Clinical outcomes and neurological complications of meningitis in Khartoum, Sudan: a hospital-based perspective during crisis

¹Faculty of Medicine, University of Khartoum, Khartoum, Sudan, ²Public Health, Ministry of Health, Khartoum, Sudan, ³Faculty of Medicine, University of Bahri, Khartoum, Sudan

^&Corresponding author
Salwa Eltigani, Faculty of Medicine, University of Khartoum, Khartoum, Sudan

To the Editors of the Pan African Medical Journal    

Meningitis remains one of the most serious public health concerns in low- and middle-income countries, particularly in settings affected by poverty, population displacement, and fragile health systems [1]. As Sudan sits entirely within the African Meningitis Belt and has historically accounted for a significant share of bacterial meningitis cases across the continent, the ongoing civil war has severely crippled domestic healthcare infrastructure, making tracking internal numbers and managing acute outbreaks exceptionally challenging [2-6]. Despite existing clinical protocols, the delivery of care within teaching hospitals in Khartoum is often hampered by significant inconsistencies, ranging from variations in diagnostic methods to limited access to essential microbiological confirmation tools. Herein, we share our findings from a hospital-based cross-sectional study conducted at Alnoe Teaching Hospital in Khartoum State between January and September 2026, evaluating the clinical presentation, neurological complications, and in-hospital outcomes of meningitis patients during this humanitarian emergency. A total of 287 consecutive patients with clinically diagnosed meningitis were enrolled and analyzed. Participants ranged in age from 0 to over 60 years, with males making up 52.0% (n=146) and females 48.0% (n=141) of the cohort. The largest age group comprised patients aged over 60 years (30.1%, n=86), followed by those aged 21-40 years (25.8%, n=74) and 41-60 years (24.7%, n=71). Geographically, the majority of patients (62.0%, n=178) resided in Omdurman city. Regarding educational background, 39.4% (n=113) had no formal education, while 35.0% (n=101) had attained a secondary education level. Only 38.6% of the cohort had documentation of prior meningitis vaccination.

The clinical presentation demonstrated an overwhelming neurological burden. Fever was documented in 85.0% (n=244) of patients, altered mental status or confusion in 76.0% (n=218), neck stiffness in 59.9% (n=172), headache in 50.2% (n=144), and vomiting in 44.9% (n=129). Physical examination revealed nuchal rigidity in 69.3% (n=199) of patients, alongside positive Brudzinski´s and Kernig´s signs in 62.7% (n=180) and 62.4% (n=179), respectively. Lumbar puncture and cerebrospinal fluid (CSF) examination were performed in 95.5% (n=274) of cases, while magnetic resonance imaging (MRI) was utilized in 59.9% (n=172). Severe neurological complications were notably frequent among the hospitalized patients. Paralysis was observed in 80.0% (n=230) of cases, seizures in 42.0% (n=121), blindness in 37.0% (n=106), epilepsy in 34.0% (n=98), hearing loss in 32.0% (n=92), and hydrocephalus in 25.0% (n=72). All patients received intravenous antibiotic therapy, and 85.0% (n=244) received adjunctive corticosteroids. Regarding in-hospital outcomes, 54.0% (n=155) successfully recovered and were discharged, 30.0% (n=86) unfortunately died during hospitalization, and 16.0% (n=46) required urgent transfer or referral to another facility Table 1. Our findings highlight the severe clinical and neurological toll of meningitis among hospitalized patients in Khartoum amidst an ongoing armed conflict. The high frequency of altered mental status, paralysis, and a 30% in-hospital mortality rate underscores the critical need for early clinical recognition, rapid antimicrobial administration, close neurological monitoring, and robust referral pathways [7,8]. While the single-hospital design and lack of complete microbiological confirmation limit generalizability and etiological determination, these baseline data provide actionable evidence to reinforce peripheral hospital care, guide empirical treatment protocols, and support targeted vaccination and public health interventions across vulnerable regions in Sudan [9,10].

Ethical considerations: this study was conducted under the administrative authorization of the Federal Ministry of Health, Sudan, and participating hospitals, with verbal ethical approval and written informed consent in accordance with the Declaration of Helsinki.

Competing interests    

The authors declare no competing interests.

Author Contributions     

Salwa Eltigani: conceived, designed, supervised, and wrote the manuscript. Ahmed Awadelkareem, Mugtaba Adam, and Elmoutaman Gumaa: collected the data. All authors have read and agreed to the final manuscript.

Tables     

Table 1: treatment outcomes and clinical characteristics among hospitalized meningitis patients in Khartoum State, Sudan, January-September 2026 (N=287)

References