The Politics of the 1996 Cerebronspinal Meningitis Epidemic in Nigeria

Article excerpt

The child's eyes, the pupils of which were tiny and showed a tendency to

squint. The pulse raced. Muscular contractions developed, and an incipient

rigidity of the neck. It was cerebro-spinal meningitis ... [T. Mann, Dr

Faustus]

In May 1996 the New York Times (1996b) reported the Saudi Arabian government's decision to ban Nigerian pilgrims from visiting Mecca on account of the cerebrospinal meningitis (CSM) epidemic in northern Nigeria. However, what appears to be a simple story of cause and effect, the CSM epidemic and subsequent pilgrimage ban, is considerably more complex, with political ramifications at the local, national, and international levels. Ibis article documents these different dimensions first by examining local attempts to stem the outbreak, based on participant-observation and epidemiological data collected from northern Kaduna State. The 1996 CSM epidemic is then considered in the national context, with the general deterioration of the health care system associated with economic decline and with a national structural adjustment programme, and with a general crisis in political leadership resulting from the failed transition to civilian rule in 1993, which has contributed to a lack of adequate supervision and accountability in the mobilisation of immunisation implementation. Finally, this discussion of the local and national context of the 1996 CSM epidemic is related to the view held by many Nigerian Muslims that reports of the epidemic's severity reflected international politics, particularly the uneasy relations between the Nigerian, Saudi Arabian, and US governments, The subsequent Saudi ban on Nigerians' pilgrimage to Mecca (Hajj) was thus widely believed to have been a result of political as well as health concerns. An understanding of the connections between the handling of the epidemic at the local and national levels and of how international reactions to the epidemic were interpreted in northern Nigeria is important if the difficult problem of stemming future CSM outbreaks in Nigeria is to be addressed. The article concludes with some recommendations for a national policy and for community health initiatives that take the politics and economics of CSM immunisation into account.

CEREBROSPINAL MENINGITIS IN NORTHERN NIGERIA

Widespread outbreaks of cerebrospinal meningitis (meningococcal meningitis caused by the gram-negative coccus Neisseria meningitidis, serogroup A; Whittle et al., 1975) have regularly occurred in the flat savannah area of West Africa (Parry, 1976: 253), the `meningitis belt', which includes parts of Nigeria, Niger, Chad, Benin, Togo, Burkina Faso, Ghana, Cote d'Ivoire, Mali, Guinea, and Senegal. CSM outbreaks have tended to occur in five- to ten-year cycles.

In northern Nigeria the earliest recorded cases of CSM were reported in 1880, although oral evidence suggests earlier occurrences:

The 1905 epidemic in Northern Nigeria was nothing new in Hausa areas; one

doctor was told it had come from the northeast, `but not in the memory of

living man,' and had caused many deaths at intervals over the last fifty

years. A physician working in the Zungeru area was told that the disease

had occurred in some previous dry seasons, causing many deaths, and one

informant described an epidemic at Kukua (Bornu) about 1875. After the

1920 outbreak, Nigerian medical officials reported oral evidence of an

epidemic or epidemics in the northwest c. 1885-1890; it was called Dan

Kanoma, after the town of Kanoma, or sankarau (`stiff neck'). [Patterson

and Hartwig, 1984: 14]

CSM outbreaks in northern Nigeria have been recorded in 1905 (Patterson and Hartwig, 1984), 1921 (Sokoto; Schram, 1971), 1924 (Adamawa; Schram, 1971), 1937 (Schram, 1971), 1944-45,(1) 1949-51 (Horn, 1951), 1960-62 (Ministry of Health, Kaduna, 1962), 1970, 1977 (Greenwood et al. …