Coma is a frequent clinical presentation of severely ill children in sub-Saharan Africa. It may have a number of infectious and non-infectious etiologies including cerebral malaria, viral encephalitis, and bacterial and tuberculous meningitis. Due to its high rates of mortality and morbidity, rapid diagnosis and targeted interventions to optimize outcomes are critical. However, clinical assessment alone cannot distinguish between these etiologies, identifying coma etiologies by lumbar puncture (LP) is important.LP is a clinical procedure that is used to collect and examine the cerebrospinal fluid surrounding the brain and spinal cord. It has been widely utilized to diagnose symptoms and signs caused by infection, inflammation, cancer, or bleeding in the central nervous system. LP is an essential, simple, and widely available, procedure that is generally the only way to definitively identify underlying infectious coma etiologies. Despite the clear efficacy of LP, clinicians may be reluctant to perform the procedure in a comatose child, due to concerns that the procedure may bring out cerebral herniation and death.In this thesis, we aim to assess the impact of LP on the survival of comatose children. We performed a retrospective cohort study on survival of comatose Malawian pediatric inpatients recruited over consecutive rainy seasons from 1997-2013. Due to the lack of randomness in being treated (LP) and untreated (Non-LP) groups, baseline characteristics are not balanced. We applied propensity score methods to compensate the imbalance. Our analysis results showed no impact in death rate associated with LP.
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