Dear CHIFA colleagues,
Below is an interesting new paper in The Lancet Global Health: citation, summary, extracts and a comment from me.
CITATION: The aetiologies, mortality, and disability of non-traumatic coma in African children: a systematic review and meta-analysis
Ray, Stephen T J et al. The Lancet Global Health, Volume 13, Issue 6, e1043 - e1056
https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(25)00055-5/fulltext
SUMMARY
Background: Non-traumatic coma in African children is a common life-threatening presentation often leading to hospital attendance. We aimed to estimate the distribution of non-traumatic coma causes and outcomes, including disease-specific outcomes, for which evidence is scarce.
Methods: We systematically reviewed MEDLINE, Embase, and Scopus databases..
Findings: 138 studies were eligible for analysis, reporting causes, outcome data, or both from 35 027 children with non-traumatic coma in 30 African countries. 114 (89%) of 128 studies were determined to be high quality. Among the causes, cerebral malaria had highest pooled prevalence at 58% (95% CI 48–69), encephalopathy of unknown cause was associated with 23% (9–36) of cases, and acute bacterial meningitis was the cause of 10% (8–12) of cases, with all other causes representing lower proportions of cases. Pooled overall case-fatality rates were 17% (16–19) for cerebral malaria, 37% (20–55) for unknown encephalopathy, and 45% (34–55) for acute bacterial meningitis. By meta-regression, there was no significant difference in cerebral malaria (p=0·98), acute bacterial meningitis (p=0·99), or all-cause coma (p=0·081) mortality by year of study...
Interpretation: The prevalence and outcomes of cerebral malaria and meningitis associated with non-traumatic coma were strikingly static across five decades. Enhanced molecular and radiological diagnostics, investment, policy making, community awareness, and health service provision are all required to facilitate earlier referral to specialist centres, to drive a step-change in diagnostic yield and treatment options to improve these outcomes.
EXTRACTS
Overall, mortality rates were unacceptably high, with death reported in almost one third of children. Strikingly, case-fatality rates were essentially static for cerebral malaria and bacterial meningitis over the entire study period.
There is an urgent need for increased political strategies and investment, improved health policy making, community awareness, and health service provision to collectively facilitate earlier appropriate referral to specialist centres and optimise the treatment of non-traumatic coma in African children.
COMMENT (NPW): Such studies are important but they cannot answer the fundamental question of why so many children are dying, and why mortality and morbidity has not been increasing over time. What is needed is an assessment of quality of care, which in turn is closely related to (a) the available resources (such as availability of specialist intensive care) and (b) the availability and use of reliable healthcare information to support decision-making. Such information is context-dependent. It ranges from the information a parent needs to recognise danger signs in their child that require urgent referral, through to the information needed by health workers at primary, district and tertiary levels. On our sister forum HIFA we are discussing artificial intelligence and its future potential to inform caregivers at different levels of care, to empower people to deliver the best possible care with available resources.
I look forward to your comments.
Best wishes, Neil
CHIFA profile: Neil Pakenham-Walsh is coordinator of HIFA (Healthcare Information For All), a global health community that brings all stakeholders together around the shared goal of universal access to reliable healthcare information. HIFA has 20,000 members in 180 countries, interacting in four languages and representing all parts of the global evidence ecosystem. HIFA is administered by Global Healthcare Information Network, a UK-based nonprofit in official relations with the World Health Organization. Email: neil@hifa.org