Last modified: 2018-09-09
Abstract
Introduction: Global data on child neurological illness is scarce and facilities to treat affected children in low-middle income countries are severely limited. Lack of even basic epidemiological data limits the ability to lobby for training, service provision and research. We aimed to establish the burden of neurological illness in paediatric admissions to Kenyan hospitals.
Methods: This was an observational cohort study of paediatric admissions to 13 purposely selected public hospitals situated in regions of high and low malaria transmission in Kenya. All children aged 1 month–15 years, admitted between September 2013 and March 2017, were included. Routine data were prospectively collected from medical records. We identified children presenting with acute neurological illness or neurological comorbidity.
Results: Data were available for 69,043 paediatric hospital admissions, median age 1.7 years, 44.9% (30,729) female; 46.8% (32,297/69,043) admissions were in malaria-endemic areas. Total mortality was 6.0% (4,108/69,043). Seizures or coma were a presenting feature in 22.1% (15,236/69,043) and 17.3% (11,955/69,043) had a clinician-assigned primary or comorbid neurological diagnosis of meningitis, cerebral malaria, seizure disorder/epilepsy or cerebral palsy (table). Overall 26.3% (18,139/69,043) had a neurological presentation and 7.6% (1,374/18,139) children with these conditions died.
A multivariate analysis of risk factors for adverse outcome (in progress) will be presented.
Discussion: A quarter of children admitted to Kenyan public hospitals had a neurological presentation, consistently high across areas of high and low malaria prevalence. Under-reporting and misclassification of neurological conditions is likely. There is urgent need to better understand and address the global burden of childhood neuromorbidity.