Article

Journal of Agricultural, Biological, and Environmental Statistics

, Volume 17, Issue 3, pp 442-460

The Role of Weather in Meningitis Outbreaks in Navrongo, Ghana: A Generalized Additive Modeling Approach

  • Vanja DukićAffiliated withDepartment of Applied Mathematics, University of Colorado Email author 
  • , Mary HaydenAffiliated withNational Center for Atmospheric Research
  • , Abudulai Adams ForgorAffiliated withWar Memorial Hospital
  • , Tom HopsonAffiliated withNational Center for Atmospheric Research
  • , Patricia AkweongoAffiliated withNavrongo Health Research Centre
  • , Abraham HodgsonAffiliated withNavrongo Health Research Centre
  • , Andrew MonaghanAffiliated withNational Center for Atmospheric Research
  • , Christine WiedinmyerAffiliated withUniversity Corporation for Atmospheric Research
  • , Tom YoksasAffiliated withUniversity Corporation for Atmospheric Research
    • , Madeleine C. ThomsonAffiliated withThe International Research Institute, Columbia University
    • , Sylwia TrzaskaAffiliated withThe International Research Institute, Columbia University
    • , Raj PandyaAffiliated withUniversity Corporation for Atmospheric Research

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Abstract

Bacterial (meningococcal) meningitis is a devastating infectious disease with outbreaks occurring annually during the dry season in locations within the ‘Meningitis Belt’, a region in sub-Saharan Africa stretching from Ethiopia to Senegal. Meningococcal meningitis occurs from December to May in the Sahel with large epidemics every 5–10 years and attack rates of up to 1000 infections per 100,000 people. High temperatures coupled with low humidity may favor the conversion of carriage to disease as the meningococcal bacteria in the nose and throat are better able to cross the mucosal membranes into the blood stream. Similarly, respiratory diseases such as influenza and pneumonia might weaken the immune defenses and add to the mucosa damage. Although the transmission dynamics are poorly understood, outbreaks regularly end with the onset of the rainy season and may begin anew with the following dry season. In this paper, we employ a generalized additive modeling approach to assess the association between number of reported meningitis cases and a set of weather variables (relative humidity, rain, wind, sunshine, maximum and minimum temperature). The association is adjusted for air quality (dust, carbon monoxide), as well as varying degrees of unobserved time-varying confounding processes that co-vary with both the disease incidence and weather. We present the analysis of monthly reported meningitis counts in Navrongo, Ghana, from 1998–2008.

Key Words

Africa Ghana GAM Humidity Meningitis Temperature Weather