Epidemiology, clinical outcomes, and factors associated with mortality among cerebrospinal meningitis cases in the Upper West Region of Ghana: an eight-year surveillance study.

introductionCerebrospinal meningitis is a clinical syndrome with multiple etiologies, however, in sub-Saharan Africa, infectious and contagious forms remain highly prevalent and carry high risks of mortality and disability. The Upper West Region of Ghana is found within the meningitis belt and frequently records the highest numbers of incident meningitis cases within the country yearly.

methodsThis study analyzed all routinely-collected data on surveillance-defined suspected and confirmed cases of meningitis in the Upper West Region of Ghana between January 2016 and December 2023. The data were obtained from the Disease Surveillance Unit of the region. Descriptive statistics were used to summarize patient characteristics, clinical presentation, consultation delays, and outcomes. Bivariate (unadjusted) analyses were conducted to explore associations between individual covariates and each outcome of interest, and then multivariable logistic regression models and reported adjusted odds ratios were used to find associations.

results407 meningitis-related clinical consultations were recorded. The median age was 13 years (IQR: 4-23 years). More than half of cases (55.3%) occurred among children aged 0-15 years. Males accounted for 55.8% of cases. 32 deaths were recorded during the study period, corresponding to a crude mortality rate of 7.9%. Fever (41.0%), neck stiffness (35.3%), and headache (31.7%) were the most frequently reported symptoms. The median time to first consultation was 2 days (IQR: 1-3 days), and almost half of patients (46.9%) sought care within one day of symptom onset. Those aged ≥ 46 years had significantly higher odds of death (aOR = 6.01, 95% CI: 1.61-22.46). Patients presenting with classic meningitis symptoms had lower odds of death (aOR = 0.38, 95% CI: 0.15-0.97), with patients presenting with other non-specific symptoms having significantly higher odds of death (aOR = 3.84, 95% CI: 1.33-11.05).

conclusionCerebrospinal meningitis affected individuals across all age groups, although the young were disproportionately affected. Older individuals and those with symptoms other than the classic meningitis symptoms had higher odds of mortality. It is important for healthcare workers to recognize this, so that they can maintain a higher index of suspicion especially during outbreaks. Policymakers need to be cognizant of the fact that meningitis remains an important public health concern and that vaccinations; health education and promotion; and targeted interventions for older populations should be prioritized. The public should be educated on the non-specific features of the disease. CLINICAL TRIAL NUMBER: Not applicable.