Despite new diagnostic methods and expanded vaccination programmes, many children in Uganda continue to suffer from severe brain infections. This is shown in a new study from Karolinska Institutet, published in The Lancet Regional Health - Africa. The researchers' analysis highlights simple clinical signs that can help healthcare providers more quickly identify children at high risk of death.
The study followed 212 children aged 0 to 12 who were treated for suspected central nervous system infections at two hospitals in southwestern Uganda. Fifteen per cent of the children died during hospitalisation, and 18 per cent were discharged with neurological disabilities such as seizures or muscle weakness. Malaria and the bacterium Streptococcus pneumoniae were the most commonly identified causes.
Simple observations can provide crucial information
"Our results show that even in settings where advanced diagnostics are not always available, simple clinical observations can provide crucial information about which children are in greatest need of rapid care," says Phuthumani Mlotshwa , doctoral student at the Department of Global Public Health and the study's first author.
The infections were caused by several different microorganisms. Malaria was detected in 20 per cent of the children, and bacteria in the cerebrospinal fluid in 11 per cent. For nearly half of the cases, no specific pathogen could be identified, which the researchers say underscores the need for improved diagnostic tools.
"The combination of high mortality and significant disabilities among survivors shows that we need to strengthen prevention, diagnostics, and follow-up," says Giulia Gaudenzi , researcher at the same department and the study's senior author.
The study was carried out in collaboration with Mbarara University of Science and Technology, the Epicentre Mbarara Research Center, and several international partners. It was funded by the Swedish Research Council, the European Commission's Horizon Europe programme, and the European Research Council. The researchers report no competing interests.
Publication
Aetiology, outcomes, and in-hospital mortality predictors of suspected paediatric central nervous system infections in southwestern Uganda: a prospective cohort study . Phuthumani Mlotshwaa, Elias Kumbakumbab, Dan Nyehanganec, Reza Rastia, Richard Migishad, Milly Nassejjeb, Deborah Nanjebec, Yap Boum, Juliet Mwanga-Amumpaireb, Tobias Alfvén, Giulia Gaudenzia. The Lancet online, 21 April 2026: doi:10.1016/j.lanafr.2026.100050
More about the researchers
- The publication is the culmination of a journey that began as Giulia Gaudenzi's postdoctoral project: Curie, 28-03-2023: Därför engagerar utvecklingsforskning (That is why development research is so engaging). She continued as an independent researcher together with Phuthumani Mlotshwa, who took his Master in Global Health at Karolinska Institutet and is now pursuing a PhD at the Deaprtment of Globa Public Health.
- "Uncle Mike" is a short documentary featuring co-authors Dr Kumbakumba and Deborah Nassejje. It was selected as a finalist at the WHO Health for "All Film Festival" 2021.
