Etiology and Outcomes of Meningitis in Rural, Northern Uganda

乌干达北部农村地区脑膜炎的病因和结果

基本信息

批准号：
10693970
负责人：
Paul R Bohjanen
金额：
$ 16.26万
依托单位：
UNIVERSITY OF ROCHESTER
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-09-01 至 2025-04-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10693970
关键词：
Acquired Immunodeficiency Syndrome Adult Affect Africa Africa South of the Sahara Antifungal Agents Antigens Area Bacteria Bacterial Meningitis Blindness Caring Cessation of life Child Communicable Diseases Country Cryptococcal Meningitis Cryptococcus Cryptococcus neoformans Diagnosis Disease Outbreaks Early Diagnosis Educational workshop Epidemic Ethiopia Etiology Freezing Genes Goals Grant HIV HIV Seropositivity Health Personnel Health care facility Healthcare Hospital Referrals Hospitals Human Resources Human immunodeficiency virus test Impaired cognition Infant Infrastructure Joints Laboratories Latex Fixation Tests Manuscripts Measures Meningitis Methodology Microbiology Minnesota Neurologic Neurologic Deficit Nucleic Acid Amplification Tests Outcome Patient Admission Patients Persons Public Health Quality of life Rehabilitation therapy Reporting Resource-limited setting Risk Rural Sampling Senegal Services Signs and Symptoms Tuberculosis Uganda Universities Vaccines Virus Yeasts antigen test antiretroviral therapy deafness design diagnostic value disability experience fungus global health hearing impairment improved improved outcome lateral flow assay long-term sequelae mortality next generation sequencing outbreak control premature prevent programs routine Bacterial stain standard of care treatment optimization treatment program

项目摘要

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.

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，该地区位于乌干达北部地区。非洲脑膜炎带，那里与诊断和管理相关的基础设施很差脑膜炎。全世界每年约有五百万人受到脑膜炎的影响。根据世界卫生组织估计，每年与脑膜炎相关的死亡人数为 30 万人，其中婴儿和儿童为最大的风险。世界卫生组织和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) 减少细菌性脑膜炎 (BM) 的病例和死亡疫苗可预防的 BM，以及 c) 减少残疾并提高生活质量。 2017年，我们开发了CM 北部农村地区里拉地区转诊医院 (LRRH) 的诊断和治疗计划 (CM-DTP) 乌干达作为一项质量改进计划，旨在改善 CM 的诊断和治疗。这正在进行的项目是该应用程序的合作者共同努力的成果：明尼苏达大学 (UMN)、麦克雷雷大学传染病研究所 (IDI) 和里拉大学/LRRH。通过CM-DTP，入院 LRRH 且有脑膜炎体征和症状的患者接受快速 HIV 检测，HIV 呈阳性然后患者接受快速隐球菌抗原 (CrAg) 检测，诊断为 CM 的患者接受标准护理抗真菌治疗。尽管该计划有效地改善了诊断和的治疗，该计划还指出了脑膜炎护理中与诊断和治疗相关的主要差距治疗由 CM 以外的病因引起的脑膜炎。 281 名成年患者中出现脑膜炎 2017年至2019年LRRH中，我们诊断了99例（35.2%）CM，但其余64.8%的病因为脑膜炎由于缺乏诊断能力，患者身份不明。具体目标是为了改善通过建设微生物学实验室能力来诊断和治疗脑膜炎的基础设施，指导针对病因的治疗并对医护人员进行教育。目标1是确定病因通过扩大微生物学实验室能力，LRRH 治疗了 400 名患者的脑膜炎拨款，目标 2 是根据病因指导脑膜炎患者的治疗，并针对每种病因进行跟踪结局包括死亡、认知障碍和神经缺陷，目标 3 是建立人类 LRRH、Lira 的卫生保健工作者识别、诊断和治疗脑膜炎的资源能力大学及周边卫生设施。该项目将建设微生物实验室和人体实验室里拉脑膜炎诊断和治疗的资源能力，并将提供有关以下方面的重要信息：在代表许多资源有限的环境中脑膜炎的负担、病因和结果农村 SSA 地区。里拉大学/LRRH 将建设诊断脑膜炎不同病因的能力如果发生脑膜炎疫情，允许确认该地区的疫情，并允许采取公共卫生措施，例如为控制疫情而实施的疫苗或缓解措施。