Development of a protocol for early treatment of endemic meningitis in children in Vanuatu

Meningitis is endemic in Vanuatu and other Pacific island countries and has a high case fatality rate. The incidence in the southern island of Tanna is especially high. This descriptive study of 64 cases in children (under 15 years) on that island was undertaken over a 21-month period from January 1988 to September 1989. Meningococcus was identified in 23 cases (36%) and Pneumococcus in 12 (19%). The age distribution showed a high rate in under 1 year olds. The symptoms of fever, convulsion and vomiting were most common. Bulging fontanelle (in children under 1 year), neck rigidity, and altered level of consciousness were the most frequent signs. These signs were as frequent in meningococcal as pneumococcal infections and were used to develop a simple protocol for use in primary care. Delay in treatment or referral because of patients seeking traditional medicine is a major problem yet to be overcome. Only a weak association between admissions with meningitis and underweight or crowding was found in this study.