title: Where is the meningitis belt? Defining an area at risk of epidemic meningitis in Africa.
abstract: Mapping an area at risk of epidemics of meningococcal meningitis in Africa has significant implications for their prevention and case treatment, through the targeted development of improved surveillance systems and control policies. Such an area was described using information obtained from published and unpublished reports of meningitis epidemics between 1980 and 1999 and cases of meningococcal disease reported by surveillance systems to WHO. The Sahel bore the greatest epidemic burden, with over two-thirds of documented outbreaks and high attack rates. In addition to those already in the Meningitis Belt, countries affected included Guinea-Bissau, Guinea, Côte d'Ivoire, Togo, the Central African Republic and Eritrea. Elsewhere epidemics were reported from a band of countries around the Rift Valley and Great Lakes regions extending as far south as Mozambique and from here west to Angola and Namibia in southern Africa. The cumulative pan-continental analysis provided evidence of an epidemic-susceptible area which extends beyond the region accepted as the Meningitis Belt and which, moreover, may be partially determined by the physical environment, as shown by a striking correspondence to the 300-1100-mm mean annual rainfall isohyets.
authors.affiliation: Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK.
authors.forename: Anna M
authors.initials: AM
authors.lastname: Molesworth
authors.forename: Madeleine C
authors.initials: MC
authors.lastname: Thomson
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Connor
authors.forename: Mark P
authors.initials: MP
authors.lastname: Cresswell
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Morse
authors.forename: Paul
authors.initials: P
authors.lastname: Shears
authors.forename: C Anthony
authors.initials: CA
authors.lastname: Hart
authors.forename: Luis E
authors.initials: LE
authors.lastname: Cuevas
mesh_terms: D000349:Africa / Q000453:epidemiology; D003710:Demography; D004196:Disease Outbreaks; D006801:Humans; D015994:Incidence; D008585:Meningitis, Meningococcal / Q000453:epidemiology*; D012111:Residence Characteristics; D018570:Risk Assessment; D012307:Risk Factors; D012621:Seasons; D019371:Topography, Medical; D014887:Weather