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Vital Prognostic Factors of Bacterial Meningitis in Morocco: A 12-year Study

Essayagh T, Essayagh M and Essayagh S

Objectives: Bacterial meningitis remains a life-threatening public health risk in Meknes with the lethality ratio surprisingly increasing from 12.7%, 18.8% to 23.2% in 2007-2009, 2010-2012 and 2013-2015 respectively. However, to our knowledge, there are no published studies analyzing predictor factors of mortality explaining this increase in meningitis-induced mortality in Meknes. Hence, the objective was to identify the predictor factors of mortality of bacterial meningitis in Meknes in order to enhance the case management system.

Study Design: Case series study.

Methods: We conducted a case series study of surveillance data from Meknes collected in 2004-2015 and performed analysis by using Epi-Info 7 and Excel 2007. The outcome variable of interest was death. Univariate analysis and logistic regression were conducted to identify vital prognostic factors. The statistical significance of the results obtained was assessed using confidence interval of the estimated odds ratios and the Pearson chi-squared test.

Results: The total number of reported meningitis cases was 271. The median age was 6 years. The sex ratio male/female was 1.4. The average case fatality rates per 100.000 populations were 0.35, 0.43 and 0.78 between 2007-2009, 2010-2012 and 2013-2015 respectively. The vital prognostic factors are conscious alterations (AOR: 5.36; p=0.003), probable meningococcal meningitis (AOR: 6.42, p=0.004) and coma (AOR: 21.76, p<0.0001).

Conclusions: All vital prognostic factors we identified are late factors. Unfortunately, the delay before admission to the hospital is reported in days in our current surveillance program and was not found to be a vital prognostic factor. This is probably introducing a limit in the analysis. Hence, to better characterize the underlying factors leading to death, we propose to adjust our management of cases by ensuring delays before admission are shortened and reported within hours and not days. We propose to tackle meningitis by: (i) shortening admission delays, (ii) improving early case management; (iii) strengthening prevention efforts.