Factors Associated With Mortality Among Hospitalized Children With Acute Bacterial Meningitis in a Resource-Limited Setting: A Retrospective Study.

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BACKGROUND: Acute bacterial meningitis (ABM) is a significant public health problem in developing countries, including Yemen, especially during warfare. This is because persistent political turmoil impedes ABM prevalence, etiology, and treatment. Here, we investigate the factors associated with mortality among hospitalized children with ABM in a resource-limited setting.

MATERIAL AND METHOD: A retrospective study between March 2018 and December 2023 at the Pediatric Center, Althora General Hospital, Yemen, included 387 children (aged <15 years) diagnosed with ABM and confirmed by bacteriology. The data on patient characteristics and cerebrospinal fluid (CSF) characteristics, culture, and treatment outcome were collected from the patient medical profile and analyzed. Factors associated with mortality were investigated in univariate and multivariate analysis using odds ratio (OR) and 95% confidence interval (CI).

RESULT: The median age was 1.00 years (interquartile range (IQR): 1.00, 4.00), with most being under one year old (n=213, 55.0%), male (n=237, 61.2%), and from rural areas (n=218, 56.3%), with symptoms lasting over five days in 58 (15%) of cases. Streptococcus pneumonia was the most common CSF culture result (n=383, 99%), with mortality reported in 15 (3.9%) cases. In multivariate analysis, younger age (OR: 1.77; 95% CI: 1.18-2.94, p=0.010), malnutrition (OR: 480.82; 95% CI: 27.78-56020.49, p=0.001), altered mental status (OR: 1536.83; 95% CI: 42.82-658,144.96, p=0.002), and the longer time before hospitalization > five days (OR: 161.84; 95 % CI: 9.97-16,700.53, p=0.005) were associated with mortality.

CONCLUSION: Our findings highlight the prognostic significance of early detection of a predisposing focus to ABM. Poor prognosis and mortality may be associated with younger age, delayed hospitalization, malnutrition, and altered mental status.