Meningitis is a serious infection of the meninges, the membranes covering the brain and spinal cord. Despite remarkable progress in the fight against meningitis over the last 20 years, this devastating disease continues to pose a major public health problem worldwide [1] . Indeed, around 8.5 million new cases of meningitis and 463,000 deaths were reported worldwide in 2019, including 22,414 new cases and 1261 deaths in the countries of the African meningitis belt [2] .

Meningitis has affected sub-Saharan Africa for centuries. Before the 1980s, it was irregular, but since the early 1980s it has become endemo-epidemic [3] [4] . In the 1980s and 1990s, the World Health Organization (WHO) recorded between 25,000 and 200,000 cases of meningitis per year in West Africa, including around 10% of deaths [5] . In 2020, the Member States of the African Meningitis Belt reported 19,552 new cases and 885 deaths from meningitis [2] .

Meningitis can be caused by many different pathogens, including bacteria, fungi and viruses [2] [6] - [8] . However, it is bacterial meningitis that represents the greatest burden worldwide . Acute bacterial meningitis is most often caused by four (4) pathogens: Neisseria meningitidis (meningococcus), Streptococcus pneumoniae (pneumococcus), Haemophilus influenzae type b (Hib) and Group B Streptococcus (GBS) [9] [10] . The route of transmission varies according to the pathogen. Meningococci, pneumococci and Haemophilus influenzae type b are transmitted via droplets of respiratory secretions, while group B streptococci are transmitted from mother to child at the time of delivery .

N. meningitidis, responsible for cerebrospinal meningitis, is the bacterium most likely to cause major epidemics. Twelve N. meningitidis serogroups have been identified, six of which (A, B, C, W, X and Y) can cause epidemics [11] [12] . Before 2010, Neisseria meningitidis serogroup A (NmA) was the main cause of meningitis epidemics, accounting for almost 90% of outbreaks. With the introduction of the Neisseria meningitidis serogroup A conjugate vaccine (MenAfriVac) between 2010 and 2020, more than 325 million people aged between 1 and 29 have been vaccinated in the African meningitis belt [13] [14] . This vaccination has considerably reduced the number of cases of Neisseria meningitidis serogroup A and changed the bacteriological profile of meningitis, which is now marked by a predominance of Streptococcus pneumoniae (50%), Haemophilus influenzae type b (15%), Neisseria meningitidis serogroup X (14%), Neisseria meningitidis serogroup C (4%) and Neisseria meningitidis serogroup W (2.8%) [2] [15] .

Recent research confirms that practical strategies such as offering vaccination directly on university campuses significantly improve meningococcal vaccine uptake rates. A UK study by Bell et al. [16] found that the majority of students preferred to receive the MenACWY vaccine on-site, not least because of frequent uncertainty about their vaccination status. Complementarily, Moore et al. [17] demonstrated that a campaign combining awareness and free on-campus vaccination led to a substantial increase in MenB vaccination initiation and completion rates in the USA. These results support the importance of targeted interventions combining physical accessibility and clear communication to promote vaccine acceptance in university settings.

Meningitis is endemo-epidemic in Côte d’Ivoire. The northern part of the country is located in the African meningitis belt stretching from Senegal to Ethiopia [18] , where the incidence can reach 1000 cases per 100,000 inhabitants [19] . In 2020, 123 suspected cases of meningitis were recorded, with 30 confirmed cases, including 10 from the north of the country [20] . Despite the highly contagious nature of this disease, a study carried out among healthcare staff at Abidjan’s university hospitals showed a meningitis vaccination coverage rate of less than 50% [21] , revealing that the practice of vaccination is still of little concern to the population. In Côte d’Ivoire, MenAfriVac is the main meningitis A vaccine. This vaccine was introduced into the Expanded Program on Immunization (EPI) in August 2018 and is intended for children aged nine months in order to reduce meningitis epidemics. Other meningococcal ACWY and B vaccines are also used as part of routine vaccination for young people and adults [22] .

The Korhogo region in northern Côte d’Ivoire, home to the Université Peleforo Gon Coulibaly (UPGC), is a meningitis-endemic area [23] . It experienced bacterial meningitis epidemics in 2012 and 2016, resulting in 11 and 14 deaths respectively [24] [25] . As young adults, students are a particularly vulnerable group, as they are often exposed to environments conducive to the transmission of infectious diseases (overcrowded lecture theaters and classrooms, crowded living conditions in university halls of residence). However, despite the availability of a meningitis vaccine, the practice of vaccination remains a worrying public health issue in Côte d’Ivoire. The aim of this study is to assess knowledge and vaccination coverage against epidemic meningitis among students at the Université Peleforo Gon Coulibaly in Korhogo, with a view to developing appropriate intervention strategies.

The sample size n for the survey was obtained using the following equation [28] [29] :

n = z²*p (1 – p)/e²

where, z, the confidence level deduced from the confidence interval. We generally take the value 1.96 for a confidence level of 95%. p, the estimated prevalence of meningitis. In Korhogo, as we do not know the prevalence of meningitis, we have assumed a maximum prevalence p of 50%. e, desired precision (margin of sampling error) traditionally set at 5%. Applying this formula, a minimum of 384 students must be surveyed. For reasons of non-response, this minimum size has been increased by 5%. Thus, a total of 404 students were surveyed.

The study was approved by the authorities of the Université Peleforo Gon Coulibaly (UPGC) in Korhogo. The study protocol was presented and approved at a validation workshop for Master’s students initiated by the Department of Animal Biology of the Training and Research Units (TRU) of UPGC. Prior to the survey, each student was informed of the objectives of the study and of the free and voluntary nature of his or her participation. Oral informed consent was obtained from each student before they completed the questionnaires. All students interviewed were assured that the information collected as part of this study would remain anonymous and strictly confidential.

Meningitis is a serious infection of the membranes surrounding the brain and spinal cord, the severe forms of which are in the majority of cases caused by bacteria [10] . It is a devastating disease that remains a major public health challenge. Despite the high lethality of this disease and the availability of preventive vaccines, the vaccination rate against meningitis remains low in Côte d’Ivoire [21] . The aim of this study was to assess knowledge and vaccination coverage against epidemic meningitis among students at the Université Peleforo Gon Coulibaly (UPGC) in Korhogo, a town in northern Côte d’Ivoire located in the African meningitis belt.

The results of this study showed that two-thirds (66%) of the students surveyed claimed to know about meningitis. However, the knowledge score showed that more than half (53%) of the students surveyed who said they knew about meningitis had poor knowledge of the disease. Indeed, the general population’s knowledge of meningitis, particularly meningococcal meningitis, is high in the countries of the meningitis belt, a geographical area of sub-Saharan Africa prone to epidemics [33] [34] . Students in meningitis belt countries in general, and those in Korhogo in particular, need to be informed and made aware of the risks, symptoms, modes of transmission, preventive measures and treatments of this devastating disease, as they are regularly in environments conducive to its transmission and spread (overcrowded lecture theaters and classrooms, crowded living conditions in university halls of residence).

The meningitis vaccination rate found among students at UPGC Korhogo was 16% (IC 95%: 12.6 - 20.04). The master’s level of study among students was identified as a factor that favors the practice of meningitis vaccination. However, being a student from Korhogo (indigenous) is a risk factor for meningitis vaccination. The absence of vaccination among Korhogo’s indigenous students could be explained by the use of traditional medicine, an endogenous practice widely used by Korhogo’s indigenous populations to treat or prevent infectious diseases [35] .

The main reasons given by non-vaccinated students for not vaccinating against meningitis were lack of information on the existence of a vaccine against this disease, and neglect of vaccination. The results obtained in this study should be brought to the attention of the Korhogo health authorities in general, and the head of the Korhogo branch of the Institut National de l’Hygiène Publique (INHP) in particular, where meningitis vaccination is carried out for young people and adults, with a view to organizing information and awareness campaigns in the public and private universities of the Korhogo region. Epidemiological studies, in particular those carried out by the Institut de Veille Sanitaire (InVS), have shown that effective awareness campaigns, providing a good understanding of diseases with epidemic potential, increase people’s adherence to vaccinations against these diseases [36] .

Lack of financial means was cited by less than 5% of unvaccinated students. Although this proportion is low, it highlights the need to make vaccination more accessible, in particular by providing free or subsidized vaccines for students, the majority of whom do not benefit from financial subsidies. In Côte d’Ivoire, the meningitis vaccine costs 6000 FCFA (around £9.2) and lasts for 3 years, renewable. This polyvalent vaccine protects against N. Meningitidis serotypes A, C, Y and W135. A study carried out in West Africa showed that the elimination of economic barriers significantly improved vaccination coverage rates [37] .

The neglect of vaccination mentioned by 18% of students reflects a problem of perceptions about vaccination. This neglect of vaccination could be resolved by more targeted communication campaigns, explaining the benefits of the vaccine. Studies have shown that clear messages, combined with the involvement of local health actors and community leaders, can reduce fears and increase vaccination rates [38] [39] . The results of this study are in line with those achieved in other countries of the “meningitis belt” in sub-Saharan Africa. In these regions, a combination of factors such as lack of awareness, cultural beliefs and economic barriers account for low vaccination rates [37] . Mass vaccination campaigns, combined with health education programs in universities, have often reversed this trend. A study carried out in Niger showed that a free vaccination campaign, combined with information sessions in universities, increased the vaccination coverage rate from 20% to 70% within six months [40] .

Our study may have limitations linked to recall and information bias, due to certain answers calling on the memory of respondents, such as the meningitis vaccination status of students, which could affect our results. To minimize this bias, in our study we considered a student to have been vaccinated against meningitis if he or she stated that he or she had been vaccinated in a health facility of the Institut National d’Hygiène Publique (INHP) or by an INHP mobile team using an advanced vaccination strategy. Indeed, the INHP is the structure of the Ministry of Health and Public Hygiene and Universal Health Coverage (MSHP-CMU) in Côte d’Ivoire authorized to vaccinate young people, adults and the elderly against meningitis. Bias was also minimized by using a questionnaire corrected and validated by an INHP public health specialist, then pre-tested on 10% of the sample for questionnaire quality control. Finally, we carried out a multivariate analysis using logistic regression, which enabled us to identify the significant factors explaining meningitis vaccination coverage among UPGC Korhogo students, and to control for confounding factors.

However, despite the potential biases in this study, our results are valuable for informing public health actors at national level and in the Korhogo region in particular, to guide strategies for the prevention and control of meningitis in university settings in Côte d’Ivoire.

To improve students’ knowledge of meningitis, we recommend that the Institut National d’Hygiène Publique (INHP) in Korhogo organize information and awareness campaigns on meningitis at the Université Peleforo Gon Coulibaly, in collaboration with university departments and student associations. These campaigns are expected to include interactive sessions, visual teaching aids and testimonials from students vaccinated against meningitis. To promote meningitis vaccination, vaccination days should be organized on the university site in partnership with local health authorities. This vaccine should be free or subsidized to enable a large number of students to be vaccinated against meningitis. Finally, it is essential to combat misinformation about vaccination through awareness campaigns, by disseminating clear, scientifically-validated messages and training student ambassadors responsible for relaying this information to their community.

The assessment of knowledge and vaccination coverage against meningitis among students at the Université Peleforo Gon Coulibaly (UPGC) in Korhogo identified the main factors explaining the low rate of vaccination against this disease. These include students’ poor knowledge of meningitis and lack of information on the vaccine against this disease. This study shows the need to intensify information and awareness campaigns on meningitis in university environments in Côte d’Ivoire in general, and in Korhogo in particular, to reinforce strategies to combat this potentially epidemic disease.