Vivian S Namale*, Carla Kim, Yifei Sun, Angela Curcio, Allison Navis, Richard Idro and Kiran T. Thakur
Community Acquired Bacterial Meningitis (CABM) is a leading cause of morbidity and mortality in Africa, affecting over 2.8 million people annually. The African continent bears the largest burden of CABM with six out of the ten countries having the highest incidence and mortality. This systematic review set out to determine the leading causes of CABM in Africa, the distribution of etiologies across regions, and the extent of antimicrobial resistance of identified microbial agents. Methodology: The databases PubMed and Embase were queried with key search words “bacterial meningitis in Africa”, “community acquired bacterial meningitis” or “meningitis in Africa” published between 1990 and 2019. Using the PRISMA guidelines for systematic reviews, the search retrieved 112,972 articles. We included studies reporting primary patient data with confirmed CABM. Results: Sixty-four studies were analyzed which were conducted in 23 African countries between 1990 and 2019. Cumulatively, we analyzed 118,716 suspected cases of CABM, with confirmed CABM in 34,593 (29%) cases. Streptococcal pneumoniae (Spn) was found to be the most prevalent cause of disease at 12.4% (CI 11.1%-13.6%), Neisseria meningitidis (Nmn) at 8.1% (CI 7.1%-9.2%) and Hemophilus influenza (Hib) at 4.0%(CI 3.6%-4.3)%. The etiologies varied by region, with Nmn being most prevalent in West and South Africa regions and Spn in the rest of the continent. Salmonella prevalence was 0.35%(0.22%-0.47%) representing 16% of the total cases in East Africa but less than 1% in other regions. Of the 64 studies reviewed, 29 (45%) reported on antimicrobial resistance. Resistance was found to be highest in ampicillin 2.7% (CI 2.1%-3.3%) and gentamycin 2.75%(2.09-3.40). Conclusions: We found a gross paucity of information on CABM in Africa despite baring the highest burden of disease. Spn and Nmn are still the leading causes of disease, and etiology varies markedly with region. Antimicrobial resistance of ampicillin and gentamycin are widespread despite being the commonest drugs used in the treatment of CABM in Africa.
