Burden, spectrum and predictors of neurological sequelae in children surviving acute bacterial meningitis in sub-Saharan Africa: a protocol for a systematic review and meta-analysis

Abstract Background. Acute bacterial meningitis (ABM) is a leading cause of childhood death and acquired lifelong disability in sub-Saharan Africa (SSA). The convergence of the African meningitis belt, a high force of infection from Streptococcus pneumoniae, Haemophilus influenzae type b and Neisseria meningitidis, frequent late presentation, and constrained diagnostic and audiology capacity means that survivors carry a substantial and often unmeasured neurological burden. Region-specific pooled estimates that could inform structured survivor follow-up and the World Health Organization “Defeating meningitis by 2030” roadmap are lacking. This protocol describes a systematic review and meta-analysis to synthesise the prevalence, clinical spectrum and predictors of neurological sequelae among children who survive ABM in SSA. Methods. We will search PubMed/MEDLINE, Embase, Scopus, Web of Science, African Journals Online and the Cochrane Library from January 2000 to the date of the search, with no language restriction. Observational studies (cohort, cross-sectional, case-control) and trial cohorts reporting neurological outcomes in children younger than 18 years surviving ABM in SSA, with at least 10 survivors, will be eligible. Two reviewers will independently screen records, extract data and appraise methodological quality using the Joanna Briggs Institute (JBI) checklist for prevalence studies. The primary outcome is the pooled prevalence of any major neurological sequela at hospital discharge and at latest follow-up. Proportions will be pooled with a random-effects model after Freeman-Tukey double-arcsine transformation using the meta package in R. Heterogeneity will be quantified with the I² statistic and explored through prespecified subgroup analyses (causative pathogen, HIV status, age band, timing of assessment, and SSA sub-region) and random-effects meta-regression. The certainty of pooled estimates will be rated using a GRADE-informed approach for prevalence data. Discussion. This review will generate the first SSA-specific pooled estimates of the neurological sequelae burden after childhood ABM, disaggregated by sequela type, pathogen and time since illness. The findings are intended to inform survivor follow-up pathways, audiology and neuro-rehabilitation service planning, and the monitoring of conjugate-vaccine impact on disabling disease. Anticipated limitations include clinical heterogeneity in how sequelae are ascertained, variable follow-up duration, and probable under-ascertainment of subtle cognitive and behavioural outcomes. Systematic review registration. PROSPERO CRD420261446042.