CONCLUSION ET RECOMMANDATION:
L'incidence de la méningite était de 0.3 % avec
le Streptococcocus pneumoniae comme germe le plus isolé et la
fièvre et la convulsion étaient les présentations les plus
communes de la méningite. La raideur de la nuque et les signes
méninges comme signes les plus communs à l'examen clinique. Il
y'avait un taux bas de mortalité à 2.4%
Compte tenue de ces conclusions, le ministère de la
santé publique est recommandé de mettre un regard sur les
campagnes de vaccination des enfants dans tout l'étendu du territoire
contre les maladies infectieuses surtout sur la méningite. Le
renforcement de l'information, l'éducation et la communication des
vaccinations chez les enfants est nécessaire.
ix
TABLE OF CONTENTS
DECLARATION i
CERTIFICATION ii
DEDICATION iii
ACKNOWLEDGEMENT iv
ABSTRACT v
RESUME vii
TABLE OF CONTENTS ix
LIST OF TABLES xii
LIST OF FIGURES xiii
LIST OF ABBREVIATIONS AND SYMBOLS xiv
HIPPOCRATIC OATH xx
CHAPITRE ONE 1
INTRODUCTION 1
I.1) Background 1
I.2) Rationale And Justification 2
I.3 ) Main Objectives 2
I .3.1) Specific Objectives 2
I.5) Research Question 3
I.6 Conceptual Framework 3
CHAPTER TWO 4
LITERATURE REVIEW 4
Ii.1) General Overview 4
Ii.4) Pathophysiology Of Bacterial Meningitis 12
Ii.4.1) Bacterial Invasion 12
Ii.4.2) Inflammatory Response 14
Ii.4.3) Raised Intracranial Pressure 14
Ii.4.4) Neuronal Damage 15
Ii.5) Diagnosis Of Meningitis In Children 16
Ii.5.1) Clinical Diagnosis Of Meningitis In Children 16
Ii.5.2) Paraclinical Diagnosis Of Bacterial Meningitis 17
Ii.5.2.1) Lumbar Pucture And Csf Analysis 17
Ii.5.2.2) Complications Of Lumbar Puncture 19
Ii.5.3) Other Laboratory Investigations 19
Ii.6)
x
Current Treatment On Bacterial Meningitis In Children 21
Ii.6.1) Antibiotic Treatment 21
Ii.6.2) Adjuvant Therapy And Supportive Therapy 22
Ii.6.3) Fluid Restriction 22
Ii.7.2) Chemoprophylaxis 24
Ii.7) Complications Of Bacterial Meningitis In Children 24
Ii.8) Publications On Meningitis 26
CHAPTER THREE 29
MATERIALS AND METHODS 29
Iii.1) Study Design 29
Iii.2) Duration Of The Study 29
Iii.3) Study Setting 29
Iii.4) Sampling 29
Iii.5) Study Population 29
Iii.5.1) Inclusion Criteria 29
Iii.5.2) Exclusion Criteria 30
Iii.6) Sample Size 30
Iii.7) Materials 30
Iii.8) Methods 31
Iii.8.1) Administrative Authorizations And Ethical Clearance
31
Iii.8.2) Patient Recruitment 31
Iii.8.3) Data Management 33
Iii.8.3.1) Ethical Considerations 33
Iii.9.1) Human Resources 33
CHAPITRE FOUR 34
RESULTS 34
Iv.1) Incidence 34
Iv.2.3) Type Of Admissions 35
V.2.4) Distribution Of Patients According To Year Of Admission
36
Iv.3) Clinical Presentation Of Bacterial Meningitis 37
Iv.5) Etiologies Of Bacterial Meningitis 41
xi
CHAPITRE FIVE 47
DISCUSSION 47
V.1) Incidence 47
V.2) Clinical Presentation Of Patients 48
V.3) Hospital Outcome Of Bacterial Meningitis In Children
50
Conclusion 51
Recommendations 51
REFERENCES 53
APPENDICES
xii
LIST OF TABLES
Table I: Distribution of patients according
to gender 35
Table 2: Distribution of clinical
presentation according to symptoms. 37
Table 3: Distribution of neurological
clinical presentation according to signs 38
Table 4: Biochemical and cytological aspect
of csf analysis of patients at admission 39
Table 5: Biochemical and cytologic aspect of
csf analysis of patients at admission 40
Table 6: Distribution of pathogens according
to age 42
Table 7: Distribution of complications found
during admission 43
Table 8: Distribution of patients according
to outcome during admission 44
Table 9: Distribution of patients according
to sequelae at time of discharge 45
Table 10: Distribution of patients according
to treatment recieved for sequalae 46
xiii
LIST OF FIGURES
Figure 1: Meningitis Belt in West Africa [14]
4
Figure 2: Countries trained to conduct
surveillance for the Pediatric Bacterial Meningitis Surveillance Network, by
performance level* --- World Health
Organization African Region, 2008 [16] 5
Figure 3:
Causes of confirmed bacterial meningitis from eleven years of
active
surveillance in a Mexican hospital, 2005 -2016. [18] 6
Figure 4 : Pathogenesis of bacterial meningitis
[38] 15
Figure 5: Lumbar spine anatomy[41]. 17
Figure 6 : Distribution of patients according to
age groups 34
Figure 7: Distribution of patients according to
the type of admission. 35
Figure 8: Flow chart illustrating the incidence
per year at YGOPH. 36
xiv
LIST OF ABBREVIATIONS AND SYMBOLS
C D14 : Cluster of differentiation 14
CbpA : Choline binding protein A
CSF : Cerebro spinal fluid
E.coli : Escherichia coli
H.influenzae : Haemophilus influenzae
Hib : Haemophilus influenzae type b
Ibe A : Invasion of brain endothelium protein
A
Ibe B : Invasion of brain endothelium
protein
N.meningitidis : Neisseria meningitidis
OmpA : Outer membrane protein A
S .pneumoniae : Streptococcus pneumoniae
SDG : Sustainable development Goal
WHO : World's Health Organisation
YGOPH : Yaoundé-Gynaeco-Obstetric and
Pediatric Hospital
xvi
THE ADMINISTRATIVE STAFF OF THE UNIVERSITY OF
BAMENDA
Prof Sammy Beban Chumbaw Pro-Chancellor
Prof Theresia Akenji Vice-Chancellor
Prof Suh Cheo Emmanuel Deputy Vice-Chancellor in
charge of Teaching,
Professionalization and
Development of Information
and Communication
Technologies
Prof Agwara Moise Ondoh Deputy Vice-Chancellor in
charge of Internal Control and Evaluation
Prof Roselyn Jua Deputy Vice-Chancellor in
charge of Research,
Cooperation and relationship with the
Business world
Prof Banlilon Victor Tani Registrar
Prof Ghogomu Julius Numbonui Director of Academic Affairs
Dr Mbifi Richard Director of Administrative
Affairs
Prof Anong Damian Nota Director Students' Affairs
MrGiyohYerima Peter Director of Finance
MmeBongnda Winifred B. Beriliy Director of Library
xvii
THE ADMINISTRATIVE AND TEACHING STAFF OF THE FACULTY OF
HEALTH SCIENCES (FHS), THE UNIVERSITY OF BAMENDA
2018/2019 Academic Year
1. Administrative staff
Prof Dora Mbanya Dean
Prof Christopher TangnyinPisoh Vice-Dean in charge of Academic
Affairs
Prof Helen KuokuoKimbi Vice-Dean in charge of Admissions
and
Records
Prof Henri Lucien F.Kamga Vice-Dean in charge of Research
and Cooperation
MrJacobTitafanVoma Faculty Officer
Dr Gerald Ngo Teke Chief of service,programmes,
Teaching
And research
Dr Moses Samje Chief of Service, Administration
and
Personnel
Mr Zaccheus Aweneg Chief of Service, Finance
Mr Humphrey Njoamomoh Chief of Service, Admissions and
Records
Mr Leonard Peyechu Chief of Service, Materials And
Maintenance
Dr Mary Garba Chief of Service, Internships
xviii
Mr Cyprien Bongwong Stores Accountant
2. Heads of Departments
Prof Frederic Agem kechia Biomedical Sciences
Prof Christopher Tangnyin Pisoh Clinical Sciences
Prof Bih Suh Mary Atanga Nursing/Midwifery
Dr Esther Etengeneng Agbor Medical Laboratory
Sciences
Teaching staff
a) Professors
1.
|
Christopher Kuaban
|
Internal Medicine/Chest Medicine
|
2.
|
Helen Kuokuo kimbi
|
Medical Parasitology
|
3.
|
|
Dora Mbanya
|
Haematology
|
|
b) AssociateProfessors
1.
|
BihSuh Mary Atanga
|
Nursing/Midwifery
|
2.
|
Henri Lucien F. Kamga
|
Medical Parasitology
|
3.
|
Frederic Agem Kechia
|
Medical Mycology
|
4.
|
|
Christopher Tangnyin Pisoh
|
General Surgery
|
|
c) Senior Lecturers
1.
|
Esther EtengenengAgbor
|
Nutritional Biochemistry
|
2.
|
Marie Ebob Bissong
|
Medical Microbiology
|
3.
|
Flore Ngoufo Nguemaim
|
Medical Parasitology
|
4.
|
Gerald Ngo Teke
|
Pharmacology
|
5.
|
|
Omarine Nfor Njimanted
|
Medical Parasitology
|
|
6.
xix
Moses Samje Biochemistry
7. William AkoTakang Obstetrics/Gynaecology
d) Assistant Lecturer
Jacob TitafanVoma Physics
e) Instructors
1. Kwende Odelia Nursing
2. Foba Marcelline Nursing
xx
HIPPOCRATIC OATH
« I solemnly pledge to dedicate my life to the service of
humanity;
The health and well being of my patient will be my first
consideration ;
I will respect the automomy and dignity of my patient ; I will
maintain the utmost respect for human life ;
I will not permit considerations of age , disease or
disability , creed , ethnic origin , gender , nationality , political
affiliation , race , sexual orientation , social standing , or any factor to
intervene between my duty and my patient ;
I will respect the secrets that are confided in me , even
after the patient has died ;
I will practise my profession with conscience and dignity and
in accordance with good medical practice ;
I will foster the honour and noble traditions of the medical
profession ;
I will give to my teachers , colleagues , and students the
respect and gratitude that is their due ;
I will share my medical knowlegde for the benefit of the
patient and the advancement of health care ;
I will attend to my own health , well being ,and abilities in
order to provide care of the highest standard ;
I will not use my medical knowledge to violate human rights
and civil liberties, even under threat ;
I make these pomises solemnly , freely , and upon my honour.
»
1
CHAPITRE ONE
INTRODUCTION
| 
