Résumé
Afin d’évaluer la surveillance et la prise en charge de la méningite cérébrospinale (MCS), une étude rétrospective a été menée dans les trois services concernés du centre hospitalier régional (CHR) et des 27 centres de santé du district de Fada N’Gourma, par revue documentaire et interview des agents de santé sur l’épidémie de 2007. Tous les centres disposaient de la définition du cas et de fiches de notification. Le ratio cas notifiés sur cas enregistrés était de 0,89. L’âge était renseigné sur l’ensemble des fiches et le délai de consultation dans 90,7 %. Sur 349 liquides céphalorachidiens (LCR) reçus, seuls les résultats de l’examen direct de 150 d’entre eux étaient disponibles. Le diplocoque Gram négatif a été trouvé dans 86 % des cas. Le méningocoque A était la souche responsable de l’épidémie. L’antibiothérapie était appropriée dans 93,6%des cas. Une rupture du stock d’antibiotiques a été notée dans sept centres; 30 décès ont été enregistrés soit une létalité de 3,5 %. Cette évaluation montre une sous-notification des cas, malgré l’existence d’un système fonctionnel de surveillance et une supervision, une faiblesse de la contribution du laboratoire dans l’identification et le suivi des germes, une prise en charge conforme au protocole national et des ruptures de stock en médicaments. L’amélioration de la notification et du plateau technique et une meilleure disponibilité des médicaments rendraient la gestion des épidémies plus efficace.
Abstract
Meningococcal meningitis remains a periodical threat in the African meningitis belt. The countries concerned, such as Burkina Faso, provided guidelines for its surveillance, diagnosis, treatment, and prevention during outbreaks. The objective of this study is to assess the quality of the surveillance system and case management during an outbreak in Fada N’Gourma district. A retrospective study of the meningitis outbreak in 2007 was conducted by literature review and interviews of health caretakers across 27 health centers (CSPS) and three units in the regional hospital in the district.We reported all data available about surveillance and case management, and then we compared it with the guidelines of the Ministry of Health. The case definition and notification forms were available in all centers and units. During the outbreak, 861 cases were recorded, but only 89% was notified at the upper level and 87% of notification forms were available. The age is marked on all the forms, while the interval between the onset of symptoms and consultation is noted only in 90.7%. The forms were distributed weekly at the district level. Cerebrospinal fluid (CSF) Gram coloration was performed for a limited number of cases (150/349 samples, 42.9%); it showed Gram-negative diplococcus in 86%. Culture was performed for a limited number of patients (7 cases). According to the results of a central level laboratory study, the outbreak was due to Group A Neisseria meningitidis. The case management guidelines were available in all the centers and units which were supervised during the outbreak. Anti-biotherapy was appropriate in 93.6% of the cases. A shortage of antibiotics (free prepositioning) was observed in 7 centers (23.3%). The mortality rate was 3.5%. This assessment shows an under-notification of cases, despite the existence of a surveillance system and supervision, a weak laboratory contribution in germ identification, appropriate case management, and shortage of antibiotics during the outbreak. Management of a meningitis outbreak may become more efficient by improving the notification, the laboratory’s capabilities, and the availability of drugs.
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Yaméogo, T.M., Kyelem, C.G., Poda, G.E.A. et al. Épidémie de méningite: évaluation de la surveillance et du traitement des cas dans les formations sanitaires d’un district du Burkina Faso. Bull. Soc. Pathol. Exot. 104, 68–73 (2011). https://doi.org/10.1007/s13149-010-0123-3
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DOI: https://doi.org/10.1007/s13149-010-0123-3
Mots clés
- Méningite
- Épidémie
- Surveillance
- Traitement
- Centres de santé
- Fada N’Gourma
- Burkina Faso
- Afrique intertropicale