Analysis of the indications for routine lumbar puncture and results of cerebrospinal fluid examination in children admitted to the paediatric wards of two hospitals in East Africa

Abstract

Lumbar puncture (LP) is an important diagnostic tool for investigating neurological conditions/diseases. This study was carried out to compare the indications for lumbar puncture and findings of cerebrospinal fluid examination in children admitted to Muhimbili National Hospital (MNH) in Dar-es-salaam, Tanzania and Kilifi District Hospital (KDH) in Kenya. Records of all children admitted to the paediatric wards of the two hospitals from 1st November 2004 to 30th April 2005 with suspected central nervous system infections and had LPs performed were analysed. Overall, 8,741 paediatric admissions were recorded in the two hospitals (Muhimbili = 6,228; Kilifi= 2,513). Of these, 607 (6.9%) had a LP performed; 154 out 6,228 (2.5%) in MNH and 453 out of 2,513 (18.0%) in KDH. LPs were performed less frequently in Muhimbili than in Kilifi Hospital. The most common indications for LP at MNH were convulsions (62.5%), neck stiffness (14.3%) and prostration (17%), whereas at KDH were convulsions (56.3%), neck stiffness (7.3%) and prostration (22.1%). The bacterial isolates were rarely (23%) obtained on culture at both hospitals. Streptococcus pneumonaie and Salmonella species were the commonest causes of pyogenic meningitis. In conclusion, the rate of LP performance in the two hospitals is low. There is need therefore to improve the rates of LP and the isolation of bacterial pathogens from cerebrospinal fluid cultures. Other possible causes for meningitis such as viruses need to be investigated.

Bacterial meningitis following introduction of Hib conjugate vaccine in northern Uganda

“…This has also been reported in various other African countries. 4,5 In the current study, the minimum incidence of acute bacterial meningitis caused by SP is 33.7/100,000 children ,5 years. This is very high and does not include non-meningitis cases, for example, pneumonia/sepsis caused by SP, and thus might be only the tip of the iceberg of pneumococcal sepsis.…”

“…[1][2][3] Non-typhoidal salmonella is also a common cause of paediatric bacterial meningitis and sepsis. 4,5 In June 2002, Uganda, through the Global Alliance for Vaccines and Immunizations (GAVI), introduced the pentavalent vaccine (for a period of 5 years) which contains Hib and hepatitis B vaccine, in addition to diphtheria, pertussis and tetanus. Disease surveillance of bacterial meningitis is used to document the impact of new interventions put in place for vaccine-preventable diseases in children.…”

Clinical features of bacterial meningitis among hospitalised children in Kenya

“…Low LP rates reported in settings like ours have raised concerns regarding missing meningitis cases [6,7]. Knowing that a large number of LPs is needed in order to diagnose each case of bacterial meningitis is important in this regard.…”

“…CSF culture is the gold standard for bacterial meningitis but has limited sensitivity [4] as it may be compromised by prior administration of antimicrobials [5] and is usually unavailable or unreliable in public hospitals in sub-Saharan Africa. Public hospitals also often lack adequate CSF microscopy capacity, and lumbar puncture (LP) may be commonly ordered but not done [6,7]. Thus, antimicrobial management decisions are often based on clinical features only.…”

Lumbar Puncture-Related Knowledge, Attitudes, and Practices among Patients, Caregivers, Doctors, and Nurses in Zambia

“…3 Delayed LP uptake may result in sterilization of CSF which complicates efforts to discontinue unnecessary treatments and may result in unintended patient harm. 21,22 Studies from Pakistan and Singapore suggest that patients who do not undergo LP are more likely to refuse other medical interventions and to be discharged against medical advice. 23,24 Additional investigation is warranted to investigate this association and the role the patient-HCW relationship plays in these outcomes.…”