---
title: "Neonatal meningitis outcomes and predictors in Harar, Ethiopia: cross-sectional analysis of 506 ca"
id: "plos-one-9-treatment-outcomes-of-meningitis-and-its-associated-factors-among-neonates"
canonical_url: "https://medichelpline.com/clinical-feed/plos-one-9-treatment-outcomes-of-meningitis-and-its-associated-factors-among-neonates"
content_type: "clinical_feed_article"
specialty: "Pediatrics"
source_name: "PLOS ONE (Medicine)"
source_url: "https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0355843"
published_at: "2026-08-11T14:00:00.000Z"
evidence_level: "Journal Feed"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Neonatal meningitis outcomes and predictors in Harar, Ethiopia: cross-sectional analysis of 506 ca
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/plos-one-9-treatment-outcomes-of-meningitis-and-its-associated-factors-among-neonates
- **Specialty:** [Pediatrics](https://medichelpline.com/clinical-feed/pediatrics.md)
- **Primary Source:** PLOS ONE (Medicine)
- **Source URL:** [Original Journal Publication](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0355843)
- **Published At:** 2026-08-11T14:00:00.000Z
- **Evidence Rating:** Journal Feed
## Executive GIST (TL;DR)
- This facility-based cross-sectional study reviewed medical records of 506 neonates with confirmed **meningitis** admitted to two public hospitals in Harar, Ethiopia, between October 2020 and October 2024. - Short-term treatment outcomes at hospital discharge were classified as **good** or **poor**; 169 neonates (33%) had poor outcomes (including in-hospital death or adverse discharge status). - Multivariable logistic regression identified multiple independent predictors of poor outcome: **assisted vaginal delivery** (AOR 3.70), positive **CSF culture** (AOR 3.74), very high CSF white blood cell count >2500 cells/mm³ (AOR 6.10), elevated CSF protein >400 mg/dL (AOR 5.43), low CSF glucose <10 mg/dL (AOR 3.57), **seizures** at admission (AOR 5.07) and after admission (AOR 3.88), **early-onset neonatal sepsis** (AOR 4.27), and non-exclusive breastfeeding (AOR 2.20). - The study sampled records from Hiwot Fana Comprehensive Specialized University Hospital and Jugal General Hospital and excluded records with incomplete documentation, early treatment discontinuation (<72 hours), or referrals. - The findings show a substantial proportion of neonates with meningitis experience adverse short-term in-hospital outcomes and that severe CSF abnormalities and clinical instability (seizures, sepsis) are strong predictors. - Authors recommend early risk stratification and timely interventions in neonatal care; detailed recommendations, microbiologic species distribution, and long-term outcomes were not fully reported in the source abstract and summary. - Data underlying the analyses are publicly available in a Zenodo repository; the study reported no specific funding and no competing interests.
## Clinical Analysis & Structured Key Points
[ Skip to main content ](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0355843#main-content) Advertisement * [plos.org](https://plos.org/) * [Create account](https://community.plos.org/registration/new) * [Sign in](https://journals.plos.org/user/secure/login?page=%2Fplosone%2Farticle%3Fid%3D10.1371%2Fjournal.pone.0355843) * * About * Browse * Publish * [](https://journals.plos.org/plosone/ "PLOS One") * Search [advanced search](https://journals.plos.org/plosone/search) * [Browse Topics](https://journals.plos.org/plosone/subjectAreaBrowse) Browse Subject Areas ? Click through the PLOS taxonomy to find articles in your field. For more information about PLOS Subject Areas, click [here](https://github.com/PLOS/plos-thesaurus/blob/master/README.md "Link opens in new window"). [](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0355843) [](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0355843) * 0 [Save](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0355843#savedHeader) [Total Mendeley and Citeulike bookmarks.](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0355843#savedHeader) * 0 [Citation](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0355843#citedHeader) [Paper's citation count computed by Dimensions.](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0355843#citedHeader) * 40 [View](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0355843#viewedHeader) [PLOS views and downloads.](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0355843#viewedHeader) * 0 [Share](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0355843#discussedHeader) [Sum of Facebook, Twitter, Reddit and Wikipedia activity.](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0355843#discussedHeader) Open Access Peer-reviewed Research Article # Treatment outcomes of meningitis and its associated factors among neonates admitted to public hospitals in Harar Town, Ethiopia: Cross-sectional study * Getahun Tamiru Yirsaw , Contributed equally to this work with: Getahun Tamiru Yirsaw, Tadesse Bekele Tafesse, Abera Jambo Bune, Shambel Nigussie Amare Roles Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Software, Validation, Visualization, Writing – original draft * E-mail: tamirugetahun53@gmail.com Affiliation Clinical Pharmacy Unit, Hiwot Fana Comprehensive Specialized Hospital, Haramaya University, Harar, Ethiopia [ ![ORCID logo](https://journals.plos.org/resource/img/orcid_16x16.png) https://orcid.org/0009-0003-7820-5102 ](https://orcid.org/0009-0003-7820-5102 "ORCID Registry") ⨯ * Tadesse Bekele Tafesse , Contributed equally to this work with: Getahun Tamiru Yirsaw, Tadesse Bekele Tafesse, Abera Jambo Bune, Shambel Nigussie Amare Roles Conceptualization, Data curation, Formal analysis, Methodology, Software, Supervision, Validation, Visualization, Writing – review & editing Affiliation Department of Pharmacology and Toxicology, Haramaya University, Harar, Ethiopia [ ![ORCID logo](https://journals.plos.org/resource/img/orcid_16x16.png) https://orcid.org/0000-0001-6394-6766 ](https://orcid.org/0000-0001-6394-6766 "ORCID Registry") ⨯ * Abera Jambo Bune , Contributed equally to this work with: Getahun Tamiru Yirsaw, Tadesse Bekele Tafesse, Abera Jambo Bune, Shambel Nigussie Amare Roles Conceptualization, Data curation, Formal analysis, Methodology, Software, Supervision, Validation, Visualization, Writing – review & editing Affiliation Department of Clinical Pharmacy, School of Pharmacy, College of Health and Medical Science, Haramaya University, Harar, Ethiopia ⨯ * Shambel Nigussie Amare Contributed equally to this work with: Getahun Tamiru Yirsaw, Tadesse Bekele Tafesse, Abera Jambo Bune, Shambel Nigussie Amare Roles Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Software, Supervision, Validation, Visualization, Writing – review & editing Affiliations Department of Clinical Pharmacy, School of Pharmacy, College of Health and Medical Science, Haramaya University, Harar, Ethiopia, Discipline of Pharmacy, Faculty of Health, University of Canberra, Canberra, Australia ⨯ # Treatment outcomes of meningitis and its associated factors among neonates admitted to public hospitals in Harar Town, Ethiopia: Cross-sectional study * Getahun Tamiru Yirsaw, * Tadesse Bekele Tafesse, * Abera Jambo Bune, * Shambel Nigussie Amare ![PLOS](https://journals.plos.org/resource/img/logo-plos-full-color.svg) x * Published: August 11, 2026 * * [Article](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0355843) * [Authors](https://journals.plos.org/plosone/article/authors?id=10.1371/journal.pone.0355843) * [Metrics](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0355843) * [Comments](https://journals.plos.org/plosone/article/comments?id=10.1371/journal.pone.0355843) * [Media Coverage](http://plos.altmetric.com/details/doi/10.1371/journal.pone.0355843) * [Peer Review](https://journals.plos.org/plosone/article/peerReview?id=10.1371/journal.pone.0355843) * [Abstract](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0355843#abstract0) * [Introduction](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0355843#sec005) * [Materials & methods](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0355843#sec006) * [Results](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0355843#sec016) * [Discussion](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0355843#sec022) * [Conclusion](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0355843#sec023) * [Acknowledgments](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0355843#ack) * [References](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0355843#references) * [Reader Comments](https://journals.plos.org/plosone/article/comments?id=10.1371/journal.pone.0355843) * [Figures](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0355843) ![Accessible Data Icon](https://journals.plos.org/resource/img/accessible_data.svg)Accessible Data [ See the data ![Link Icon](https://journals.plos.org/resource/img/data_link_icon.svg) ](https://doi.org/10.5281/zenodo.21490590) This article includes the Accessible Data icon, an experimental feature to encourage data sharing and reuse. [Find out how research articles qualify for this feature.](https://theplosblog.plos.org/2023/07/accessible-data/) ## Abstract ### Background Meningitis in neonates remains a major public health concern, particularly in low- and middle-income countries. Despite its high morbidity and mortality, evidence on treatment outcomes and determinants of poor prognosis is limited. This study aimed to assess treatment outcomes of meningitis and its associated factors among neonates admitted to public hospitals in Harar town, Ethiopia. ### Methods A facility-based cross-sectional study was conducted among 506 neonates diagnosed with meningitis admitted between October 2020 and October 2024. Data were extracted from medical records. Treatment outcomes were categorized as good or poor. Binary and multivariable logistic regression analyses were performed to identify factors associated with poor treatment outcomes. Statistical significance was declared at a p-value 2500 cells/mm³ (AOR = 6.10; 95% CI: 2.54–14.69), high CSF protein >400 mg/dL (AOR = 5.43; 95% CI: 2.84–10.36), low CSF glucose . All data necessary to reproduce the analyses and support the conclusions reported in this manuscript are available without restriction. **Funding:** The author(s) received no specific funding for this work. **Competing interests:** The authors have declared that no competing interests exist. ## Introduction Meningitis is a serious infection that causes inflammation of the subarachnoid space of the brain and spinal cord. It is usually caused by bacteria, viruses, fungi, or parasites [[1](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0355843#pone.0355843.ref001)]. Newborns are especially vulnerable due to immature immunity, with neonatal meningitis classified as early-onset (≤72 hours after birth) or late-onset (>72 hours) [[2](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0355843#pone.0355843.ref002),[3](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0355843#pone.0355843.ref003)]. The pathogens causing neonatal meningitis depend on gestational age, postnatal age, and location [[3](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0355843#pone.0355843.ref003)]. Early-onset cases are mainly due to _Group B Streptococcus_ (GBS) and _Escherichia coli_ (_E. coli_) [[2](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0355843#pone.0355843.ref002),[4](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0355843#pone.0355843.ref004)–[7](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0355843#pone.0355843.ref007)]. Late-onset pathogens vary by gestational age, birth weight, and healthcare setting: GBS and _E. coli_ are common in community-acquired cases, while staphylococci, _Staphylococcus aureus_ (_S. aureus_), and _Klebsiella_ species are frequent in healthcare-associated infections [[7](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0355843#pone.0355843.ref007)–[10](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0355843#pone.0355843.ref010)]. Globally, the incidence and mortality rates of neonatal meningitis were estimated at 854 and 137.2 per 100,000 population, respectively, in 2019 [[11](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0355843#pone.0355843.ref011)]. The disease also imposes a substantial economic burden, with healthcare expenditures ranging from US$222 to US$33,635 per patient worldwide [[12](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0355843#pone.0355843.ref012)]. The incidence and mortality of neonatal meningitis are disproportionately higher in low- and middle-income countries, with 0.5–6 cases per 1,000 live births and mortality rates of 20–37%, compared to 0.3–0.4 cases per 1,000 live births and 2–10% mortality in high-income countries [[5](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0355843#pone.0355843.ref005),[6](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0355843#pone.0355843.ref006),[13](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0355843#pone.0355843.ref013)–[18](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0355843#pone.0355843.ref018)]. Among survivors, 20–50% develop long-term neurological sequelae, including hearing loss, blindness, epilepsy, hydrocephalus, subdural empyema, and psychomotor developmental delay [[19](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0355843#pone.0355843.ref019)–[21](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0355843#pone.0355843.ref021)]. Sub-Saharan Africa, part of the global “meningitis belt,” continues to bear a disproportionately high burden, with reported incidence and mortality rates including 96 per 1,000 live births in Kenya [[22](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0355843#pone.0355843.ref022)], and mortality rates of 24.0% in Angola [[23](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0355843#pone.0355843.ref023)], 29.4% in Tanzania [[24](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0355843#pone.0355843.ref024)], and 37% in Gambia [[16](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0355843#pone.0355843.ref016)]. Ethiopia ranks third globally in meningitis mortality, with treatment for bacterial meningitis costing a median of 98,812 ETB (≈US$3,593.2) per patient [[25](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0355843#pone.0355843.ref025),[26](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0355843#pone.0355843.ref026)]. Multiple clinical factors have been identified as predictors of poor prognosis in neonatal meningitis, including seizures, elevated CSF protein, low birth weight or prematurity, early onset of disease, and low CSF glucose levels [[18](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0355843#pone.0355843.ref018),[19](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0355843#pone.0355843.ref019),[27](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0355843#pone.0355843.ref027)]. Predictors of neonatal meningitis outcomes can differ across populations and healthcare settings. Although the disease causes substantial morbidity and mortality in low-income countries, studies on treatment outcomes and prognostic factors are scarce, especially in Ethiopia. To the best of the author’s knowledge, only one Ethiopian study has examined this issue [[28](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0355843#pone.0355843.ref028)], but its small sample size and limited representativeness restrict the generalizability of its findings. Given the scarcity of evidence and the high burden of disease, context-specific data are essential to improve neonatal care and clinical outcomes. Therefore, this study aimed to assess treatment outcomes of meningitis and its associated factors among neonates admitted to public hospitals in Harar town, Ethiopia. The main research question was: _Which clinical, demographic, and healthcare-related factors are associated with adverse outcomes in neonatal meningitis in this setting?_ Given the limited prior data, this study is primarily **exploratory** , generating evidence to inform clinical practice and guide future confirmatory research. ## Materials & methods ### Study design and settings A cross-sectional study design was conducted in Hiwot Fana Comprehensive Specialized University Hospital (HFCSUH) and Jugal General Hospital (JGH) from February 10 to March 20, 2025. Harar is the capital city of the Harari regional administration. It is located in the eastern part of the country, around 500 kilometers from the Ethiopian capital city, Addis Ababa. HFCSH was founded in 1948 and transitioned to a university-specialized hospital in 2010. JGH was founded in 1909. Both hospitals provide medical, surgical, pediatric, obstetric, and gynecologic services and have neonatal intensive care units. ### Study population and variables All medical records of neonates admitted to the Neonatal Intensive Care Units (NICUs) of HFCSUH and JGH with a confirmed diagnosis of meningitis between October 1, 2020, and October 31, 2024, were included in this study. Records with incomplete information, such as missing diagnosis, treatment regimen, or discharge summary, as well as those who discontinued treatment within the first 72 hours, and those referred to other facilities, were excluded. Data were collected on socio-demographic factors (admission site, sex, age at admission, birth weight, and gestational age); clinical factors, including pre-existing medical conditions (congenital heart defects, Down syndrome, congenital hydrocephalus), maternal conditions and complications during delivery (history of premature rupture of membranes (PROM), meconium-stained amniotic fluid, and chorioamnionitis), and mode of delivery (spontaneous vaginal delivery, cesarean section, or assisted vaginal delivery (Forceps Delivery or Vacuum Extraction); diagnostic information such as symptoms at presentation, blood test results, CSF findings, type of pathogen, and specific isolated organisms; and treatment-related factors, including antimicrobial therapy (choice of antimicrobials) and supportive care (nutritional support and management of complications). ### Outcome measurement In this study, treatment outcomes were categorized as either _good_ or _poor_. Outcomes were assessed at the time of hospital discharge or in-hospital death, representing short-term in-hospital outcomes. A good treatment outcome was defined as clinical
## Related Clinical Research

- [Therapeutic coma in non‑convulsive status epilepticus: higher complications, longer ICU stay, and](https://medichelpline.com/clinical-feed/pubmed-42701136.md) (DOI: 10.1007/s00415-026-14090-8)
- [Adaptive Immune Dysregulation in New‑Onset Refractory Status Epilepticus (NORSE)](https://medichelpline.com/clinical-feed/frontiers-in-immunology-1-adaptive-immune-dysregulation-drives-new-onset-refractory-status-epilepticus.md)
- [Reanalysis of Prenatal Acetaminophen and Neurodevelopmental Disorders Using Bias-Correction Methods](https://medichelpline.com/clinical-feed/medrxiv-0-testing-claimed-associations-of-prenatal-acetaminophen-with-neurodevelopmental.md)
- [Balanced Fluid versus 0.9% Saline for Children With Septic Shock: NEJM Randomized Trial](https://medichelpline.com/clinical-feed/pubmed-42028918.md) (DOI: 10.1056/NEJMoa2601969)
- [High AUROC can hide threshold failure in sepsis transcriptomic classifiers: preprocessing stabilit](https://medichelpline.com/clinical-feed/plos-one-13-high-auroc-can-mask-decision-failure-in-sepsis-transcriptomic-classifiers.md)

## Navigation
- [← Back to Pediatrics Feed](https://medichelpline.com/clinical-feed/pediatrics.md)
- [← All Clinical Specialties](https://medichelpline.com/clinical-feed.md)
## Medical & Regulatory Disclaimer

> [!CAUTION]
> MedicHelpline content is structured for research, educational, and professional discovery purposes. It does not constitute individual medical advice, clinical diagnosis, or treatment recommendations.
> Always verify dosing, contraindications, and regulatory alerts against official product labeling and primary regulatory sources before clinical decision-making.