{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T03:01:41Z","timestamp":1787022101972,"version":"build-2736575974"},"reference-count":44,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2022,8,10]],"date-time":"2022-08-10T00:00:00Z","timestamp":1660089600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["OPP1020327"],"award-info":[{"award-number":["OPP1020327"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100009187","name":"Medical Research Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100009187","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      The introduction in many countries of conjugate vaccines against\n                      <jats:italic>Haemophilus influenzae<\/jats:italic>\n                      type b,\n                      <jats:italic>Streptococcus pneumoniae<\/jats:italic>\n                      , and\n                      <jats:italic>Neisseria meningitidis<\/jats:italic>\n                      has led to significant reductions in acute bacterial meningitis (ABM) in children. However, recent population-based data on ABM in sub-Saharan Africa are limited.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Population-based surveillance for meningitis was carried out in a rural area of The Gambia under demographic surveillance from 2008 to 2017, using standardised criteria for referral, diagnosis and investigation. We calculated incidence using population denominators.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      We diagnosed 1,666 patients with suspected meningitis and collected cerebrospinal fluid (n = 1,121) and\/or blood (n = 1,070) from 1,427 (88%) of cases. We identified 169 cases of ABM, 209 cases of suspected non-bacterial meningitis (SNBM) and 1,049 cases of clinically suspected meningitis (CSM). The estimated average annual incidence of ABM was high at 145 per 100,000 population in the &lt;2-month age group, 56 per 100,000 in the 2\u201323-month age group, but lower at 5 per 100,000 in the 5\u201314-year age group. The most common causes of ABM were\n                      <jats:italic>Streptococcus pneumoniae<\/jats:italic>\n                      (n = 44),\n                      <jats:italic>Neisseria meningitidis<\/jats:italic>\n                      (n = 42), and Gram-negative coliform bacteria (n = 26). Eighteen of 22 cases caused by pneumococcal serotypes included in PCV13 occurred prior to vaccine introduction and four afterwards. The overall case fatality ratio for ABM was 29% (49\/169) and was highest in the &lt;2-month age group 37% (10\/27). The case fatality ratio was 8.6% (18\/209) for suspected non-bacterial meningitis and 12.8% (134\/1049) for clinically suspected meningitis cases.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Gambian children continue to experience substantial morbidity and mortality associated with suspected meningitis, especially acute bacterial meningitis. Such severely ill children in sub-Saharan Africa require improved diagnostics and clinical care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0265299","type":"journal-article","created":{"date-parts":[[2022,8,10]],"date-time":"2022-08-10T13:37:11Z","timestamp":1660138631000},"page":"e0265299","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":5,"title":["Childhood meningitis in rural Gambia: 10 years of population-based surveillance"],"prefix":"10.1371","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6118-5326","authenticated-orcid":true,"given":"Usman N.","family":"Ikumapayi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip 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