Conference abstract

Pneumococcal meningitis outbreak and associated factors in Six Districts of Brong Ahafo Region, Ghana, 2016

Pan African Medical Journal - Conference Proceedings. 2017:3(120).01 Dec 2017.
doi: 10.11604/pamj-cp.2017.3.120.470

Contact the corresponding author
Keywords: Meningitis, outbreak, Brong Ahafo Region, case-control
Oral presentation

Pneumococcal meningitis outbreak and associated factors in Six Districts of Brong Ahafo Region, Ghana, 2016

Charles Lwanga Noora1,2,&, Timothy Letsa2, George Khumalo Kuma1, Ernest Asiedu1, Gideon Kye-duodu1, Edwin Afari1, Osei Afreh Kuffour2, Joseph Opare1, Kofi Nyarko3, Donne Ameme1, Emmanuel Bachan2, Kofi Issah2, Franklin Aseidu Bekoe2, Moses Aikins4, Ernest Kenu1

1Ghana Field Epidemiology and Laboratory Training Program, Ghana, 2Ghana Health Service, Ghana, 3Namibia FELTP, Namibia, 4University of Ghana School of Public Health, Ghana

&Corresponding author
Charles Lwanga Noora, GFELTP, Ghana Health Service, Brong Ahafo Region, Ghana

Abstract

Introduction: meningitis, a disease of the central nervous system is described as inflammation of the covering of the brain and spinal cord (meninges). It is characterized by fever, severe headache, nausea, vomiting, stiff neck, photophobia, altered consciousness, convulsion/seizures and coma. In December, 2015, twelve suspected cases of meningitis were reported in Tain district in Brong Ahafo region (BAR). Subsequently, dozens of suspected cases were hospitalized in five district hospitals in BAR. We investigated to determine the magnitude, causative agent and risk factors for the disease transmission.

Methods: we defined a suspected case of meningitis as anyone living in BAR reporting with sudden onset of headache and fever (Temp. > 38.0C) with one of the following signs neck stiffness, altered consciousness, convulsions, other meningeal signs, and bulging fontanelle (infants) from 10/12/15 to 26/03/16. We collected CSF samples and performed serological testing using Pastorex-Meningitis-Kit and culture for bacterial isolation. A community-based 12 case-control study (sample-size of 126) was conducted. Controls were selected as persons from neighborhood of cases without the defined symptoms. We collected data on socio-demographics, living conditions, health status and other risk factors. We conducted univariate data analysis and logistic regressions to study disease-exposure associations using STATA.

Results: total of 969 suspected cases with 85 deaths (CFR = 9.0%) were recorded between December, 2015 and March, 2016. Majority, 55.9% (542/969) were females aged between 10months-74 years (median 20 years, IQR; 14-34). Of the 969 cases, 141 were confirmed by Laboratory test with Streptococcus pneumoniae identified as the causative agent. Twenty districts recoded cases with six reporting cases above threshold levels. The outbreak peaked in week 6 with 178 cases. Overall attack rate (AR) was 235.0/100,000 population. District specific ARs were: Tain: 143.6/100,000, Wenchi: 110.0/100,000, Techiman: 46.6/100,000, Jaman North: 382.3/100,000 and Nkoranza South: 86.4/100,000. Female and male specific ARs were 251.3/100,000 and 214.5/100,000 respectively. Age-group 10-19 years were most 33.8% (317/940) affected. We identified sore throat [aOR = 5.2, 95% (CI 1.1-26.1)] and alcohol use [aOR = 9.1, 95 %( CI 1.4-55.7)] as factors associated with the disease transmission.

Conclusion: meningitis outbreak due to Streptococcus pneumoniae was established in BAR. Upper respiratory tract infection and alcohol use were associated with the outbreak. Mass educational campaigns on healthy living habits, signs and symptoms of meningitis, need for early reporting were some of the control measures instituted. We further recommend Pneumococcal vaccination in BAR to prevent future outbreaks.