Evaluation of the enhanced meningitis surveillance system, Yendi municipality, northern Ghana, 2010–2015

Abstract Background Meningitis is the inflammation of the meninges of the brain and or spinal cord. Global mortality rates vary from 2% to 30%. Epidemic meningitis remains a public health concern along the meningitis belt of Africa. Despite the operation of an enhanced meningitis surveillance system in Ghana, institutional mortality rates are estimated to range from 36% to 50%. In 2014, Yendi recorded 83 confirmed cases; with focal epidemics in some sub-municipals. We evaluated the system over a five-year period to find out whether it was achieving its objectives of systematic collection and analyses of data for the prevention or early detection of meningitis epidemics. Methods We used cross-sectional design. Both qualitative and quantitative data from Yendi Municipality between January 2010 and December 2015 were collected and analyzed. The updated guidelines for evaluating surveillance systems from Centers for Disease Control and Prevention were used. Content analysis was performed on the responses of key informants. Surveillance data was analyzed using MS-Excel. Results Fifteen healthcare workers were interviewed. For the period under evaluation, the annual incidence of meningitis ranged from 1.6/100,000 in 2012 to 62.6/100,000 in 2014. The average case fatality rate for the period was 8.3%. The system was sensitive, representative, and acceptable. The predictive value positive was 100% from 2010 to 2014 and 63.3% in 2015. Data quality was good, but timeliness of reporting was poor. Conclusions The enhanced meningitis surveillance system in Yendi Municipality is achieving most of its objectives. However, financial constraints and poor personnel motivation pose threats to the sustainability of the system

Adherence to the test, treat and track strategy for malaria control among prescribers, Mfantseman Municipality, Central Region, Ghana.

BackgroundThe test, treat, and track (T3) strategy is directed at ensuring diagnosis and prompt treatment of uncomplicated malaria cases. Adherence to T3 strategy reduces wrong treatment and prevents delays in treating the actual cause of fever that may otherwise lead to complications or death. Data on adherence to all three aspects of the T3 strategy is sparse with previous studies focusing on the testing and treatment aspects. We determined adherence to the T3 strategy and associated factors in the Mfantseman Municipality of Ghana.MethodsWe conducted a health facility based cross-sectional survey in Saltpond Municipal Hospital and Mercy Women's Catholic Hospitals in Mfantseman Municipality of the Central Region, Ghana in 2020. We retrieved electronic records of febrile outpatients and extracted the testing, treatment and tracking variables. Prescribers were interviewed on factors associated with adherence using a semi-structured questionnaire. Data analyses was done using descriptive statistics, bivariate, and multiple logistic regression.ResultsOf 414 febrile outpatient records analyzed, 47 (11.3%) were under five years old. About 180 (43.5%) were tested with 138 (76.7%) testing positive. All positive cases received antimalarials and 127 (92.0%) were reviewed after treatment. Of 414 febrile patients, 127 (30.7%) were treated according to the T3 strategy. Higher odds of adherence to T3 were observed for patients aged 5-25 years compared to older patients (AOR: 2.5, 95% CI: 1.27-4.87, p = 0.008). Adherence was low among physician assistants compared to medical officers (AOR 0.004, 95% CI 0.004-0.02, pConclusionAdherence to T3 strategy is low in Mfantseman Municipality of the Central Region of Ghana. Health facilities should perform RDTs for febrile patients at the OPD with priority on low cadre prescribers during the planning and implementation of interventions to improve T3 adherence at the facility level

Impact of mobile health on maternal and child health service utilization and continuum of care in Northern Ghana

Maternal and child mortality are of public health concern. Most of these deaths occur in rural communities of developing countries. Technology for maternal and child health (T4MCH) is an intervention introduced to increase Maternal and Child Health (MCH) services utilization and continuum of care in some health facilities across Ghana. The objective of this study is to assess the impact of T4MCH intervention on MCH services utilization and continuum of care in the Sawla-Tuna-Kalba District in the Savannah Region of Ghana. This is a quasi-experimental study with a retrospective review of records of MCH services of women who attended antenatal services in some selected health centers in the Bole (comparison district) and Sawla-Tuna-Kalba (intervention district) of the Savannah region, Ghana. A total of 469 records were reviewed, 263 in Bole and 206 in Sawla-Tuna-Kalba. A multivariable modified Poisson and logistic regression models with augmented inverse-probability weighted regression adjustment based on propensity scores were used to quantify the impact of the intervention on service utilization and continuum of care. The implementation of T4MCH intervention increased antenatal care attendance, facility delivery, postnatal care and continuum of care by 18 percentage points (ppts) [95% CI - 17.0, 52.0], 14 ppts [95% CI 6.0%, 21.0%], 27 ppts [95% CI 15.0, 26.0] and 15.0 ppts [95% CI 8.0, 23.0] respectively compared to the control districts. The study showed that T4MCH intervention improved antenatal care, skilled delivery, postnatal services utilization, and continuum of care in health facilities in the intervention district. The intervention is recommended for a scale-up in other rural areas of Northern Ghana and the West-African sub-region

Additional file 1: of Evaluation of the enhanced meningitis surveillance system, Yendi municipality, northern Ghana, 2010–2015

Meningitis Surveillance Data Yendi 2010-2015. (XLSX 36 kb

The effect of malaria prevention and control interventions on malaria morbidity among children under 5 years and pregnant women in Kintampo North Municipality, Ghana

Background: Malaria prevention and control interventions have been scaled-up in the last decade in Ghana. We analysed the malaria surveillance data to assess the trends and the association between some malaria prevention interventions and malaria incidence in Kintampo North Municipality (KNM). Methods: We extracted data on malaria indicators and interventions from the District Health Information Management System 2 database for 2012–2016. Proportions and cumulative incidence of malaria episodes were computed using STATA 14 software. We performed correlation analysis between malaria interventions and malaria morbidity. We used linear regression models to determine the association between Long-Lasting Insecticide-treated Nets (LLINS) distribution, Intermittent Preventive Treatment in Pregnancy (IPTp) and episodes of malaria in children <5 years old and pregnant women. Results: A total of 280,890 episodes of malaria were recorded in the KNM from 2012–2016. Of the total malaria episodes, 64,953 (23.1%) were children <5 years and 57.5% (161,486/280,890) were females. The incidence of malaria in KNM declined from 650/1,000 population in 2012 to 444/1,000 population in 2016. The proportion of confirmed malaria increased from 35.2% in 2012 to 80.7% in 2015, and subsequently declined to 77.5% in 2016. The malaria Case Fatality Rate decreased by 65% in 2012 to 0.04% (16/37646) in 2016. Long Lasting Nets distribution to children showed a weak negative linear relationship with malaria morbidity in children <5 years (R= –0.20). IPTp1, IPTp2 showed a weak negative linear relationship with malaria morbidity in pregnancy, IPTp3 showed a weak positive linear relationship while IPTp4 and IPTp5 showed a negative moderate linear relationship with malaria morbidity in pregnancy. A unit increase in LLINs distribution to pregnant women was significantly associated with a reduction in malaria in pregnancy episodes by 0.21 (R2 = 0.19, 95% CI: -0.3 ─ -0.7). The IPTp first dose (IPTp1) coverage declined from 75.5% in 2012 to 69.0% in 2014, but rose to 80.9% in 2016. IPTp5 (fifth dose) increased from 0.7% in 2014 to 4.8% in 2016. A percentage increase in the coverage of only IPTp4 was associated with a reduction of malaria in pregnancy by two episodes (R2 = 0.34, 95% CI = ─ 1.68 – (─0.78). Conclusion: Malaria morbidity trend declined in the municipality. Increase coverage in LLINs and IPTp were associated with declines in malaria episodes in children <5years old and pregnancy women. Coverage of IPTp4 and IPTp5 were relatively low. Health staff should intensify promotion of the use of malaria prevention interventions among pregnant women and children < 5 years old. Midwives should promote uptake of optimal IPTp doses through health education and community antenatal outreach services

Sociodemographic and Maternal Determinants of Postnatal Care Utilization: A Cross-Sectional Study

Introduction Postnatal care (PNC) is critical for the newborn and the mother, as it offers the opportunity to examine the mother and child to ensure early and timely intervention of any obstetric anomalies that might have gone unnoticed during delivery. However, there is a lack of data on PNC utilization and associated determinants in Ghana. Meanwhile, it is suspected that the PNC service should be more patronized by mothers, particularly within the first 2 days after delivery; therefore, investigating PNC utilization and associated factors could inform policies to enhance PNC uptake. Objective The objective is to determine the level of utilization of PNC service and associated factors in the Savannah region of Ghana. Methods The study used a facility-based analytical cross-sectional study design. The study was carried out in 311 postnatal mothers using consecutive sampling. Data collection was carried out using a questionnaire. Univariate and multiple logistic regression was performed to establish the determinants of PNC. Variables/variable categories with P < .05 were significantly associated with PNC. The significance level is anchored at P < .05. Results The study showed that almost all respondents (98.7%) have heard about PNC services through health workers (39.7%), media (13.0%), and friends and relatives (47.2%). Most of the respondents (88.7%) have used PNC services within 48 h. Mothers aged 25–39 years were about seven times more likely to utilize PNC compared to those who were less than 25 years old (AOR [adjusted odds ratio] = 7.41, 95% CI [confidence interval]: 1.98–7.71); mothers with high school education (SHS) and above were also approximately four times more likely to use PNC compared to those who had no formal education (AOR = 3.65, 95% CI 1.97–13.66). In the same vein, married mothers were 10 times more likely to use PNC compared to those who are single mothers (AOR = 10.34, 95% CI: 3.69–28.97), whereas mothers who had at least four antenatal care (ANC) visits during pregnancy were approximately seven times more likely to use PNC compared to those who had less than four ANC visits (AOR = 6.92, 95% CI: 1.46–32.78). Reasons for not attending PNC include waiting time (40.5%), health workers’ attitude (32.4%), being attended by a student (16.2%), being busy (27.0%), inadequate information on PNC (24.3%), and no family support (18.9%). Conclusion All mothers knew about the PNC services, with a higher proportion patronizing the services. The increasing age, the level of mothers, marital status, and participation in ANC were significant determinants of the use of PNC. More education during ANC on the importance of PNC service is required to achieve universal coverage of PNC

Hospital-Based Surveillance for Viral Hemorrhagic Fevers and Hepatitides in Ghana

<div><p>Background</p><p>Viral hemorrhagic fevers (VHF) are acute diseases associated with bleeding, organ failure, and shock. VHF may hardly be distinguished clinically from other diseases in the African hospital, including viral hepatitis. This study was conducted to determine if VHF and viral hepatitis contribute to hospital morbidity in the Central and Northern parts of Ghana.</p><p>Methodology/Principal Findings</p><p>From 2009 to 2011, blood samples of 258 patients with VHF symptoms were collected at 18 hospitals in Ashanti, Brong-Ahafo, Northern, Upper West, and Upper East regions. Patients were tested by PCR for Lassa, Rift Valley, Crimean-Congo, Ebola/Marburg, and yellow fever viruses; hepatitis A (HAV), B (HBV), C (HCV), and E (HEV) viruses; and by ELISA for serological hepatitis markers. None of the patients tested positive for VHF. However, 21 (8.1%) showed anti-HBc IgM plus HBV DNA and/or HBsAg; 37 (14%) showed HBsAg and HBV DNA without anti-HBc IgM; 26 (10%) showed anti-HAV IgM and/or HAV RNA; and 20 (7.8%) were HCV RNA-positive. None was positive for HEV RNA or anti-HEV IgM plus IgG. Viral genotypes were determined as HAV-IB, HBV-A and E, and HCV-1, 2, and 4.</p><p>Conclusions/Significance</p><p>VHFs do not cause significant hospital morbidity in the study area. However, the incidence of acute hepatitis A and B, and hepatitis B and C with active virus replication is high. These infections may mimic VHF and need to be considered if VHF is suspected. The data may help decision makers to allocate resources and focus surveillance systems on the diseases of relevance in Ghana.</p></div

Demographic data and symptoms of patients.

<p>Statistical analysis of the data: Each sub-group with diagnosis was tested vs. the sub-group without diagnosis for all quantitative variables and categories of a qualitative variable. Statistically significant differences are indicated by footnotes; all other differences were not significant.</p><p>Abbreviations: Q25, lower quartile, 25% of the data lie below this value; Q75, upper quartile, 75% of the data lie below this value.</p>a<p>18 patients were positive for anti-HAV IgM and HAV RNA; 7 patients were positive for anti-HAV IgM; 1 patient was positive for HAV RNA. Co-infections: 1 patient was positive for HBV DNA and HBsAg.</p>b<p>19 patients were positive for anti-HBc IgM, HBV DNA, and HBsAg; 2 patients were positive for anti-HBc IgM and positive for HBV DNA in two different PCR assays, but negative for HBsAg. Co-infections: 1 patient was HCV RNA positive.</p>c<p>All patients were positive for HBV DNA and HBsAg, but negative for anti-HBc IgM. Co-infections: 1 patient was anti-HAV IgM positive; 1 patient was HCV RNA positive.</p>d<p>All patients were HCV RNA positive. Co-infections: 1 patient was positive for anti-HBc IgM, HBV DNA, and HBsAg; 1 patient was positive for HBV DNA and HBsAg.</p>e<p>p = 0.001, no diagnosis vs. acute hepatitis A; p = 0.0001, no diagnosis vs. chronic hepatitis B; p = 0.00004, no diagnosis vs. acute & chronic hepatitis B combined; p = 0.005, no diagnosis vs. hepatitis C.</p>f<p>p<0.0001, no diagnosis vs. chronic hepatitis B; p<0.0001, no diagnosis vs. acute & chronic hepatitis B combined.</p>g<p>p<0.0001, no diagnosis vs. chronic hepatitis B; p = 0.0004, no diagnosis vs. acute & chronic hepatitis B combined.</p>h<p>p = 0.0005, no diagnosis vs. acute hepatitis A; p = 0.0003, no diagnosis vs. acute hepatitis B.</p

PCR assays used in the study.

a<p>Flaviviruses including YF and dengue virus.</p>b<p>Filoviruses including Ebola and Marburg virus.</p

Molecular Characterization of Circulating Yellow Fever Viruses from Outbreak in Ghana, 2021–2022

Yellow fever virus, transmitted by infected Aedes spp. mosquitoes, causes an acute viral hemorrhagic disease. During October 2021–February 2022, a yellow fever outbreak in some communities in Ghana resulted in 70 confirmed cases with 35 deaths (case-fatality rate 50%). The outbreak started in a predominantly unvaccinated nomadic community in the Savannah region, from which 65% of the cases came. The molecular amplification methods we used for diagnosis produced full-length DNA sequences from 3 confirmed cases. Phylogenetic analysis characterized the 3 sequences within West Africa genotype II; strains shared a close homology with sequences from Cote d’Ivoire and Senegal. We deployed more sensitive advanced molecular diagnostic techniques, which enabled earlier detection, helped control spread, and improved case management. We urge increased efforts from health authorities to vaccinate vulnerable groups in difficult-to-access areas and to educate the population about potential risks for yellow fever infections