Prospective cohort study of disabling sequelae and quality of life in children with bacterial meningitis in urban Senegal.

BACKGROUND: No studies have prospectively examined disabling sequelae and quality of life in children with bacterial meningitis in Sub-Saharan Africa. METHODS: Objectives were to (i) follow-up pediatric bacterial meningitis surveillance system children from urban Dakar, Senegal; (ii) use standardized tools to classify disabling sequelae (Global Burden of Disease classification system) and quality of life (Pediatric Quality of Life Inventory tool); and (iii) compare these sequelae with an age- and community-matched control group. RESULTS: Sixty-six cases and 66 controls had follow-up examinations. The odds of a major sequelae was 3 times greater in the cases (65.1%, 43/66) than the age- and community-matched control group (40.9%, 27/66) (adjusted odds ratio, 3.24; 95% confidence interval, 1.25-8.38). Hearing loss was the most common major sequelae in the cases (51.8%, 29/56) followed by cognitive deficit (40.0%, 26/65), seizures (21.2%, 14/66), and motor deficit (21.2%, 14/66). Of these cases, 34.9% (23/66) had multiple impairments. The risk of major sequelae was 79.2% (17/22) in children with previous pneumococcal meningitis, 59.1% (14/24) in Haemophilus influenzae type b meningitis, and 54.6% (6/11) in meningococcal meningitis. Total quality of life scores were significantly lower in cases (mean, 69.7; standard deviation, 25.6) than controls (mean, 84.0; standard deviation,: 14.4) (weighted mean difference, 12.98; 95% confidence interval, 6.15-19.82). CONCLUSIONS: Children with bacterial meningitis are at high risk of complex multiple impairments and impaired quality of life. Many of these disabilities could have been averted with use of the new conjugate vaccines against Haemophilus influenzae type b, pneumococcus, and meningococcus.