Abstract
BackgroundKebbi State remains the epicentre of the seasonal epidemic meningitis in northwestern Nigeria despite interventions. In this setting, no previous study has been conducted to understand the risk factors of the recurrent meningitis epidemics using qualitative approach. Consequently, this study intends to explore and better understand the environmental, economic and socio-cultural factors of recurrent seasonal epidemic meninigitis using a qualitative approach.MethodsWe conducted in-depth interview (40 IDIs) and focus group discussions (6 FGDs) in two local government areas (LGAs) in Kebbi State, Northwestern Nigeria to understand the environmental, economic and socio-cultural factors of recurrent meningitis outbreaks. Routine surveillance data were used to guide the selection of settlements, wards and local government areas based on the frequency of re-occurrences and magnitude of the outbreaks.ResultsThe discussions revealed certain elements capable of potentiating the recurrence of seasonal meningitis epidemics. These are environmental issues, such as poorly-designed built environment, crowded sleeping and poorly ventilated rooms, dry and dusty weather condition. Other elements were economic challenges, such as poor household living conditions, neighbourhood deprivation, and socio-cultural elements, such as poor healthcare seeking behaviour, social mixing patterns, inadequate vaccination and vaccine hesitancy.ConclusionAs suggested by participants, there are potential environmental, socio-cultural and economic factors in the study area that might have been driving recurrent epidemics of cerebrospinal meningitis. In a bid to addressing this perennial challenge, governments at various levels supported by health development partners such as the World Health Organisation (WHO), United Nation Habitat, and United National Development Programme can use the findings of this study to design policies and programmes targeting these factors towards complementing other preventive and control strategies.
Highlights
Kebbi State remains the epicentre of the seasonal epidemic meningitis in northwestern Nigeria despite interventions
Nigeria is one of the countries that lie along the traditional African meningitis belt which spans from Senegal in the western part of the African continent to Ethiopia in the eastern part [1,2,3] Characteristically, cerebrospinal meningitis (CSM) epidemics start around February when the prevailing weather is hot and dry and tails off with the onset of rainfall in May or June [1,2,3]
The recurrent CSM epidemics are of public health importance due to relatively high morbidity and case fatality rate, the huge population at risk and the over-stretching of the weak health services [7, 9, 10]
Summary
Kebbi State remains the epicentre of the seasonal epidemic meningitis in northwestern Nigeria despite interventions. In this setting, no previous study has been conducted to understand the risk factors of the recurrent meningitis epidemics using qualitative approach. Neisseria meningitidis type A was the major cause of seasonal CSM epidemic within African meningitis belt [4,5,6,7]. Northern Nigeria has experienced recurrent seasonal CSM epidemics for several years, despite efforts being made by the government and development partners [5, 7, 9]. Between January and April, 2017, outbreak of type C meningitis was reported in northern states of Zamfara, Sokoto, Kebbi, Katsina, Niger and Yobe with it attendant high death toll
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