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Changing trends in incidence and aetiology of childhood acute non-traumatic coma over a period of changing malaria transmission in rural coastal Kenya: A retrospective analysis

Changing trends in incidence and aetiology of childhood acute non-traumatic coma over a period of changing malaria transmission in rural coastal Kenya: A retrospective analysis
Changing trends in incidence and aetiology of childhood acute non-traumatic coma over a period of changing malaria transmission in rural coastal Kenya: A retrospective analysis

Objectives: Recent changes in malaria transmission have likely altered the aetiology and outcome of childhood coma in sub-Saharan Africa. The authors conducted this study to examine change in incidence, aetiology, clinical presentation, mortality and risk factors for death in childhood non-traumatic coma over a 6-year period. Design: Retrospective analysis of prospectively collected data. Setting: Secondary level health facility: Kilifi, Coast, Kenya. Participants: Children aged 9 months to 13 years admitted with acute non-traumatic coma (Blantyre Coma Score =2) between January 2004 and December 2009 to Kilifi District Hospital, Kenya. Exclusion criteria: delayed development, epilepsy and sickle cell disease. Results: During the study period, 665 children (median age 32 (IQR 20-46) months; 46% were girls) were admitted in coma. The incidence of childhood coma declined from 93/100 000 children in 2004 to 44/ 100 000 children in 2009. There was a 64% overall drop in annual malaria-positive coma admissions and a 272% overall increase in annual admissions with encephalopathies of undetermined cause over the study period. There was no change in case death of coma. Vomiting, breathing difficulties, bradycardia, profound coma (Blantyre Coma Score=0), bacteraemia and clinical signs of meningitis were associated with increased risk of death. Seizures within 24 h prior to admission, and malaria parasitaemia, were independently associated with survival, unchanging during the study period. Conclusion: The decline in the incidence and number of admissions of childhood acute non-traumatic coma is due to decreased malaria transmission. The relative and absolute increase in admissions of encephalopathy of undetermined aetiology could represent aetiologies previously masked by malaria or new aetiologies.

2044-6055
Gwer, Samson
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Thuo, Nahashon
4ad88f70-2960-494c-bb06-3f598b3ff2ae
Idro, Richard
4b04dd1a-6f52-4b7b-bdea-31fb066ff558
Ndiritu, Moses
6c643265-5267-4ef3-a989-83f9c0488e73
Boga, Mwanamvua
4cecedd3-b0a0-4d44-b438-97d90410a4d6
Newton, Charles
ea661613-9a2d-4e14-8d04-2d1c0804a321
Kirkham, Fenella
1dfbc0d5-aebe-4439-9fb2-dac6503bcd58
Gwer, Samson
6418bf02-004a-489f-b8b6-6fee801ec692
Thuo, Nahashon
4ad88f70-2960-494c-bb06-3f598b3ff2ae
Idro, Richard
4b04dd1a-6f52-4b7b-bdea-31fb066ff558
Ndiritu, Moses
6c643265-5267-4ef3-a989-83f9c0488e73
Boga, Mwanamvua
4cecedd3-b0a0-4d44-b438-97d90410a4d6
Newton, Charles
ea661613-9a2d-4e14-8d04-2d1c0804a321
Kirkham, Fenella
1dfbc0d5-aebe-4439-9fb2-dac6503bcd58

Gwer, Samson, Thuo, Nahashon, Idro, Richard, Ndiritu, Moses, Boga, Mwanamvua, Newton, Charles and Kirkham, Fenella (2012) Changing trends in incidence and aetiology of childhood acute non-traumatic coma over a period of changing malaria transmission in rural coastal Kenya: A retrospective analysis. BMJ Open, 2 (2), [e000475]. (doi:10.1136/bmjopen-2011-000475).

Record type: Article

Abstract

Objectives: Recent changes in malaria transmission have likely altered the aetiology and outcome of childhood coma in sub-Saharan Africa. The authors conducted this study to examine change in incidence, aetiology, clinical presentation, mortality and risk factors for death in childhood non-traumatic coma over a 6-year period. Design: Retrospective analysis of prospectively collected data. Setting: Secondary level health facility: Kilifi, Coast, Kenya. Participants: Children aged 9 months to 13 years admitted with acute non-traumatic coma (Blantyre Coma Score =2) between January 2004 and December 2009 to Kilifi District Hospital, Kenya. Exclusion criteria: delayed development, epilepsy and sickle cell disease. Results: During the study period, 665 children (median age 32 (IQR 20-46) months; 46% were girls) were admitted in coma. The incidence of childhood coma declined from 93/100 000 children in 2004 to 44/ 100 000 children in 2009. There was a 64% overall drop in annual malaria-positive coma admissions and a 272% overall increase in annual admissions with encephalopathies of undetermined cause over the study period. There was no change in case death of coma. Vomiting, breathing difficulties, bradycardia, profound coma (Blantyre Coma Score=0), bacteraemia and clinical signs of meningitis were associated with increased risk of death. Seizures within 24 h prior to admission, and malaria parasitaemia, were independently associated with survival, unchanging during the study period. Conclusion: The decline in the incidence and number of admissions of childhood acute non-traumatic coma is due to decreased malaria transmission. The relative and absolute increase in admissions of encephalopathy of undetermined aetiology could represent aetiologies previously masked by malaria or new aetiologies.

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Accepted/In Press date: 8 February 2012
e-pub ahead of print date: April 2012

Identifiers

Local EPrints ID: 429122
URI: http://eprints.soton.ac.uk/id/eprint/429122
ISSN: 2044-6055
PURE UUID: 8c9396b4-1cce-4847-8e57-314ff22d46c6
ORCID for Fenella Kirkham: ORCID iD orcid.org/0000-0002-2443-7958

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Date deposited: 21 Mar 2019 17:30
Last modified: 23 Jul 2022 01:48

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Contributors

Author: Samson Gwer
Author: Nahashon Thuo
Author: Richard Idro
Author: Moses Ndiritu
Author: Mwanamvua Boga
Author: Charles Newton
Author: Fenella Kirkham ORCID iD

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