How MSF helped fight a meningitis outbreak in northwest Nigeria

“I woke up one morning with pain in the neck, stiffness in one leg, and back pain,” said 26-year-old Aisha Faruq, while recovering in the MSF-supported General Hospital of Gwandu, a local government area (LGA) in Kebbi, the most northwestern state of Nigeria. “I vaguely remember what happened next, like going to school. That’s where I lost consciousness. When I woke up, I was here.”

As hospitals filled with patients, MSF health educators connected with the hardest hit communities to raise awareness and direct residents to MSF-supported medical facilities. 

“Initially, community members often thought they had contracted malaria, as they were suffering from fever and headache,” said David Musa, an MSF community health educator in Gwandu. “But some distinct symptoms such as neck stiffness or brain swelling in infants alerted health professionals that we were dealing with something else.”

Soon after, meningitis was officially confirmed as the cause for the surge in admissions to health facilities in Kebbi and Sokoto states.

A deadly, but treatable, disease

Meningitis is considered a major global health threat. According to a study based on 2021 data and published in The Lancet, more than 2 million cases of meningitis are estimated to occur globally each year, with over 200,000 resulting in death.  

Meningitis is highly lethal if left untreated, and outbreaks are common in the “meningitis belt,” an area stretching from Senegal to Ethiopia. Studies show that 50 to 80 percent of patients may die without prompt medical care. 

The disease can be caused by viral or bacterial infections, and spreads from person to person by respiratory droplets, throat secretions, or by fecal contamination. Bacterial meningitis,  commonly found in Nigeria, is the most serious type of meningitis and can cause inflammation of the tissues surrounding the brain and spinal cord.

MSF rapidly responded with supplies and training 

To help authorities respond to this very dangerous outbreak, MSF teams in Kebbi and Sokoto states quickly provided support by deploying staff and medical supplies to hard-hit areas, expanding bed capacity in several health facilities, training medical staff from the state ministries of health, and launching awareness-raising campaigns. 

“In Kebbi, where most cases were reported, we admitted over 500 patients in the first 12 days of our intervention in the LGAs of Gwandu, Jega, and Aliero,” said Dr. Sham’un Abubakar, MSF’s emergency coordinator in Kebbi. “Even with the additional beds we installed, we had to place mattresses on the floor to accommodate the overflow of patients.”

Over nine weeks, 2,095 patients were admitted for meningitis in the facilities supported by MSF in Kebbi. 

In neighboring Sokoto state, MSF teams supported case management (including remote assistance), training, and the supply of medical supplies in five primary health care centers and two general hospitals in Tambuwal LGA.  

By early May, MSF teams in Sokoto had treated a total of 880 meningitis patients in MSF-supported facilities.

Children are especially vulnerable

Meningitis can affect people of all ages, but the highest proportion of reported cases is among children aged 1 to 15 years. Children under the age of 5, due to their weaker immune systems, are especially at high risk of dying.

“Unfortunately, survivors are also at risk of developing long-term neurological and cognitive problems,” said Dr. Abubakar. “Patients may suffer hearing loss, vision problems, and seizures, as well as increased pressure on the skull and brain. Many survivors also remain at risk of experiencing a stroke.”

Ten-month-old Sha’ayau was admitted to the Jega General Hospital in late April with multiple symptoms, including brain swelling. He was discharged many days later but referred to a specialist to evaluate potential neurological complications. 

“His older brother was hospitalized [for meningitis] weeks ago,” said his mother, Saratu Hamza. “But now he has lost his hearing.”

A mass vaccination campaign

While providing rapid treatment is key to preventing fatalities and long-term consequences, fighting meningitis also requires vaccinating as many people as possible to break the transmission chain.  

“Conducting a mass vaccination is essential, as it provides immunity against the disease for up to five to eight years, hence significantly reducing the risk of infection – even in the event of another outbreak,” said Dr. Abubakar.

In Kebbi state, MSF teams partnered with UNICEF and WHO to support the Ministry of Health in setting up an immunization campaign. In just one week, close to half a million people were vaccinated, with two thirds of them under the age of 15. 

While official figures are still being compiled, the Nigerian Centre for Disease Control (NCDC) recorded more than 4,000 meningitis cases nationwide between early February and early May. Seventy percent of those cases were treated in MSF-supported facilities in Kebbi and Sokoto states. 

Today, thanks in large part to MSF's swift and effective response, the number of cases in both states has declined, and our teams have been able to gradually wind down emergency responses and transition back to routine treatment and regular medical activities, including supporting the Ministry of Health.