Clinical findings and management of patients with meningitis with an emphasis on Haemophilus influenzae meningitis in rural Tanzania.

INTRODUCTION: The spectrum of meningitis pathogens differs depending on the age of patients and the geographic region, amongst other. Although meningitis vaccination programs have led to the reduction of incidence rates, an imbalance between low- and high-income countries still exists. METHODS: In a hospital-based study in rural northern Tanzania, we consecutively recruited patients with confirmed meningitis and described their clinical and laboratory characteristics. RESULTS: A total of 136 patients with meningitis were included. Fever (85%), meningism (63%) and impairment of consciousness (33%) were the most frequent clinical symptoms/signs. Nearly 10% of all patients tested were positive for malaria. The majority of the patients with bacterial meningitis (39%), especially those under 5years of age, were confirmed to be infected with Haemophilus influenzae (26%), Streptococcus pneumoniae (19%) and Neisseria meningitidis (15%). Haemophilus influenzae represented the dominant causative organism in children under 2years of age. CONCLUSION: Our study emphasizes the importance of recognizing warning symptoms like fever, meningism and impairment of consciousness, implementing laboratory tests to determine responsible pathogens and evaluating differential diagnoses in patients with meningitis in sub-Saharan Africa. It also shows that Haemophilus influenza meningitis is still an important cause for meningitis in the young, most probabaly due to lack of appropriate vaccination coverage.

Febrile seizures in rural Tanzania: hospital-based incidence and clinical characteristics.

OBJECTIVE: Febrile seizures may contribute to epilepsy later in life, but data in sub-Saharan Africa are scarce. We, therefore, conducted a hospital-based study on clinical characteristics of children with febrile seizures. METHODS: Over 2 years, we screened all pediatric admissions of Haydom Lutheran Hospital, northern Tanzania, and recruited 197 children with febrile seizures. RESULTS: The incidence of febrile seizures was 4% of all admitted children aged <10 years, with a mortality of almost 4%. The peak age at the first febrile seizure was 2 years. One of five children experienced repeated episodes, and the majority of children showed features of complex seizures. Approximately 20% of children had a positive family history of febrile seizures or epilepsy. CONCLUSION: Febrile seizures represent a frequent cause for admission of children, bearing a rather high mortality. Most children exhibit complex febrile seizures, which may contribute to the development of epilepsy later in life.

Aetiologies of altered states of consciousness: a prospective hospital-based study in a series of 464 patients of northern Tanzania.

BACKGROUND: Empirical knowledge suggests that altered states of consciousness are common in sub-Saharan Africa. However, to date prevalence studies are scarce. METHODS: The study was conducted at the Haydom Lutheran Hospital in northern Tanzania. Over a period of eight months all patients with altered states of consciousness were seen prospectively by a neurologist. The study population was subdivided into patients with acute confusional states (ACS) and those with impairment of consciousness (IOC). RESULTS: Out of 768 patients with neurological/psychiatric diagnoses 464 patients (60.4%) with altered states of consciousness were admitted. 159 patients had ACS (20.7%) and 447 IOC (58.2%). The diagnoses were not mutually exclusive. The most frequent aetiologies were of non-infectious origin. In patients with ACS, non-infectious encephalopathy, psychiatric disorder and dementia made up for 13.8%, 7.6% and 6.9%, respectively. In 25.2% of the cases with ACS, the reason remained obscure. In patients with IOC, the leading causes were epileptic seizures (febrile seizures 20.6% and epilepsy 13.9%) and head trauma 13.9%. Both ACS and IOC carried a bleak prognosis with 26% and 27% in-hospital mortality, respectively. INTERPRETATION: The above data emphasize that altered states of consciousness contribute substantially to morbidity and mortality in a rural African hospital. In our study sample, non-infectious causes represented the leading aetiologies although HIV testing was not available at the time of the study.

The pattern of neurosurgical disorders in rural northern Tanzania: a prospective hospital-based study.

BACKGROUND/OBJECTIVES: The prudent allocation of neurosurgical resources and training efforts requires an understanding of prevalence and clinical pattern of neurosurgical disorders in a particular region. The aim of our study was to assess the hospital-based prevalence of neurosurgical disease in the setting of rural sub-Saharan Africa. METHODS: The study was conducted at Haydom Lutheran Hospital in northern Tanzania. Over a period of 8 months, all patients suspected of having neurologic or neurosurgical disorders were seen by a neurologist in consecutive order. Patients were assessed clinically and with plain radiographs, a computed tomography scanner was not available. RESULTS: Of 8676 admissions, 151 patients (1.7%) were given a neurosurgical diagnosis. The most frequent diagnoses were traumatic brain injury (n=90), followed by tuberculosis of the spine (n=22), spina bifida (n=14), space-occupying cerebral lesion (n=13), and hydrocephalus (n=12). The overall mortality was 10.6%; it was especially high in patients with hydrocephalus (25%), space-occupying cerebral lesions (54%), and spina bifida (29%). CONCLUSIONS: Initial neurosurgical training and resource allocation in sub-Saharan Africa should focus on neurotrauma, spinal infections, congenital malformations, and hydrocephalus.