Seizure Activity and Neurological Sequelae in Ugandan Children who have Survived an Episode of Cerebral Malaria

Background: Seizures are a common presenting feature in children with cerebral malaria (CM) and neurologic deficits have been described in survivors of CM. However few prospective studies have described the frequency of seizure activity and neurologic deficits in survivors of CM over time. Methods: Eighty-two children aged 3 to 12 years who survived an episode of CM were followed up and monitored for seizure activity and neurologic deficits at discharge; 3; 6 and 24 months. Seventy six children with uncomplicated malaria (UM) and 105 healthy community controls (CC) age 3 to 12 years were recruited as comparison groups and the frequency of seizures in the 6 to 24 month follow-up period was compared in the 3 groups. Results: Cumulative incidence of seizures increased over time in children with CM; with a total of 2 of 76 children (2.6) reporting seizures at 3 months; 3 of 74 children (4.1) at 6 months and 11 of 68 children (16.2) at 24 months (Chi square for trend = 9.36; P=0.002). In contrast; neurologic deficits almost completely resolved over time; occurring in 19 of 76 children with CM (25) at discharge; 2 of 74 children (2.7) at 6 months; and 1 of 68 (1.5) children at 24 months. Conclusions: During the 24 months following a CM episode; neurologic deficits resolve but the cumulative incidence of seizures increases in children with CM. Neurologic impairment after an episode of CM may not be limited to the neurologic deficits seen at discharge

Intravascular Catheter Related Infections in Children Admitted on the Paediatric Wards of Mulago Hospital; Uganda

Introduction: Worldwide use of intravascular catheters (IVC) has been associated with both local and systemic infections. No studies have been done in the sub-Saharan region on IVC related infections. Objective: To determine the prevalence; causative organisms and their antimicrobial susceptibility pattern and the factors associated with infections related to short term peripheral venous catheters in children admitted to the general paediatric wards in Mulago Hospital; Uganda. Methods: A cross-sectional study of 391 children aged one day to 12 years; on Jelliffe ward in Mulago Hospital; who had short peripheral venous intravascular catheters uncoated with no antibiotic or antiseptic; was done. Social demographic characteristics; anthropometry; clinical examination including the catheter site were determined at enrollment. The children had their blood; catheter tip and hub samples taken off for culture and sensitivity as well as complete blood counts. The data collected was entered using EPIINFO and analysed with SPSS packages. Results: Out of the 391 short term peripheral venous catheters collected; 20.7catheter tips and 11.3catheter hubs were colonised. Phlebitis was observed in 17.4. Bacteria isolated from colonised catheter tips were Staphylococcus aureus (60.5); Staphylococcus epidermidis (23.5). The most common organism isolated from the hub was Staphylococcus aureus (56.8) followed by Staphylococcus epidermidis (18.1). Gram positive and negative organisms were sensitive to ciprofloxacin; gentamycin for gramnegative organisms and augmentin; cefuroxime; ceftriaxone for the gram-positive organisms. After logistic regression; factors such oedema; modified Glasgow coma score of 10/15; 6 hourly benzyl penicillin were significantly associated with colonisation of the tip while use of 25dextrose; chloramphenicol 6 hourly and blood transfusion were significantly associated with colonisation of the hub. Conclusion: The study showed that infections related to short peripheral venous catheters in paediatric general wards in Mulago Hospital occurs and prevalence was 20.72for tips and 11.3for hubs