Emergence of Bacterial Meningitis in Ghana: Implications for Nursing Care

Bacterial meningitis is a seasonal priority disease categorized as epidemic prone disease and represents a serious public health problem with high rates of morbidity and mortality. In resource poor settings, fatality rates can be as high as 50%. About 100,000 deaths had occurred in the meningitis belt in the last 20 years (WHO, 2010). Meningitis is inflammation of the meninges of the brain and spinal cord. There are many organisms that can cause meningitis. These include Fungi, such as Cryptococcus neoformans, viruses, like Lymphocytic choriomeningitis and bacteria, such as Neisseria Meningitidis (Smelter, Bare, Hinkle, & Cheever, 2010).

Globally, Meningitis outbreak was first recorded in Geneva in 1805 by Vieusseux, an Italian scientist. Over one million cases of bacterial meningitis are estimated to occur worldwide each year. The first outbreak of meningitis occurred in Africa in 1840. African epidemics became much more common in the 20^th Century. The first major outbreak in Africa was reported in Nigeria and Ghana in 1905 (Ghana Health Nest 2015/2016). Meningitis is prevalent in the sub-Saharan meningitis belt, an area that stretches from Senegal and The Gambia in the West to Ethiopia in the East. Epidemics occur in the dry season (December to May) in areas of high population density. Incidence during an epidemic can reach 1,000 cases per 100,000 population without interventions (Ghana Health Nest, 2015/2016). Neisseria meningitides is endemic in most African countries. The countries mostly affected include; Democratic Republic of Congo, Burkina Faso, Niger, Uganda, Nigeria, Ghana, Ethiopia, Mali, Burundi, Senegal, Guinea Bissau, Togo, Cameroon and Cote D’Voire (Kabedel, Duales, Yokouide & Alemu, 2010).

In Ghana, outbreaks due to meningococcal meningitis remain a major public health challenge in the meningitis belt (the Northern, Upper West and Upper East Regions). Additionally, outbreaks due to Streptococcus pneumoniae have also become more pronounced and a public health threat which demands effective preparedness and response strategies. Common Strains of Neisseria Meningitides in Ghana are; A, C, and W135 (vaccines are available for these strains). From November 2015 to March 2016, there was an increased number of suspected meningitis cases of meningitis in the Brong-Ahafo region of Ghana (Ghana Web, 2016). The predominant pathogen identified by Rapid Antigen Test was Streptococcus pneumoniae with a few Neisseria Meningitides. Expert information from the Nogouchi Memorial Institute for Medical Research revealed that no new strains of bacteria have been identified (Centers for Disease Control, 2016).

Nurses play a vital role in promoting safety and advocacy in order to ensure optimal care. It is critical to examine what the nursing profession is currently doing in response to the meningitis outbreak and what future steps need to be taken to keep communities, patients and clinicians safe. (Marques Salgado, Gonçalves, Okuyama Fukasawa, Fábio Takenori , Thalita Paulino & Tavares Sacchi, 2013).

Aim: The study aimed to explore and describe nurses’ perspectives on nursing implications for the spread of meningitis beyond the meningitis belt.

Methods: The study adopted the rapid appraisal method of acquiring information. Key informant individual interviews were conducted using senior nurses, nurse managers/ leaders as well as nurse educators in Accra- Ghana. Fifteen participants were purposively selected and interviews were conducted in English lasting between 30-45minutes. The interviews were audiotaped and transcribed verbatim. Content analysis procedures were followed to analyse the data. Member checking, prolonged engagement and detailed audit trail were ensured during the data collection and analysis phase. Ethical clearance was sought.

Results: Considering the demographic data, participants were aged between 30-50 years and comprised 7 clinicians, 6 tutors and 2 lecturers. Findings indicated the need to train nurses and other health professionals in rendering care to victims of meningitis across the country due to the spread of meningitis beyond the meningitis zone. Accurate and detailed patient assessment was deemed necessary to enhance early detection. Adherence to infection prevention and control practices and the use of appropriate personal protective equipment (PPE) were emphasized. Health education of community members to create awareness of the meningitis infection and report early signs and symptoms of meningitis were identified. Nurses stressed the need for provision of the needed resources for meningitis care across the country. They stressed the NHIS should cover drugs for meningitis since most of the people are poor. Communal gathering and practices should be discouraged in order to reduce the number of people infected with meningitis.

Recommendation and conclusion: The emergence of bacterial meningitis requires a comprehensive approach. In this regard, there is the need for training of nurses on infectious disease management as well as the development or review of national plans for epidemic management.

Designing a nurse specialist programme in infectious disease management and incorporating infectious disease management as a course in the training curricular for student nurses should also be on the priority list.