Integrated management of childhood illness indicators of childhood tuberculous meningitis at a tertiary hospital in the Western Cape Province of South Africa
BACKGROUND: Tuberculous meningitis (TBM) is the most common type of bacterial meningitis in the Western Cape of South Africa. Early clinical diagnosis is notoriously difficult and often delayed, with disastrous consequences for patients. The Integrated Management of Childhood Illness (IMCI) strategy is the primary child-care approach of choice for South Africa which ensures accurate assessment of sick children using simple yet reliable clinical signs at the first contact level. METHODS: A retrospective observational study of 30 consecutively diagnosed TBM children at Tygerberg Children’s Hospital with the aim of identifying IMCI clinical indicators which would warrant urgent referral and earlier treatment RESULTS: Of the 30 TBM children, 17 male, median age 35 months, 6 (20%) presented with stage I TBM, 6 (20%) with stage II TBM and 18 (60%) with stage III TBM. The median number of healthcare visits prior to hospital admission was 4.0 (range 1-6). At the 1st healthcare visit, 10 (33%) of TBM children had at least one IMCI general danger sign, 22 (73%) had TB-specific signs/symptoms and 18 (60%) “TBM-specific signs/symptoms”. CONCLUSION: If correctly applied, IMCI clinical indicators would ensure earlier diagnosis of TBM.
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