Clinical outcomes and predictors of poor prognosis among children with probable and confirmed bacterial meningitis in Northwest Ethiopia: a prospective multicenter cohort study

Pediatric bacterial meningitis remains a major cause of mortality and neurological disability in low-resource settings despite improvements in vaccination. The majority of studies conducted in Ethiopia previously have been retrospective and single-center studies with little information about the prognosis of the disease. This prospective multicenter cohort study evaluated clinical outcomes and identified independent predictors of poor prognosis among children with bacterial meningitis. A prospective multicenter cohort study was conducted from June 3, 2024, to May 25, 2025, at Felege Hiwot Comprehensive Specialized Hospital and Tibebe Ghion Specialized Teaching Hospital. A total of 342 study participants aged 0–14 years with probable or confirmed bacterial meningitis were enrolled and prospectively followed from admission to discharge or death. Patients with probable bacterial meningitis had clinical presentation that was compatible with the disease together with either leukocytosis in the CSF (> 100 cells/mm³ or 10–100 cells/mm³ in conjunction with increased protein concentration (> 100 mg/dL) or decreased glucose (< 40 mg/dL). Poor outcome was categorized as mortality, neurological complications on discharge, or prolonged hospital stay (> 14 days). Poor outcomes occurred in 28.4% of patients (n = 97). Independent predictors included delayed hospital admission (AOR = 3.1, 95% CI: 1.9–5.2), coma at presentation (AOR = 4.6, 95% CI: 2.6–8.1), malnutrition (AOR = 2.8, 95% CI: 1.5–4.9), and positive CSF culture (AOR = 2.5, 95% CI: 1.1–5.8). Nearly one-third of children experienced poor discharge outcomes. Late presentation, severe neurological impairment, malnutrition, and positive bacterial culture results were strongly associated with poor outcome. Improved recognition, referral pathways, nutritional support, and diagnostic techniques could greatly decrease morbidity and mortality due to childhood meningitis in developing countries.