1. Spatio-Temporal Factors Associated with Meningococcal Meningitis Annual Incidence at the Health Centre Level in Niger, 2004–2010.
- Author
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Paireau, Juliette, Maïnassara, Halima B., Jusot, Jean-François, Collard, Jean-Marc, Idi, Issa, Moulia-Pelat, Jean-Paul, Mueller, Judith E., and Fontanet, Arnaud
- Subjects
MENINGOCOCCAL infections ,HEALTH service areas ,MEDICAL centers ,SPATIO-temporal variation ,HUMIDITY ,RAINFALL - Abstract
Background: Epidemics of meningococcal meningitis (MM) recurrently strike the African Meningitis Belt. This study aimed at investigating factors, still poorly understood, that influence annual incidence of MM serogroup A, the main etiologic agent over 2004–2010, at a fine spatial scale in Niger. Methodology/Principal Findings: To take into account data dependencies over space and time and control for unobserved confounding factors, we developed an explanatory Bayesian hierarchical model over 2004–2010 at the health centre catchment area (HCCA) level. The multivariate model revealed that both climatic and non-climatic factors were important for explaining spatio-temporal variations in incidence: mean relative humidity during November–June over the study region (posterior mean Incidence Rate Ratio (IRR) = 0.656, 95% Credible Interval (CI) 0.405–0.949) and occurrence of early rains in March in a HCCA (IRR = 0.353, 95% CI 0.239–0.502) were protective factors; a higher risk was associated with the percentage of neighbouring HCCAs having at least one MM A case during the same year (IRR = 2.365, 95% CI 2.078–2.695), the presence of a road crossing the HCCA (IRR = 1.743, 95% CI 1.173–2.474) and the occurrence of cases before 31 December in a HCCA (IRR = 6.801, 95% CI 4.004–10.910). At the study region level, higher annual incidence correlated with greater geographic spread and, to a lesser extent, with higher intensity of localized outbreaks. Conclusions: Based on these findings, we hypothesize that spatio-temporal variability of MM A incidence between years and HCCAs result from variations in the intensity or duration of the dry season climatic effects on disease risk, and is further impacted by factors of spatial contacts, representing facilitated pathogen transmission. Additional unexplained factors may contribute to the observed incidence patterns and should be further investigated. Author Summary: Meningococcal meningitis (MM) is a severe infection of the meninges caused by a bacterium transmitted through respiratory droplets. During January–May, epidemics of MM recurrently strike sub-Saharan countries, including Niger. Understanding why epidemics occur in a particular place at a particular time would help public health authorities to develop more efficient prevention strategies. To date, factors that govern the occurrence of localized outbreaks are still poorly understood and epidemics remain unpredictable. In this retrospective study (2004–2010), we developed a statistical model in order to investigate the influence of various factors (climatic, demographic, epidemiologic, etc.) on the annual incidence of MM serogroup A at a fine spatial scale (the health centre catchment area) in Niger. We found that mean relative humidity and occurrence of early rains were protective climatic factors and that a higher risk was associated with the presence of a road, the percentage of neighbouring areas having cases and the occurrence of early cases before January. These findings contribute to improve our understanding of MM epidemics in Africa and the associated factors, and might be used in the future for the subsequent development of an early warning system. [ABSTRACT FROM AUTHOR]
- Published
- 2014
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