Effect of malnutrition on immediate outcome of childhood bacterial meningitis: a hospital based prospective cohort study in Bangladesh

Abstract

Acute bacterial meningitis is an important serious illness worldwide and causing mortality and morbidity in children. In developed countries, only 5% of patients die and 15-20% develop sequel whereas in underdeveloped countries 12-50% of patients die and 25-50% of patients develop sequel. Malnutrition can make a person more susceptible to infection, and infection also contributes to malnutrition, which causes a vicious cycle. A hospital based prospective cohort study was conducted in the Pediatrics department of Mymensingh Medical College & Hospital from February 2012 to February 2013 to compare immediate outcome of bacterial meningitis: in malnourished and well nourished children. Thirty (30) cases of well-nourished and 30 malnourished were enrolled by using purposive sampling. Fever, convulsion, bulged fontanel, abnormal behavior, headache and respiratory symptoms were presenting complaints in both groups and convulsion was significantly more in malnourished group. In Malnourished group, GCS on admission was <13 in majority whereas among well-nourished group it was 13-15. CSF findings were similar. Most of the exposed children were anaemic. Total 12(20%) children died, 14(23%) developed major sequel, 10(17%) patients developed minor sequel. Relative risk of death was 5 fold followed by major sequel 6 fold and minor sequel 4 fold in malnourished group. Hospital stay was more in malnourished group. This study reveals that acute bacterial meningitis occurred in all ages from 1 to 12years child of both sexes and more in under five age group and in males. Fever, convulsion and sign of meningeal irritation were prominent clinical features. This study concludes that death, major and minor neurological sequel were more common in malnourished children and young age, male sex, anaemia, weight for age Z score <3rd percentile, GCS< 13 were the bad prognostic factors.