George Khumalo Kuma

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.

Analysis of laboratory confirmed meningitis data after an outbreak of meningitis in Brong Ahafo Region, Ghana, 2016

Introduction : laboratory confirmation of etiologic agents of meningitis is important for disease classification, treatment decisions, and surveillance. In 2016, there was a major outbreak of meningitis in the Brong Ahafo Region (BAR), with 968 cases and 87 deaths (CFR 9.0%). Most of the Cerebro-spinal fluid (CSF) samples collected during the outbreak were sent to Brong Ahafo Regional Hospital Laboratory (BARHL), for the confirmation of etiologic agent(s). We analyzed laboratory data for meningitis at the BARHL to establish the predominant causative agent(s), their distribution and antibiotic susceptibility profiles. Methods : we conducted a retrospective descriptive study. We extracted and reviewed meningitis data from the BARHL registers and meningitis case-based forms for the 2016 outbreak. Variables collected included the district of residence, sex, age, etiologic agent, and antibiotic results. Univariate analyses were done to generate frequencies, ranges, percentages, and proportions. These were presented as text and graphs. Results : samples were received from 20 (74%) of 27 districts in BAR. Of 608 samples, 537(88.3%) had confirmed results. Majority of confirmed cases were females, 297(55.3%), and, ages ranged from 7days to 98years (modal age 18years). A total of 125 (23.7%) were positive for bacterial pathogens. The distribution of pathogens were Streptococcus pneumonia, 97 (77.6%), Neisseria meningitides, 27 (21.6%), Haemophilus influenza type B, 2(1.6%) and Group B Streptococcus, 1 (0.8%). Majority of pathogens, 46(36.8%) were isolated from age-group, 10-19years. Over 80% of the pathogens were susceptible to Ciprofloxacin and Ceftriaxone, but resistant to co-trimoxazole, (77.4%) and tetracycline, (91.0%). Of the districts, Jaman North, 36 (28.8%), Wenchi, 16 (12.8) and Tain, 13 (10.4) had the highest proportion of confirmed meningitis pathogens Conclusion : predominant pathogen identified during the outbreak was Streptococcus pneumoniae. Most were susceptible to Ceftriaxone and Ciprofloxacin. Majority of identified pathogens were amongst age-group 10-19years and from Jaman North District. We recommend the use of Ceftriaxone antibiotic during meningitis outbreaks and vaccination of at risk populations in BAR.

Analysis of malaria diagnosis and treatment data amongst pregnant women after the implementation of test-treat-track policy, Brong Ahafo Region-2017

Introduction : in 2015, WHO estimated 212 million malaria cases, with resulting 429 000 deaths globally. In the same year, Africa recorded 90% of malaria cases and 92% of malaria deaths. In Ghana, among pregnant women, malaria accounts for 17.6% of OPD attendance, 13.7% of admissions, and 3.4% of maternal deaths. Strategy for malaria control in endemic countries hinges on diagnosis, treatment, and surveillance. However, the proportion of suspected Malaria treated without laboratory diagnosis has remained high. In 2012, WHO initiated the Test-Treat-Track (T3) policy to reduce the proportion of suspected malaria not confirmed by a laboratory before treatment. We analyzed malaria data amongst pregnant women to determine trends of laboratory diagnosis to provide information on the progress of the T3 policy in the Brong Ahafo Region (BAR). Methods : we conducted a retrospective descriptive data analysis of suspected malaria among pregnant women in BAR, for the period 2012 to 2016. We abstracted data from the District Health Information Management System (DHIMS) data base, consulting room, admissions and Ante-natal Clinic registers. Variables collected included diagnostic and treatment status, age, and district of residence. Data were analyzed using Microsoft Excel for frequencies and proportions and presented in text, tables, and charts. Results : a total of 99,896 pregnant women were suspected of Malaria for the period 2012-2015 in BAR. The age range was 10-49years (median 26years). Majority of suspected cases were age group 20-34years, 4560/99896 (4.6%). Of the total suspected cases, 7826/99896(7.8%) were treated without laboratory diagnosis confirmation. The trend of proportion of suspected cases not confirmed by laboratory was 2014, 3.3% (3336/99896), 2015, 1.9% (1849/99896), and 2016, 2.6% (2641/99896). There was no data for laboratory confirmed cases for the period 2012 and 2013 in the DHIMS data base. The highest proportion of suspected cases without laboratory confirmation was from Techiman Municipal, 12.8% (1004/7826), while the least proportion was from Nkoranza North, 0.3% (21/7826). Conclusion : the proportion of treated Malaria in pregnancy not confirmed by a laboratory has increased from 2015 (1.9%) to 2016 (2.6%) in BAR, despite the T3 policy implementation. We recommend Brong Ahafo regional health directorate to sensitize clinician on the need for laboratory testing before treatment of malaria amongst pregnant women.

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.

Diarrheal diseases among children under five years in Brong Ahafo Region, Ghana, 2016

Introduction : diarrhoea is the frequent and excessive discharge of bowels caused by a wide range of agents. Rotavirus is the most common agent that causes acute watery diarrhoea in children Under Five Years (U5). Globally, Diarrheal Diseases (DD) account for 1 in 9 deaths in children U5. In Ghana, rotavirus vaccine is administered in two doses at six and ten weeks. DD in children U5 from Brong Ahafo Region (BAR) were analyzed to establish trends and long-term changes, describe reasons for changes, determine where cases were occurring, detect aberrations in the patterns and determine the data quality.