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Determining the bacterial and viral meningitis trend in Iraq from 2007 till 2023 using joinpoint regression
Hanan Abdulghafoor Khaleel1, Riyadh Abdulameer Alhilfi2, Salman Rawaf3
1Communicable Diseases Control Centre, Directorate of Public Health, Ministry of Health, Baghdad, Iraq.
Background:
Acute meningitis is a disease with case fatality and disability rate that is dependent on the causative agent.
Objective:
Determine the meningitis trend in Iraq from 2007 to 2023 using a joinpoint regression at national and sub-national levels and describe the epidemiology.
Methods:
Joinpoint regression model was used on surveillance data from Jan 2007 until May 2023, to calculate annual and average annual percent changes to determine the trend. Meningitis total count was modelled by year of reporting and province using the log transformation and Poisson variance. Best-fit model was chosen based on the weighted BIC criteria as the final point.
Results:
Bacterial meningitis was higher than viral meningitis from 2007 to 2018, then viral meningitis started to exceed till 2023. Meningococcal meningitis was lower than other bacterial and viral meningitis from 2007 to 2023. Most meningitis cases across the years were lower than 15 years, at almost 80 %, while 20 %-40 % were lower than one year. Across all years, 55 % of the cases were males; apart from 2019, 70 % were females.
Conclusion:
In Iraq, viral meningitis has been the predominant type since 2018. Most meningitis patients were lower than 15-year-old males. The meningitis trend in Iraq was stable from 2007 till 2023.
Insights
Viral meningitis has predominated in Iraq since 2018, with most cases affecting males under 15. The overall meningitis trend in Iraq remained stable between 2007 and 2023.
Area of Science:
- Epidemiology
- Infectious Diseases
- Public Health
Background:
- Meningitis presents varying case fatality and disability rates contingent on the causative agent.
- Understanding disease trends is crucial for effective public health interventions.
Purpose of the Study:
- To analyze the epidemiological trends of meningitis in Iraq from 2007 to 2023.
- To identify shifts in causative agents and demographic patterns of meningitis cases.
Main Methods:
- Joinpoint regression analysis applied to national and sub-national surveillance data from January 2007 to May 2023.
- Modeling meningitis counts by year and province using log transformation and Poisson variance.
- Selection of the best-fit model based on weighted Bayesian Information Criterion (BIC).
Main Results:
- Viral meningitis surpassed bacterial meningitis in prevalence after 2018.
- Meningococcal meningitis remained less common than other bacterial and viral types throughout the study period.
- Individuals under 15 years constituted approximately 80% of cases, with 20%-40% being infants under one year. Males represented 55% of cases, with a notable female predominance (70%) in 2019.
Conclusions:
- Viral meningitis has been the dominant form in Iraq since 2018.
- The majority of meningitis cases involved males under 15 years old.
- The overall trend of meningitis in Iraq demonstrated stability from 2007 to 2023.
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