Toward Establishing Integrated, Comprehensive, and Sustainable Meningitis Surveillance in Africa to Better Inform Vaccination Strategies

An intervention to improve lumbar puncture rates for meningitis surveillance in children at four secondary health facilities in Malawi: A before/after analysis

OBJECTIVES

A lumbar puncture (LP) procedure plays a key role in meningitis diagnosis. In Malawi and other sub-Saharan African countries, LP completion rates are sometimes poor, making meningitis surveillance challenging. Our objective was to measure LP rates following an intervention to improve these during a sentinel hospital meningitis surveillance exercise in Malawi.

METHODS

We conducted a before/after intervention analysis among under-five children admitted to paediatric wards at four secondary health facilities in Malawi. We used local and World Health Organization (WHO) guidelines to determine indications for LP, as these are widely used in low- and middle-income countries (LMIC). The intervention comprised of refresher trainings for facility staff on LP indications and procedure, use of automated reminders to perform LP in real time in the wards, with an electronic data management system, and addition of surveillance-specific clinical officers to support existing health facility staff with performing LPs. Due to the low numbers in the before/after analysis, we also performed a during/after analysis to supplement the findings.

RESULTS

A total of 13,375 under-five children were hospitalised over the 21 months window for this analysis. The LP rate was 10.4% (12/115) and 60.4% (32/53) in the before/after analysis, respectively, and 43.8% (441/1006) and 72.5% (424/599) in the supplemental during/after analysis, respectively. In our intervention-specific analysis among the three individual components, there were improvements in the LP rate by 48% (p < 0.001) following the introduction of surveillance-specific clinical officers, 10% (p < 0.001) following the introduction of automated reminders to perform an LP and 13% following refresher training.

CONCLUSIONS

This analysis demonstrated a rise in LP rates following our intervention. This intervention package may be considered for planning future facility-based meningitis surveillances in similar low-resource settings.

Lessons from the field: COVID-19 outbreak investigations in Kpone-Katamanso, Greater Accra, Ghana: a Global South approach to disease control and contact tracing

In the Kpone-Katamanso Municipality (Greater Accra, Ghana), as part of the coronavirus disease 2019 (COVID-19) pandemic response, public health teams implemented and carried out enhanced contact tracing and surveillance from March 2020 to March 2021. There were 725 confirmed COVID-19 cases during this time period, most of which were detected as part of the enhanced surveillance. This is resource intensive, but beneficial in the early detection of cases, thus reducing further community transmission and, in effect, stopping larger outbreaks at the source. A proactive approach to case detection can be successful in reducing community transmission and supporting the pandemic response.