Pneumonia, meningitis, and septicaemia in adults and older children in rural Gambia: eight years of population-based surveillance

BACKGROUND: Representative data describing serious infections in over five-year-old children and adults in Africa are limited. METHODS: We conducted population-based surveillance for pneumonia, meningitis, and septicaemia in a demographic surveillance area in The Gambia between May 12, 2008 and December 31, 2015. We used standardised criteria to identify, diagnose, and investigate patients aged ≥5 years using conventional microbiology and radiology. RESULTS: We enrolled 1638/1657 eligible patients and investigated 1618. Suspected pneumonia, septicaemia, or meningitis was diagnosed in 1392, 135, and 111 patients respectively. Bacterial pathogens from sterile sites were isolated from 105 (7·5%) patients with suspected pneumonia, 11 (8·1%) with suspected septicaemia, and 28 (25·2%) with suspected meningitis. Streptococcus pneumoniae (n = 84), Neisseria meningitidis (n = 16) and Staphylococcus aureus (n = 15) were the most common pathogens. Twenty-eight (1·7%) patients died in hospital and 40 (4·1%) died during the 4 months after discharge. Thirty post-discharge deaths occurred in patients aged ≥10 years with suspected pneumonia. The minimum annual incidence was 133 cases per 100,000 person-years for suspected pneumonia, 13 for meningitis, 11 for septicaemia, 14 for culture-positive disease, and 46 for radiological pneumonia. At least 2·7% of all deaths in the surveillance area were due to suspected pneumonia, meningitis or septicaemia. CONCLUSIONS: Pneumonia, meningitis and septicaemia in over five year-old children and adults in The Gambia are responsible for significant morbidity and mortality. Many deaths occur after hospital discharge and most cases are culture negative. Improvements in prevention, diagnosis, inpatient and follow up management are needed urgently.