The proposed trial responds to this call, and goes one step further by adding a third arm in which chemoprophylaxis would happen at a village level following the notification of the village’s first case. This addition responds to on-the-field realities in many parts of the meningitis belt, where it may be politically difficult to treat only one household in a small village when other villagers would also be at risk. Also, despite the higher risk for household members, most households will still report only one case during an epidemic, so this community-wide strategy may have a greater impact on overall meningitis incidence.