Importance of underweight in childhood bacterial meningitis in Finland, Latin America and Angola

Abstract

Our objective was to explore the importance of underweight on the course of childhood bacterial meningitis (BM) at different study sites, because prior studies showed discrepant results. Using directly comparable, prospective data from three continents, weight-for-age z-scores (WAZ) were determined by WHO Anthro programs in children with BM in Finland (N = 318), LatAm (N = 580), and Angola (N = 780) and compared with data describing the admission, course, and outcome of BM. WAZ < -1 indicates underweight; either mild (< -1 to -2), moderate (< -2 to -3), or severe (< -3). The mean WAZ (SD) was 0.17 (1.17), -0.42 (1.53), and -1.36 (1.44), and the prevalence of moderate-severe underweight 2.8%, 12.6%, and 31.3%, in Finland, LatAm, and Angola, respectively. In univariate analysis, LatAm and Angola showed an association between lower WAZ and poorer condition on admission, slower recovery, and more deaths. In Finland, infrequent underweight limited meaningful analysis. In multivariate analysis of different variables for increasing the odds of death, severe underweight had lower odds compared to disease severity in Angola, but highest in LatAm. Thus, the apparent discrepancy in underweights´ importance for increasing deaths varied from primary to more secondary according to locally more prominent risks.

Figure 1

Distribution of weight-for-age z-scores in Finland, Latin America, and Angola.

Figure 2

Clinical course according to weight-for-age category in all patients. Ordinary: Daily improvement and diminishing irritability. No seizures after day 3 of treatment. No focal neurological signs at any time. Complicated: Fever (axillary temperature > 37.4 °C), or irritability over 5 days. Seizures after day 3 of treatment, or focal seizures any time. Focal neurological signs at any time. Another focus of infection. Causal micro-organism resistant to the administered antibiotic. Fatal: Death caused by bacterial meningitis.