# Etiology and short-term outcome of pediatric coma at a tertiary hospital in Douala, Cameroon

## TL;DR

This study examines the causes and outcomes of pediatric coma in Cameroon, finding that infections like cerebral malaria are the main cause and that young children face the highest risk.

## Contribution

The study provides new epidemiological data on pediatric coma in a sub-Saharan African setting, identifying key risk factors and outcomes.

## Key findings

- Infectious causes, especially cerebral malaria, were the leading etiology of pediatric coma.
- Mortality was 26.6%, with neurological sequelae in 30.9% of survivors.
- Young age, female sex, direct home admission, and deeper coma stages were significant predictors of mortality.

## Abstract

Pediatric coma is a critical emergency with high morbidity and mortality in sub-Saharan Africa, where limited data hinders effective management strategies. Understanding its epidemiology and prognostic factors is essential for improving outcomes.

A cross-sectional study with retrospective (1st January 2017 to 30 November 2018) and prospective (1st December 2018 to 30th April 2019) phases was conducted at Gyneco-Obstetric and Pediatric Hospital of Douala, Cameroon. Children aged 1 month to 15 years with Glasgow Coma Scale (GCS) ≤ 14 were included. Data on demographics, clinical presentation, etiology, and outcomes were collected. Statistical analysis used SPSS version 20.0 and CSPro with Chi-square, Fisher’s exact tests, and multivariable logistic regression.

Among 864 hospitalized children, 109 presented with coma (prevalence 12.6%), comprising 88 retrospective and 21 prospective cases. The male-to-female ratio was 1.4:1, with mean age 48.8 ± 47.5 months; 64.2% were under 5 years. Infectious causes predominated (62.4%, n = 68), with cerebral malaria accounting for 42.2% (46/109) and septicemia 15.6% (17/109). Other etiologies included metabolic/toxic causes (16.5%, 18/109), post-epileptic coma/status epilepticus (14.7%, 16/109), and traumatic brain injury (4.6%, 5/109); 12.8% (14/109) remained undiagnosed. Clinical features included fever (73.4%, 80/109) and seizures at admission (68.8%, 75/109). Overall mortality was 26.6% (29/109), with 30.9% (25/81) of survivors experiencing neurological sequelae, predominantly motor deficits (14.8%, 12/81). In multivariable analysis, significant mortality predictors included age under 2 years (adjusted OR 4.55, 95% CI: 1.23–16.82), female sex (adjusted OR 2.89, 95% CI: 1.23–6.79), direct home admission (adjusted OR 2.76, 95% CI: 1.02–7.47), and deeper coma stages (Stage III-IV: adjusted OR 6.92, 95% CI: 2.54–18.86).

Pediatric coma at this tertiary center in Douala predominantly affects young children and stems primarily from infectious etiologies, particularly cerebral malaria. The high mortality (26.6%) and substantial neurological morbidity among survivors underscore urgent needs for strengthened malaria prevention programs, improved community awareness, enhanced referral systems, and increased diagnostic and intensive care capabilities. Early recognition and prompt management of preventable causes could significantly reduce mortality and morbidity from pediatric coma in Central Africa.

The online version contains supplementary material available at 10.1186/s12887-025-06466-y.