Etiology and Outcomes of Meningitis in Rural, Northern Uganda

我们的长期目标是改善乌干达北方农村地区脑膜炎的预后， 非洲脑膜炎带，那里与诊断和管理有关的基础设施很差， 脑膜炎每年，全世界约有500万人受到脑膜炎的影响。根据 据世卫组织估计，每年与脑膜炎有关的死亡人数为30万，其中婴儿和儿童为 最大的风险世卫组织及其合作伙伴制定了一项到2030年战胜脑膜炎的全球卫生倡议。 主要目标是：a）消除细菌性脑膜炎（BM）的流行，B）减少 疫苗可预防的BM，以及c）减少残疾并提高生活质量。2017年，我们开发了CM 北方农村地区里拉地区转诊医院的诊断和治疗方案 乌干达作为一个质量改进倡议，旨在改善CM的诊断和治疗。这 正在进行的计划是一个共同努力的合作者在这个应用程序：明尼苏达大学（UMN）， Makerere大学传染病研究所和里拉大学/LRRH。通过CM-DTP， 患有脑膜炎体征和症状的LRRH患者接受快速HIV检测，HIV阳性 然后患者接受快速隐球菌抗原（CrAg）检测，诊断为CM的患者接受 标准抗真菌治疗尽管该方案有效地改善了诊断， 治疗CM，该计划还指出了与诊断相关的脑膜炎护理的主要差距， 治疗由CM以外的病因引起的脑膜炎。在281名成人脑膜炎患者中， LRRH从2017年到2019年，我们在99例（35.2%）中诊断出CM，但其他64.8%的患者的病因为脑膜炎。 由于缺乏诊断能力，患者不详。具体目标是改善 通过建立微生物实验室能力，建立诊断和治疗脑膜炎的基础设施， 指导病因治疗，并教育卫生保健工作者。目的1是确定 通过扩大微生物学实验室的能力， 格兰特，目标2是根据病因指导脑膜炎患者的治疗，并对每种病因进行跟踪， 包括死亡、认知障碍和神经功能缺损，目标3是建立人类 里拉LRRH卫生保健工作者识别、诊断和治疗脑膜炎的资源能力 大学和周围的卫生设施。该项目将建立微生物实验室和人类 在里拉诊断和治疗脑膜炎的资源能力，并将提供重要信息， 脑膜炎的负担，病因和结果，在一个环境中，这是许多资源有限的代表， 在农村地区，SSA。在里拉大学/LRRH建立诊断脑膜炎不同病因的能力， 允许在该地区发生脑膜炎暴发时予以确认，并允许采取公共卫生措施， 如疫苗或缓解措施，以控制疫情。

Our long-term goal is to improve outcomes from meningitis in rural, northern Uganda, an area within the meningitis belt of Africa, where there has been poor infrastructure related to the diagnosis and management of meningitis. Each year, approximately five million people worldwide are affected by meningitis. According to the WHO, the estimated number of annual deaths related to meningitis is 300,000, with infants and children at greatest risk. A global health initiative to defeat meningitis by 2030 was developed by the WHO and partners. The key goals are to: a) eliminate epidemics of bacterial meningitis (BM), b) reduce cases and deaths from vaccine-preventable BM, and c) reduce disability and improve quality of life. In 2017, we developed a CM diagnosis and treatment program (CM-DTP) at Lira Regional Referral Hospital (LRRH) in rural, northern Uganda as a quality improvement initiative designed to improve the diagnosis and treatment of CM. This ongoing program is a joint effort by collaborators on this application: University of Minnesota (UMN), the Infectious Diseases Institute (IDI) at Makerere University, and Lira University/LRRH. Through the CM-DTP, patients admitted to LRRH with signs and symptoms of meningitis undergo rapid HIV testing, HIV-positive patients then undergo rapid cryptococcal antigen (CrAg) testing, and patients diagnosed with CM receive standard of care antifungal treatment. Although this program was effective at improving the diagnosis and treatment of CM, the program also pointed out major gaps in meningitis care related to the diagnosis and treatment of meningitis due etiologies other than CM. Of 281 adult patients who presented with meningitis at LRRH from 2017 to 2019, we diagnosed CM in 99 (35.2%), but the etiology of meningitis for the other 64.8% of patients was unknown, due to lack of diagnostic capabilities. The specific aims are directed at improving infrastructure for the diagnosis and treatment of meningitis by building microbiology laboratory capacity, directing treatments at etiologies, and educating health care workers. Aim 1 is to identify the etiology of meningitis in 400 patients at LRRH through expanded microbiology laboratory capacity developed through this grant, aim 2 is to direct treatment of patients with meningitis based on etiology, and for each etiology, track outcomes including death, cognitive impairment and neurological deficits, and aim 3 is to build human resources capacity among health care workers to identify, diagnose, and treat meningitis at LRRH, Lira University, and surrounding health facilities. This project will build microbiology laboratory and human resources capacity for the diagnosis and treatment of meningitis in Lira and will provide vital information about the burden, etiology, and outcomes of meningitis in a setting that is representative of many resource-limited regions in rural SSA. Building capacity to diagnose different etiologies of meningitis at Lira University/LRRH will allow recognition of meningitis outbreaks in the area if they should occur and allow public health measures, such as vaccines or mitigation efforts, to be implemented for outbreak control.