title: Meningococcal meningitis in Mali: a long-term study of persistence and spread.
abstract: OBJECTIVE
  Meningococcal meningitis (MM) is still a huge threat in the African meningitis belt. To fight against epidemics, a strengthened health information system, based upon weekly collected data, was set up in Mali. We aimed to study the spatio-temporal dynamics of MM in this country between 1992 and 2003.
  
  
  METHODS
  We were first interested in the impact of population size on the disease persistence. We then used cross-correlation analysis to study the spread of the disease on three different spatial scales, i.e., inter-region (global) and inter-district and intra-district (local) levels.
  
  
  RESULTS
  We found no persistence of MM at district level in Mali during the whole of the study period. However, we found persistence on a nationwide scale after the 1997 big epidemics, as opposed to the 1992-1996 time periods. In terms of spread, two main regions seem to lead MM dynamics in Mali, even if on a local scale the 'cities-villages' diffusion pattern was not systematically observed.
  
  
  CONCLUSIONS
  This study improves knowledge on the spread and persistence of MM in Mali in recent years. It constitutes a first spatial study describing persistence and spread of MM in an African meningitis belt country. The next step should be the integration of vaccination and genetic variability data to clarify the route of spread of the disease in the human population.
authors.affiliation: PRODIG, UMR 8586 - CNRS, Université Paris I, Paris, France.
authors.forename: Solenne
authors.initials: S
authors.lastname: Philippon
authors.forename: Hélène
authors.initials: H
authors.lastname: Broutin
authors.forename: Guillaume
authors.initials: G
authors.lastname: Constantin de Magny
authors.forename: Kandioura
authors.initials: K
authors.lastname: Toure
authors.forename: Cheick Hamala
authors.initials: CH
authors.lastname: Diakite
authors.forename: Nicole
authors.initials: N
authors.lastname: Fourquet
authors.forename: Marie-Françoise
authors.initials: MF
authors.lastname: Courel
authors.forename: Benjamin
authors.initials: B
authors.lastname: Sultan
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Guégan
mesh_terms: D004196:Disease Outbreaks; D006801:Humans; D008137:Longitudinal Studies; D008302:Mali / Q000453:epidemiology; D008585:Meningitis, Meningococcal / Q000453:epidemiology* / Q000382:microbiology / Q000635:transmission*; D009345:Neisseria meningitidis; D011156:Population Density; D011159:Population Surveillance / Q000379:methods; D012424:Rural Population; D014505:Urban Population