Etiology and Outcomes of Meningitis in Rural, Northern Uganda

我们的长期目标是改善乌干达北部农村地区脑膜炎的治疗结果 非洲脑膜炎带，那里与诊断和管理脑膜炎相关的基础设施很差 脑膜炎。每年，全世界约有500万人受到脑膜炎的影响。根据 世卫组织估计，每年与脑膜炎有关的死亡人数为30万人，婴儿和儿童在 最大的风险。世卫组织和合作伙伴制定了一项全球卫生倡议，以在2030年前战胜脑膜炎。 主要目标是：a)消除细菌性脑膜炎的流行；b)减少以下方面的病例和死亡 疫苗可预防的BM；c)减少残疾和提高生活质量。2017年，我们开发了CM 北部农村利拉地区转诊医院(LRRH)的诊断和治疗计划(CM-DTP) 乌干达作为一项旨在改善CM诊断和治疗的质量改进倡议。这 正在进行的计划是该应用程序的合作者的共同努力：明尼苏达大学(UMN)， Makerere大学传染病研究所(IDI)和Lira大学/LRRH。通过CM-DTP， 有脑膜炎症状和体征的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，被诊断为CM的患者接受 标准护理抗真菌治疗。尽管这项计划在提高诊断和诊断方面是有效的 对于CM的治疗，该方案还指出了与诊断和治疗相关的脑膜炎护理的主要差距 CM以外原因所致脑膜炎的治疗。在281名患有脑膜炎的成人患者中 LRRH从2017-2019年，我们诊断为CM的99例(35.2%)，但其他64.8%的脑膜炎的病因 由于缺乏诊断能力，患者尚不清楚。具体目标是针对改进 通过建设微生物学实验室能力，为脑膜炎诊断和治疗提供基础设施； 指导病因治疗，并教育卫生保健工作者。目标1是确定该病的病因 通过扩大微生物学实验室能力在LRRH对400名患者进行脑膜炎 格兰特，目标2是根据病因指导脑膜炎患者的治疗，并对每个病因进行跟踪 结果包括死亡、认知障碍和神经缺陷，目标3是建立人类 在LRRH，Lira，卫生保健工作者中识别、诊断和治疗脑膜炎的资源能力 大学和周围的卫生设施。该项目将建设微生物学实验室和人类 在里拉为脑膜炎的诊断和治疗提供资源能力，并将提供关于 脑膜炎的负担、病因和结果在许多资源有限的环境中具有代表性 SSA农村地区。在Lira大学/LRRH建立诊断不同脑膜炎病因的能力将 允许在应该发生脑膜炎暴发时识别该地区的脑膜炎暴发，并允许公共卫生措施， 例如疫苗或缓解努力，以实施暴发控制。

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.