multiples. Children with sequelae tended to have had prior hospitalization and treatment. However no clinical or socio-economic factors showed significant relationship with the development of neurological sequelae. Conclusions: The distribution of sequelae in our study is similar to findings of other authors but shows a higher prevalence thus further confirming the need for primary prevention of this disease and for prompt and adequate treatment of cases. We recommend early screening of survivors for sequelae so that adequate rehabilitation can be planned. RESUME Introduction: Les séquelles neurologiques secondaire à une méningite bactérienne au cours de l\'enfance sont fréquentes en particulier lorsque le diagnostic et le traitement sont retardés. Objectif: Nous rapportons dans ce travail les aspects séquellaires neurologiques observés chez les enfants hospitalisés pour méningite pyogénique en relevant les facteurs de risque liés à cette affection. Méthode: Nous avons passé en revue rétrospectivement, quarante neuf enfants traités atteints de la méningite purulante au centre hospitalier universitaire de Lagos (LUTH) au cours d'une période de 10 ans. Les informations cliniques, paracliniques et thérapeutiques tirés de leurs dossiers médicaux ont été analysés. Résultats: Trente deux soit 65,3% des cas enfants présentaient des séquelle neurologicales: troubles neuro-moteurs (31%), hydrocéphalie (28%), troubles de l'ouie (25%), troubles du language et (25%), crise chronique (22%), retard mentale (22%), troubles visuelles (19%) et de comportement (3%). Aucun facteur clinique, socio-économique n'a pas été relevé et relié avec la survenue de séquelle neurologique. Conclusion: Nos résutalts sont semblabes à ceux présentés par d\'autres auteurs. La prévalence est élevée, impliquant ainsi la nécessité d\'une politque de prévention de cette affection ainsi qu\'un traitement précoce et la prise en charge des enfants porteurs de séquelles Key Words: Africa, neurological sequelae, pyogenic meningitis, Afrique, méningite purulente, Nigeria, séquelles African Journal of Neurological Sciences Vol.23(2) 200

Pneumococcal vaccination in developing countries.

WHO estimates that about 1·6 million people, including up to 1 million children under 5 years old, die every year of pneumococcal pneumonia, meningitis, and sepsis.1 In populations with high child-mortality rates, pneumonia is the leading infectious cause of mortality and accounts for about 20–25% of all child deaths.2 In these populations, Streptococcus pneumoniae is identified consistently as the leading cause of bacterial pneumonia, and pneumococcal bacteraemia is an important cause of child mortality. 3, 4 and 5 HIV infection increases risk for pneumococcal disease 20–40-fold, and antibiotic resistance makes treatment difficult and expensive. 6 Thus pneumococcal disease is a major global-health issue