Donne Ameme

Assessing Lymphatic Filariasis Data Quality in Endemic Communities in Ghana, Using the Neglected Tropical Diseases Data Quality Assessment Tool for Preventive Chemotherapy

Background The activities of the Global Programme for the Elimination of Lymphatic Filariasis have been in operation since the year 2000, with Mass Drug Administration (MDA) undertaken yearly in disease endemic communities. Information collected during MDA–such as population demographics, age, sex, drugs used and remaining, and therapeutic and geographic coverage–can be used to assess the quality of the data reported. To assist country programmes in evaluating the information reported, the WHO, in collaboration with NTD partners, including ENVISION/RTI, developed an NTD Data Quality Assessment (DQA) tool, for use by programmes. This study was undertaken to evaluate the tool and assess the quality of data reported in some endemic communities in Ghana. Methods A cross sectional study, involving review of data registers and interview of drug distributors, disease control officers, and health information officers using the NTD DQA tool, was carried out in selected communities in three LF endemic Districts in Ghana. Data registers for service delivery points were obtained from District health office for assessment. The assessment verified reported results in comparison with recounted values for five indicators: number of tablets received, number of tablets used, number of tablets remaining, MDA coverage, and population treated. Furthermore, drug distributors, disease control officers, and health information officers (at the first data aggregation level), were interviewed, using the DQA tool, to determine the performance of the functional areas of the data management system. Findings The results showed that over 60% of the data reported were inaccurate, and exposed the challenges and limitations of the data management system. The DQA tool is a very useful monitoring and evaluation (M&E) tool that can be used to elucidate and address data quality issues in various NTD control programmes.

Review of meningitis surveillance data, upper West Region, Ghana 2009-2013

Introduction The Upper West region of Ghana is within the meningitis belt. Analysis of long term surveillance data is necessary for understanding changes in the disease occurrence. We analyzed five years of surveillance data to describe by person, place and time and to determine trends in meningitis. Methods Meningitis surveillance data from Ghana Health Service in the Upper West Region, from 2009 to 2013 were reviewed. Data was obtained from District-Health Information Management System and line list from the Disease Control Unit. Population figures (denominators) and rainfall data were also analyzed. Results Within the period 980 cases of meningitis were reported in the region, 507(52%) females and 473(48%) males. The mean age of cases was 20.1years and standard deviation 18.8 years with, 77.6 %( 761/980) cases occurring in persons aged under 30 years. Children under five years were 19.3% (190/980). Attack rates ranged from 6.1/100,000 population in the Daffiama-bussei-Issa-district to 47.5/100,000 in Jirapa. Overall case fatality rate of meningitis was 12.2% with 14deaths/100,000 population. Bacterial agents were isolated from 35% (245/702) of CSF. Majority were Streptococcus pneumonia 48.2 % ( 122/258), and N. meningitides Y/W 135 40.3% (102/258). Meningitis was found to be seasonal with peaks in the dry season. Conclusion Meningitis in the region is seasonal, and showed a decreasing trend. Jirapa, Lawra, Nadowli and Wa West districts had the highest burden. Control effort of the disease should focus on vaccination against streptococcus pneumonia and N. meningitis W135 especially within crowded settlements such as boarding schools.

Capacity assessment of selected health care facilities for the pilot implementation of Package for Essential Non-communicable Diseases (PEN) intervention in Ghana.

Introduction Non-communicable diseases (NCDs) continue to pose threats to human health and development worldwide. Though preventable, NCDs kill more people annually than all other diseases combined. The four major NCDs namely cardiovascular diseases, chronic respiratory diseases, diabetes and cancers share common modifiable risk factors. In order to prevent and control NCDs, Ghana has adopted the World Health Organisation Package for Essential NCD (WHO-PEN) intervention, to be piloted in selected districts before a nationwide scale-up. We assessed the capacity of these facilities for the implementation of the WHO-PEN pilot. Methods We conducted a cross-sectional health facility-based survey using a multistage sampling technique. We collected data on human resource, equipment, service utilization, medicines availability and health financing through interviews and observation. Descriptive data analysis was performed and expressed in frequencies and relative frequencies. Results In all, 23 health facilities comprising two regional hospitals, three district hospitals, nine health centres and nine Community-based Health Planning and Services (CHPS) compounds from three regions were surveyed. All the hospitals had medical officers whilst 4 (44.4%) of the health centres had physician assistants. Health financing is mainly by the National Health Insurance Scheme (NHIS). None of the health facilities had spacers and only one health centre had oxygen cylinder, glucometer and nebulizer. Conclusion Gaps exist in the human resource capacity and service delivery at the primary care levels, the focus of WHO-PEN intervention. Adequately equipping the primary health care level with trained health workers, basic equipment, medications and diagnostics will optimize the performance of WHO-PEN intervention when implemented.

Trends of diarrhoeal diseases in children under five years in the War Memorial Hospital-Navrongo, Ghana: 2010-2013

Introduction Diarrhoea is the third leading cause of hospital morbidity in children under five years in the War Memorial Hospital (WMH). With the current changes in climate, little is known about the seasonal and spatial distribution of diarrhoeal diseases in the WMH. We determined trends of diarrhoeal diseases in children under five years in the WMH. Methods We reviewed secondary data of children under five years who attended the WMH and were diagnosed of diarrhoea. Diarrhoea was defined as a clinicians diagnosis of the passage of three or more watery stools a day in a child under five years in the WMH. Descriptive data analysis was done and expressed as frequencies and relative frequencies. Monthly proportions of diarrhoea and rainfall figures were presented to show seasonal distributions of cases. Geographical distribution of cases was determined using Epi Info and Arc GIS. Results A total of 865 diarrhoeal cases in children under five years reported to the hospital. Out of this, 425 (49.13%) were female children with 346 (40%) aged 0-11 months. The highest peak occurred in the rainy season from May to August. However, there was a weak negative relationship between diarrhoeal diseases and rainfall for the whole study period. Cases were clustered in the northeastern part of the Kassena Nankana Municipality (KNM). Conclusion The most affected age group was in 0-11months. Majority of cases were from the North Eastern part of the Municipality. There was seasonal variation of diarrhoeal diseases. Diarrhoeal diseases have the highest occurrence in the rainy season but an increase in rainfall does not necessarily lead to an increase in diarrhoeal cases. Intervention to reduce diarrhoea should be intensified before the rainy season and in the northeastern parts of the municipality.

Evaluation of bacterial meningitis surveillance data of the Northern Region, Ghana, 2010-2015

INTRODUCTION Bacterial meningitis is a disease of major public health importance especially for countries such as Ghana; whose northern part lies within the meningitis belt. The Northern region of Ghana has been recording cases with outbreaks over the years. In order to generate evidence to improve surveillance, we described the epidemiology of bacterial meningitis using surveillance data of the northern region. METHODS Bacterial meningitis datasets from January 2010 to December 2015 for all the 26 districts of the Northern region were retrieved from line lists. Data were analyzed in terms of person, place, time, and identity of causative organisms using descriptive statistics. The results were presented as proportions, rates, tables and graphs. RESULTS A total of 1,176 cases were reported. Of these, 53.5% (629/1,176) were males. The proportion of cases aged 0 to 29 years was 77.4%. The Overall Case Fatality Rate (CFR) was 9.7% (114/1,176). About 65% of all cases were recorded from January to April. Only 23.7% (279/1,176) of cases were laboratory-confirmed. Neisseria meningitides and Streptococcus pneumonia accounted for 91.4% of confirmed cases. Over the period, the incidence reduced from 9.0/100,000 population to 3.8/100,000 population and CFR reduced from 16.6% to 5.7%. CONCLUSION Most cases of bacterial meningitis were recorded in the dry season and in persons younger than 30 years. Less than a quarter of cases were laboratory confirmed, and no new bacteria species were identified. Both morbidity and mortality rates were on the decline. There is the need to consolidate these gains by intensifying meningitis surveillance and improving on the rate of laboratory case confirmation.

Pattern of diarrheal diseases in Atwima Nwabiagya District-Ghana, 2009- 2013.

Introduction Diarrheal diseases remain one of the most important public health challenges worldwide. In 2011, Ghana recorded average annual diarrheal cases of 2,218 per 100,000 populations for children under-five with Ashanti region recording the third highest. In the Atwima Nwabiagya District, summary statistics are done without detailed analysis. We analyzed diarrheal surveillance data to determine its pattern and to develop threshold levels for the disease in Atwima Nwabiagya District in the Ashanti Region of Ghana. Methods District level diarrheal morbidity data from January 2009 to December 2013 was extracted from District Health Information Management System II, cleaned and analyzed. Descriptive analysis was done and expressed as frequencies and relative frequencies. Description of the data was done in time, place and person. We calculated diarrhea threshold using the C2 method. Results Overall, 51,131 cases were reported with 55.2% being females over the five year period. The highest episode of diarrhea by age-group occurred in children under-five during the study period. Changes in disease occurrence did not conform to a seasonal pattern. District analysis showed one outbreak whilst sub-district analysis revealed more than one outbreak. Conclusion Diarrheal disease pattern did not show a seasonal trend. Only one outbreak was observed at district level but each sub-district, showed more than one outbreak. The highest number of episodes of diarrhea per year occurred in Children under- five. Data analysis should be done at lower levels to inform interventions. Interventions should be targeted towards children under-five years.

Training Ghanaian frontline healthcare workers in public health surveillance and disease outbreak investigation and response

Introduction Beyond initial formal academic education, the need for continuous professional development through in-service workforce capacity improvement programs that are aimed at enhancing knowledge and skills of public healthcare workers has assumed immense priority worldwide. This has been heightened by the on-going Ebola Virus Disease outbreak, which is exposing the weak public health systems in West Africa. In response to this need, the Ghana Field Epidemiology and Laboratory Program organized a short-course for frontline health workers in the Greater Accra region of Ghana in order to augment their surveillance and outbreak response capacity. Methods Human and veterinary health workers were trained using Field Epidemiology and Laboratory Training Program short course model. A two-week didactic course was conducted with a 10-week field placement. Evaluation of the course was done by assessment of participants’ outputs during the training as well as pretest and posttest methods. Results A total of 32 frontline health workers from both the human and veterinary health services benefited from the two-week initial training of the 12-week course. There was a significant gain in knowledge by the participants after the training course. Participants developed concept papers and implemented their fieldwork projects. Overall assessment of the workshop by the participants was very good. Conclusion Capacity of the health workers has been improved in the area of public health surveillance, outbreak investigation and response. We recommend a scale-up of this training course to other regions.

Direct observation of outpatient management of malaria in a rural ghanaian district

Introduction In Ghana, malaria continues to top outpatient morbidities; accounting for about 40% of all attendances. Effective case-management is key to its control. We evaluated case-management practices of uncomplicated malaria in Kwahu South District (KSD) health facilities to determine their conformity to guidelines. Methods We conducted a cross sectional survey at all public health facilities in three randomly selected sub-districts in KSD. A non-participatory observation of suspected malaria consultations was conducted. Suspected malaria was defined as any person with fever (by history or measured axillary temperature > or equal 37.5 oC) presenting at the selected health facilities between 19th and 29th April 2013. Findings were expressed as frequencies, relative frequencies, mean (± standard deviation) and median. Results Of 70 clinical observations involving 10 prescribers in six health facilities, 40 (57.1%) were females and 16 (22.9%) were below five years. Median age was 18 years (interquartile range: 5-33). Overall, 63 (90.0%) suspected case-patients had diagnostic tests. Two (3.6%) were treated presumptively. All 31 confirmed and 10 (33.3%) of the test negative case-patients received Artemisinin-based Combination Therapies (ACTs). However, only 12 (27.9%) of the 43 case-patients treated with ACT received Artesunate-Amodiaquine (AA). Only three (18.8%) of the under-fives were examined for non-malarial causes of fever. Mean number of drugs per patient was 3.7 drugs (± 1.1). Only 45 (64.3%) patients received at least one counseling message. Conclusion Conformity of malaria case-management practices to guidelines in KSD was suboptimal. Apart from high rate of diagnostic testing and ACT use, prescription of AA, physical examination and counseling needed improvement.

Gastroenteritis Outbreak in a Senior H igh School, Akwapim North District, Eastern Region-Ghana, 2012

Background : On the 28 th of October, 12 students from a Senior -High-School (SHS) in the Akwapim North-District-Ghana, reported to the district hospital with abdominal cramps, diarrhea and vomiting. We investigated to identify the cause, the source of infection and to recommend control measures. Methods: We conducted a descriptive investigation; with activ

Upsurge in meningitis cases in Jirapa district, Upper West Region – 2017

introduction : cerebrospinal meningitis is an inflammation of the meninges around the brain and spinal cord, characterized by sudden onset headache, fever, neck stiffness and sensitivity to light. The most common form of meningitis is bacterial which includes Neisseria meningitides, Haemophilus influenza, and Streptococcus pneumonia . Epidemics occur annually between late November and June in the African belt and constitutes a major health threat. Beginning 2017, Ghana reported 69 suspected cases with 9 deaths in Ashanti and Upper West Region. By the 8 th epidemiological of 2017, Jirapa District in the Upper West Region reported 41 suspected cases of meningitis with six deaths. We investigated to verify the diagnosis, identify risk factors and implement control measures. Methods : we conducted a descriptive study. A case-patient was anybody living in Jirapa and its environs and reporting with or without fever of acute onset and with one or more of the following signs; neck stiffness, poor sucking (in infants), bulging fontanelles (in infants), altered consciousness, irritability, seizures, and other meningeal signs. We reviewed medical records, conducted active case search and contact tracing. We interviewed case-patients and contacts and conducted an environmental search. We reviewed laboratory records for CSF examinations. We analyzed data by person, place and time. Results : of 61 case-patients, 32 (53.3%) were female. The case fatality was 6/61 (9.8%). Median age was 16.5 years (interquartile range: 1-86 years). Most affected age group were below 10 years. Conclusion : streptococci pneumonia was responsible for the upsurge in cases. Children were mostly affected.