Outbreaks due to meningococcal meningitis remain a major public health challenge in Ghana since the first recorded outbreak in Cape Coast in 1900, among East African labourers who were brought to the Gold Coast to support the British campaign against the Ashanti tribe of central Ghana.
There was a second outbreak in 1906 which estimate showed the death toll of 20,000 people between 1906 and 1908.
Over the years, an array of studies of public health relevance on meningitis have been done, some of which considered risk factors, survival and sequelae issues associated with the disease. Other studies investigated different serogroups associated with the disease and emergency vaccination against epidemics of the disease.
For example, studies from the recurrent meningitis outbreaks in Ghana particularly in the northern regions, led to the conduct of a mass preventive immunization campaign in the country in 2012 to address the burden of Group A meningococcus. Before the mass immunization exercise, Group A meningococcus was accounting for an estimated 80–85% of all cases in the meningitis belt in the country, with epidemics occurring at intervals of 7–14 years.
As a consequence of the mass preventive campaign in the three northern regions, the proportion of meningococcus serogroup A declined dramatically and the occurrence of meningitis outbreaks due to other Neisseria meningitidis serogroups as well as other bacteria are now becoming new concerns. More recent studies have considered knowledge, attitude and practice related to the disease and economic burden of the disease to households in Ghana.
For example, in a 2014 study by Samuel Nii Ardey and others on Climate change and Cerebrospinal Meningitis in the Ghanaian Meningitis Belt, they found that some settlements in the meningitis belt in the Upper East Region, are against the National mass CSM immunization exercise though it is identified and used as the main strategy to reduce the incidence of CSM. These sections of the population are of the opinion that, CSM is caused by the gods and ancestors as punishment on families that have wronged the gods or their ancestors and therefore since they do not offend the gods and their ancestors, they will not contract the disease hence do not make themselves and families available for immunization.
Ghana experiences seasonal reports of meningitis normally during the dry periods of October to March. During this climate characterized by dry winds with relatively low humidity and abundance of dust, there is a considerably reduced local immunity of the upper airway (pharynx) and individuals become susceptible to meningitis infection. Meningitis is somewhat endemic in the three northern regions of Ghana, however in recent years, other regions in the middle belt such as the Brong Ahafo, Ashante, have been reporting cases.
Occasionally coastal or regions in the Southern belt such as Eastern and Greater Accra Regions also report cases. The change in epidemiology of the meningitis and the way it is occurring and spreading beyond the traditional meningitis belt can be attributed to the introduction of the Meningitis vaccine, climate change with subsequent extension of drought areas, increased mobility of the population triggered by economic demands and introduction of new strains of organisms into susceptible populations.
The year 2017 witnessed a number of sporadic outbreaks of meningitis in some second cycle institutions with reported deaths of students across the country. Five students of the Kumasi Academy died in that year, and in December of same year, an SHS student died in Asamankese, in the Eastern Region, a student of the Koforidua Sec Tech also died also in the Eastern Region.
There were other reported student deaths from Tempane SHS, Bawku SHTS both in the upper East Regions and Damongo SHS in the Northern Region.
Nandom and Lawra Districts in the Upper West Region started recording cases of meningitis (17 cases) and hitting epidemic threshold as far back as November 2019. In February 2020, there was an outbreak of meningitis in the Assin South District of the central region killing three students of the Nyakumasi SHS. This was followed in March by the report of 18 deaths in the upper west region and the death of an 80 year old man at the Bolgatanga regional hospital from streptococcal pneumonia meningitis.
Roughly, the Upper West Region has currently recorded a rapid rise in the reported cases of meningitis of 258 with 40 fatalities. The Upper West Regional Director of Health Services, Dr. Osei Kufuor Afreh at a media encounter at Wa on April 4, 2020, attributed the deaths to late reporting or a failure to report to health facilities. This is a very worrying trend especially because it lacks the needed National attention due to the outbreak of COVID19.
All National efforts and resources are now directed towards the novel viral pneumonia to the neglect of Meningitis whose case fatality far exceeds that of COVID19.
In other to reverse this worrying trend, this write up, as a matter of urgency seeks to call all relevant stakeholders to action.
The Ministry of Health must intensify efforts in surveillance, laboratory case detection, case management and public education. This can be done through early health alerts to health facilities in the meningitis belt, line listing of suspected cases and monitoring of alert and epidemic thresholds. Also, there should be an immediate provision of laboratory reagents to the regions, especially affected regions, free laboratory testing of all samples and treatment of cases at all health facilities free of charge.
To add to these, there should be orientation of all health staffs, orientation of community based surveillance volunteers, and the training of health staffs on case management and case definitions. Not only this, there should be an immediate expansion of public education in the health facilities and in the communities taking advantage of the chiefs, opinion leaders, youth leaders, community radio and or community information centers and the deployment of information vans.
The MOH through the Ghana Health Service as a matter of urgency should make stockpile of drugs available including relevant antibiotics, intravenous fluids or infusions, make vaccines available and support the districts in the affected regions with funding by instructing the NHIA to give priority in the reimbursement of insurance claims to the Upper West region which is now stricken with the burden of COVID-19 and Meningitis.
Furthermore, the people in the meningitis belt especially the Upper West Region are encouraged to observe spatial distancing particularly avoiding persons sneezing and coughing and wash their hands as often as possible under running water or use alcohol-base sanitizers, same instructions for the prevention of covid19.
They are also encouraged to drink a lot of water to keep their throat moist at all times, keep their windows open to improve ventilation and ultimately, report to the nearest health facility early with symptoms of fever, headache and pain in the neck. END
Source: Dr. Frederick Mawuli Agbemafoh (Bsc, Mbchb), Deputy Medical Manager, Cocoa Clinic, Sefwi-Debiso, Western North Region
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