Category: Projects

Meningitis Outbreak In Nigeria

Statistics: The outbreak began in March 2016, approximately 15 States have been affected, almost 2000 Suspected Cases. Approximately 300 deaths so far. The states with the largest number of cases include: Kebbi, Katsina, Niger, Sokoto, Zamfara State.

Who Is In Charge of Managing The Outbreak? 

  • Nigeria’s Centre for Disease Control  is leading outbreak control in coordination with the World Health Organization (WHO), UNICEF, US Centers for Disease Control (CDC), Medecins Sans Frontieres, and Ehealth Africa
  • NPHCDA is leading vaccination in Zamfara state, similar efforts are being coordinated in other affected states
  • WHO is working to ensure the availability of vaccines.

What Are The Risk Factors?

  • Outbreak tends to occur in dry season because of low humidity and dusty conditions
  • The northern part of Nigeria seems to have a higher perdisposition because of their environment
  • Overcrowding and poor sanitation can contribute to outbreaks
  • Living in Dormitories, military bases, child facilities
  • Lack of Vaccination
  • Compromised immune system
  • Pregnancy increases risk of Listeria meningitis.

What Is Meningitis? 

  • It is an Infection of the brain and spinal cord. Organisms can enter the blood stream and travel to the brain and spinal cord, or invade the meninges directly through an ear or sinus infection, skull fracture, or after surgeries in the brain or spinal area
  • Can be caused by bacteria, virus, or fungus
  • Bacterial meningitis most common in teenagers and young adults, it is very severe and can lead to death
  • Viral meningitis are most common in children <5 years, but often mild, can clear on its own
  • Fungal meningitis is rare, usually chronic, it is not contagious, and may be seen in people with immunodeficiency such as AIDS.

Bacterial Meningitis

  • Could be caused by multiple organisms including Streptococus Pneumonia, Haemophilus Influenzae, Listeria Monocytogenes, and most commonly Neisseria Meningitidis (N. meningitidis).
  • Nigeria’s current outbreak is of N. meningitidis (C serogroup), affects mostly teenagers and young adults.
  • Bacterial Meningitis is highly contagious, can lead to death with 24 to 48 hours if untreated.

How Bacterial Meningitis Spreads

  • It spreads through the respiratory system via droplets. Exposure to kissing, coughs, sneezes, shared cutlery, or sharing items that were in contact with an affected person’s saliva such as toothbrush, cigarettes etc.
  • Can contact meningitis by staying in an enclosed environment or room with an affected person.
  • Spreads very quickly in a crowded environment.

Symptoms Of Meningitis

  • Severe Headache that’s different from your usual
  • Difficulty concentrating or Confusion
  • Sudden high fever
  • Stiff neck
  • Sensitivity to light
  • Sleepiness or difficulty waking up
  • seizures
  • Poor appetite
  • Skin rash
  • Muscle and joint aches

Symptoms Of Meningitis In Infants

  • High fever
  • Irritability or Constant Crying
  • Poor feeding
  • Excessive sleepiness
  • Inactivity or sluggishness
  • Stiff neck or body
  • A bulge in the soft spot on the baby’s head

What To Do If You Suspect Meningitis

  • Prompt response and treatment can save lives and prevent complications
  • Avoid exposing others, wear mask and isolate yourself if possible
  • Go to the nearest hospital immediately
  • Tell the Doctor all your symptoms

Evaluation And Management Of Bacterial Meningitis

  • Bacterial meningitis is a medical emergency. Treatment must be initiated immediately to reduce the risk of death
  • Evaluate Patient for:
    • Recent exposure to persons with meningitis
    • Otorrhea (leaking ears) or rhinorrhea (runny nose)
    • Recent travel to areas with endemic meningitis
    • Recent or remote head injury
    • Recent infection (especially ear infection)
    • Immunocompromised conditions
    • Intravenous drug use
  • Obtain blood cultures and Cerobrospinal (CSF) fluid through lumbar puncture if no contraindications
  • Initiate empiric intravenous antibiotics immediately, can use third-generation cephalosporin like cefotaxime (2grams every 4 to 6 hours) and ceftriaxone (2grams every 12 hours), or fourth-generation cephalosporin such as cefepime (2 grams every 8 hours). These drugs can consistently penetrate the cerebrospinal fluid to kill the causative organism
  • Chloramphenicol is preferred for N. meningitides during epidemics. Ceftriaxone can be used as an alternative if Chloramphenicol is not available or contraindicated. The World Health Organization recommends the use of chloramphenicol as the empiric antibiotic of choice in treatment of patients with N. Meningitidis in Sub-Saharan Africa. 1 or 2 injections of the long-acting formula is acceptable.
  • Add vancomycin (15 to 20 mg/kg every 8 to 12 hours) for empiric gram positive coverage until culture results indicate the absence of other infections
  • Can use dexamethasone as an adjunct to decrease brain inflammation, risk of hearing loss, and other complications
  • Antibiotic dosing should be adjusted for patients with poor renal function.

Complications Of Meningitis

  • Complications usually occurs if a person is left untreated for a long time, and includes:
  • Brain damage
  • Hearing loss
  • Seizures
  • Gait problems
  • Shock
  • Death
  • Memory problems and learning disabilities

Prevention of Meningitis

  • Vaccination of high risk populations is the best option for prevention
  • Vaccination against meningitis should be provided as part of the routine childhood vaccination
    • Haemophilus Influenzae type B (Hib) vaccine prevents infections that cause meningitis and pneumonia
    • MMR (measles-mumps-rubella) vaccine prevents meningitis caused by measles and mumps
    • Pneumococcal vaccines also prevent bacterial meningitis especially in those older than 65, immunodeficient persons, or those with some chronic diseases
    • Varicella (chickenpox) vaccine and shingles vaccine prevent viral meningitis
  • Vaccination with the Haemophilus Influenzae type B (Hib) is recommended for boarding school students or new college students
  • Avoid traveling to areas with meningitis outbreaks or epidemics

Written by Dr. Idongesit Udoh

 

References
BellaNaija (March 30, 2017). Meningtis: 1966 suspected cases reported in five states. Article obtained from http://www.bellanaija.com.
Mayo Clinic Staff. Meningitis symptoms and causes. Article obtained from http://www.mayoclinic.org/diseases-conditions/meningitis
Stephanie Busari (March 31, 2017). Meningitis outbreak in Nigeria kills nearly 300. Article obtained from http://www.cnn.com.
Tunkel, A. R., Calderwood, S. B., Thorner, A. R. (2017). Initial therapy and prognosis of bacterial meningitis in adults. Article obtained from http://www.uptodate.com
Waure, C. D., Miglietta, A., Nedovic, D., Mereu, G., & Ricciardu, W. (2016). Reduction in Neisseria meningitides infection in Italy after meningococcal C. conjugate vaccine introduction: a time trend analysis of 1994-2012 series. Human Vaccines & Immunotherapeutics, 12(2), 467-473.
World Health Organization (March 13, 2015). Meningococcal disease – Nigeria. Article obtained from http://www.who.inte/csr.

 

Arise Nigeria, Arise !!!

There comes a time in human existence when a group of people have to choose a path. Either stay the course and continue on the path of struggle, mediocrity, and further destruction, or take a stand and fight to redeem the nation and leave an inheritance for future generations. Nigeria is at that crossroad, where we risk losing the value of the democracy we obtained in 1960 if we continue to stand and watch as the nation is being stripped of its identity, and the future more uncertain.

The question we all have to ask ourselves is this; how did we get here? We got here because of negligence on the path of leadership and citizens to look out for the well-being of all, rather than a select few. We got here because we failed to adopt a culture of maintenance and diligence towards the preservation of our national treasures. We got here because despite the blessings we have in natural resources, we failed to seek understanding on how to manage our resources and maximize our revenues. We are here because at so many instances we lacked vision, direction, and passion for our people and nation.

Chief Seattle once said “man did not weave the web of life; he is merely a strand in it. Whatever he does to that web, he does to himself.” What are we doing to our web of life as Nigerian citizens? Are we destroying it? How are we contributing to the challenges we face as a nation? Are we willing to become a part of the solution? What is the limit of our compassion? Are we able to see those who are suffering because of the failed systems in the country? Can we see that the young are most affected, and their futures more bleak? How about the poor children in the villages who do not have enough to eat on a daily basis, and may not have an opportunity to obtain an education? Are they not deserving of a brighter future? Think of our broken down educational system, particularly institutions of higher learning. What will it look like in the future if not fixed today? We can also speak of millions of youths who have completed higher education but remain unemployed. How will they grow and contribute to society, if they have no platform to build their skills and display their talents?

Chief Seattle went on to say “take only memories, leave nothing but footprints.” This statement speaks to the fact that what we do today determines the Nigeria that our children and grandchildren will inherit. Are we creating footprints? Will our footprints lead to a destination that is greater than where we started in 1960? We have to understand that many of the great policies and social institutions we admire in foreign countries were envisioned and implemented by leaders who saw opposition and challenges, but pushed through to establish something that made their nations better for the citizens. Most of these leaders did not see the full manifestation of their vision while in office, but they left traceable footprints that enabled incoming leaders to continue to improve on what was started, allowing the changes or projects to stand the test of time.

The president just launched a “change begins with me campaign.” It does not matter what our political affiliations are, this campaign should speak to the core of all Nigerians. What part are we going to play in our communities and our nation in order to establish the changes we want to see? Look around you. Do you see schools in your community with broken amenities that can benefit from your donation? Have you gone to your local healthcare facility recently? What is lacking that you have the power to provide or help improve? Can our elected leaders begin to value the lives and experiences of those who voted them into office? Will our leaders ensure that our resources are not diverted, misused or wasted? Can we seek to maintain transparency and accountability to our nation and the future of our children? Will our business men and women commit to provide quality and efficient services while maintaining honesty throughout?

As a doctor, are you ready to deliver ethical care within the limits of your expertise and provide timely referral and transfers for complex cases that need a higher level of care? As a senior nurse with years of experience, are you willing to mentor your colleagues and bring structure to the way nursing care is delivered at your facility? Will our teachers rise up to inspire and mentor students, teach them to value integrity and respect the rights of their fellow man? Can our students commit to careful use and maintenance of the structures in our schools? As a person with great wealth, can you go back to your Alma Mata, and pay some of the salaries of a group of teachers and professors who may not have been compensated for their work for several months?

Let us start today, stand for the truth, stand for one another, stand for our children and their children. Let us stand for the identity and future of our nation. We all have our roles to play in this movement. We can do so in our communities or advocate in the corridors of power. We have a shared responsibility to take back the values of our nation, and rebuild our Jerusalem. Our contributions to bring the changes we want to see may be small or big, but we must not underestimate the impact we will create, as we all drop a piece of goodwill in our web of life, and watch as our web becomes stronger and redefines the color of our tomorrow.

written by Dr. Idongesit Udoh