The aetiologies, mortality, and disability of non-traumatic coma in African children: a systematic review and meta-analysis
Year: 2025
Type: review
Study designs: Systematic Review, Meta-Analysis
Abstract: BACKGROUND: Non-traumatic coma in African children is a common life-threatening presentation often leading to hospital attendance. We aimed to estimate the distribution of non-traumatic coma causes and outcomes, including disease-specific outcomes, for which evidence is scarce. METHODS: We systematically reviewed MEDLINE, Embase, and Scopus databases from inception to Feb 6, 2024. We included studies recruiting children (aged 1 month to 16 years) with non-traumatic coma (Blantyre Coma Scale score ≤2, ie deep coma or comparable alternative) from any African country. Disease-specific studies were included if outcomes were reported. Primary data were requested where required. We used a DerSimonian-Laird random effects model to calculate pooled estimates for prevalence of causes, mortality, and morbidity (in-hospital and post-discharge), including analysis of mortality by temporality. This study was registered with PROSPERO (CRD4202014193). FINDINGS: We screened 16 666 articles. 138 studies were eligible for analysis, reporting causes, outcome data, or both from 35 027 children with non-traumatic coma in 30 African countries. 114 (89%) of 128 studies were determined to be high quality. Among the causes, cerebral malaria had highest pooled prevalence at 58% (95% CI 48-69), encephalopathy of unknown cause was associated with 23% (9-36) of cases, and acute bacterial meningitis was the cause of 10% (8-12) of cases, with all other causes representing lower proportions of cases. Pooled overall case-fatality rates were 17% (16-19) for cerebral malaria, 37% (20-55) for unknown encephalopathy, and 45% (34-55) for acute bacterial meningitis. By meta-regression, there was no significant difference in cerebral malaria (p=0·98), acute bacterial meningitis (p=0·99), or all-cause coma (p=0·081) mortality by year of study. There was no substantial difference in deaths associated with cerebral malaria in-hospital compared with post-discharge (17% [16-19] vs (18% [16-20]). Mortality was higher post-discharge than in-hospital in most non-malarial comas, including acute bacterial meningitis (39% [26-52]) vs 53% [38-69]). Disability associated with cerebral malaria was 11% (9-12). Pooled disability outcomes associated with other non-malarial diseases were largely absent. INTERPRETATION: The prevalence and outcomes of cerebral malaria and meningitis associated with non-traumatic coma were strikingly static across five decades. Enhanced molecular and radiological diagnostics, investment, policy making, community awareness, and health service provision are all required to facilitate earlier referral to specialist centres, to drive a step-change in diagnostic yield and treatment options to improve these outcomes. FUNDING: Wellcome Trust. TRANSLATIONS: For the Chichewa, French and Portuguese translations of the abstract see Supplementary Materials section.
Source: The Lancet Global Health
Authors: Stephen T J Ray, Charlotte E Fuller, Alex Boubour, Taty Tshimangani, Edith Kafoteka, Alice Muiruri-Liomba, Albert Malenga, Andrew Tebulo, Paul Pensulo, Monfort B Gushu, Maryke Nielsen, Madiha Raees, Elisabeth Stockdale, Josephine Langton, Gretchen L Birbeck, Naomi Waithira, Laura J Bonnett, Marc YR Henrion, Ericka L Fink, Douglas G Postels, Nicole O'Brien, Anne-Laure Page, Emmanuel Baron, Stephen B Gordon, Elizabeth Molyneux, Arjen Dondorp, Elizabeth C George, Kathryn Maitland, Benedict D Michael, Tom Solomon, Yamikani Chimalizeni, David G Lalloo, Christopher A Moxon, Terrie Taylor, Macpherson Mallewa, Richard Idro, Karl Seydel, Michael J Griffiths
Institutions: University of Liverpool, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, University of Oxford, Kamuzu University of Health Sciences, University of San Francisco, Sheffield Children's NHS Foundation Trust, Sheffield Children's Hospital, Cliniques Universitaires de Kinshasa, University of Pennsylvania, University of Rochester, Mahidol University, Mahidol Oxford Tropical Medicine Research Unit, Liverpool School of Tropical Medicine, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Children's National, George Washington University, Nationwide Children's Hospital, The Ohio State University, Epicentre, MRC Clinical Trials Unit at UCL, University College London, Medical Research Council, Kenya Medical Research Institute, Imperial College London, Walton Centre, National Institute for Health and Care Research, Health Protection Research Unit in Emerging and Zoonotic Infections at University of Liverpool, University of Glasgow, Michigan State University, Makerere University, The University of Sydney
Language: English
Subfield: Neurology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $6,680
Funders: American Society of Tropical Medicine and Hygiene, Wellcome Trust, Newton Fund, UK Research and Innovation, National Institute for Health Research Health Protection Research Unit, International Seafood Sustainability Foundation, National Institute for Health and Care Research, University of Cambridge, University College London, University of Oxford, National Institutes of Health, Novartis Pharma, Horizon 2020 Framework Programme, Medical Research Council
Awards: G1423143640, G1626344731, G1627812290, G1962299536, G2035586602, G2131471902, Understanding cerebral inflammation in viral encephalitis - how does neuron-glial signalling drive blood-brain barrier permeability?, G2658043112, G2930696194, G3143484946, G3244023616, COVID-19 Neurological Disease: a Global Meta-Analysis and Prospective Case Control Study in Brazil, India and Malawi., Dynamic Imaging in Viral Encephalitis Defines Unique Roles for Chemoattractants., G4184597061, G4340092928, G4538710342, G5208948526, MICA: Development of a novel host blood test using TRanscripts to Identify bacterial Meningitis - TRIM test study, G5492396179, G5514976981, G6091644065, Syndromic infections, G659165159, G6595441929, G749457554, Enceph-IG - Intravenous Immunoglobulin in Autoimmune Encephalitis in Adults: A Randomised Double-Blind Placebo-Controlled Trial, G839011573, The COVID-19 Clinical Neuroscience Study (COVID-CNS), G8415457339, G8518431165, G869621869, Improving diagnosis of brain infections in Indonesia using novel and established molecular diagnostic tools., Single cell interrogation of the blood-brain barrier in human cerebral malaria: a translational approach
OpenAlex ID: W4409656878