Predictors of survival in children with bacterial meningitis: a multilevel survival analysis

Abstract

Bacterial meningitis is a serious infection mainly affecting children, causing high illness and death rates, particularly in Sub-Saharan Africa. It is often seen in low-income countries, and children who survive may face long-term health issues. This study aimed to find out what factors affect the timing of death among children with bacterial meningitis, using parametric AFT, parametric shared frailty, multilevel parametric AFT, and multilevel parametric shared frailty models. A retrospective cohort study was done with 510 children diagnosed with bacterial meningitis were admitted from February 22, 2021, to April 20, 2023. The researchers used several statistical models, including parametric Accelerated Failure Time (AFT) models, shared frailty models, and multilevel models to analyze the data. They applied log-likelihood, AIC, and BIC methods for model selection and considered Kebeles as a clustering effect in the study. Among the covariates, children patient with BM who lived in urban area (Φ = 0.56; 95% CI (− 0.98,-0.18); p-value = 0.004), male patient (ϕ = 0.41,95%CI ((− 1.38, − 0.39);p value = 0.000), vaccination group patient (ϕ = 1.82;95%CI (0.41, 0.79); p-value = 0.000), breastfeeding children patient (Φ = 0.46; 95% CI (− 1.24, − 0.17); p-value < 0.009), existence Altered consciousness (Φ = 0.36; 95% CI (− 1.22, − 0.79); p-value = 0.000), ≤ 20 mg/dl CSF glucose of patient (Φ = 1.2; 95% CI (0.02, 0.45); p-value = 0.031) and overcrowding (Φ = 0.31; 95% CI (− 1.40, − 0.96); p-value = 0.000) significantly affected the time to death of bacterial meningitis patient. Clustering had a significant effect on the variable of interest. The study identified key factors that significantly influence the time to death among pediatric patients with bacterial meningitis. It was observed that male patients tend to have a shorter time to death compared to females, and a prolonged symptom duration before hospitalization is associated with increased mortality. Critical factors influencing outcomes included the child's sex, place of residence, breastfeeding habits, number of siblings, living conditions (crowding), altered consciousness, existing health conditions, vaccination status, and the specific pathogens causing the illness. These elements were correlated with a higher risk of death in affected children. This information can be instrumental for healthcare providers and policymakers in their efforts to reduce mortality rates and enhance health outcomes for children with bacterial meningitis.