Diagnosis of acute bacterial meningitis in children at a district hospitalin sub-Saharan Africa

Background The diagnosis of acute bacterial meningitis in children is diffi cult in sub-Saharan Africa, because the clinical features overlap with thos e of other common diseases, and laboratory facilities are inadequate in man y areas. We have assessed the value of non-laboratory tests and incomplete laboratory data in diagnosing childhood acute bacterial meningitis in this setting. Methods We prospectively studied 905 children undergoing lumbar puncture at a rural district hospital in Kenya over 1 year. We related microbiological findings and cerebrospinal-fluid (CSF) laboratory measurements to tests th at would typically be available at such a hospital. Findings Acute bacterial meningitis was proven in 45 children (5.0% [95% CI 3.7-6.6]) and probable in 26 (2.9% [1.9-4.2]). 21 of the 71 cases of prove n or probable acute bacterial meningitis had neither neck stiffness nor tur bid CSF. In eight of 45 children with proven disease the CSF leucocyte coun t was less than 10x10(6)/L or leucocyte counting was not possible because o f blood-staining. The presence of either a leucocyte count of 50x10(6)/L or more or a CSF/blood glucose ratio of 0.10 or less detected all but two of the 45 children with proven acute bacterial meningitis; these two samples w ere grossly blood-stained. Interpretation The diagnosis of childhood acute bacterial meningitis is lik ely to be missed in a third of cases at district hospitals in sub-Saharan A frica without adequate and reliable laboratory resources. CSF culture facil ities are expensive and difficult to maintain, and greater gains could be a chieved with facilities for accurate leucocyte counting and glucose measure ment.