Abstract
BackgroundNon-traumatic coma is a common acute childhood presentation to healthcare facilities in Africa and is associated with high morbidity and mortality. Historically, the majority of cases were attributed to cerebral malaria (CM). With the recent drastic reduction in malaria incidence, non-malarial coma is becoming a larger proportion of cases and determining the aetiology is diagnostically challenging, particularly in resource-limited settings. The purpose of this study will be to evaluate the aetiology and prognosis of non-traumatic coma in African children.MethodsWith no date restrictions, systematic searches of MEDLINE, Embase, and Scopus will identify prospective and retrospective studies (including randomised controlled trials, cluster randomised trials, cohort studies, cross-sectional, and case-control studies) recruiting children (1 month–16 years) with non-traumatic coma (defined by Blantyre Coma Score ≤ 2 or comparable alternative) from any African country. Disease-specific studies will be included if coma is associated and reported. The primary outcome is to determine the aetiology (infectious and non-infectious) of non-traumatic coma in African children, with pooled prevalence estimates of causes (e.g., malaria). Secondary outcomes are to determine overall estimates of morbidity and mortality of all-cause non-traumatic coma and disease-specific states of non-traumatic coma, where available. Random effects meta-analysis will summarise aetiology data and in-hospital and post-discharge mortality. Heterogeneity will be quantified with τ2, I2, and Cochran’s Q test.DiscussionThis systematic review will provide a summary of the best available evidence on the aetiology and outcome of non-traumatic coma in African children.Systematic review registrationPROSPERO CRD42020141937
Highlights
Non-traumatic coma is a common acute childhood presentation to healthcare facilities in Africa and is associated with high morbidity and mortality
In malaria-endemic regions, cerebral malaria (CM) is diagnosed in children with coma and peripheral malaria parasitaemia with no other identifiable cause [1]
Limited diagnostic resources in many African settings and the phenomenon of asymptomatic malaria parasitaemia have rendered the alternate diagnoses of childhood coma under-described, resulting in a poor epidemiological understanding of this clinical presentation [4, 5]
Summary
Protocol development and registration The present protocol has been registered within the PROSPERO database (registration number CRD42020141937) and is being reported in accordance with the reporting guidance provided in the Preferred Reporting Items for Systematic Reviews and MetaAnalyses Protocols (PRISMA-P) statement [14] (see checklist in Additional file 1). We will review a reference for the full text if this reference includes (1) a mention of coma, children (1 month–16 years) and non-traumatic aetiology and (2) recruitment in an African setting for which it is possible to disaggregate a total number of children with non-traumatic coma and possible to extract aetiology or outcome data. Those articles which do not clearly meet the inclusion criteria will be excluded. A sensitivity analysis will be performed only including studies classified as medium- and low-risk, and a separate sensitivity analysis will be performed at the outcomelevel using only high-quality studies [15]
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