(C) PLOS One
This story was originally published by PLOS One and is unaltered.
 . . . . . . . . . .



Effect of climate change on cerebrospinal meningitis morbidities and mortalities: A longitudinal and community-based study in Ghana [1]

['John Baptise Akanwake', 'Centre For Climate Change', 'Sustainability Studies', 'College Of Basic', 'Applied Sciences', 'University Of Ghana', 'Legon', 'Accra', 'Roger Ayimbillah Atinga', 'Public Administration']

Date: 2022-08 

Abstract Cerebrospinal Meningitis (CSM) is one of the climate-sensitive diseases affected by global climate change. Its causal agent, Neisseria meningitidis bacterial, thrives well in warm environments. CSM epidemics are likely to be exacerbated by the warming globe emanating from climate change. Yet studies have rarely examined the association between climat’e change and CSM. Moreover, studies drawing on quantitative and qualitative data to understand the pathways of climate change domains and CSM relationships as well as community perspectives of CSM are rare. This study deployed mixed-method research to analyse community perceptions of and the relationship between climate change and CSM. We collected 96 months of data on changes in metrological weather parameters (temperatures, sunshine, relative and absolute humidity, and rainfall) and CSM cases and mortalities recorded between 2012 and 2019. Community-level data were elicited using a semi-structured questionnaire. The results showed a statistically significant relationship between climate variables and CSM. High temperatures and sunshine, low rainfall, low relative and absolute humidity were significantly associated with CSM outbreaks. Community participants demonstrated fair knowledge about CSM and attributed its outbreak to climate change. The respondents asserted that the symptoms of CSM, such as severe headache, high fever, stiff neck and waist pains, among others, are often prevalent in their communities when there is high temperature, low relative and absolute humidity, excessive sunshine and dusty winds (harmattan winds). They also revealed that poor environmental sanitation, poor room ventilation, overcrowding in a room, and social integration such as festivals, markets, and religious activities, among others, can exacerbate the outbreak of CSM. We recommend awareness campaign in the communities on the need to ensure proper ventilation in their homes and workplaces, keep their surroundings clean and preserve the econ-system to reduce high temperatures.

Citation: Akanwake JB, Atinga RA, Boafo YA (2022) Effect of climate change on cerebrospinal meningitis morbidities and mortalities: A longitudinal and community-based study in Ghana. PLOS Clim 1(8): e0000067. https://doi.org/10.1371/journal.pclm.0000067 Editor: Erin Coughlan de Perez, Tufts University / Red Cross Red Crescent Climate Centre, UNITED STATES Received: April 4, 2022; Accepted: July 18, 2022; Published: August 15, 2022 Copyright: © 2022 Akanwake et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability: All data are uploaded as Supporting information files. Funding: This research received financial support from the Open Society Initiative (OSI) through the African Climate Change Adaptation Initiative (ACCAI) in collaboration with the Centre for Climate Change and Sustainability Studies (C3SS), University of Ghana. The funding was awarded to only JBA (John Baptise Akanwake) to support his MPhil Thesis work. This manuscript is an excerpt from the thesis. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing interests: The authors have declared that no competing interest exist.

Introduction Climate change is one of the most topical environmental problems affecting all countries [1,2]. Numerous extreme weather events are associated with climate change. These include widespread wildfires, drought, flooding, storms, heatwaves and the rising number of insect-borne diseases in Europe and the United States [3,4]. The adverse impacts of climate change on human health and health care systems are alarmingly comprehensive as they affect every human organ system and challenge the smooth running of health systems and organisations [5]. In most tropical countries such as Ghana, heatwaves, high temperatures, dusty and dry weather conditions give rise to a range of infectious diseases epidemics, including cerebrospinal Meningitis (CSM). CSM is an airborne bacterial disease usually caused by the Neisseria meningitidis bacteria. This bacterial mainly causes an infection of the meninges resulting in Meningitis [6]. CSM agent is highly communicable and easily transmitted via person-to-person through respiratory and throat secretions [7]. Meningitis is an inflammation of the protective membranes covering the brain and spinal cord, collectively known as the meninges [8]. This inflammation of the meninges often results in an obstruction in the normal circulation of blood and oxygen to the brain tissue, which sometimes leads to brain damage, sight problems, seizures, hearing deficiency, and arthritis, among other sequelae [9,10]. The swelling membranes can result from infection with bacteria, viruses, fungi, or some other microorganisms and rarely by certain drugs [11]. Meningitis is caused by different agents and "manifests itself in various forms depending on the type of infectious agent. Acute purulent Meningitis is the predominant form of Meningitis under non-epidemic conditions. Cerebrospinal Meningitis, also known as meningococcal Meningitis, is the most common type of Meningitis that is very epidemic and endemic under infectious Meningitis [12]. Cerebrospinal Meningitis is a climate-sensitive disease that is fatal within a few hours if it is not treated early. Even with appropriate treatment, about 10% of the patients die, and about 20% of the survivors have permanent health conditions such as epilepsy, deafness, mental retardation, etc. (Meningitis Research Foundation of Canada [9]. Cerebrospinal Meningitis is endemic along the ’Africa Meningitis Belt’ that stretches from Senegal in the West to Ethiopia in the Eastern part of Africa. Areas along this belt receive relatively high temperatures than the rest of Africa, giving rise to the disease. Earlier studies have examined the extension of the meningitis belt globally [13], the epidemiology of the disease [14,15] and areas in the northern hemisphere that have similar seasonal prevalence compared to the African meningitis belt [16]. Also a few studies focused on the seasonality of the CSM epidemic [6,12,17,18]. [19] asserted that the epidemic stops abruptly with the onset of the rainy season and resumes during the dry season. Thus, the disease is linked to humidity [20], rainfall [21], and dry and dusty harmattan winds [6]. Meningitis scholars, therefore, recommended close surveillance of CSM incidence in the areas bordering the meningitis belt to allow for early detection because of the continuous expansion of the meningitis belt due to climate change and related factors [22]. Yet, studies have rarely given attention to establishing the link between climate change and CMS to inform appropriate policy decisions. Moreover, studies triangulating panel and primary data to inform a comprehensive understanding of the association of climate behaviour with CSM and the perceptions held by communities on climate change are uncommon. Codjoe and Nabie [23] explored climate change and CSM nexus based on perceptional data. Community perception data, however, may diverge from existing data on CSM cases and the prevailing weather conditions. This study sought to fill the knowledge gap by deploying empirical and panel data to analyse community perceptions and the relationship between climate change and CSM. Climate change and CSM spread Through direct and indirect channels such as climate-element variations and frequent occurrences of disease-producing agents respectively, human populations have become susceptible to health risks resulting from climate change [24]. Cerebrospinal Meningitis is one of the contagious diseases that has existed for over two centuries and remains a significant public health burden globally but more disproportionate to Sub-Saharan Africa’s meningitis belt [14,25]. Environmental factors such as poor sanitation, congestion of structures, the immune receptivity of individuals and some specific climatic circumstances often result in CSM outbreaks within the local population [7]. Meningitis thrives well in warm environments; hence poorly ventilated and crowded rooms are a risk factor for the disease [26]. During warm weather, the risk of CMS spread is facilitated by poor socioeconomic conditions, including overcrowded living areas, malnutrition, poor access to health services and social and religious congregations [6]. In addition, climatic conditions such as dusty and dry winds, high temperature, intensive sunshine, low relative humidity and poor rainfall promote a stable progression of asymptomatic pneumococcal nasopharyngeal carriage to pneumonia and invasive disease [17,18]. Regular exposure to dust significantly reduces phagocyte-mediated bacterial killing, and exposure to extreme temperatures increases the release of the key pneumococcal toxin pneumolysin through amplified bacterial autolysis that could easily result in a meningitis outbreak [27]. Globally, many people asymptomatically carry the CSM causative bacterial in their nose and throat but may be healthy-looking. However, when these people meet risk factors such as compromised immune systems, it can trigger the invasion of nasopharyngeal epithelial cells into the bloodstream, resulting in fatality cases [28]. The most common symptoms of CSM in adults and the aged include but are not limited to severe headache, high fever, stiff neck, vomiting, rashes, sight problems, loss of appetite and convulsion. Children and infants constantly cry, sleep excessively, feed poorly, become sluggish or inactive, and with a stiffness of the body or neck [10].

Materials and methods Study area The study was conducted in three communities across three districts: Builsa North Municipality (BNM), Kassena Nankana Municipality (KNM) and Kassena Nankana West District (KNWD), in the Upper East region of Ghana. The communities and the districts were purposively chosen because they are hotspots of climate change-induced CSM. The districts are among the worst affected parts of Ghana where increasing ‘savannization’ attributable to climate change is producing harsh harmattan conditions [29]. CSM has been one of the endemic diseases in the districts occurring between November and May for the past 50 years [30]. The three districts collectively lie at latitude 11°10’ and 10°3’ North and longitude 1° 05’ and 10° 1’ West. The vegetation at the Builsa North Municipality is characterised by the Savannah woodland, which consists mainly of deciduous but widely spaced drought and fire-resistant trees of different sizes and densities. The grass and herbs in the district are dispersed and perennial by nature. On the other hand, the vegetation in the Kassena Nankana districts is characterised by the Sudan Savannah, with grassland separating widely dispersed reserved economic trees. Some of these economic trees are the African locust bean, locally known as ‘dawadawa (Parkia biglobosa), shea nut (Vitellaria paradoxa), mangoes (Mangifera indica), baobab (Adansonia digitata), and acacia (Acacia kamerunensis) [31]. The districts experience a single rainy season between May and October, followed by a prolonged dry season for the rest of the year. Two major air masses blow across the districts. The North-East Trade Winds, which originate from the Sahara Desert, is commonly known as Harmattan air mass which is dry and hazy and blows between November and March each year [32]. The South-Westerlies, also known as Tropical Maritime air mass, originates from the Atlantic Ocean and blows between May and October. The air mass brings rain to Ghana and the study districts [32]. According to the 2010 Population and Housing Census, the majority of the population in the districts live in rural areas and are predominately farmers. The main type of housing in the three districts is the compound housing system, where families live in adjacent rooms and share basic facilities such as washrooms. Study design and data collection This study drew on mixed-methods involving interviews, and data on weather parameters and CSM cases and mortalities recorded between 2012 and 2019. A semi-structured questionnaire was administered to 150 households using face-to-face interviews. A purposive sampling technique was employed to select 150 households across the three districts. First, CSM-affected households between 2012 and 2019 data were obtained at the Upper East Regional Health Directorate and the health directorates of the three districts. As such, those households were then traced to the communities for the interview. The household heads or their representatives at the time of the study were interviewed in the English Language. For those who could not speak English, translators were engaged to translate the questions into the respective local languages: frafra for KNWD, Buli for BNM and Kasem for KNM. A semi-structured questionnaire was used to collect data. The tool was structured into themes such as demographic data, perceptions and knowledge about climate and household-related causes of CSM in the study area. The demographic data collected included their age, sex, level of education, district of residence, main occupation, level of income, and the type of housing they occupied. Respondents were assessed on their knowledge about the symptoms of CSM and their opinions as to whether climate variables such as high temperature, low absolute humidity, dust/dry winds, rainfall, and sunshine could cause the prevalence of CSM symptoms. The opinions of the household respondents were also sought to find out if housing conditions such as overcrowding in a room and poor room ventilation as well as environmental factors such as poor sanitation and deforestation could cause meningitis outbreaks. The mode of transmission, as well as preventive measures, were also assessed. Three focus group discussions (FGD) with an average of 11 participants were organized, one in each of the study communities. In-depth interviews were held with the disease control officers of KNM and KNWD. Both the focus group discussions and the in-depth interviews were recorded and retrieved via the call recorder app for android. The panel data for CSM cases and mortalities and weather parameters were obtained from the Ghana Health Service (GHS) and the Ghana Meteorological Agency (GMET), respectively. The CSM data contained basic demographic information about the patients and the health facilities visited. A total of 96 months of CSM cases and mortalities were found to be complete and helpful for this study. The climate data consisted of minimum (min) and maximum (max) temperatures, sunshine, relative and absolute humidity, and rainfall. Data on wind speed and direction, as well as dust, were not available at the time of the data collection. The min-max temperatures are measured concurrently using a mercury-filled thermometer shaded with Stevenson Screen. The temperature was recorded in degrees Celsius (°C). Temperature data were recorded daily, and the average was taken at the end of each month to represent the monthly temperature. Rainfall was measured daily in millimetres using a rain gauge. Absolute humidity was measured by the percentage amount of real water vapour in the atmosphere regardless of the atmospheric temperature. It was recorded as grams of water vapour per cubic meter volume of air. The relative humidity was recorded in percentages. These humidity variables were recorded at the weather station on a daily basis. The daily humidity recordings were converted to monthly data. Data analysis The climate and CSM data were computed monthly for 96 months and analysed using the Statistical Package for Social Sciences (SPSS) Version 23.0, EViews software, and Microsoft Excel. Pearson’s correlations were used to determine the association of CSM cases and mortalities with rainfall, min and max temperatures, sunshine, relative and absolute humidity. The Pearson’s correlation had been previously used to determine the relationship between climate variables and Meningitis along the ’African Meningitis Belt’ [18,21,33–35]. A Generalised Linear Model was used to assess the effects of climate variables (predictors) on the outbreak of Meningitis (dependent variable). We checked for multicollinearity by inspecting the correlation table to ensure that highly correlated independent variables were eliminated from the regression model [36,37]. According to Pallant [37], the problem of multicollinearity exists when there is a high correlation (r = .9) between or among independent variables. To reduce or eliminate the effects of multicollinearity, absolute humidity and maximum temperature were excluded from the model. The final model was based on the best approach for the data and a combination of variables that best predicted the effects of climate on the outbreak of Meningitis. The qualitative data obtained from the FGDs and the key informant interview were recorded using an android recorder application. The data was later transcribed verbatim. The transcribed scripts from the FGDs and the in-depth interviews were crossed checked with the audio for accuracy. The scripts were then analysed using thematic analysis. The themes were modelled along with the themes in the questionnaire for easy triangulation. Both the quantitative and qualitative data were triangulated in the results and discussion.

Discussion The results demonstrate that respondents have a high level of knowledge and awareness about CSM and the climate change-CSM nexus. Severe headaches, high fever, stiff neck and vomiting were some of the major symptoms of CSM. Participants held that these symptoms were somewhat linked to high temperature, excess sunshine, low humidity, and dusty/dry winds. A similar study by Omoleke et al. [26] in Northwestern Nigeria revealed that communities attributed the endemic nature of Meningitis to harsh environmental and climatic factors such as high temperatures prevalent in the State during the dry season. The study observed a significant positive relationship between maximum temperature and meningitis cases and a negative but significant association between meningitis cases and rainfall, absolute humidity and relative humidity. The finding suggested that meningitis cases fall when the moisture content atmosphere increases within the study areas, a finding consistent with earlier studies [6,12,17,18,27]. Literature has argued that there was a seasonality in the upsurge of the CSM epidemic, which often arises during the dry season and gradually diminishes at the arrival of the rains, which is accompanied by an increase in the amount of water vapour in the atmosphere [12]. When there is high water vapour content in the atmosphere, the Neisseria bacterial that causes CSM cannot thrive well hence the reduction and complete seizure of the CSM cases. This explains why fewer CSM cases are recorded in the study areas when the rain sets in. A similar study on the relationship between climate and meningitis epidemics in Niger showed that extreme temperature is a risk factor that drives the outbreak of Meningitis [27]. We found sunshine to be a key driver of CSM outbreaks in the communities. A high sunshine promotes the survival and transmission of Neisseria meningitidis, the bacterial that causes cerebrospinal Meningitis [38]. Sunshine also suppresses the immune system of human beings when they are exposed to it during the day. This further makes humans vulnerable to infections, thereby exposing them to Meningitis. This could be a plausible explanation for the positive relationship between sunshine and meningitis outbreaks in this study. A high amount of moisture in the air reduces meningitis cases and deaths, while high temperatures and sunshine drive the onset of Meningitis in the three study districts. The participants mentioned dry and dusty winds (harmattan winds) to be a major cause of CSM. Literature has argued that high harmattan winds often carry a lot of particulate matter that causes damage to the nasopharyngeal’s mucosa in humans. This predisposes people to the risk of Meningitis [39]. Nasopharyngeal mucosa facilitates normal breathing through the nose. It also contains adenoid tissue, which fights against infection. Consequently, when a person’s nasopharyngeal mucosa is damaged, he/she is exposed to all forms of infections which can trigger meningococcal invasion [40]. Other key factors identified as the causes of CSM were living in poorly ventilated and crowded rooms, poor environmental sanitation, deforestation, malnutrition, and compromised immune system. It is argued that Meningitis thrives well in warm environments. Poorly ventilated rooms produce heat at night predisposing people to Meningitis. It even becomes worse because the human body emits heat during the night, which could exacerbate the room’s warm condition. Moreover, during breathing, carbon dioxide is exhaled further, causing warming in rooms with poor ventilation and hence can cause a meningitis epidemic [27]. Deforestation as a cause of CSM exposes people to the ventilation of aerosols, particulate matter, dust, and undistracted winds, thereby increasing the transmission rate of meningitis infections [22]. It was also discovered that deforestation exposes people to the direct sun rays and denies them shades, yet worsening global warming could expose them to CSM. It was discovered that social and religious gatherings such as festivals, funerals, weddings, markets, naming ceremonies etc could result in a meningitis outbreak. This is because CSM is a contagious disease that spreads from person to person through the respiratory and throat secretion and body fluid of infected persons. Large gatherings increase the risk of transmission of the disease. A number of measures were suggested to prevent CSM occurrence which among others included proactive meningitis vaccination and avoidance of poorly ventilated and crowded rooms. The communities believe that vaccinating their citizens against CSM before its season helps minimise the number of meningitis cases recorded yearly. Observation from the trend of meningitis cases, mortalities and climate variables has shown that whilst the climate is getting worse, resulting in climate change, meningitis cases and deaths are falling and are relatively low in recent years in the study area. This low and yet continuous falling rate of meningitis cases and deaths could be attributed to the introduction of annual mass meningitis vaccinations, effective public health education, and change in personal lifestyle. Trivalent A, C. conjugate vaccine, and W135 polysaccharide vaccines are often used to immunise people [41]. The Conjugate protein-polysaccharide vaccine has proven to be very effective in fighting Meningitis. A study by Dogee [42] on the trend of reported CSM cases in the Upper West Region of Ghana asserted that three years after the introduction of the conjugate vaccine in Ghana had resulted in about 50% reduction in the number of meningitis cases from 2013 to 2015 as compared to 2010 to 2012 in the region. Meningitis cases were recorded in almost all the months of the year. For instance, between June and October which is the rainy season for Northern Ghana, there were 31 confirmed meningitis cases in 2012, 13 cases in 2013, 3 cases each in 2014 and 2015, and 8 cases in 2016 [43]. This occurrence demonstrates a strong link between climate change and CSM. Climate change has resulted in relatively high temperatures all year round hence the recording of CSM cases in all the months of the year. Although meningitis cases during the dry season are relatively higher than during the rainy season in Northern Ghana, the assertion that rainfall is an antidote to meningitis outbreaks must be re-looked at again in this era of an ever-changing climate. This, therefore, calls for more investigation into the factors that might be responsible for the occurrence of the disease in the study area during the rainy season. Similar measures implemented during the dry season to prevent and control the disease should be employed all year round, which may help eradicate Meningitis in Northern Ghana.

Conclusion and policy implication The study assessed the effects of climate change on cerebrospinal meningitis morbidities and mortalities in the Builsa North Municipality, Kassena Nankana Municipality and Kassena Nankana West District in the Upper East region of Ghana. The results have shown that cerebrospinal Meningitis is one of the climate-sensitive diseases that are endemic in Northern Ghana. The disease is mainly caused by climatic, environmental and socioeconomic factors. The climatic factors are exacerbated by the global climate change, thereby reinforcing the occurrence of Meningitis in Ghana. Meningitis could be prevented if its drivers are put under control. It is therefore imperative for policymakers to take practical and proactive measures to prevent and control the endemic nature of the disease. Hence, public health departments at the study districts’ health directorates and hospitals must be well resourced to embark on intensive mass early public health education via TV shows and radio discussions on the importance of minimising overcrowding at public gatherings during the meningitis epidemic. Health providers and volunteers should also embark on periodic community sensitisations on the need to modify their traditional buildings to make room for better air circulation. There should be early mass vaccination of the population against CSM. Vaccines such as Trivalent A, C. conjugate vaccine, and W135 polysaccharide have been proven to be very potent in preventing CSM. Policymakers should prioritise climate change actions by putting measures in place to help mitigate CSM occurrence. This can be done through afforestation and reforestation, proper waste management, efficient energy utilisation, modernisation of our transport system to encourage crowd-bussing etc. Limitation of the study Data on climate were mainly drawn at one region in the Upper East region of Ghana. Future studies should consider two regions for the purpose of comparison. Also, at the time of the data collection, there was no wind and dust data available at the synoptic station.

[END]
---
[1] Url: https://journals.plos.org/climate/article?id=10.1371/journal.pclm.0000067

Published and (C) by PLOS One
Content appears here under this condition or license: Creative Commons - Attribution BY 4.0.

via Magical.Fish Gopher News Feeds:
gopher://magical.fish/1/feeds/news/plosone/