Educational inequalities in Burkina Faso leave young women at greater risk of meningitis

14 Jul 2021
Educational inequalities in Burkina Faso leave young women at greater risk of meningitis
  • Most young adults and adolescents living in Burkina Faso were aware of practices to reduce their meningitis risk, however young women have particularly low levels of knowledge
  • This difference could be explained by at least one year of high school, which suggest that girls should be targeted by interventions outside of school and perinatal care
  • Local understandings and practices for risk and prevention such as the application of shea butter in the nostrils were also commonly reported and used
  • National and international vaccination initiatives therefore need to take local understandings and practices into account
Research published today in PLOS ONE and funded by Meningitis Research Foundation has revealed a gender gap in knowledge of meningitis risk and prevention in Burkina Faso – an area prone to meningitis epidemics. While most young adults and adolescents living in an urban region of Burkina Faso are aware of meningitis risks and prevention strategies, young women have a much poorer understanding, leaving them at greater risk.

Burkina Faso is in the meningitis belt, an area in sub Saharan Africa with high numbers of meningitis cases. Each year between December and April, these countries are subject to a long dry season, with low relative humidity and large dust clouds. During this time, an increased incidence of meningococcal and pneumococcal meningitis is seen. It is believed that the effects of the dry, dusty air on the back of the nose and throat contributes to this, by enabling the bacteria which are usually harmlessly carried in the nose and throat, to invade the body.

In 2010, MenAfriVac®, a meningococcal serogroup A (MenA) conjugate vaccine was introduced in the meningitis belt through mass campaigns for 1-29 year olds. From 2016, countries have started to introduce the vaccine into their routine immunisation schedules to protect new babies being born. These vaccination efforts have led to the virtual disappearance of MenA, which once ravaged meningitis belt communities in massive epidemics. However, other strains of meningitis continue to circulate unchecked.

Young people attend an educational event in Burkina Faso

To explore the beliefs surrounding meningitis and vaccine prevention, the researchers conducted a questionnaire with over 200 15-33 year olds to assess current knowledge and practices of meningitis risk and prevention in Bobo-Dioulasso, Burkina Faso.

Dr Judith Mueller, Professor in Epidemiology at EHESP French School of Public Health and lead investigator for the study said: “Our survey results revealed a wide range of reported knowledge, beliefs, and practices of meningitis risk and prevention among young adults and adolescents living in Burkina Faso. While the majority of participants were aware of accurate facts and good practices, such as reducing their meningitis risk through vaccination and avoiding exposure to dusty dry air, young women were found to have particularly low levels of knowledge, largely explained by educational inequalities. Closing this gender gap is important not only for women, but also to ensure that families make the best health care decisions for their children.

Even after adjusting for education, differences still existed between women aged below and above 21 years. The study authors suggest this could be due to women primarily receiving information from perinatal care, therefore in the absence of an early pregnancy, there would be less exposure to educational information from health professionals. This highlights the need for specific educational interventions outside of school and health care facilities for young women who are no longer at school, but not yet seen in perinatal care.

The research also revealed that local understandings and practices for risk and prevention were commonly reported and used. This included applying shea butter in the nostrils, which although not clinically evaluated, may have some preventative effect by protecting the back of the nose and throat from dust and dry air. Respondents also cited avoiding eating unripe mangos, which reflects local logic, as the availability and subsequent consumption of unripe mangoes takes place towards the end of the dry season, which coincides with the period of highest risk for meningitis and meningitis epidemics.

Linda Glennie, Director of Research Evidence and Policy at Meningitis Research Foundation said: “While it is encouraging to see that most participants are aware of the importance of vaccination in preventing meningitis, it is essential that no-one is left behind, including young women. The WHO Defeating Meningitis by 2030 Global Roadmap recognises this, and sets out a goal to ensure that people and communities know how to access meningitis vaccines, other prevention and support after meningitis, and that they value and demand them.
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