Six-hundred-and-forty-two previously healthy children aged 1 month to 5 years with fever of acute onset, without localizing signs of infection, were prospectively recruited over 1 year. Sixty-three per cent had malaria, 4 per cent bacteraemia, and 7 per cent malaria and bacteraemia. Neither infection was identified in 27 per cent. Malaria was the predominant infection irrespective of season, temperature on presentation, or age (except under 6 months). Although Gram-negative bacteraemia was overall commoner than Gram-positive bacteraemia, Staphylococcus aureus was the commonest single organism (43 per cent) in bacteraemic patients. The prevalence of malaria increased with age while that of bacteraemia decreased with age (P < 0.0005). The prevalence of an identifiable infection increased with the temperature on presentation (P < 0.025). It is concluded that although malaria is the predominant infection in previously healthy under-5 children with acute fever without specific localizing signs of infection, bacteraemia (alone or associated with malaria) occur with an importantly high frequency. It is recommended that while presumptive treatment for malaria is justified in such children, evaluation for bacteraemia should be given consideration.
The pattern of epilepsy in children in Nigeria showed little difference from that seen in children in western countries, except that birth asphyxia was relatively common as a cause and there was a longer time between onset of seizures and parents seeking medical care. It was estimated that good control of seizures was achieved in 52.9% of children, but more than a quarter attended the clinic only once or twice and the reasons for this are not known. The response to medication was less satisfactory for children under 1 year, a result consistent with most other studies. Some uncommon forms and associations of epilepsy were recognised. An EEG was not essential for management but was useful for the diagnosis of syndromes. Treatment was equally effective when commenced 5 years or more after the onset of seizures. The anti-convulsant used for most children was phenobarbitone which had to be discontinued in only two cases because of side-effects. Phenobarbitone has been successfully used to treat epilepsy by primary health workers in rural Africa and this is expected to continue in the future.
Five-hundred-and-twenty-two infants and children aged 1 month to 6 years presenting at the Children's Emergency Room of the University of Benin Teaching Hospital with convulsions associated with fever (CAF) of acute onset were prospectively evaluated to determine the pattern of infections. Twenty-six per cent had localized infections of which 38 per cent were intracranial (meningitis = 16 per cent, cerebral malaria = 19 per cent, and encephalitis = 3 per cent) and 62 per cent were extracranial with respiratory tract infections contributing 51 per cent. Although, the prevalence of meningitis was significantly higher in 1-6 months old infants when compared with older children (47 per cent v. 12 per cent; P < 0.005), it was, none-the-less, present in all the other age groups (with a prevalence of 8-17 per cent). Seventy-four per cent of the children had no localizing signs of infection. Of these 68 per cent had malaria, 4 per cent bacteraemia, and 7 per cent malaria with bacteraemia, while no infections were identified in 21 per cent. Among children with bacteraemia Staphylococcus aureus was the commonest single isolate (33 per cent) although, overall, enterobacteriaceae were the commonest. We conclude, first, that meningitis should be excluded in all children aged under 6 years who present with CAF of acute onset and, secondly, that although anticipatory treatment for malaria is justified in children with CAF of acute onset without localizing signs of infection, consideration should also be given to the problem of bacteraemia.
There is a paucity of literature about the pattern of neurological diseases in children attending out-patient departments in Africa. In this study more boys than girls presented at our clinic. Almost all the principal diseases seen are eminently preventable. There appears to be no effective immunization programme. There is need for epidemiological studies to ascertain the true incidence of subacute sclerosing panencephalitis in view of the high incidence of measles in the community.
A total of 522 children, aged 1 month to 6 years, who presented with convulsions and fever of acute onset at the Children's Emergency Room of the University of Benin Teaching Hospital over a 1-year period, were prospectively evaluated. Bacterial meningitis was diagnosed in 22 (4.2%) on bacteriological and/or biochemical evidence. The causative organisms were cultured from the CSF in 13 (Neisseria meningitidis = 7, Streptococcus pneumoniae = 5 and Haemophilus influenzae = 1) and identified by Gram stain only in three (Gram-positive diplococci = 2 and Gram-negative diplococci = 1). No organisms were identified in the CSF of six of the children with meningitis. The prevalence of meningitis declined sharply after 6 months of age. Six of the children with bacterial meningitis lacked classical meningeal signs but had other indications for lumbar puncture. The following were significantly associated with meningitis: age under 6 months; focal or multiple seizures; absence of a past or family history of seizures; unrousable coma; and an extracranial focus of infection. It is concluded that bacterial meningitis occurs in a good proportion of children, even beyond infancy, with convulsions associated with fever of acute onset, and that decision on the need for lumbar puncture should be guided by clinical features such as age and the presence of complex febrile seizures.
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