Fred Wurapa

Bovine tuberculosis surveillance system 2valuation, Greater-Accra region, Ghana, 2006-2011

Introduction Bovine tuberculosis (bTB) is a chronic, zoonotic, multi-species disease of cattle caused by Mycobacterium bovis. In developed countries, effective surveillance and enforcement of regulations on bTB control resulted in significant reduction of infections in cattle and hence, humans. However, in developing countries, weak surveillance systems affect accurate and timely reporting of bTB in humans and cattle. In Ghana, transhumance movement of cattle increases the risk of bTB importation and spread, however, the extent to which surveillance detects bTB is unknown. We therefore evaluated the bTB surveillance system in the Greater-Accra Region to determine its performance and assessed its attributes. Methods We interviewed stakeholders, and reviewed bTB surveillance data for all ten districts in the region from 2006-2011 using the CDC Guidelines for Evaluation of public health surveillance systems. Results From 2006-2011, bTB was suspected in 284/244,576 (0.12%) cattle slaughtered, of which 7/284 (2.5%) were submitted for laboratory confirmation and all tested positive. Predictive value positive was 100%. There is no standard case definition which guides bTB detection. Fifty percent of carcasses slip through inspection, and confirmed cases are not traced back. There were 99/284 (34.9%) condemnations from suspected carcasses and 57/97 (58.8%) from positive reactors from screening. Ninety percent (9/10) of districts submitted reports late to the region whereas representativeness was 30%. Regional and district data were manually stored with no electronic backups. The regions cattle population is unknown. Conclusion Although the bTB surveillance system is sensitive, it is under performing, and the possibility of bTB transmission from cattle to humans is high.

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

Dog Bites and Rabies in the Eastern Region of Ghana in 2013–2015: A Call for a One-Health Approach

Background A One-Health approach is advocated to ensure effective rabies surveillance in sub-Saharan Africa. Information is needed to assess the current state of dog bites and rabies in Ghana. We analyzed data on reported events in the Eastern Region of Ghana from 2013 to 2015 to generate information that can be used for rabies elimination in Ghana through the One-Health approach. Method We extracted data on dog bites and rabies from the database of the regional health service and performed descriptive analysis using Epi Info version 7™. We followed up with interviews with three key informants from the health and veterinary services on issues related to surveillance and data quality. Results Overall, 4821 dog bites were reported over the three-year period. This translated into an annual incidence of 172 cases per a population of 100,000. Most of cases were in children aged less than 10 yrs. Fifteen (53.3% males) cases of rabies were recorded in seven out of the 26 municipalities and districts, translating into a rabies to dog bite ratio of 3: 1000. The median age of victims was 9 years (range: 3-72 years). A parallel and uncoordinated system of rabies surveillance is maintained by the health and veterinary services, with gross disparities in the number of reported events and overall impression of underreporting. Conclusion Rabies remains an important cause of preventable deaths in this region. An integrated approach to surveillance based on the One-Health concept needs to be adopted.

Foodborne disease outbreak in a resource-limited setting: a tale of missed opportunities and implications for response

Introduction Foodborne diseases (FBD) have emerged as a major public health problem worldwide. Though the global burden of FBD is currently unknown, foodborne diarrhoeal diseases kill 1.9 million children globally every year. On 25th September 2014, health authorities in Eastern Region of Ghana were alerted of a suspected FBD outbreak involving patrons of a community food joint. We investigated to determine the magnitude, source and implement control and preventive measures. Methods A retrospective cohort study was conducted. We reviewed medical records for data on demographics and clinical features. A suspected foodborne disease was any person in the affected community with abdominal pain, vomiting and or diarrhea between 25th and 30th September 2014 and had eaten from the food joint. We conducted active case search, descriptive data analysis and calculated food specific attack rate ratios (ARR) and their corresponding 95% confidence intervals. Results Of 43 case-patients, 44.2% (19/43) were males; median age was 19 years (interquartile range: 17-24 years). Overall attack rate was 43.4% (43/99) with no fatality. Case counts rose sharply for four hours to a peak and fell to baseline levels after 12 hours. Compared to those who ate other food items, patrons who ate “waakye” and “shitor” were more likely to develop foodborne disease [ARR = 4.1 (95% CI = 1.09-15.63)]. Food samples and specimens from case-patients were unavailable for testing. Laboratory diagnostic capacity was also weak. Conclusion A point source FBD outbreak linked to probable contaminated “waakye” and or “shitor” occurred. Missed opportunities for definitive diagnosis highlighted the need for strengthening local response capacity.

Outcome of Streptomycin-Rifampicin treatment of Buruli Ulcer in two Ghanaian districts

Introduction Buruli ulcer (BU) is an infectious skin disease, caused by Mycobacterium ulcerans, endemic in more than 30 countries worldwide especially Africa. Brong-Ahafo Region implemented WHO recommended daily treatment with streptomycin and rifampicin for eight weeks (SR8). Yet limited assessment of therapy exists. This study seeks to determine the outcome of SR8 therapy on BU in two endemic districts in Brong-Ahafo. Methods Longitudinal study was done with laboratory confirmed Buruli ulcer patients selected consecutively and put on SR8. Patient follow-up involved daily administration of SR8 and Bi-Weekly monitoring of treatment in the form of measurement of wound size and taking photographs. Results The mean age of participants was 34.6 ± 16.6 years with minimum and maximum ages of 10 to 65 respectively. Those in the 10-19year age group 13 (26%) were most affected. Majority, 26 (52%) had no formal education and 27 (54.0%) were peasant farmers. Thirty-eight (76.0%) had previously used traditional treatment. Forty completed treatment and of these, 28 (70.0%) healed completely and 12 (30. 0%) improved by 80%-90%. Duration of lesion before seeking healthcare (P =0.04), use of traditional treatment P < 0.001, clinical form of lesion P = 0.04, lesion category (p = 0.01), significantly affected healing. Mean time to healing, was 7.7 weeks (95% CI, 7.3 - 7.9). Conclusion Though SR8 is effective in curing BU, late reporting, use of herbs and access to health care impeded wound healing. This calls for provision of accessible health care and education to improve early reporting.