The incidence, aetiology and outcome of acute seizures in children admitted to a rural Kenyan district hospital

Richard Idro,Kathryn Maitland,Moses Ndiritu,Michael Kahindi,Tony Kazungu,Charles Rjc Newton,Samson Gwer,Brian Gr Neville,Piet A Kager,Hellen Gatakaa

doi:10.1186/1471-2431-8-5

Abstract

BackgroundAcute seizures are a common cause of paediatric admissions to hospitals in resource poor countries and a risk factor for neurological and cognitive impairment and epilepsy. We determined the incidence, aetiological factors and the immediate outcome of seizures in a rural malaria endemic area in coastal Kenya.MethodsWe recruited all children with and without seizures, aged 0–13 years and admitted to Kilifi District hospital over 2 years from 1st December 2004 to 30th November 2006. Only incident admissions from a defined area were included. Patients with epilepsy were excluded. The population denominator, the number of children in the community on 30th November 2005 (study midpoint), was modelled from a census data.ResultsSeizures were reported in 900/4,921(18.3%) incident admissions and at least 98 had status epilepticus. The incidence of acute seizures in children 0–13 years was 425 (95%CI 386, 466) per 100,000/year and was 879 (95%CI 795, 968) per 100,000/year in children <5 years. This incidence data may however be an underestimate of the true incidence in the community. Over 80% of the seizures were associated with infections. Neonatal infections (28/43 [65.1%]) and falciparum malaria (476/821 [58.0%]) were the main diseases associated with seizures in neonates and in children six months or older respectively. Falciparum malaria was also the main illness (56/98 [57.1%]) associated with status epilepticus. Other illnesses associated with seizures included pyogenic meningitis, respiratory tract infections and gastroenteritis. Twenty-eight children (3.1%) with seizures died and 11 surviving children (1.3%) had gross neurological deficits on discharge. Status epilepticus, focal seizures, coma, metabolic acidosis, bacteraemia, and pyogenic meningitis were independently associated with mortality; while status epilepticus, hypoxic ischaemic encephalopathy and pyogenic meningitis were independently associated with neurological deficits on discharge.ConclusionThere is a high incidence of acute seizures in children living in this malaria endemic area of Kenya. The most important causes are diseases that are preventable with available public health programs.

Highlights

Acute seizures are a common cause of paediatric admissions to hospitals in resource poor countries and a risk factor for neurological and cognitive impairment and epilepsy
Acute seizures are a major risk factor for neurological and cognitive impairment [12,13,14] and for the development of epilepsy [15,16,17] in children living in these regions
The incidence of acute seizures and status epilepticus in Kilifi DSS Among the remaining 5,863 admissions from the study area, there were 942(16.1%) children defined as re-admissions

Summary

Introduction

Acute seizures are a common cause of paediatric admissions to hospitals in resource poor countries and a risk factor for neurological and cognitive impairment and epilepsy. Febrile seizures are common but the prevalence of acute symptomatic seizures (which have a poorer outcome) may be higher than Western countries [6,7,8]. Acute seizures are a major risk factor for neurological and cognitive impairment [12,13,14] and for the development of epilepsy [15,16,17] in children living in these regions. Most of the available reports are of rates in hospital in the 1990's and are limited to the diagnoses associated with the seizure-events [18,19,20]

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Results

Discussion

Conclusion