1. Kenya Paediatric Association Annual Scientific Conference 2019
Welcome to Neurology!
“Recognising and managing treatable childhood neurological conditions”
Kenya Paediatric Association
Annual Scientific Conference 2019

2. Your faculty
Dr Alvin Ndondo, Red Cross Children’s Hospital, SA Dr Edward Kija, Muhimbili National Hospital, Tz Dr Richard Idro, Makarere University, Ug Dr Pauline Samia, AKUH, Nairobi Dr Sam Gwer, Afya Research, Nairobi Dr Kate Oyieke, Red Cross Children’s Hospital, SA Dr Jane Hassell, Gertrude’s, Nairobi/ Great Ormond St, UK

3. Objectives for Neurology track
To demystify the child neurological assessment and teach delegates how to approach to the child with neurological symptoms
To demonstrate the spectrum of common (non- epilepsy) child neurological conditions and show that many of these can be treated
To empower delegates to manage children with neurological conditions and to help improve the quality of lives of their patients

4. Plan for the day Morning: Overview of child neuromorbidity in Kenya
Approach to the child with movement difficulties, recongising treatable conditions
Lectures and case-based workshops
Afternoon:
Childhood coma, encephalopathy, headache and stroke, focus on recognising treatable neurological diagnoses early and preventing lasting sequela
4 lectures

6. What is the burden of childhood Neurological conditions in Kenya?
Clinical Information Network (CIN) of 15 hospitals
Routine data collection on Paediatric hospital admissions
Centralised electronic database
Primary supervisor:
Dr Sam Akech

7. Methods 5-year period, Oct 2013 – Sept 2018 Exclusions:
Neonatal, surgical and burn cases
“Minimum data set” cases
Identified any child with a neurological presentation:
History of seizures, altered responsiveness at assessment
Any ICD10 neurological diagnosis at discharge
Reviewed management and outcomes:
Numbers who died, numbers with documented neuroseqeula
Adherence to guidelines
Follow-up plans

8. Preliminary results 123,850 children admitted 2013-2018
86,872 met inclusion criteria
44.5% (38,653) female
Median age 21 months (IQR 10, 48)
45.5% (39,504) admitted to high-malaria hospitals
6.0% (5,209) died

9. Preliminary results
ANY neurological presentation or diagnosis = 26,125 (30.1%).
Of these, 2,170 (8.3%) died.
Any neurological presentation
22,198 (25.6%)
- Seizures
19,442 (22.4%)
- Altered consciousness (AVPU = V/P/U)
4,782 (5.5%)
Any neurological discharge diagnosis
14,442 (16.6%)
- CNS infection
7,295 (8.4%)
- Seizure disorder
7,519 (8.7%)
- Any other
1,632 (1.9%)

10. Diagnosis by malaria endemicity

11. Diagnosis by age group

12. Key findings and conclusions
30% of all paediatric medical admissions to Kenyan public hospitals had a neurological presentation
The most common diagnoses were seizure disorders and CNS infections, although diagnostics were not routinely available
Neurological symptoms/signs were more frequent in high malaria hospitals; neurological diagnoses more frequent in low malaria hospitals - ?reflects workload
These data demonstrate a very high burden of acute childhood neuromorbidity in Kenya, next step will be to interrogate these presentations in more detail