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. 2012 Sep;17(3):442-460.
doi: 10.1007/s13253-012-0095-9. Epub 2012 Aug 3.

The Role of Weather in Meningitis Outbreaks in Navrongo, Ghana: A Generalized Additive Modeling Approach

Vanja Dukić  1 , Mary Hayden  2 , Tom Hopson  2 , Andrew Monaghan  2 , Abudulai Adams Forgor  3 , Patricia Akweongo  4 , Abraham Hodgson  4 , Christine Wiedinmyer  5 , Tom Yoksas  5 , Raj Pandya  5 , Madeleine C Thomson  6 , Sylwia Trzaska  6
Affiliations

The Role of Weather in Meningitis Outbreaks in Navrongo, Ghana: A Generalized Additive Modeling Approach

Vanja Dukić et al. J Agric Biol Environ Stat. 2012 Sep.

Abstract

Bacterial (meningococcal) meningitis is a devastating infectious disease with outbreaks occurring annually during the dry season in locations within the 'Meningitis Belt', a region in sub-Saharan Africa stretching from Ethiopia to Senegal. Meningococcal meningitis occurs from December to May in the Sahel with large epidemics every 5-10 years and attack rates of up to 1000 infections per 100,000 people. High temperatures coupled with low humidity may favor the conversion of carriage to disease as the meningococcal bacteria in the nose and throat are better able to cross the mucosal membranes into the blood stream. Similarly, respiratory diseases such as influenza and pneumonia might weaken the immune defenses and add to the mucosa damage. Although the transmission dynamics are poorly understood, outbreaks regularly end with the onset of the rainy season and may begin anew with the following dry season. In this paper, we employ a generalized additive modeling approach to assess the association between number of reported meningitis cases and a set of weather variables (relative humidity, rain, wind, sunshine, maximum and minimum temperature). The association is adjusted for air quality (dust, carbon monoxide), as well as varying degrees of unobserved time-varying confounding processes that co-vary with both the disease incidence and weather. We present the analysis of monthly reported meningitis counts in Navrongo, Ghana, from 1998-2008.

Keywords: Africa; GAM; Ghana; Humidity; Meningitis; Temperature; Weather.

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Figures

None
PAIRWISE RELATIONSHIPS AMONG NAVRONGO VARIABLES
Figure 1.
Figure 1.
The African Meningitis Belt map (courtesy of CDC), and the enlarged map of Ghana, with the study region shaded.
Figure 2.
Figure 2.
The GAM (full model) fit for the model with 4 degrees of freedom (dashed line) and the model with 8 degrees of freedom (full line); as can be seen, very little difference is observed in model fit. The estimated smooth functions of time, ĝ(t), across 12 months, show slight difference.
Figure 3.
Figure 3.
The reduced GAM fit for the model and the estimated smooth function of time, ĝ(t) (with 4 degrees of freedom) across 12 months.
Figure 4.
Figure 4.
The fit for the 4-degree-of-freedom GAM with lagged predictors only: the model with pneumonia (dashed line) and without pneumonia (full line). As can be seen, the model with pneumonia added as a predictor shows slightly better fit. The estimated smooth functions of time, ĝ(t), across 12 months, show almost no difference.
Figure 5.
Figure 5.
The GLM fit, with pneumonia (dashed line) and without pneumonia (full line). As can be seen, the model with pneumonia added as a predictor shows a slightly better fit.
Figure 6.
Figure 6.
The GAM estimates for the model with 4 degrees of freedom, without any predictors (full line) and with pneumonia predictor added (dashed line). As can be seen, the model with pneumonia performs slightly better. Note that neither of the two models show as good of a fit as the models with weather and pollution predictors. The estimated smooth functions of time, ĝ(t) across 12 months, show minimal difference for the models with and without pneumonia.
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