The Prevalence Of Cerebrospinal Meningitis

Medical and Health Science Project and Seminar Material

The Prevalence Of Cerebrospinal Meningitis


Chapter One


Introduction

Background of the Study

Cerebrospinal Meningitis (CSM) is a major public health problem in many parts of the world. Cerebrospinal Meningitis is one among the first category of Epidemic Prone Diseases in Gombe State and equally among the first category of revised list of Nigeria Integrated Disease Surveillance Response (IDSR) priority diseases, conditions and events. Cerebro-spinal Meningitis (CSM) is a disease of public health importance considering the synergy between cases and case fatality rate do occurs. The worst CSM epidemics experienced in Nigeria occurred in 1996 when about 109,580 cases and 11,717 deaths were recorded, followed by the one in 2003; 4,130 cases with 401 deaths recorded then in 2008; 9,086 cases and 562 deaths (WHO, 2010).

The current Cerebro-Spinal Meningitis (CSM) outbreak in Nigeria continues to pose a public health concern. According to the Nigeria Centre for Disease Control (NCDC), cases of CSM were first reported in Zamfara State in 2016 and have since spread to sixteen (16) States including the Federal Capital Territory (FCT). Ninety (90) Local Government Areas (LGAs) in Sixteen (16) States across the federation are so far affected which includes Zamfara, Kastina, Sokoto, Kebbi, Niger, Nassarawo, Jigawa, FCT, Gombe, Taraba, Yobe, Kano, Osun, Cross Rivers, Lagos and Plateau. The total number of people affected across these States is 2524 with 328 Deaths (case fatality rate) as of Friday, March 31, 2017 (FMOH). These indicators shows that Nigeria is repeatedly experiencing an outbreak of Cerebrospinal Meningitis (CSM) that has spread across the country and mostly affecting States in the upper parts of the country which falls within the African Meningitis Belt. Other countries that are facing similar outbreaks at the moment include our West-African Neighbours like Niger, Chad, Cameroun, Togo and Burkina Faso (WHO, 2010).

An extensive survey of published and unpublished records, obtained by personal visits to hospitals and Ministries of Health across West Africa, enabled Lapey (2010) to produce the definitive report on CSM in West Africa during the first half of the 20th century. He documented in detail the epidemiological features of CSM in Africa and drew attention to the fact that it is only in a restricted area of Africa that the infection behaves in such a characteristic and peculiar way. This led him to define the ‘‘African meningitis belt’’ bounded to the North by the Sahara and to the south by areas of tropical rain forest. Various mining activities augment the spread of diseases. Activities of surface mining in and around textiles areas pollute the air with a lot of dust which caused upper respiratory tract infections. Secondly, disposal of mining waste such as cyanide in rivers exposes the inhabitants to the risk of meningitis (Lapey, 2010).


Statement of the Problem

Infection of the meningitis affects the thin lining that surrounds the brain and the spinal cord. Cerebro-Spinal Meninigitis infection spread mainly by contact with an infected person usually through sneezing, coughing and nose secretions from infected person and is particularly worse in overcrowded areas. Perhaps indicators shows that Nigeria is repeatedly experiencing an outbreak of Cerebrospinal Meningitis (CSM) that has spread across the country and mostly affecting States in the upper parts of the country which falls within the African Meningitis Belt of which Gombe State is inclusive (see map in appendix.…. and graphic illustration in appendix.…). Meningococcal meningitis remains associated with a high mortality rate and persistent neurological defects particularly among infants and young children. As a way of prevention, it is important to avoid overcrowded spaces, sleep in well-ventilated rooms and avoid close and prolonged contacts with infected individuals. Therefore, the study is geared toward appraising the prevalence of cerebrospinal meningitis infections which comes year-in year-out frequently in Gombe Local Government Area of Gombe State.


Purpose of the Study

The purpose of this study is to assess the Prevalence of Cerebrospinal Meningitis in Gombe Local Government Area, Gombe State. Specifically, it seeks to:

  1. Investigate the epidemiology of Cerebrospinal Meningitis in Gombe Local Government Area.
  2. Determine the factors that predispose to Cerebrospinal Meningitis in Gombe Local Government Area, Gombe State.
  3. Determine the strategies that could be adopted to solve the prevalence Cerebrospinal Meningitis in Gombe Local Government Area of Gombe State.

Significance of the Study

This study aims at finding out predisposing factors, epidemiological strength, determine and suggest the best intervention and preventive strategies to curb with the prevalence of cerebrospinal meningitis infections in Gombe Local Government Area of Gombe State. Furthermore, findings from this study and the appropriate recommendations if implemented, will be of great help to the health institutions, concerns authorities and or the country at large in reducing morbidity and mortality through new intervention programs, update the treatment protocols for proper management, follow up and care of all patients with Cerebrospinal Meningitis case and it’s complications associated. It should be used to formulate the policy and make public awareness regarding Cerebrospinal Meningitis within the study area. The findings of this study also could of help to improve upon the welfare of the people, as persons recovered from the sickness and are able to earn their livelihood and improve their lot.


Research Questions

  1. What is the epidemiology of Cerebrospinal Meningitis in Gombe Local Government Area?
  2. What are the factors that predispose to Cerebrospinal Meningitis in Gombe Local Government Area, Gombe State?
  3. What strategies could be adopted to solve the problem of Cerebrospinal Meningitis in Gombe Local Government Area of Gombe State?

Scope of the Study

This study is centered on the Prevalence of Cerebrospinal Meningitis in Gombe Local Government Area, Gombe State. It would focus on the factors and effects of Cerebrospinal Meningitis and also it is expected to note that the preventive measures to curb the problems of Cerebrospinal Meningitis would have been known in the course of this study.


Chapter Five


Discussion and Conclusion

5.1 Discussion

Cerebrospinal Meningitis (CSM) is an acute inflammation of the membranes covering the brain and the spinal cord. It is a very serious infection that can lead to death if left untreated. This data shows a relative sparing of the under 5 year olds as only 13.8% of cases belonged to this age group. This finding is similar to previous but smaller outbreaks in neighbouringYabo and Silame LGAs of Sokoto state in 2013 – 2014. It is also similar to findings from another outbreak in Gusau, Zamfara state where majority of cases were among the 5 – 14 years and the 15 – 29 years age group.The much higher presentation seen in older children and adults in recent epidemics may be worth taking up as a research problem to be investigated in subsequent researches.

Outbreaks of Neisseria Meningitides (Nm) type C has been on the increase since 2013 in Sokoto and Gombe states in Northwest, Nigeria.7 Eight hundred and fifty six (856) cases were reported in Sokoto state in 2013 with a case fatality rate (CFR) of 6.8%. Gombe state had less than 200 cases in 2013, 333 cases with a CFR of 10.5% in 2014.7 The 2015 figure gives an alarming 5 fold rise in the number of cases seen compared to that of 2014. This implies it could get worse in subsequent years if no public health measures are put in place to stop the trend.

The case fatality rate for 2015 (4.0%) was less than half that of 2014 (10.5%) though it involved more than twice the number of deaths reported in 2015 (80 deaths) when compared to 2014 (35 deaths). The relatively lower CFR in 2015 was possibly due to the effect of health education/promotion messages given to affected communities and the state as a whole via the mass media during the 2014 outbreak. This led to better health seeking behavior at treatment centres in 2015 and therefore the relatively better health outcomes. Strengthening the surveillance system to make it more effective (sensitive and specific) and giving DSNOs and healthcare workers refresher training on how to promptly identify Meningitis cases will further help in reducing Meningitis burden. The case definitions of Meningitis should be conspicuously displayed at health facilities to help health workers identify cases.

Outbreaks of NmC in Nigeria are rare, the most recent documented outbreak of this serotype in Northern Nigeria was in 1975 before its resurgence in 2013. There is a possibility of emergence of new strains or less commonly seen serogroups such as NmC following mass vaccination campaigns against a particular serogroup. In this case MenAfriVac a conjugate vaccine against serogroup “A” was used for vaccination campaigns between 2012 and 2013 in Gombe state.7 Serogroup replacement following mass meningitis vaccination has been noted in West Africa; reports from Niger republic and Burkina Faso have indicated a significant increase in serogroup W135 prevalence in the years following campaigns with MenAfriVac® around 2010.13, 14 More recently in Nigeria mass vaccination campaigns with monovalent oral polio vaccine against (OPV1) led to an outbreak of the less common wild polio virus type 3 (WPV3). This necessitates the need for the use of multivalent vaccines especially in scenarios where more than one serogroup has epidemic potential and the need for strengthening instituted enhanced surveillance systems.


5.2 Conclusion

Gombe state has experienced seasonal outbreaks of cerebro-spinal Meningitis (serogroup Nm C) since 2013 with a massive outbreak in 2015. Mass vaccination campaigns have been carried out in previous years against Nm A (MenAfriVac) with about two thirds of the cases immunized. There is a need to vaccinate vulnerable populace with polyvalent vaccines containing serogroup C to prevent future occurrence.


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