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Tackling The Scourge Of Meningitis



ODIRI UCHENUNU-IBEH, FAITH EKEH AND VICTORIA UNONGO, write on national response to combat meningitis.

One issue that raises concern in Nigeria today is that of the meningitis, a disease that was first recorded in Geneva in 1805 by bacteriologist Anton Vaykselbaum. This disease found its way to Africa in 1840 with the first outbreak in Nigeria and Ghana between 1905 and 1908,  of which large numbers of people died of the disease. Nigeria as one of the 26 countries within sub-Saharan Africa known as the “Meningitis Belt” has a long history of  cerebrospinal meningitis (CSM) epidemics. Reflectively, one of the worst CSM epidemics occurred in 1996 when 109,580 cases and 11,717 deaths were recorded, according to a  World Health Organisation (WHO) report. In recent times, beginning from September 2017 to January 2018 which is known to be the season in which this epidemic is on the high, a total of 481 suspected cases of meningitis were recorded by the Emergency Operation Centre (EOC) in twelve states. A breakdown showed that in Zamfara state,  257 cases were recorded;  Katsina state has 86 cases; Sokoto state 41; Jigawa  state recorded 29 cases,  Bauchi 20, Cross River 17, Kebbi 12, Yobe 9, kano 14,  Borno 3, Adamawa  2 with one reported case recorded in  Kaduna state. Of the 481suspected cases, 176 (36.6 per cent) samples were collected and tested and of the 176 samples tested 79 (44.9 per cent ) were positive for bacterial meningitis.

So far, 82 deaths (17.0 per cent) have been recorded among all suspected cases. Also, according to the  Nigeria Center for Disease Control (NCDC), Weekly Epidemiological Report of week 6, as at February 2018, there were 87 suspected cases of Cerebrospinal Meningitis (CSM) reported from 41 local government areas in 16 States of Adamawa, Bauchi, Borno, Ebonyi, Gombe, Jigawa, Kaduna, Katsina,  Kebbi, Nasarawa, Oyo, Sokoto, Taraba, Yobe and Zamfara and, the FCT.  The breakdown  showed that Adamawa, and Bauchi states recorded two cases each,  Borno 5, Ebonyi, Kaduna, Oyo Nasarawa  and Jigawa states recorded one case each. According to the breakdown, four cases were recorded in  Gombe state,  Katsina 18, Kebbi 5,  Sokoto 4, Taraba 2, Yobe 5 with the highest cases being  Zamfara state with 33. With these records, stakeholders in the health sector have called for increased surveillance and enlightenment toward curtailing the epidemic. Meningitis is a dangerous and a life threatening disease that affects the thin layers of the tissue around the brain and spinal cord of an infected human person and it is caused by bacteria. Indeed, cerebrospinal meningitis is an epidemic prone disease that spreads from person to person through contact with discharges or droplets from nose and throat of an infected person. Medical experts said that it can also be transmitted through kissing, sneezing and coughing especially amongst people living in close quarters, hotels, refugee camp, barracks, public transportation and areas with poor ventilation or overcrowded places.

Speaking on the disease and the pressing need to combat it, like any other disease, the Lagos State commissioner of health, Dr Jide Idris stressed the need for stakeholders to intensify efforts. The  Commissioner noted that though, seasonal Meningitis outbreak usually affects the mainly Northern States that fall within the meningitis belt of the country, it is not impossible that outbreaks can occur in any part of the country, Lagos inclusive, in view of the phenomenal climatic change as well as the high human migration. He explained that the disease usually presents with high body temperature, pain and stiffness of the neck, headache, vomiting, fear of light, restlessness and confusion stressed that death may occur if not promptly and properly managed. Idris therefore emphasised the need for   environmental hygiene as a preventive measure against the disease including hand washing with soap and water frequently; avoiding direct contact with the discharges from an infected person and covering of the mouth and nose when coughing and sneezing. “It is strongly advised for people to avoid overcrowding in living quarters, provide cross ventilation in sleeping and work-rooms and other places where many people come together and get vaccinated with CSM vaccine when you are travelling to areas where Meningitis outbreaks have been reported”, he added. Dr. Idris noted that health workers in the State, especially health workers in the hospitals, the State Epidemiology team and the Disease Surveillance and Notification Officers (DSNOs) in all the 57 Local Governments and Local Council

Development Areas have been placed on high alert and therefore the disease surveillance and monitoring activities have since been intensified. “Health workers are also advised to avoid close contact with suspected and probable cases of CSM based on the case definition distributed, ensure proper disposal of respiratory and throats secretions of cases, report suspected or probable cases, observe universal safety precautionary measures and make use of personal protective equipment when in contact with such cases as highlighted in the Fact-Sheets earlier forwarded to them” he noted. Also, Dr Waziri Paul, a medical doctor at the Community Health Care Centre, Aleyita, in  Abuja, said meningitis is the swelling of the brain covering which can occur once the body is infected with meningococcal bacteria (bacteria responsible for meningitis).

But what are the symptoms of CSM? Dr Paul said symptoms of meningitis are fever, stiffness on one side of the neck, headache, skull fracture and some kinds of surgery that may allow a way for bacteria to enter into the nervous system. Regarding availability of vaccines for treatment of meningitis, Dr Paul said, “Formerly, we do give vaccines especially to children from the ages of one and above but then we stopped because the government  decided to manage the situation whenever there is a major outbreak.” On prevention, he said one should always maintain a clean environment, avoid overcrowding, adapt good personal hygiene and also ensure homes are properly ventilated. The good news however, according to him, is that meningitis can be treated depending on the cause, saying it may get better on its own or it can be life threatening which would require urgent antibiotics treatment. Paul also advised that proper public awareness should be made, even though meningitis  cases is not on the increase right now. The Chief Executive Officer, NCDC, Dr. Chikwe Ihekweazu said every Nigerian has a role in prevention by ensuring that safe and hygienic practices become a part of our lifestyle.

He however said that  improving and digitalising disease surveillance is one of agency’s priorities for 2018. According to him, at NCDC, our priorities for 2018 include implementing electronic, casebased surveillance for six priority epidemic prone diseases namely  Measles, meningitis, cholera, yellow fever, Lassa fever, and monkeypox, from all 774 local government areas in Nigeria. “While we hope that outbreaks are kept to a minimum this year, a robust surveillance system and functional EOC and laboratories, once in place, should allow the government to respond quicker to outbreaks when they do occur. Should this not happen, we must hold our government officials accountable. “As 2018 begins in earnest, we know that there will be many issues that will demand our time and resources, but we must continue to ensure that health is at the forefront of Nigeria’s socio-political agenda if we are to make considerable progress in our nation’s health outcomes.