Meningococcal Meningitis Outbreak (2009) among Children in Maiduguri North-Eastern Nigeria: Epidemiology and Determinants of Outcome

Abstract

Introduction: Large scale epidemic meningococcal meningitis outbreaks had occurred in the African meningitis belt every 5-12 years for the past century. Children are at high risk yet little attention had been directed toward them. Methods: This was a prospective cross-sectional study among all the children with clinical suspicion or diagnosis of cerebrospinal meningitis during the meningococcal meningitis outbreak from January to December 2009. Results: One hundred and seventeen children were confirmed with meningococcal meningitis with incidence of 10.1%. The results of the unadjusted regression analyses, headache (p=0.046, OR 2.895 95% CI 1.019 – 8.229), duration of symptoms before first antibiotic (p=0.035, OR 3.289 95% CI 1.090 –9.920), dehydration (p=0.002, OR 5.225 95% CI 1.885 – 15.391) and type of antibiotic combination; crystalline penicillin and chloramphenicol (p=0.009, OR 4.043 95% CI 1.426 – 11.463) the only factors that correlate significantly with the death rate. However multivariate (adjusted) logistic regression using only factors with p < 0.05 in univariate analysis, only the type of antibiotic combination: Crystalline penicillin/Chloramphenicol and Ceftriaxone/Gentamicin (p=0.030, OR 5.782, 95% CI 1.191 – 28.080) that showed independent association with mortality rate in meningococcal meningitis among children. Conclusion: Children remained the large population affected with high morbidity and mortality especially in the African meningitis belt. The factors contributing to such effect includes lack of immunization, poor recognition of the disease and lack of policy directed at children wellbeing.