Diagnosis and Management of Bacterial Meningitis by Pediatric Residents in Sudan

TL;DR

This study examines how pediatric residents in Sudan diagnose and manage bacterial meningitis, highlighting inconsistent practices and training gaps.

Contribution

The study is the first to evaluate BM management practices among Sudanese pediatric residents and identifies specific training and resource deficiencies.

Findings

Most residents diagnosed BM based on cerebrospinal fluid findings rather than culture-proven disease.

Only 26% of residents documented consent or refusal for lumbar puncture procedures.

Training gaps were identified in obtaining consent and performing post-treatment hearing assessments.

Abstract

Background

Bacterial meningitis (BM) is a life-threatening emergency requiring timely and accurate diagnosis. In Sudan, a country within the meningitis belt, pediatric residents play a key role in BM management, yet no prior studies have evaluated their practices. This study aims to assess diagnostic and management approaches among pediatric residents and identify related challenges.

Methodology

A descriptive cross-sectional study was conducted among pediatric residents registered with the Sudan Medical Specialization Board (SMSB). Data were collected using a validated, self-administered questionnaire distributed via email and WhatsApp. The survey included items on diagnostic methods, lumbar puncture (LP) practices, antibiotic use, training, and follow-up care. Descriptive statistics and Chi-square or Fisher's exact tests were used to analyze associations, with a significance level set at P < 0.05.

Results

Of 283 respondents, 249 (88%) were female, and 158 (56%) were in their final residency year. BM diagnosis was confirmed in 106 (37%) cases based on cerebrospinal fluid findings consistent with BM-elevated white cell count, low glucose, and high protein - rather than culture-proven disease, while 40% relied on clinical and basic lab criteria. LP was performed by 212 (75%) of residents, but 168 (59%) reported patient or family refusal as a primary barrier. Only 73 (26%) documented consent/refusal. While 243 (86%) were trained to interpret LP results, just 157 (55%) received training on obtaining consent. Empirical treatment commonly included vancomycin-based regimens (142, 50%) or third-generation cephalosporins (138, 49%). Most residents adhered to a 10- to 14-day intravenous antibiotic regimen (264, 93%), but only 63 (22%) consistently arranged hearing assessments post-treatment.

Conclusions

Findings reveal inconsistent diagnostic practices and significant training and resource gaps among pediatric residents managing BM in Sudan. Addressing these deficiencies may improve diagnostic accuracy, treatment outcomes, and post-discharge care.