# 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.

## Key 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.