Etiology and Short-term Outcome of Pediatric Coma at a Tertiary Hospital in Douala, Cameroon

Background Pediatric coma is a critical emergency with high morbidity and mortality in sub-Saharan Africa, where limited data hinders effective management strategies. Understanding its epidemiology and prognostic factors is essential for improving outcomes. Methods A 28-month cross-sectional study (January 2017-April 2019) was conducted at Gyneco-Obstetric and Pediatric Hospital of Douala, Cameroon. Children aged 1 month to 15 years with Glasgow Coma Scale ≤ 14 were included. Data on demographics, clinical presentation, etiology, and outcomes were collected through retrospective record review and prospective patient enrollment. Statistical analysis used SPSS version 20.0 and CSPro with Chi-square and Fisher's exact tests. Results Among 864 hospitalized children, 109 presented with coma (prevalence 12.6%). The male-to-female ratio was 1.4:1, with mean age 48.8 ± 47.5 months; 64.2% were under 5 years. Infectious causes predominated (62.4%), with cerebral malaria accounting for 42.2% and septicemia for 15.6%. Other etiologies included metabolic/toxic causes (16.5%), post-epileptic coma/status epilepticus (14.7%), and traumatic brain injury (4.6%); 12.8% remained undiagnosed. Clinical features included fever (73.4%) and seizures at admission (68.8%). Overall mortality was 26.6%, with 30.9% of survivors experiencing neurological sequelae, predominantly motor deficits (14.8%). Significant mortality predictors included age under 2 years (6–10 times higher odds), female sex (3.54 times higher odds), direct home admission (3.24 times higher odds), and deeper coma stages (100% mortality in Stage IV versus 3.8% in Stage I). Conclusion Pediatric coma at this tertiary center predominantly affects young children and stems primarily from infectious etiologies, particularly cerebral malaria. The high mortality (26.6%) and substantial neurological morbidity among survivors underscore urgent needs for strengthened malaria prevention programs, improved community awareness, enhanced referral systems, and increased diagnostic and intensive care capabilities. Early recognition and prompt management of preventable causes could significantly reduce mortality and morbidity from pediatric coma in Central Africa.