Document Detail


A 43-year systematic review and meta-analysis: case-fatality and risk of death among adults with tuberculous meningitis in Africa.
MedLine Citation:
PMID:  23963469     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
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.
Authors:
Yohannes W Woldeamanuel; Belaineh Girma
Related Documents :
2477989 - Histochemical and immunohistochemical evidence of glandular differentiation in thymic c...
8826789 - A case of flutamide-induced acute cholestatic hepatitis--a case report.
12752189 - Multiple squamous cell carcinomas complicating linear porokeratosis.
17669719 - Concomitant secretion of glucocorticoid, androgens, and mineralocorticoid by an adrenoc...
683639 - Squamous cell carcinoma in situ of the vagina and cervix after intrauterine des exposure.
15195859 - Squamous cell carcinoma in untreated psoriasis: a case report.
19033709 - Recurrent hemifacial spasm following minor trauma: report of a case.
16329069 - Unilateral exophthalmos associated with ipsilateral mucosal turbinate hypertrophy: beni...
19166599 - A patient with superior semicircular canal dehiscence presenting with tullio's phenomen...
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-8-21
Journal Detail:
Title:  Journal of neurology     Volume:  -     ISSN:  1432-1459     ISO Abbreviation:  J. Neurol.     Publication Date:  2013 Aug 
Date Detail:
Created Date:  2013-8-21     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0423161     Medline TA:  J Neurol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Department of Neurology, Addis Ababa University Faculty of Medicine, P.O.Box 2739, Addis Ababa, Ethiopia, yohannes.woldeamanuel@gmail.com.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


Previous Document:  Ischemia-reperfusion model of acute kidney injury and post injury fibrosis in mice.
Next Document:  The relationship among restless legs syndrome (Willis-Ekbom Disease), hypertension, cardiovascular d...