Distrubition, and associated factors affecting children’s outcomes of bacterial meningitis in Morocco

Abstract Background and objective Purulent meningitis in children remains a major global public health challenge. In Morocco, despite continuous improvements in disease control, the national case-fatality rate remains high at 11.2%. The present study aimed to describe the epidemiological distribution of pediatric purulent meningitis in Morocco and to identify the determinants influencing its evolution. Methods A retrospective was conducted on suspected cases of purulent meningitis among children from January 2013 to December 2022 in the Marrakech-Safi region, central Morocco. Data were obtained from the Prefectural Epidemiology Unit through the national computerized meningitis surveillance system. Results A total of 199 cases were analyzed, showing a male predominance (68.8%). The most frequent clinical manifestations were vomiting (74.4%), headache (59.3%), and neck stiffness (65.3%). The final diagnosis was purulent meningitis in 47.2% and viral meningitis in 46.7% of cases. Recovery was achieved in 86.4% of patients, while mortality reached 7.5%. The main prognostic risk factors were neurological (coma, altered state of consciousness, seizures) and infectious (purpura, fever), with odds ratios ranging from 2 to 37. The appearance of cerebrospinal fluid also emerged as a significant independent risk factor (OR 6.154; CI 95% 1.853–40.850). In contrast, viral meningitis (OR 0.075; CI 95% 0.013–0.430) and cephalosporin therapy (OR 0.129; CI 95% 0.040–0.422) were identified as protective factors. Conclusion Pediatric purulent meningitis was common among male and younger age. The highest incidence was during spring and in Marrakech-Safi region. Altered consciousness, coma, seizures, fever, and the presence of purpura were identified as major predictors of poor outcomes. These results allow for improved monitoring of the regional distribution of bacterial meningitis and help to better target control measures and improve clinical outcomes.