Incidence and Spatial Distribution of Bacterial Meningitis, Uganda, 2015-2018

Abstract Background: Uganda is one of the countries with the highest risk of meningitis because it lies within the extended meningitis belt of Sub-Saharan Africa. The most susceptible regions include West Nile, Bunyoro, Acholi, Lango, Teso, and Karamoja regions. Although there have been efforts to vaccinate against meningitis, sporadic cases still occur. Weestimated the incidence and described the spatial distribution of bacterial meningitis in Uganda using surveillance data, 2015-2018, to inform targeted interventions. Methods: We analysed bacterial meningitis surveillance data from the District Health Information System 2. We specifically considered data on suspected bacterial meningitis cases. We calculated the overall meningitis incidence during 2015-2018 and disaggregated the incidence by age-group, sex, and region. We generated choropleth maps to describe the meningitis incidence per year at the regional level. Results: The overall meningitis incidence was4.7/100,000. Overall, there was an increase in the incidence of meningitis from 3.2/100,000 in 2015 to 5.3/100,000 population in 2017; and a decline in 2018. The incidence was higher among under-five population ranging between 6.5-10.6/ 100,000 compared to those aged five and above (2.5-4.2/ 100,000). Karamoja region was most affected compared to the other 14 regions in the country. Conclusion: Overall, there was an increase in the incidence of meningitis from 2015 to 2017; and a decline in 2018 after a countrywide mass vaccination campaign in 2017. Children under five and Karamoja region were most affected. Regardless of efforts to vaccinate, meningitis remains a disease of public health concern. We recommended that Ministry of Health should introduce the meningitis vaccine in routine immunisation.