Meningitis diagnosis, treatment, and outcomes in rural, northern Uganda: 2015-2024

Abigail Link; Mark Okwir; Betty Nabongo; Fred Okello; Jimmy Alal; David Meya; Paul R Bohjanen

doi:10.1371/journal.pgph.0005800

Meningitis diagnosis, treatment, and outcomes in rural, northern Uganda: 2015-2024

PLOS Glob Public Health. 2026 Jan 12;6(1):e0005800. doi: 10.1371/journal.pgph.0005800. eCollection 2026.

Authors

Abigail Link^{1

2}, Mark Okwir^{2

3

4}, Betty Nabongo⁵, Fred Okello², Jimmy Alal⁵, David Meya^{2

6

7}, Paul R Bohjanen^{1

2

8}

Affiliations

¹ Division of Infectious Diseases, Department of Medicine, School of Medicine and Dentistry, University of Rochester, Rochester, New York, United States of America.
² MARA-Rural Health Consortium, Lira, Uganda.
³ Department of Public Health Sciences, School of Medicine and Dentistry, University of Rochester, Rochester, New York, United States of America.
⁴ Department of Internal Medicine, Lira University, Lira, Uganda.
⁵ Lira Regional Referral Hospital, Lira, Uganda.
⁶ Infectious Diseases Institute, Makerere University, Kampala, Uganda.
⁷ Department of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda.
⁸ Department of Medicine, Infectious Diseases and International Medicine, University of Minnesota, Minneapolis, Minnesota, United States of America.

Abstract

Meningitis affects over 2.5 million people worldwide, primarily within resource-limited regions of the meningitis belt of Africa. In 2017, we implemented a cryptococcal meningitis (CM) diagnosis and treatment program (CM-DTP) designed to improve CM outcomes. In 2021, a meningitis diagnosis and treatment program (MEN-DTP) began to include all etiologies of meningitis to assess the impact of expanded diagnosis and treatment of meningitis. We conducted a retrospective study utilizing clinical records from 1443 adult patients admitted to Lira Regional Referral Hospital (LRRH) over three time periods between 2015-2024. Group 1 included 321 patients in a historical control group; Group 2 consisted of 890 patients during the CM-DTP and Group 3 included 232 patients during the MEN-DTP. Group 1 received routine meningitis care, Group 2 received testing and treatment focused on CM, and Group 3 received expanded diagnostic testing, including gram stain, culture, PCR- and antigen-based testing. Meningitis diagnosis and in-hospital mortality outcomes were assessed to evaluate our programs. A confirmed meningitis etiology was found in 13.7% in Group 1, 20.7% in Group 2, and 42.2% in Group 3. In Group 3, confirmed etiologies were identified based on culture (n = 30), Pastorex LA (n = 23), BioFire PCR (n = 56), GeneXpert Ultra (n = 14), and serum or CSF CrAg LFA (n = 53). Overall, more confirmed etiologies of meningitis were identified among people living with HIV (PLWH) (n = 319) compared to those without HIV (n = 22) in Group 3. Antibiotic use increased with pre-admission antibiotic use doubling from Group 1 to Group 3 (10.6% to 27.2%). Compared to Group 1, mortality improved in Groups 2 and 3. Overall, PLWH had increased mortality compared to those without HIV (32.4% vs. 13.3%). Introduction of molecular diagnostics increased meningitis diagnoses and improved outcomes, particularly in those with CM. MEN-DTP increased confirmed diagnoses, yet half remained undiagnosed, supporting investigation of deep sequencing technologies.

Copyright: © 2026 Link et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.