Charles Lwanga Noora

Analysis of tuberculosis surveillance data, Sunyani West District, Brong Ahafo

Introduction : more people die from tuberculosis (TB) than from any other curable infectious disease in the world. Though there have been many new interventions and investment in controlling and eradicating TB in the world particularly in Africa, TB still remains a major public health threat. In 2015, Brong Ahafo recorded a TB detection rate of 84% meaning 16% of cases went undetected. Sunyani West District recorded 37 new TB cases with 7 (19%) deaths. Each year, surveillance data on TB is recorded in the districts. In Sunyani West District however, this data is not evaluated or used in improving the system. The aim of the study was to analyse a five-year tuberculosis surveillance data in the District. Methods : we conducted secondary analysis on TB surveillance data in the Sunyani West District from 2011-2015. Data was obtained from TB registers and District health information management system (DHIMS 2) of the Sunyani West District. Variables abstracted were age group, sex, sub-district and treatment outcome and presented in tables and graphs. Results : a total of 140 patients were diagnosed with TB in Sunyani West District between 2011 and 2015, with the mean (SD) age of 41.7(18.06) years. Males were most affected (72.9%) with year 2014 recording the highest proportion (50.33%). Chiraa sub-district recorded the highest proportion (28.6%) and 45% of the total patients with TB completed treatment. Conclusion : TB infection increased in 2014 with a death rate of 7.5 per 100,000 therefore health education on prevention and benefits early treatment should be intensified in the communities especially among males and in the sub-district.

Analysis of meningitis outbreak data, Jaman North District (JND), August 2016

Introduction : meningitis is the inflammation of the covering of the brain and the spinal cord. On 28 th January, an outbreak of meningitis occurred in JND. We conducted a secondary data analysis of the outbreak to characterize it to suggest preventive strategies for control of future outbreaks. The objective of this study was to determine the magnitude and the trend of the outbreak. Analysis of data focused on incidence and case fatality. Methods : the study was descriptive secondary data analysis. Data analysis was performed by the researcher using Microsoft Excel 2007 spreadsheet. VariableS such as Sex, age groups, date of onset, bacterial strain and sub district distribution were analyzed by the use of tables and graphs. Data was extracted from case based forms and line list. Results : a total of 367 cases with 44 confirmed were recorded during the period of January to March, 2016. The case fatality rate was 0.82% and the proportion among males and females was 43.6% against 56.4%. The modal age group was 15-29 years (201 cases) and the lowest age groups were 0-14 years (49 cases) with a mean age of 58 years. Streptococcus pnuemoniae formed 77.3% of confirmed cases whilst Neisseria meningitis was 20.5%. Conclusion : sporadic, protracted propagated outbreak was observed. Cases were more among females and the most vulnerable group were people aged 0-29 years. The predominant bacteria strain among confirmed cases was Streptococcus pneumonia. It is recommended that, Jaman North District Health Directorate should intensify IE&C on meningitis by targeting females and people less than 29 years in the district.

Large cholera outbreak in Brong Ahafo Region-Ghana, 2014

Introduction : a nationwide outbreak of Vibrio cholera occurred in Ghana in 2014. Accra, the nation’s capital, was the epicenter. The outbreak spread to the Brong Ahafo region (BAR) which is geographically located in the middle belt of the country. In this region a review of data collected during the outbreak was carried out and analyzed descriptively to determine the hot spots in order to make recommendations for effective response to future outbreaks. Methods : a review of patient’s records and line lists of cases of cholera reported in all hospitals during the period of the outbreak (July-December 2014) was conducted. Hospitals used IDSR (integrated disease surveillance and response system) standard case definitions to detect and report cases for management. The GPS coordinates of all districts and health facilities were collected and utilized in the construction of spot maps. We also obtained populations (denominators) from the BAR Health surveillance unit of the Ghana Health service. All the data thus collected was analyzed descriptively and expressed as frequencies and rates. Results : a total of 1,035 cases were reported, 550 (53.4%) were males. Their ages ranged from 1 to 95 years; (mean age of 28.2 ±19.6 years). The most affected (23.5%) was the 20-29-year old age group. On the 30th July 2014, a 26-year old male (recorded as the index case of the cholera outbreak in the Brong Ahafo region) with a travel history to Accra reported to the Nkoranza district hospital and presented with signs and symptoms suggestive of cholera. The outbreak lasted 25 weeks; peaking in the week 15 with 179 (17.3%) cases. An overall attack rate of 71/100,000 population and a case fatality rate of 2.4% were recorded in the region. Asutifi South district, however, recorded a case fatality of 9.1%, the highest amongst all affected districts. The majority of the cases reported in the region were from Atebubu-Amanten (31.1%), Sene West (26.2%), Pru (18.2), and Asunafo North (9.9%) districts. Vibrio cholerae serotype O1 was isolated from rectal swabs/stool samples. Conclusion : vibrio cholerae serotype O1 caused the cholera-outbreak in the Brong Ahafo Region and mainly affected young adult-males. The most affected districts were Atebubu-Amanten, Sene west, Pru (located in the eastern part of the region), and Asunafo North districts (located in the south west of the region). Case Fatality Rate was higher (2.4%) than the WHO recommended rate (< 1%). Active district level public health education is recommended for prevention and effective response to future outbreaks of cholera.

Management of dog bites by frontline service providers in primary healthcare facilities in the Greater Accra Region of Ghana, 2014–2015

BackgroundDog bites are common in developing countries including Ghana, with the victims often being children. Although some breeds of dogs have been identified as being more aggressive than others, all dog bites carry a risk of infection. Immediate and initial assessment of the risk for tetanus and rabies infection with appropriate interventions such as wound management and subsequent selection of prophylactic antibiotics are essential in the management of dog bites. This study examined the management of patients with dog bites by frontline service providers at primary healthcare facilities in the Greater Accra Region, Ghana.MethodsWe conducted a cross-sectional study in 66 public health facilities in the Greater Accra Region from July 2014 to April 2015. Up to four frontline service providers were randomly selected to participate from each facility. A structured questionnaire was administered to all consenting participants. Continuous variables were presented as means and standard deviations. The frontline service providers’ knowledge was assessed as a discrete variable and values obtained presented as percentages and proportions. The chi-square test of proportions was used to determine any significant associations between the various categories of the frontline service providers and their knowledge about the management of rabies.ResultsRegarding the frontline service providers’ knowledge about rabies, 57.8% (134/232) were correct in that the rabies virus is the causative agent of rabies, 39.2% (91/232) attributed it to a dog bite, 2.6% (6/232) did not know the cause, and one person (0.4%) attributed it to the herpes virus. Only 15.5% (36/232) knew the incubation period in dogs and the period required to observe for signs of a rabies infection. With respect to the administration of rabies immunoglobulin, 42.2% (98/232) of the frontline service providers did not know how to administer it. Of the facilities visited, 76% (50/66) did not have the rabies vaccines and 44% (102/232) of frontline service providers did not know where to get the rabies vaccines from. Most of the service providers (87.9%; 204/232) had never reported either a dog bite or a suspected case of rabies. Overall, there was gross underreporting of dog bites and suspected rabies cases at public healthcare facilities in the Greater Accra Region of Ghana.ConclusionsIn view of the high morbidity and mortality associated with bites from rabid dogs and the poor knowledge and practices of frontline service providers, there is an urgent need for capacity-building such as training in the management of dog bites and subsequent potential rabies infection.