Nigeria’s response to meningitis

THE outbreak of Cerebrospinal Meningitis (CSM serotype C) has recorded a fatality that is unprecedented in the history of the pestilence in the country. On Thursday, April 27, official confirmation of a total of 839 dead people, out of 9,646 suspected cases, was made. This was according to an update released by the Nigeria Centre for Disease Control (NCDC) through its Technical Assistant Communication Officer, Dr. Lawal Bakare. In the statement, a total of 628 cases were said to have been laboratory-confirmed. It will be recalled that the CSM outbreak currently rages in five states, namely Zamfara, Sokoto, Katsina, Kebbi and Niger.

The history of meningococcal meningitis in Africa since it reached epidemic proportions has been undertaken in the medical world. First reckoned with around 100 years ago, the epidemic strain of the meningococcus was reportedly introducwed into West Africa from the Sudan by pilgrims who were returning from the Hajj at the turn of the century. Countries of the Sahel and sub-Sahel regions have since 1905 recorded major epidemics of the meningococcal meningitis every few years. This resulted in a massive CSM epidemic wherein nearly 200,000 cases of infection got reported in 1996. A major militating factor against the control of the epidemic in Africa through vaccination efforts with meningococcal polysaccharide vaccines has been discovered to be the proclivity of the epidemic to progress with baffling rapidity even when vaccinations are often begun late.

The current outbreak in Nigeria and the fatality that it recorded in the process have revealed the rotten underbelly of Nigeria’s response to outbreaks of sicknesses and diseases that have been with it for decades. That the CSM, a disease that had been the fate of some parts of the country for years could catch the Nigerian medical authorities napping can only suggest governmental tardiness. On the surface, the Nigerian medical authorities had a strong defence in their response to allegation of unpreparedness. According to the Ministry of Health, while the country had always been afflicted by the outbreak of serotype A and was prepared for its attack through millions of immunisation drugs every year, the serotype C that suddenly erupted was not anticipated at all, since it was alien to the country. As a result of this suddenness, 839 Nigerians lost their precious lives.

What makes this alibi unacceptable is the proactiveness by government and all its agencies for occurrences that should logically be anticipated. The CSM is not a strange ailment in Nigeria. Indeed, the ecology and geography of many states in the northern part of the country are so conducive to the disease that the possibility of perennial attacks is very high. Having established this fact, a proactive government would not have rested on its oars, waiting for that same ailment to attack it yearly. Such a government would have anticipated that there was the possibility that out of the two other serotypes B and C, the country stood the possibility of a variant attacking it suddenly. This is so because the serotypes bear similar manifestations.

The meningitis serotype C outbreak is said to occur infrequently in the African meningitis belt. Reportedly, Burkina Faso, before now and specifically in 1979, was the latest victim of the serotype. Médecins sans Frontières (MSF), which has been at the vanguard of the curtailment of the outbreak of the disease in the northwestern part of Nigeria since 2007, is said to have failed to closely monitore this move. However, in 2013, a novel strain was discovered in Sokoto State, followed by another smaller outbreak in the contiguous Kebbi State in 2014. Details of the serotype samples were collected from  patients and sent to the WHO Reference Laboratory in Oslo, Norway, where analyses were performed.

The point is that government has to accept that its inability to proactively engage the CSM serotype C caused the death of at least 839 people. The delay in procuring vaccination and the consequent deaths of these Nigerians should have been averted. We urge it to work hard towards averting a recurrence of such fatalities.