Background
Zamfara State, Nigeria, lies within the African meningitis belt, where Neisseria meningitidis causes epidemic disease. Despite recurring outbreaks, epidemiological data remain scarce due to diagnostic and surveillance limitations. This study aimed to identify barriers to laboratory confirmation of meningitis cases and characterise the epidemiology of clinically diagnosed meningitis in children across Zamfara State.
Methodology
This is a retrospective and descriptive study conducted over 2 years period. Children aged one month to 18years, years with clinical diagnosis of meningitis seen at two tertiary health facilities in Gusau or reported to state epidemiology unit from 14 Local Governments in Zamfara, Nigeria, from January 2024 to December 2025 were retrieved. Cerebrospinal fluid samples were sent to the laboratory were traced and retrieved from the register.
Research was approved by Zamfara State Health Research Ethic Committee Ministry of Health, assigned number (NHREC/10/11/2011b)
Case definition was adopted from (WHO Standard case definition of invasive meningococcal disease for routine surveillance)
SPSS version 25 was used; descriptive statistics, chi-square, Fisher’s exact test, and logistic regression. Level of significance set at p < 0.05.
Results
Over 2 year period, 238 cases had clinical diagnosis of meningitis, 127 females 111 male F:M of 1.1, the mean age and standard deviation of the subjects was 10.41± 3.65. Ninety six (40.3%) had lumbar puncture done, and of those, 53 (22.3%) samples reached the laboratory for investigation, conventional culture of all the 53 (22.3%) yielded no growth. Nine (3.9%) had PCR done and 6 (2.5%) of these cases had a PCR confirmed diagnosis, Serotype Men C, with 232(97.5%) being classified as probable. Among the 191 subjects seen in tertiary hospitals with expertise for lumbar puncture, the caregivers of 61 (31.9%) subjects did not consent for lumbar puncture.
Conclusion
In this meningitis belt setting, 2.5% of meningitis cases achieved laboratory confirmation, with only 22.3% of clinical cases having CSF reach the laboratory. Refusal of lumbar puncture consent, sample attrition, and limited diagnostic capacity were the main barriers. Strengthening community counselling, specimen transport, and laboratory infrastructure is urgently needed to generate reliable epidemiological data for meningococcal prevention and control in this high-burden region.