Welcome to Neurology!

1. 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 neuromorbidityin Kenya • Approach to the child with movement difficulties, recongising treatable conditions • Lecturesand 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.

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