Journal of Neurology

, Volume 261, Issue 5, pp 851–865

A 43-year systematic review and meta-analysis: case-fatality and risk of death among adults with tuberculous meningitis in Africa

Review

DOI: 10.1007/s00415-013-7060-6

Cite this article as:
Woldeamanuel, Y.W. & Girma, B. J Neurol (2014) 261: 851. doi:10.1007/s00415-013-7060-6

Abstract

Tuberculous meningitis (TBM) is a preventable and curable common health problem among African adults. Poor nutrition, poverty, household crowding, drug resistant tuberculosis (TB) strains, AIDS, and malfunctioning TB control programs are important risk factors. We conducted a systematic review and meta-analysis of published literature reporting case-fatalities of TBM among adults in African countries from 1970 till date. A PubMed search identified relevant papers. Employed terms include ‘adult tuberculous meningitis’ AND ‘tuberculosis Africa’. PRISMA review guidelines were applied. Adult TBM case-fatalities, odds ratio (OR), relative risk (RR), forest-plot meta-analysis for weighted OR and RR, funnel plots, L’Abbé plots, meta-regressed bubble plots, and inter-study homogeneity were computed. Among 15 studies included, adult TBM occurred in up to 28 % of all meningitis forms with case-fatality of 60 % (inverse-variance weighted 54 %). Fixed-effect meta-analysis revealed weighted OR and RR of adult TBM fatalities to be 4.37 (95 % CI 3.92, 4.88) and 2.53 (95 % CI 2.38, 2.69), respectively. Inter-study homogeneity was reliable, regional representativeness was adequate allowing generalizability, and funnel-plots behaved symmetrically with insignificant inconsistency. All cases were initiated with anti-TB medication, while some had ‘breakthrough’ TBM. In Africa, adult TBM has a significant public health importance with a very high fatality which has remained stagnant for the past half-century. This reflects ongoing low quality of medical care at facilities where lengthy referrals end up. Community-based studies can reveal higher unaccounted morbidity, accrued disability, and larger mortality. Improving access points for early TB management at community-level, developing health infra-structure for comprehensive case management at facility-level, and poverty reduction can help combat this multi-faceted problem—whose reduction can in return help fight poverty.

Keywords

Meningitis Tuberculous meningitis Africa Systematic review Meta-analysis Case-fatality 

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  1. 1.Department of NeurologyAddis Ababa University Faculty of MedicineAddis AbabaEthiopia
  2. 2.Faculty of Medicine, Imperial College LondonChelsea and Westminster Hospital CampusLondonUK
  3. 3.Monitoring and Evaluation TeamUSAID - Management Sciences for Health – Help Ethiopia Address Low TB (HEAL TB) ProjectAddis AbabaEthiopia

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