Meningitis- why Immunisation could be the best solution

Jan 11, 2009

THE New Year has started on a bad note for people in Hoima, western Uganda. The Ministry Of Health has confirmed a meningitis outbreak in the region. The death toll is nine with over 27 victims admitted.

By Irene Nabusoba

THE New Year has started on a bad note for people in Hoima, western Uganda. The Ministry Of Health has confirmed a meningitis outbreak in the region. The death toll is nine with over 27 victims admitted.

To check the disease, the ministry’s director of healthcare services, Dr. Nathan Kenya Mugisha, advises people to restrict their movements, observe hygiene and avoid crowded places like markets.

Mugisha, who is in charge of clinical and community services, says: “We can now ably say it is a meningitis epidemic of Type A strain, according to our laboratory tests.

It presents with high fever, headache and a stiff neck. “Victims are also sensitive to light, may show mental confusion and vomiting in later stages.”
The outbreak was first reported on December 30, creating a worrying scenario that calls for an emergency response.

“It’s one week old. We are considering immunisation if it hits the threshold of five cases, but we are struggling to contain it. We are praying that we do not reach the recommended threshold because the ministry is understaffed. This presents us with a challenge of getting medics on the ground,” he says.

According to the World Health Organisation (WHO), there must be five confirmed cases of every 100,000 people for meningitis to be called an epidemic, which calls for immunisation.

Mugisha says the condition is so far restricted to only Kigorobya sub-county.
“We are conducting mass health education campaigns for locals to seek medical attention as soon as they notice any symptoms.

Meningitis spreads rapidly and kills quickly, but it can be treated if it is reported early,” he says. The disease is treated with oily chloramphenical and expen drugs. Patients are also given intravenous fluids to stabilise them.

Dr. Simon Byaruhanga, the acting medical superintendent of Hoima Hospital, says an emergency special room has been created to accommodate suspected meningitis patients at the hospital.

“Meningitis patients cannot be mixed with other patients because the disease is airborne and can spread fast,” Byaruhanga says.

“Health workers at the hospital have protective gear and have been sensitised about the dangers of the disease.”
There are several types of meningitis.

These include Meningococcal, Pneumococcal, Haemophilus Influenzae b (Hib), Group B Streptococcal (GBS), E. coli, Listeria, Tubercular (TB), Salmonella, Viral meningitis.

Viruses and bacteria that spread to, or directly infect the central nervous system, cause most cases of infectious meningitis.

Symptoms may develop within a few hours (acute bacterial meningitis) or a few days. Some patients experience cough, runny nose and congestion prior to developing other symptoms.

WHO often warns of possible outbreaks of the disease at the beginning of the year.

In October 2007, the global health body predicted that Uganda and 13 other countries, including Kenya, Sudan and the DR Congo could face one of the worst meningitis strains in early 2008 and it came to pass.

Dr. William Mbabazi, the in-charge of integrated disease surveillance and response at the WHO, says the disease, which thrives in dry weather, is a yearly occurrence in Africa’s meningitis belt that stretches from Ethiopia, through central to West Africa.

“Uganda experienced it in early 2005, 2006, 2007 and even 2008,” he says, adding that they often make their predictions based on weather forecasts that indicate Africa is in for a severe drought this year, and on historical occurrences which have been constant for eight to 10 years.

Mbabazi says Kotido, Moroto, Kitgum, Pader, Gulu, Adjumani, Yumbe, Arua and Nebbi districts should particularly be on alert because they lie in the belt. He adds that Masindi is also vulnerable because it is generally epidemic-prone.

He also warns of spill overs like it is now happening in Hoima. Could this outbreak be a warning for a looming national outbreak?

Well, they say, lose but never lose the lesson and it only takes a prepared government to tackle such outbreaks. Mugisha says the ministry is ready with the necessary logistics and is working with local leaders for support.

“The main problem we face is when people expect to cash in from such epidemics.

The village healthcare teams and grassroot personnel that traditionally used to be handy now expect fat allowances, yet we are financially constrained,” he says.

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