Risk Factors for Cerebrospinal Meningitis during an Outbreak in Gombe State - Nigeria, 2009

Background: Cerebrospinal meningitis (CSM) is an epidemic prone disease with high morbidity and a case fatality rate of 90-100% if untreated. CSM due to Neisseria meningitides group A is the major cause of CSM, it is vaccine preventable. Nigeria is located in sub-Saharan African meningitis belt. In 2009, it recorded 56,022 cases with 2,474 deaths. Gombe recorded 338 cases with 12 deaths. We conducted a case-control study to determine risk factors for CSM transmission during the 2009 outbreak. Methods: An unmatched case- control study was conducted with 190 cases and 190 controls. Cases were persons resident in Gombe State with sudden onset of fever (>38.50c) with stiff neck, altered consciousness or other meningeal signs starting January 2009. We administered a structured questionnaire to obtain demographic and clinical data to assess possible risk factors. Univariate and multivariate logistic regression analysis of risk factors were performed. Adjusted odds ratios (AOR) are given with 95% of confidence interval (CI). Result: Of the 380 respondents, 242 (67%) were male, mean age was 9.5 years, (male: 10 years; female: 9 years). Children < 15 years constituted 84.2% of the cases. Cases among children attending quranic schools were 62 (33%) and 15 (7.8%) among controls (AOR= 8.34, 95% CI=4.13-16.82). 58% of cases and 26% of controls had history of close contact with a CSM case (AOR=8.75, 95% CI=4.08-18.74). History of vaccination was protective (AOR=0.22, 95% CI=0.12-0.41). Conclusion: Attendance of congested quranic schools, low vaccination status and having close contact with a case were risk factors. Reconstructing the quranic schools to demarcated classrooms was recommended and implemented. Timely vaccination campaigns should be targeted at children <15 years.

Author (s): 

Lilian S. Maina, L. Aluke, P. Jatau, S. Ogobua, P. Nguku, H. Akpan, J.Oladejo

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