Meningitis in Africa and Western intent.

In Africa in the year 1905, the first reported outbreak of meningococcal meningitis occurred in West Africa in the part of the continent known today as the Meningitis Belt. The first outbreak was made up of 32 cases in Zungeru, northern Nigeria; it then spanned west into northern Ghana and resulted in an estimated 20,000 reported cases. Epidemiologists believe that meningococcal meningitis was brought to northern Nigeria by Islamic pilgrims who were infected in the Sudan. The month it would have taken pilgrims to travel from Sudan to northern Nigeria by camel would likely have been within the time period that the microorganisms could remain alive in the nasopharanx of the travelers.

After the initial outbreak, subsequent large and deadly outbreaks tended to occur every 5-10 years, usually during the winter months of the meningitis belt. The most widespread outbreaks occurred in 1996 and in the first 11 weeks of 2009. In 1996, in what is now known as the largest recorded meningococcal meningitis outbreak in history, about 361,000 cases were reported and more than 83,000 deaths occurred.

The meningitis belt is in Africa and consists of all West and almost all of East African sub regions, which are the Gambia, Senegal, Guinea-Bissau, Guinea, Mali, Burkina Faso, Ghana, Niger, Nigeria, Cameroon, Chad, Central African Republic, Sudan, South Sudan, Uganda, Kenya, Ethiopia, Eritrea. The “belt” has an estimated 300 million people in its total area. This region is not only prone to meningitis, but also very prone to epidemics such as malaria.

The most affected countries in the region are Burkina Faso, Chad, Ethiopia, and Niger. Burkina Faso, Ethiopia, and Niger were accountable for 65% of all cases in Africa.

In major epidemics, the attack rate range is 100 to 800 people per 100,000. However, communities can have attack rates as high as 1000 per 100,000. During these epidemics, young children have the highest attack rates.

Meningitis is inflammation of the meninges. The meninges is the collective name for the three membranes that envelope the brain and spinal cord (central nervous system), called the dura mater, the arachnoid mater, and the pia mater.
The meninges’ main function, alongside the cerebrospinal fluid is to protect the central nervous system.

The word “meningitis” comes from the Modern Latin word ‘meninga’ and the Greek word ‘Menix’ meaning “membrane”. The suffix “itis” comes from the Greek word ‘itis’ meaning “pertaining to”. In medical English, the suffix “-itis means” “inflammationof”.

Meningitis is generally caused by infection of viruses, bacteria, fungi, parasites, and certain organisms. Anatomical defects or weak immune systems may be linked to recurrent bacterial meningitis. In the majority of cases the cause is a virus. However, some non-infectious causes of meningitis also exist.

Bacteria mimic human cells to get in and stay in
a study carried out by researchers at the University of Oxford and Imperial College London, England,showed how bacteria that cause bacterial meningitis mimic human cells in order to evade the body’s innate immune system.

Although viral meningitis is the most common, it is rarely a serious infection. It can be caused by a number of different viruses, such as mosquito-borne viruses. There is no specific treatment for this type of meningitis. In the vast majority of cases the illness resolves itself within a week without any complications.

Bacterial meningitis is generally a serious infection. It is caused by three types of bacteria: Haemophilus influenzae type b,Neisseria meningitidis, and Streptococcus pneumoniaebacteria.

Meningitis caused by Neisseria meningitidesis known as meningococcal meningitis, while meningitis caused by Streptococcus pneumoniaeis known as pneumococcal meningitis. People become infected when they are in close contact with the discharges from the nose or throat of a person who is infected.

A type of streptococci, called group B streptococci commonly inhabits the vagina and is a common cause of meningitis among premature babies and newborns during the first week of life. Escherichia coli, which inhabit the digestive tract, may also cause meningitis among newborns.
Meningitis that occurs during epidemics can affect newborns -Listeria monocytogenesbeing the most common.

Children under five years of age in countries that do not offer the vaccine are generally infected by Haemophilus influenzaetype B.

Older children generally have meningitis caused by Neisseria meningitides (meningococcus), and Streptococcus pneumoniae (serotypes 6, 9, 14, 18 and 23).

About 80% of all adult meningitis are caused by N. meningitidis and S. pneumoniae. People over 50 years of age have an increased risk of meningitis caused by L. monocytogenes.

People who received a recent trauma to the skull are at increased risk of bacteria in their nasal cavity entering the meningeal space. Patients with a cerebral shunt or related device also run a higher risk of infection with staphylococci and pseudomonas through those devices.

People with weak immune systems are also at higher risk of infection with staphylococci and pseudomonas.

Rarely,otitis media, mastoiditis, or some infection to the head or neck area may lead to meningitis. People who have received a cochlear implant run a higher risk of developing pneumococcal meningitis.

A study published in Otolaryngology-Head and Neck Surgery found that children who are stricken with severe hearing loss are five times more likely to contract meningitis.

In countries where tuberculous meningitis is common, there is a higher incidence of meningitis caused by Mycobacterium tuberculosis.

Either congenital or acquired anatomical defects may be linked to recurrent bacterial meningitis. An anatomical defect might allow a way to penetrate into the nervous system from the external environment. The most common anatomical defect which leads to meningitis is skull fracture, especially when the fracture occurs at the base of the brain, or extends towards the sinuses and petrous pyramids.
59% of recurrent meningitis cases are due to anatomical defects, while 36% are due to weakened immune systems.

As meningitis and septicemia tend to show similar symptoms and incidences of both tend to rise and fall at the same time in geographical areas, this section refers to both meningitis and septicemia.

Meningitis is not always easy to recognize. In many cases meningitis may be progressing with no symptoms at all. In its early stages, symptoms might be similar to those of flu. However, people with meningitis and septicemia can become seriously ill within hours, so it is important to know the signs and symptoms. Early symptoms of meningitis broadly include:
Muscle pain
High temperature (fever)
Cold hands and feet
A rash that does not fade under pressure. This rash might start as a few small spots in any part of the body – it may spread rapidly and look like fresh bruises. This happens because blood has leaked into tissue under the skin. The rash or spots may initially fade, and then come back.

In babies, you should look out for at least one of the following symptoms:
a high-pitched, moaning cry
a bulging fontenelle
being difficult to wake
floppy and listless or stiff with jerky movements
refusing feeds
rapid/ unusual/ difficult breathing
pale or blotchy skin
red or purple spots that do not fade under pressure.

In older children, you should look out for:
a stiff neck
severe pains and aches in your back and joints
sleepiness or confusion
a very bad headache (alone, not a reason to seek medical help)
a dislike of bright lights
very cold hands and feet
rapid breathing
red or purple spots that do not fade under pressure.

Press the side of a drinking glass firmly against the rash.
If the rash fades and loses color under pressure, it is not a meningitis rash.
If it does not change color you should contact a doctor immediately.

Meningitis treatment will generally depend on four main factors:
The age of the patient
The severity of the infection
What organism is causing it?
Are other medical conditions present?
Viral meningitis will resolve itself fairly quickly and does not usually need any medical treatment. If symptoms continue after two weeks the person should see his/her doctor.

The treatment for severe meningitis, which is nearly always bacterial (but can be viral), may require hospitalization, and includes:
Antibiotics- usually administered intravenously by injection, or through an IV.

Corticosteroids- if the patient’s meningitis is causing pressure in the brain, corticosteroids, such as dexamethasone, may be administered to adults and children.

Acetaminophen(paracetamol) – effective in bringing the patient’s temperature down. Other methods for reducing the patient’s fever may include a cool sponge bath, cooling pads, plenty of fluids, and good room ventilation.

Anti-convulsants- if the patient has seizures (fits), he/she will be given an anti-convulsant, such as phenobarbital or dilantin.

Oxygen therapy- if the patient has breathing difficulties oxygen therapy may be given. This may involve a face mask, a nasal cannula, a hood, or a tent. In more severe cases a tube may be inserted into the trachea via the mouth.

Fluid control-dehydrationis common for patients with meningitis. If a meningitis patient is dehydrated he/she may develop serious problems. It is crucial that he/she is receiving adequate amounts of fluids. If the patient is vomiting, or cannot drink, liquids may be given through an IV.

Blood tests- measuring the patient’s blood sugar and sodium is important, as well as other vital body chemicals.

Sedatives- these are given if the patient is irritable or restless.
If the meningitis is severe the patient may be placed in an ICU (intensive care unit).

The fight against meningitis in sub- Saharan Africa took a new dimension on friday this year when the UN World Health Organization (WHO) approved a vaccine called MenAfriVac to be injected on vulnerable children.

The UN health agency said in a statement that routine immunization on infants in the meningitis belt of Sub- Saharan Africa will commence to reduce fatalities associated with the disease.

The introduction of meningitis vaccine by WHO was said have dealt the epidemic a fatal blow. Nonetheless, there is the need for African head of states under the continental body of the African Union(AU) to establish and fund a scientific medical research institute on the continent instead of allowing the WHO to research, fund, prescribe and administer medication to Africans without knowing the content and intent of such medication in other to chekmate alien and future diseases against Africa and also future biological attack that the continent currently witness in the likes of HIV AIDS virus and of late the Ebola virus.

WHO was said to have partnered with global health nonprofit-PATH and Serum Institute of India Limited (SIIL) to form the Meningitis Vaccine Project (MVP) that announced the introduction of MenAfriVac.

Suspiciously ‘The Bill&Melinda Gates Foundation’ bankrolled the research and development of the Meningitis vaccine.

WHO said that during clinical trials in several African countries, MenAfriVac reduced new meningitis infections and deaths among infants.

WHO Marie-Pierre Preziosi also said it health officials will be able to ensure that population wide protection in Africa is sustained by routinely immunizing infants.

The body said new meningitis vaccine meets the international standards on quality, safety and efficacy, a standard that is only define by the United state government through the UN and WHO it controls.

“With MenAfriVac, we have created a revolutionary new model for vaccine development and now we stand on the brink of protecting an entire generation of Africans from a devastating disease,” said the Director of vaccine access and delivery at PATH Kathy Neuzil.

Its believe that western neo-colonial political policies fast-tracked the development of a meningitis vaccine for African infants.

The west hailed the role of vaccines in tackling contagious diseases that have kill and maim a large population in sub-Saharan Africa, but pan Africanist see it as a biological weapon aimed toward the reduction of rapid population growth and population density of the continent rather than the intended disease prevention motive.

“The benefits of childhood immunization last a lifetime and MenAfriVac? vaccine is one of the greatest success stories that showcase what partners can accomplish when united for a common mission,” said Chris Elias, the President, Global Development Program, Bill&Melinda Gates Foundation.


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