Knowledge, Attitude And Practice Towards Meningitis Disease Among Health Care Workers

Meningitis is an acute inflammation of the protective membranes covering the brain and the spinal cord, known collectively as the meninges. Ginsberg, (2012). The most common symptoms are fever, headache, and neck stiffness (CDC. 2014). Other symptoms include confusion or altered consciousness, vomiting, and an inability to tolerate light or loud noises. (CDC. 2016) . Young children often exhibit only nonspecific symptoms, such as irritability, drowsiness, or poor feeding. (CDC. 2016). If a rash is present, it may indicate a particular case of meningitis caused by meningococcal bacteria may be accompanied by a characteristic rash. (McCracken GH 2008 Tunkel, et al 2009). Meningitis can be life-threatening because of the inflammation`s proximity to the brain and spinal cord; therefore, the condition is classified as a medical emergency. (McCracken, 2008; Kaplan, 2011). A lumbar puncture can diagnose or exclude meningitis (CDC. 2014). A needle is inserted into the spinal canal to collect a sample of cerebrospinal fluid (CSF), that envelops the brain and spinal cord. The CSF is examined in a medical laboratory. (Kaplan SL; et al 2011). Some form of meningitis are preventable by immunization with the meningococcal, mumps, pneumococcal, and Hib vaccines. (Ferri, Fred F. 2010) . Giving antibiotics to people with significant exposure to certain types of meningitis may also be useful. (CDC 2008).The first treatment in acute meningitis consists of promptly giving antibiotics and sometimes antiviral drugs. (CDC, 2014; CDC.2016). Corticosteroids can also be used to prevent complications from excessive inflammation.(Beek D. et al 2016; Tunkel . et al; 2011). Meningitis can lead to serious long- term consequences such as deafness, epilepsy, hydrocephalus, or cognitive deficits, especially if not treated quickly. (McCracken; 2008; Beek, 2016). 

In 2015 meningitis occurred in about 8.7 million people worldwide (GBD, 2015). This resulted in 379,000 deaths , if down from 464,000 deaths in 1990. (GBD. 2016; GBD 2013).With appropriate treatment the risk of death in bacterial meningitis is less than 15%. (CDC. 2014) Outbreaks of bacterial meningitis occur between December and June each year in an area of sub-Saharan Africa known as the meningitis belt. (WHO, (2016). Smaller outbreaks may also occur in other areas of the world. (WHO, (2015) The word meningitis is from Greek meninx, “membrane” and the medical suffix –it is, “inflammation”.

Meningitis mostly caused by virus, bacteria or fungus results in the acute swelling of the meninges that cover the brain and the spinal cord. Viral meningitis is quite common and is treatable. Bacterial meningitis is dangerous and fatal if left untreated, Viral and bacterial meningitis share the same symptoms like stiff neck, fever, severe headache, nausea, vomiting and are not distinguishable. However bacterial meningitis cause irreparable and permanent damages like learning disabilities, hearing loss, brain damage (Erdem H, et al., 2016)

The symptoms include nausea, vomiting, photophobia (increased sensitivity to light), sensitivity to loud noise, confused state etc. This can also lead to serious body complications like sepsis which can cause tissue damage leading to organ failure and ultimately death. Babies, elderly individuals and person with compromised immune system are more likely to be at higher risk to be infected (Edwards RS, et al., 2016)

Humans are carriers (carry the germs without being affected), of this air borne disease and spreads through cough, sneezing, kissing etc. The main causative bacteria are Streptococcus pneumonia, Group B Streptococcus, Neisseria meningitides, Haemophilus influenza and Listeria monocytogenes. Meningococcal meningitis is caused by Neisseria meningitides.

Mothers can pass group B Streptococcus and Escherichia coli to their babies during labor and birth. According to a report every year 4100 cases are registered in USA with 500 deaths (Barnett, 2016)

The main reason behind the death due to meningitis is lack of ignorance. People cannot even know when they get affected. It is mostly characterized by irritation, poor feeding, sluggishness, bulging fontanelle or abnormal reflexes in babies while headache, rashes, vomiting, confusion are the signs in older adults. (Singh, 2016)

The main focus in eradication of the deadly disease is proper diagnosis at right time, vaccination, self-consciousness and proper knowledge. However, vaccines are available but are not 100% effective which demands self-consciousness and self-realization about the disease. ?wadays internet has proved itself to be very useful and the most accessible way to make people learn, know, acquire about anything they want or need and also in turn make people knowledgeable (Ndubisi NO,et al. 2016)

Meningitis is an inflammatory disease of the meninges membranes that covers the brain and the spinal cord. The inflammation and swelling may extend through the membranes of the pia matter, arachnoid or subarachnoid (Mace, 2008) Meningitis can be classified classified into infectious and noninfectious disease. ?n infectious meningitis can emerge from administration of certain drugs, such as non-steroidal anti-inflammatory drugs, immunoglobulins, or some antibiotics. It can develop from diseases like sarcoidosis and neoplastic meningitis. Infectious meningitis can be further sub-divided to non-bacterial and bacterial (pyogenic) meningitis. ?n-bacterial meningitis is typically caused by viral or fungal infection (Mace, 2008).

Bacterial meningitis is still considered serious life threatening disease in spite of the decline

in morbidity and mortality in the last decade. The expeditious diagnosis og the disease, a prompt empiric antibiotic treatment and the proper adjunctive therapy are corner stones for successful management of the disease. Bacterial meningitis is characterized by the significant polymorph nuclear changes in the cerebrospinal fluid (CSF).

The introduction of conjugate vaccines and the prophylactic antibiotic treatment during pregnancy caused a change in the epidemiology of bacterial meningitis (Brouwer, 2010; World Health Organization (WHO), 2010). In spite of the advances in medical care with the introduction and wide spread use of antibiotics, meningitis still has high morbidity and mortality rates. According to WHO, the incidence of bacterial meningitis is exceeding

1.2million of cases each year worldwide (WHO, 1988).

Streptococcus pneumonia and Neisseria meningitides are the most common and most aggressive pathogens of meningitis. Emerging antibiotic resistance is an upcoming challenges. Clinical and experimental studies have established a more detailed understanding of the mechanisms resulting in brain damage, sequelae and neuro-psychological deficits. Despite modern antibiotics and improved critical care, bacterial meningitis is still an unresolved problem in clinical medicine. Although highly effective antibiotics kill bacteria effectively, mortality rates are still up to 34% (Van de Beck et al. 2006)

Up to 50% of the survivors suffer from long term sequelae (Weisfelt et al. 2006). Consequently, the widening gap between whether societies and countries with limited resources presents an equally important issue beside the scientific and medical challenges in unraveling the molecular basis of bacterial meningitis, developing new treatments and meeting new upcoming challenges such as increasing resistance to pathogens to currently used antibiotics, for example, pneumococci up to 35% (Richter et al., 2002, Doern et al. 2001; Whitney et al. 2000). It is important to state that the proportion of resistant isolates is extremely dependent on geographical and other factors. Bacterial meningitis has great social

relevance due to its ability to produce sequelae and cause death. It is most frequently found in developing countries, especially among children. Meningococcal meningitis occurs at a high frequency in populations with poor living conditions. Bacterial meningitis reaches all social strata, however, areas with poor living conditions have a greater proportion of cases that progress to death. This finding reflects the difficulties for ready access and poor quality of medical care faced by theses population.

The hallmark of bacterial meningitis is the recruitment of highly activated leucocytes into the cerebrospinal fluid (CSF). Besides bacteria, viruses, fungal and non infectious causes as in systemic and neoplastic disease as well as certain drugs can induce meningeal inflammation. Usually, the inflammatory process is not limited to the meninges surrounding the brain but also affects the brain parenchyma (meningoencephalitis) (Swartz, 1984), the ventricles (ventriculitis) and spreads along the spinal cord (Kastenbour, 2001).

In recent years the damage of neurons, particularly in hippocampal structures, has been identified as a potential cause of persistent neuropsychologocal deficits in survivors (Zysk et al. 1996). During the last twenty years, the epidemiology of bacterial meningitis has dramatically changed. Haemophilus influenza, formerly a major cause of meningitis has disappeared in developed countries and serves as a remarkable example of a successful vaccination campaign. ?wadays, pneumococci are the most important causes of bacterial meningitis in children and adults in the United States as well as Europe. The incidence of the disease was decreased to 1.38 cases in 2006 to 2007 in exchange for two out of every hundred thousand people in 1998 to 1999 (Thigpen et al. 2011).

However, the attack rates for newborn infants are in the ranges of 400 cases per 100,000 I exchange for 20 per 100,000 in older adults (Loring, 2004).

Furthermore, males are affected than females. The incidence and the proportion of deaths among bacterial meningitis diagnosed cases are dependent on area and country, the causative micro-organism and age (Centre for disease control(CDC) 2013). The reported mortality rate of meningitis ranges from 3 to 33%. Major mortality predictors include over 60 age, immunocompromised status, low Glassgow Coma Scale Score and infection with Gram negative bacteria. The common morbidity associated with meningitis typically encompasses neurological sequelae, such as hearing loss, mental disability or weakness of a limb (Tang et al 1999; Rosenstein et al; 2001) Predisposing factors for meningitis include head trauma, immuno-suppression, central nervous shunts, cerebrospinal fluid fistula/leak, neurological patients, alcoholism, sinusitis, otitis media, pharyngitis, bacterial pneumonia, splenectomized patients sickle cell disease and congenital defects.

Risk factors for meningitis can be summarized as follows:

Age (Geiseler et al; 1980). Extremes of age: (age > 60years; young children (age <5 years,) especially infants (age < 2 years/newborns).

Demographic/Socioeconomic (Choi, 1992; Chares-Bueno and McCrcken, 2005); (Male gender, African American ethnicity, poor populations, crowding (Military recruits and crowded dormitories). Exposure to pathogens (Mace, 2008), recent colonization (household close contact with meningitis patient). Contagious infection, sinusitis, mastoiditis, otitis media or bacterial endocarditis, intravenous drugs abuse or dural defect, status post neurosurgery, central nervous system (CNS) trauma, congenital trauma, ventriculoperitoneal shunt, other central nervous system devices or cochlear implants.

Immuno-compromised factors ( Schutze, 2002); Post splenectomy, hematologic disorders such as sickle cell disease or thalassemia major, malignancy, diabetes, alcoholism/cirrhosis or HIV.

Drugs (Porto, 2012): ?nsteroidal anti-inflammatory drugs (NSAIDS), trimethoprim – sulfamethoxazole or immunosuppressive drugs Desease (Porto, 2012): Systemic lupus erythematosus.

Bacterial meningitis is very serious and should be treated as a medical emergency’ If the bacterial infection is left untreated it can cause severe brain damage and infect the blood (septiceamia). In 2008, there were 2,553 cases of bacterial meningitis reported in Ireland. Since then the number of cases has decreased because of the meningitis vaccination programme that protect against many of the bacteria that can cause meningitis Meningococcal group B disease is the most common cause of bacterial meningitis in Ireland. The meningitis B vaccine protects against meningitis B disease. The vaccine has not yet been introduced into the primary childhood immunization schedule but is available privately from a general practitioner. Bacterial meningitis is most common in children who are under five years of age and in particular in babies under the age of one. It is also common among teenagers aged 15 to 19 years. However, the attack rates for newborn infants are the in the range of 400 cases per 100,000 in exchange for 20 per 100,000 in older adults (Loring, 2004).

Furthermore, males are affected slightly more than females, The incidence and the proportion of deaths among bacterial meningitis diagnosed cases are dependent on area and country, the causative micro-organism and age (Centre for Disease Control (CDC) 2013). The reported mortality rate of meningitis ranges from 3 to 33%. Major of mortality predictors include over 60 age, immunocompromised states low Glasgow Coma Scale Score and infection with Gram negative bacteria. The common morbidity associated with meningitis typically encompasses neurological sequelae, such as hearing loss, mental disability or weakness of a limb (Rosenstein, 2001).

Meningitis is a great burden for patients, families and medical staff. Even epidemiology has changed a lot after novel immunization and infection prevention strategies, bacterial meningitis continues to be associated with high mortality and morbidity especially in those still could not be vaccinated. Delay in diagnosis increases mortality and early diagnosis of the aetiology of meningitis provides better out comes.

Furthermore, bacterial meningitis has great social relevance due to its ability to produce sequelae and cause death. It is most frequently found in developing countries especially among children. Meningococcal meningitis occurs at a high frequency in populations with poor living conditions. This study describes d temporal evolution of bacterial meningitis in Salvador, Brazil. 1995-2009, and verifies the association between its spatial variation and the living conditions of the population. Bacterial meningitis reaches all social strata, however, areas with poor living condition have a greater proportion of cases that progress to death. This finding reflects the difficulties for ready access and poor quality of medical care faced by these population.

Bacterial meningitis is serious and can be fatal within days without prompt antibiotic treatment. Delayed treatment increases the risk of permanent brain damage or death.

Viral infections are the most common cause of meningitis, followed by bacterial infection and rarely, fungi infections. Because bacterial infections can be life-threatening identifying the cause is essential (Brouwer, 2010). Bacteria that enter the blood stream and travel to the brain and spinal cord cause acute bacterial meningitis. But it can also occur when bacteria directly invade the meninges. This may be caused by an ear or sinus infection, a skull fracture, or, rarely, after some surgeries (Loring, 2004).

Knowledge is prerequisite to an action, including the actions that are necessary for the prevention of infections (who,2006).  Okafor, (1997) stressed that knowledge is a precursor for perception and behaviour though not all knowledge are translated to these. These inability to tranmslate knowledge especially, health knowledge to perception and behaviour has been the major setback in the development of health education and therefore, setback in prevention of diseases such as meningitis and othe hospital acquired infections. Knowledge is very important in acquiring and practicing health knowledge which also is important in the development of optimum health attitude formation, particularly positive attitude, depends more on the sources of information than on amount of information received.

Adequate knowledge in infection prevention and control: According to the Oxford dictionary (2010:827), knowledge is the information, understanding and skills that are gained through education and experience in this case knowledge about infection prevention and control. The surveillance of hospital acquired infections are regarded as an essential part of infection control and prevention. In this regard, Razine, Azzouzi, Barkat, Khoudri, Hassouni, Chefchaouni and Abouqal (2012:26) determined the prevalence of hospital acquired infections (HAIs) in all institutions of Rabat University Medical Centre in Morocco. The study showed that the prevalence of HAIs was high. Therefore, recommendations for future control measures to focus on patients who stay longer in the hospital, patients with invasive devices were made. Lack of knowledge among health care workers can increase the rate of the hospital acquired infections. Failure to apply infection control procedures due to inadequate knowledge of infection prevention and control, favours the transmission of pathogens, and health care settings can act as amplifiers of disease during epidemics, with a bearing on both hospital and public health (WHO, 2016:1). According to WHO (2016:1), a huge gap exists between the knowledge accumulated over the past decades and implementation of infection control practices.

Attitude towards infection prevention and control: According to the Oxxford dictionary (2010:80), attitude is the way you think, feel and behave about something, in this case case, attitude towards infection prevention and control. Despite the knowledge that dirty hands play a significant role in the spread of health-care related pathogens, and that hand hygiene (HH) decreases the spread of these organisms, health care worker`s adherence with HH is poor (Dixit, Hagtvedt, Raay, Ballermann and Forgie, 2012:1). Dixit et al (2012:1), who explored the attitude and beliefs about hand hygiene among paediatric residents showed that paediatric residents` compliance with HH was influenced by role modeling, balancing hand hygiene with other competing factors and the drive for self-protection and personal cues. According to Lemass et al. (2013:11), hands of practice staff are the most important vehicles to cross-infection. Furthermore, hand s of patients can also carry microbes to other body sites, equipment and staff. Hand hygiene is one of the most effective means of preventing nosocomial infections (Lemass et al., 2013:18).

An attitude of not washing hands among individuals involved in the provision of healthcare services can increase the rate of hospital-acquired infections. In a study that was conducted in India, where Nair, Hanumantappa, Hinemath, Siraj and Raghunath (2013:3) assessed knowledge, attitude and practices of hand hygiene among health care personnels at a tertiary health care centre, the majority of HCWs had poor knowledge with regard to hand hygiene. Olalekan. Olusegun, Olufunmilaya and Lanre, (2012:285-289) in a study assessed awareness and attitude of health care workers in LAUTECH Teaching Hospital Osogbo towards nosocomial infections. The study showed that there was a need to raise awareness of nosocomial infections among health care workers as well as preventive measures against these infections as preventive practices towards nosocomial infections were favourable for hand washing and unfavourable for self-reporting to the staff clinic when sick. The negative attitude towards infection prevention and control can promote transmission of infection from one point to another.  According to Ward (2012:301-306), nursing students generally

observed a bad approach towards infection prevention and control from qualified staff, besides IPC was considered to be an added job load as different to a central feature of patient safety and excellent care. Positive attitude towards infection prevention and control can reduce the rate of Hospital acquired infections. Conducting a study to assess knowledge and attitude of health-care workers (HCWs) and patients on health care associated infections (HAIs) in the central regional hospital in Ghana, Ocran and Tagoe (2014:135-139) indicated that attitudinal change is the best means of prevention.

Practices of healthcare professionals in infection prevention and control: According to the Oxford dictionary (2010:1148), to practice is to do something regularly as part of your normal behaviour which in this case is infection prevention and control practices. It is, therefore, important that all health workers strictly adhere to infection control guidelines, especially nurses because they spend more time with the patients. A safe injection is one that does not hurt the recipient, does not render the provider to any preventable risks and does not cause harm to the community when disposed of. Unsafe injection practices can lead to the transmission of blood-borne pathogens, with their associated burden of disease (WHO, 2010:13). Safe injection practices are standard precaution aimed at maintain basic levels of patient safety and provider protections. In this regard, Ambulatory Surgical Center (ASC) quality collaboration (2016:1) states that when safe injection practices are not used, diseases like meningitis, HIV, hepatitis C virus and hepatitis B virus can be spread from patient to patient, and patient to health personnel when safe infection practices are not used. Furthermore, general good practices include ensuring that occupational immunization and clearance are up to date for all staff. All staff must dispose of clinical waste according to local policy with sharps in assembled sharp container.

1.2 Statement of the Problem

Several  strains  of  bacteria  can  cause  acute  bacterial  meningitis,  most  commonly: Streptococcus Pneumoniae (Pneumococcus). This bacterium is the most common cause of bacterial meningitis in infants, young children and adults in the United states. It more commonly causes pneumonia or ear or sinus infections. A vaccine can help prevent this infection. Neisseria meningitides (meningococcus) is another bacterium leading cause of bacterial meningitis. These bacterium commonly cause an upper respiratory infection but can cause meningococcal meningitis when they enter the blood stream. This is a highly contagious infection that affects mainly teenagers and young adults. It may cause local epidemics in college dormitories, boarding schools and military bases.

Haemophilus Influenzae (haemophilus). Haemophilus influenza typeb (Hib) bacterium was once the leading cause of bacterial meningitis in children. But new Hib vaccines have greatly reduced the number of cases of this type of meningitis.

Listeria monocytogenesis (Listeria). These bacteria can be found in unpasteurized cheese, hot dogs and luncheon meats. Pregnant women, newborns, older adults and with people with weakened immune systems are most susceptible. Listeria can cross the placental barrier and infections in late pregnancy may be fatal to the baby. Listeriosis increases the risk of miscarriage, stillbirth and premature delivery. Listeria monocytogenesis (Streptococcus agalactiae) is considered responsible for more than 80% of cases of bacterial meningitis (Porto,2012). The existing underlying disease states together with the patient`s age highly influences the aetiology of the disease.

An emerging problem is the growing prevalence of pneumococci resistance to beta-lactam antibiotics (Whitney et al. 2003. Prolonged persistence of pneumococci in the cerebrospinal fluid (CSF) may result in higher mortality as well as in pronounced neurological damage in survivours (Fiore et al. 2000).

Bacteria causing meningitis in newborns, most importantly group B streptococcal (GBS) and E, coli, are also well equipped with adhesive proteins allowing them to invade the Central Nervous System (CNS) (Maisey et al. 2007 Prasadarao et al. 1997).

Bacterial meningitis is one of the most sever infectious diseases, causing neurologic sequelae and accounting for an estimated 200,000 deaths worldwide per year. Although most diseases occur in infants, the societal impact is also important because of the continued high incidence in healthy older children and adolescents. Despite many new antibacterial agents, bacterial meningitis fatality rates remain high, with reported rates between 2% and 30%. Furthermore, permanent sequelae, such as epilepsy, mental retardation, or sensor neural deafness are observed in 10%-20% of those who survive (Brouwer et al. 2010).

It is a public problem demanding early diagnosis, effective treatment, prevention and control. There are three main organisms that accounts for over 90% of the world`s cases of meningitis. These are N. meningitides, S. pneumonia and H. influenza type b (Hib). I n Africa, meningitis prevails in the semiarid sub-Saharan area between 10o and 12o ?rth latitude from West to East Africa, dubbed the meningitis belt. A region in sub-Saharan Africa, extending from Ethiopia in the east to the Gambia in the west and containing 15 countries with >260 million people, is known as the “meningitis belt” because of its high prevalence of endemic disease with periodic epidemics caused by N. meningitides (Ghugh et al.2011).

Endemic meningitis among children takes the form of sporadic cases or small clusters with an endemicity rate of 1.5/100,000 and 20/100,000 population in the developed and developing countries respectively. At least 890,000 cases (500,000 in Africa; 210,000 in pacific countries; 100,000 in Europe and 80,000 in America) are estimated to occur annually. Of these cases, 160,000 and 135,000 of them are disabling and fatal, respectively (Rezaeizadeh et al.2012).

Despite great advances in antimicrobial therapy, neonatal and paediatric life support measures, bacterial sepsis and meningitis continue to be a major cause of morbidity and mortality in newborns, particularly in infants. A wide variety of spectrum of organisms has been described for cases of septic meningitis and this spectrum is subjected to geographical alterations. The organisms isolated are more often resistant to multiple antimicrobials, making treatment more difficult and leading to grave sequelae (Donnel, 2009).

The severity of this problem is increased among groups of individuals who live in close proximity with one another because of the easier transmission of respiratory droplets of throat secretions. The actual disease is caused by an infection in the thin lining surrounding the brain and spinal cord. The swelling can result in nerve damage, learning disabilities or death. The World Health Organization found that even when diagnosed early, 5-10% of infected individuals die within 24-48 hours of diagnosis (World Health Organization, 2003).

The risk of the disease is highest in individuals younger than 5 years and older than 60 years. Some predisposing factors such as a former splenectomy, malnutrition or sickle cell disease are known (Kastenbauer and Pfister, 2003). An emerging problem is the growing prevalence of Pneumococci resistant to beta-lactam antibiotics, prolonged persistence of pneumococci in the cerebrospinal fluid (CSF) may result in higher mortality as well as in pronounced neurological damage in survivors (Whitney et al. 2003).

1.3 Aims and Objectives of the Study

1.3.1 Aim

To assess knowledge, attitude and practice of health personnels towards meningitis disease in Ahmadu Bello University Teaching Hospital (ABUTH) Zaria, with a view to making recommendation for effective infection control practice to prevent the spread of bacterial meningitis.

1.3.2 Objectives:

i. To assess the level of knowledge of health care personnels on infection (meningitis) prevention and control in Ahmadu Bello Universisty teaching hospital (ABUTH) Zaria

ii. To determine attitude of health care personnels towards infection (meningitis) prevention and control

iii. To identify the practices of health care personnel toward infection (meningitis) prevention and control

1.4 Research Questions

i. What is the level of knowledge of Ahmadu Bello University (ABUTH) health personnel about meningitis prevention and control

ii. What is the attitude of these health personnels towards the prevention and control of the spread of the disease

iii. What are their practices towards meningitis prevention and control

1.5 Scope of the Study

The researcher will focus mainly on information on demographic characteristics, knowledge, attitude and practice of health care workers of Ahmadu Bello University Teaching Hospital Shika Zaria towards infection (meningitis) prevention and control, determine attitudes of ABUTH health professionals on infection prevention and control, also to determine the practices of HCWs of Ahmadu Bello University Teaching Hospital Zaria towards infection prevention and control. It will include statement of problem, literature review on meningitis, methodology of study, data analysis, discussion, conclusion and recommendations.

The Ahmadu Bello University Teaching Hospital (ABUTH) Zaria is one of Nigerian`s first generation teaching hospital. The institution was designed from inception to serve as a major tertiary health centre for the defunct northern region. This is the basis of its hitherto multicenter structure. It is the largest health facility within the ?rth-West geopolitical region with regards to both size and personnel. The Ahmadu Bello University Teaching Hospital Zaria ultra modern complex is located in Shika, Giwa Local Government in Kaduna State. It is located about 2km from Shika town and bounded by Ahmadu Bello university (ABU) on the South, Shika town on the ?rth and Milgoma town on the East. It is situated on the crystalline metamorphic rocks of the ?rthern Nigerian Basement Complex. It lies between latitudes 11o 7/N and 11o 24/N and longitudes 7o 31/E and 7o 50/E all and has an elevation of about 650m-700m above mean sea level. ABUTH was established as institute of health in 1967 by statute 15 of the Ahmadu Bello University (ABU) law, The institute of health was transformed to Ahmadu Bello University Teaching Hospital, amendmenet act schedule (16), by the then ?rthern Nigerian government with the objective of providing facilities for training of doctors and other health professionals and for the provision of healthcare to the people. It is presently being run by a board, established by decree ?10 of 1985 and it comprises the Chief executive (CMD) and the following statutory Officers., The chairman, Medical Advisory Committee, The Director of administrator, the Director of Finance and Supplies and the Chief Internal Audit. The hospital has clinical department, wards, out- patient department, radiology department, Accident and Emergency Unit, Laboratories,

operating theatres, Intensive care unit (ICU), Administrative department etc. The hospital is a referral centre for primary, secondary public health institutes as well as private hospitals within Zaria and Kaduna State and other neighbouring states of Katsina, Kano, Bauchi, Sokoto and Zamfara states. There are also referral cases from all tertiary health facilities all over the nation.

Time scope: This study commenced in July, 2017 and expected to be completed before June 2018.

1.6 Significance of the Study

To be able to diagnose and manage meningitis properly. Health personnels have to be aware of the types of micro-organisms prevalent in the local community and their susceptibility against different antibiotics. What is true in the western may not be similar in other part of the world.

The study provides information that will motivate other health personnel to carry out further study in the area

The study will be evaluating the health personnel`s knowledge and attitudes towards meningitis, be able to identify ways of preventing its spread hence appropriate intervention.

This study will also add to the body of knowledge related to meningitis prevention. Increase awareness of the outbreaks and coordinate response across states.

Findings from the study will be used by hospital management and other stakeholders in planning and targeting appropriate measures/interventions to improve compliance to standard precautions among health care workers. The health care workers would be the ultimate beneficiary of interventions that will be based on findings from the study.

1.7 Justification of the Study

Following the recent outbreak of cerebrospinal meningitis (CSM) serotype C in some states in the country, Zamfara, Sokoto, Katsina, Kebbi and Niger, it is imperative that Nigeria should be prepared at all times for another outbreak hence the need for the health worker to be knowledgeable on how to contain an outbreak, what are their attitude towards it and what practice measures are in place. The Ahmadu Bello University Teaching Hospital (ABUTH) Zaria is a foremost teaching hospital in the ?rthern part of Nigeria that is suppose to carter for the health needs of the people in the ?rth-West and ?rth Central. So the question is are the health professionals in this centre knowledgeable about meningitis outbreak and what do they know about the disease and preventive measures.

1.8 Operational Definition of Terms

Meningitis: Also termed arachnoiditis or leptomeningitis, is an inflammation of the membranes that surround the brain and spinal cord, thereby involving the arachnoid, the piamater, and the interposed cerebrospinal fluid (CSF).

Knowledge of meningitis: The extent to which the health personnels are aware of meningitis (infections) its causes, prevention and control.

Attitude : Refers to the opinion, feelings expressed by the health personnels towards ways to contain the disease.

Practice: To practice is to do something regularly as part of your normal behaviour which in this case is infection prevention and control practices.

Health care personnel (HCP): Are persons who have special education on health care and who are directly related to provision of care services. HCP includes all paid and unpaid persons working in health-care settings.