@article{fdi:010079891,
  title = {{T}he environmental drivers of bacterial meningitis epidemics in the {D}emocratic {R}epublic of {C}ongo, central {A}frica},
  author = {{M}azamay, {S}. and {B}routin, {H}. and {B}ompangue, {D}. and {M}uyembe, {J}. {J}. and {G}u{\'e}gan, {J}ean-{F}ran{\c{c}}ois},
  editor = {},
  language = {{ENG}},
  abstract = {{I}ntroduction {B}acterial meningitis still constitutes an important threat in {A}frica. {I}n the meningitis belt, a clear seasonal pattern in the incidence of meningococcal disease during the dry season has been previously correlated with several environmental parameters like dust and sand particles as well as the {H}armattan winds. {I}n parallel, the evidence of seasonality in meningitis dynamics and its environmental variables remain poorly studied outside the meningitis belt. {T}his study explores several environmental factors associated with meningitis cases in the {D}emocratic {R}epublic of {C}ongo ({DRC}), central {A}frica, outside the meningitis belt area. {M}ethods {N}on-parametric {K}ruskal-{W}allis' tests were used to establish the difference between the different health zones, climate and vegetation types in relation to both the number of cases and attack rates for the period 2000-2018. {T}he relationships between the number of meningitis cases for the different health zones and environmental and socio-economical parameters collected were modeled using different generalized linear ({GLM}s) and generalized linear mixed models ({GLMM}s), and different error structure in the different models, i.e., {P}oisson, binomial negative, zero-inflated binomial negative and more elaborated multi-hierarchical zero-inflated binomial negative models, with randomization of certain parameters or factors (health zones, vegetation and climate types). {C}omparing the different statistical models, the model with the smallest {A}kaike's information criterion ({AIC}) were selected as the best ones. 515 different health zones from 26 distinct provinces were considered for the construction of the different {GLM} and {GLMM} models. {R}esults {N}on-parametric bivariate statistics showed that there were more meningitis cases in urban health zones than in rural conditions (chi(2)= 6.910,p-value = 0.009), in areas dominated by savannah landscape than in areas with dense forest or forest in mountainous areas (chi(2)= 15.185,p-value = 0.001), and with no significant difference between climate types (chi(2)= 1.211,p-value = 0,449). {A}dditionally, no significant difference was observed for attack rate between the two types of heath zones (chi(2)= 0.982,p-value = 0.322). {C}onversely, strong differences in attack rate values were obtained for vegetation types (chi(2)= 13.627,p-value = 0,001) and climate types (chi(2)= 13.627,p-value = 0,001). {T}his work demonstrates that, all other parameters kept constant, an urban health zone located at high latitude and longitude eastwards, located at low-altitude like in valley ecosystems predominantly covered by savannah biome, with a humid tropical climate are at higher risk for the development of meningitis. {I}n addition, the regions with mean range temperature and a population with a low index of economic well-being ({IEW}) constitute the perfect conditions for the development of meningitis in {DRC}. {C}onclusion {I}n a context of global environmental change, particularly climate change, our findings tend to show that an interplay of different environmental and socio-economic drivers are important to consider in the epidemiology of bacterial meningitis epidemics in {DRC}. {T}his information is important to help improving meningitis control strategies in a large country located outside of the so-called meningitis belt. {A}uthor summary {B}acterial meningitis remains an international public health threat. {T}he most affected area worldwide is the {S}ahelian region between {S}enegal and {E}thiopia called the meningitis belt. {I}n parallel recurrent epidemics have also occurred out of the belt in {A}frica for the last twenty years. {W}hile environmental, socioeconomic and demographic factors are well described to explain the epidemiology of meningitis in the belt, very few studies have focused on the role of these factors to understand meningitis epidemics outside of the belt. {B}ased on epidemiological, socio-economic, demographic and environmental data collected for the period 2000-2018 in the {D}emocratic {R}epublic of {C}ongo ({DRC}), we used different statistical methods to explore the links between meningitis cases and the different explored factors. {O}ur results showed that urbanized areas where populations have a low economic index of well-being, high latitude and longitude eastwards, medium to low altitude level, savannah-type vegetation, medium temperature value, are risk factors of meningitis outbreaks from {N}orth to {S}outh in the {DRC}. {T}his information is important to help improving meningitis control strategies in a large country located outside the so-called meningitis belt.},
  keywords = {{REPUBLIQUE} {DEMOCRATIQUE} {DU} {CONGO}},
  booktitle = {},
  journal = {{PL}o{S} {N}eglected {T}ropical {D}iseases},
  volume = {14},
  numero = {10},
  pages = {e0008634 [16 ]},
  ISSN = {1935-2735},
  year = {2020},
  DOI = {10.1371/journal.pntd.0008634},
  URL = {https://www.documentation.ird.fr/hor/fdi:010079891},
}