THE FIGHT AGAINST MENINGITIS IN AFRICA: THE ROLE OF THE MEDICAL STUDENT
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This is an edited presentation made at a meeting of the members of the Federation of African Medical Students' Associations (FAMSA) Headquarters Board regarding the role of medical students in promoting healthy living in Africa, using the recent meningitis outbreak in Nigeria as an example
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THE FIGHT AGAINST MENINGITIS IN AFRICA: THE ROLE OF THE MEDICAL STUDENT
- 1. THE FIGHT AGAINST MENINGITIS IN AFRICA (THE MEDICAL STUDENT’S ROLE) • MISS BOLAKALE-RUFAI, I.K • MR. NWADURU, C.E
- 2. OUTLINE INTRODUCTION GEOGRAPHICAL DISTRIBUTION AND GLOBAL BURDEN OF THE DISEASE CLINICAL ASPECT OF MENINIGITIS THE ROLE OF MEDICAL STUDENTS CONCLUSION 9/19/2017 2
- 3. IS MENINGITIS REALLY A PROBLEM FOR AFRICA? “Although meninigitis can occur sporadically, the major cause of public health concern is the epidemic outbreaks that occur.” (WHO) 9/19/2017 3
- 4. MENINGITIS…??? A disease of enormous global health concern A challenging public health threat in many African countries. Alarming increase in number of cases since 1970, necessitating emergency levels 9/19/2017 4
- 5. THE MENINGITIS BELT OF AFRICA 9/19/2017 5
- 6. THE MENINGITIS BELT OF AFRICA Epidemics in Europe, Asia and in the Americas during the last 30 years Largest and most frequently recurring outbreaks - Semi-arid Area of Sub- Saharan Africa. The extended meningitis belt of sub-Saharan Africa, stretches from Senegal in the west to Ethiopia in the east (26 countries) Estimated total population of approximately 300million people Has the highest rates of the disease 9/19/2017 6
- 7. THE MENINGITIS BELT OF AFRICA Benin Burkina Faso Burundi Cameroon Central African Republic Chad Côte d’Ivoire Democratic Republic of Congo Eritrea, Ethiopia The Gambia Ghana Guinea Guinea Bissau Kenya Mali Mauritania Niger Nigeria Rwanda Senegal South Sudan Sudan Tanzania Togo Uganda. 9/19/2017 7
- 8. GEOGRAPHICAL DISTRIBUTION AND GLOBAL BURDEN OF THE DISEASE Explosive epidemics of meningococcal disease have occurred throughout the extended meningitis belt Major outbreaks occurring between 1971-1997 Peak incidence - Sudan in 1988 and 1989 (over 30000 and 40000 cases reported in each year respectively) 8
- 9. GEOGRAPHICAL DISTRIBUTION AND GLOBAL BURDEN OF THE DISEASE The outbreaks tends to occur during the dry seasons of December to June. The WHO suspects a cyclical attack of this disease in Africa Meningococcus, serotype c First in Nigeria in 2013 and 2014, then Niger in 2015 Now in Nigeria in 2016 and 2017 Excluding epidemics, at least 1.2million cases of bacterial meningitis are estimated to occur each year and 135000 of those patients die. 9/19/2017 9
- 10. GEOGRAPHICAL DISTRIBUTION AND GLOBAL BURDEN OF THE DISEASE 9/19/2017 10
- 11. 9/19/2017 11 NEXT PRESENTER MR NWADURU, C.E
- 12. …THE ECONOMIC IMPLICATION? (AKWEONGO ET AL., 2013; COLOMBINI ET AL., 2009) 9/19/2017 12
- 13. MENINIGITIS….THE CLINICIAN’S VIEW Inflammation of the meninges of the brain and spinal cord is caused by bacteria, fungi, virus, protozoa or chemicals Meningococcal meningitis is caused by Neisseria meningitides; a gram negative diplococcus Incubation period spans between 1-10 days usually less than 4 days Serotypes A, B,C, W, X and Y are associated with epidemics. Geographic distribution and epidemic potential differ according to serogroup. 9/19/2017 13
- 14. SYMPTOMS Sudden onset of intense headache Fever Nausea and vomiting Photophobia Stiff neck High grade fever. 9/19/2017 14
- 15. PROGNOSIS AND PREVENTION The prognosis is guarded. The primary prevention - vaccination Secondary prevention - treatment with antibiotics. Tertiary - rehabilitation of DISABLED individuals 9/19/2017 15
- 16. VACCINES AS A PREVENTIVE STRATEGY • Meningococcal A conjugate vaccine • Meningococcal C conjugate vaccines • Tetravalent A, C, Y, W conjugate vaccine • Meningococcal polysaccharide vaccines 9/19/2017 16
- 17. THE WAY FORWARD; EPIDEMIC MENINGITIS CONTROL The World Health Association - a three-pronged strategy. Goal is to eliminate epidemic meningitis as a public health problem through: 1. Preparedness, 2. Early detection and 3. Effective response to outbreaks, 4. Protection of individuals at risk through vaccination, 5. Collection, dissemination and use of key information through surveillance and coordination of ongoing control and research 9/19/2017 17
- 18. HOW CAN MEDICAL STUDENTS CONTRIBUTE TO FIGHT MENINGITS? 9/19/2017 18 THE ROLE OF MEDICALSTUDENTS
- 19. THE WHO’S FIVE STRATEGIC AXIS AXIS ONE: Strengthening outbreak preparedness, detection and response AXIS TWO: Implement case-based surveillance AXIS THREE: Preventing Meningococcal A disease through vaccination AXIS FOUR: Developing a forum for global collaboration AXIS FIVE: Stimulating research and innovative tools 9/19/2017 19
- 20. TOMAS EDWARDS, A FOURTH YEAR MEDICAL STUDENT; WON THE AWARD FOR BEST RESEARCH POSTER ON MENINGITIS IN 2013 IN THE UK 9/19/2017 20
- 21. THE ROLE OF MEDICAL STUDENTS’ ORGANISATIONS 9/19/2017 21 UIMSA FAMSA IFMS A And many other Medical Students’ bodies worldwide…
- 22. INTERNATIONAL FEDERATION OF MEDICAL STUDENTS’ ASSOCIATIONS (IFMSA) Projects and Workshop Organization Establishing network Promoting medical students’ exchange Research Promotion 9/19/2017 22
- 23. FEDERATION OF AFRICAN MEDICAL STUDENTS’ ASSOCIATION Scientific Conference/Assembly Community Awareness Media Coverage Research Promotion (Afromedica Journal) 9/19/2017 23
- 24. THE ROLE OF THE MEDICAL STUDENT Ideal target for sensitization strategies Movement against Meningitis in Africa (Kishore et al., 2017) Sensitization and Curricular Change (Villafuarte-Galvez et al., 2008) Focused Research Fund raising projects Smaller student clubs 9/19/2017 24
- 25. COMMEMORATION WITH WORLD MENINGITIS DAY APRIL 24 Awareness of Meningitis in Africa Debilitating effects among high risk groups Problems with vaccination Paucity of funds Partnership with other international bodies – Confederation of Menigitis Organizations (CoMo) 9/19/2017 25
- 26. CONFEDERATION OF MENINGITIS ORGANIZATION (COMO) 9/19/2017 26
- 27. FUND RAISING FOR PATIENTS WITH MENINGITIS Maranthon race – Revlon race for Breast Cancer Awareness T-shirts Car Wash Newspaper articles Ribbon sales Bake Sales 9/19/2017 27
- 28. LION HEART CHALLENGE 9/19/2017 28 • Started by Alex Flatley in 2017 • A survivor of viral meningitis • Founder of the Lion Heart Challenge • Sold over 74 shirts • Generated $1350 to facilitate activities against global meningitis
- 30. CONCLUSION A lot of work still needs to be done to fight meningitis in Africa. There is a need for a collaboration between African Leaders across all countries. More important of all, is the need for every member of the health sector to stand up to responsibilities and synergise effort to find long lasting solution to the Meningitis issue. Nobody is excluded in this fight, not even the Medical Student! 9/19/2017 30
- 31. THANK YOU FOR LISTENING 9/19/2017 31
- 32. REFERENCES Akweongo et al., 2013, “The Economic Burden of Meningitis to Households in Kassena-Nankana District of Northern Ghana”, US National Library of Medicine, vol. 8, no.11, viewed 9 September 2017, < https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3836898/ > Colombini et al., 2009, ‘Costs for Households and Community Perception of Meningitis Epidemics in Burkina Faso. Clinical Infectious Diseases’, US National Library of Medicine, vol. 8, no.11, viewed 9 September 2017,<https://www.ncbi.nlm.nih.gov/pubmed/19842972> Villafuerte-Galvez et al., 2008, “The role of medical students in the fight to control Neglected Tropical Diseases: A view fro Peru”, US National Library of Medicine, vol. 2, no.9, viewed 9 September 2017, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2561065/ Meningitis Research Foundation 2017, Study of the duration of protection after mass vaccination with a new vaccine against epidemic meningitis in the general population of Burkina Faso, a country of the African meningitis belt, viewed 10 September 2017, <http://www.meningitis.org/current-projects> Williams, S 2013, University of Bristol students wins poster presentation, 22 November, Media Relations Manager, Meningitis Research Foundation, viewed 10 September 2017, http://www.meningitis.org/news- media/university-of-bristol-medical-74990
Editor's Notes
- Although meninigitis can occur sporadically, the major cause of public health concern is the epidemic outbreaks that occur. It is important to know that although many organisms can cause meningitis, the only form of bacteria with the potential to cause epidemics is the Neisseria meningitides which is the organism implicated in meningococcal meningitis
- In the meningitis belt countries, an estimated incidence of 800000 cases was reported from 1970-1992 In order to curb this aggressive menace, there is need for a strategy comprising epidemic preparedness, prevention and response.
- This region has the highest rates of the disease in the world with large scale epidemics occur at greater intervals with irregular patterns
- The history of Clinical meningococcal disease dates back to when Vieusseux in 1805 described the disease during an outbreak in Geneva Switzerland. During the 20th century, major outbreaks were noted during the first and second world war.
- “The average direct and indirect costs of treating meningitis in the district was GH¢152.55 (US$101.7) per household. This is equivalent to about two months minimum wage earned by Ghanaians in unskilled paid jobs in 2009. Households lost 29 days of work per meningitis case and thus those in minimum wage paid jobs lost a monthly minimum wage of GH¢76.85 (US$51.23) due to the illness”. (Akweongo et al., 2013) A study in Burkina Faso on household cost of treating meningitis in Africa, reported households spending of US$90.00 per meningitis case and up to US$154.00 when meningitis sequelae occurred. (Colombini et al., 2009)
- In addition neurological signs such as lethargy, delirium, coma, convulsions may be present. Meningococcal septicemia is characterized by an abrupt onset of fever, shock, petechial rashes, purpura, meningeal symptoms
- Even when the disease is diagnosed early and adequate treatment is started, 5% to 10% of patients die, typically within 24 to 48 hours after the onset of symptoms. Complications of bacterial meningitis include brain damage, hearing loss, mental retardation, epilepsy or a learning disability in 10% to 20% of survivors especially in children. A less common but even more severe (often fatal) form of meningococcal disease is meningococcal septicaemia, which is characterized by a haemorrhagic rash and rapid circulatory collapse.
- Several vaccines are available to control the disease; meningococcal A conjugate vaccine, C conjugate vaccines, tetravalent A, C, Y, W conjugate vaccine and meningococcal polysaccharide vaccines Polysaccharide vaccines have been available to prevent the disease for over 30 years. Meningococcal polysaccharide vaccines are available in either bivalent (groups A and C), trivalent (groups A, C and W), or tetravalent (groups A, C, Y and W) forms to control the disease. For group B, polysaccharide vaccines cannot be developed, due to antigenic mimicry with polysaccharide in human neurologic tissues. The first vaccine against NmB, made from a combination of 4 protein components, was released in 2014.
- Tomos Edwards, a fourth-year medical student at the University of Bristol, was awarded first prize for his poster presentation on ‘The Orthopaedic Sequelae of Childhood Meningococcal Septicaemia’ at the Meningitis Research Foundation (MRF) conference ‘Meningitis and Septicaemia in Children and Adults 2013’. The biannual conference, which was held at The Royal Society of Medicine, brought together renowned experts from a range of specialties in the UK and abroad to address the most important issues of the day, including burden of illness, recognition and treatment, vaccine development, vaccine implementation and public health policy, and tackling meningitis in Africa. (Meningitis Research Foundation, 2013)
- This organization is solely run by medical students alone, and most of her activities are channeled towards global health improvement.
- The importance of team work in tackling a disease such as Meningitis in Africa cannot be over-emphasized. “Medical Students are the future clinicians, researchers, and leaders of organizations, they should constitute one of the ideal targets for any NTD sensitization strategy” (Villafuarte-Galvez et al., 2008) It is possible for medical students in the Africa to lead a movement that can rapidly gather researchers, more students, and different organizations to tackle Meningitis. Medical students have, to a certain degree, higher chances than others of being exposed to Meningitis—either through lectures, laboratory sessions, or patient care. The incorporation of medical students at earlier stages of research, not only affords them the knowledge into the aetiopathogenesis of the disease, but gives room for critical thinking to lasting solution to the problem
- Theme for this year’s WMD – 24hours, Trust your Instinct. An initiative of Confederation of Meningitis Organization
- A non-for-profit organization committed to preventing meningitis worldwide. The HQ is in Bristol, United Kingdom
- At the beginning of 2017, Alex Flatley, founder of the Lion Heart Challenge approached CoMO. A survivor of viral meningitis himself, Alex, through his Lion Heart Challenge, wanted to raise awareness of meningitis and to raise funds for CoMO so that people across the world are aware of meningitis and its devastating effects Over 74 shirts were sold and $1350 generated which was sent directly to CoMO to facilitate activities against global meningits