Descriptive data analysis of tuberculosis surveillance data, Sene East District, Ghana, 2020

Introduction: On 20th February 2017, health officials in Nadowli-Kaleo District (NKD) of Ghana's Upper West Region received reports of an upsurge in the number of meningitis case-patients reporting to the district's health facilities. The number of cases had exceeded the alert but not epidemic threshold for meningitis for the district. We investigated to identify the aetiologic agent, determine the risk factors and implement control measures. Methods: We conducted an unmatched case-control study. A meningitis case-patient was any NKD resident with any of the following signs and symptoms: neck stiffness, convulsion, bulging fontanelle (infants), altered consciousness or other meningeal signs with or without fever, from 1st January to 30th March 2017. For each case-patient, 2 controls (neighbours of case-patients without meningitis signs and symptoms) were identified. Demographic and clinical data were obtained through records review and case-patient interviews. Cerebrospinal fluid (CSF) samples were collected for laboratory investigation. Significant risk factors were identified using multivariable logistic regression. Results: In all 67 case-patients comprising 35 (52.2%) males and two (3%) children aged < 5 years were identified. The median age of case-patients was 24 years (interquartile range: 15–46 years). Ten deaths were recorded (case fatality rate: 14.9%). Most affected age group was 15-24 years with 18 (26.9%) case-patients and an age-specific attack rate of 170.8/100000 population. Nadowli Central sub-district, the epicenter, recorded 14 (22.4%) cases. Dominant aetiologic agent was Neisseria meningitidis isolated from 17 (58.6%) of 29 culture-positive CSF samples. Compared to controls, meningitis case-patients had higher odds of living in single window rooms (adjusted odds ratio (aOR) =5.05; 95% confidence interval (CI) =1.35-11.66), or in rooms inhabited by more than two people (aOR=3.28, CI=1.57-7.73). Conclusion: Neisseria meningitidis caused the upsurge in meningitis cases in NKD, with the youth being the most affected age group. Living in poorly ventilated rooms and overcrowded rooms were risk factors. Prompt casemanagement and health education helped control the occurrence and prevented an outbreak

Prevalence and factors associated with low medication adherence among Type 2 Diabetic patients attending a diabetic clinic at the Tema general hospital, Ghana

Introduction: Poor adherence to diabetes medication has been linked to poor glycemic control, increased cost, morbidity, and mortality rates. This study assessed factors influencing adherence to medication regimens among outpatients with type 2 diabetes mellitus (T2DM) patients at a diabetes clinic, Tema General Hospital, Ghana. Methods: This was a cross-sectional study using quantitative methods. A culturally tailored semi-structured questionnaire and the Morisky Medication Adherence Scale (MMAS-8) were used to evaluate the levels of adherence to T2DM medications. Chi-square test and logistic regression were used to assess the association between exposure variables and medication adherence. Results: A total of 206 T2DM patients aged 24 to 90 years, mean age=59.1(±1) years were interviewed. The majority were female (82.5%) and married (56.8%). The prevalence of low adherence to T2DM medication was 47.6% (95%CI: 0.41-0.55). Respondents who were on herbal medication (AOR: 5.99; 95%CI= (0.21–71.65)) had the lowest adherence compared to those on insulin followed by Insulin +OHA (AOR; 95%CI=3.15(0.79-12.53)) and OHA medication (AOR: 1.24; 95%CI (0.42-3.68)). Among those who reported side effects from medication, the odds of low adherence was 2.9 times compared to those who did not report any (AOR;95%CI=2.91(1.16-7.29)). Those who reported that their pill burden affected the continued usage of medication had 8.3 times the odds of low adherence compared to those who did not (AOR; 95%CI=8.25 (2.95-23.08)). Irregular visits to the health facility (AOR; 95%CI=6.71(2.35-19.16)) and the provision of information on the disease condition by the health provider (AOR; 95%CI= 1.14 (0.15-8.75)) significantly influenced adherence to the medication regimen. Conclusion: The prevalence of low adherence to the T2DM medication regimen was influenced by current medication intake, experiencing side effects from medication, pill burden, irregular visits to the health facility, and adequacy of information provided by health providers on the disease condition. National level interventions are needed to intensify health education on diabetes management

Imminent meningitis outbreak prevented by early warning and response action: Nadowli-Kaleo District, Upper West Region, Ghana-2017

Introduction: On 20th February 2017, health officials in Nadowli-Kaleo District (NKD) of Ghana's Upper West Region received reports of an upsurge in the number of meningitis case-patients reporting to the district's health facilities. The number of cases had exceeded the alert but not epidemic threshold for meningitis for the district. We investigated to identify the aetiologic agent, determine the risk factors and implement control measures. Methods: We conducted an unmatched case-control study. A meningitis case-patient was any NKD resident with any of the following signs and symptoms: neck stiffness, convulsion, bulging fontanelle (infants), altered consciousness or other meningeal signs with or without fever, from 1st January to 30th March 2017. For each case-patient, 2 controls (neighbours of case-patients without meningitis signs and symptoms) were identified. Demographic and clinical data were obtained through records review and case-patient interviews. Cerebrospinal fluid (CSF) samples were collected for laboratory investigation. Significant risk factors were identified using multivariable logistic regression. Results: In all 67 case-patients comprising 35 (52.2%) males and two (3%) children aged < 5 years were identified. The median age of case-patients was 24 years (interquartile range: 15–46 years). Ten deaths were recorded (case fatality rate: 14.9%). Most affected age group was 15-24 years with 18 (26.9%) case-patients and an age-specific attack rate of 170.8/100000 population. Nadowli Central sub-district, the epicenter, recorded 14 (22.4%) cases. Dominant aetiologic agent was Neisseria meningitidis isolated from 17 (58.6%) of 29 culture-positive CSF samples. Compared to controls, meningitis case-patients had higher odds of living in single window rooms (adjusted odds ratio (aOR) =5.05; 95% confidence interval (CI) =1.35-11.66), or in rooms inhabited by more than two people (aOR=3.28, CI=1.57-7.73). Conclusion: Neisseria meningitidis caused the upsurge in meningitis cases in NKD, with the youth being the most affected age group. Living in poorly ventilated rooms and overcrowded rooms were risk factors. Prompt case-management and health education helped control the occurrence and prevented an outbreak

Upsurge in meningitis cases in Jirapa district, 2017, Upper West - Ghana

Introduction: Meningitis is the inflammation of the meninges. In the first eight (8) epidemiological weeks of 2017, Jirapa District, Upper West Region, Ghana recorded 41 suspected cases with six deaths and this had exceeded the alert threshold of 5 suspected cases per 100,000 population per week. We therefore conducted an epidemiological investigation, assessed surveillance and epidemic response and helped implement control measures. Methods: We conducted a descriptive study in Jirapa District 21st to 25th March, 2017. We reviewed patient records from January to March with clinicians, response and surveillance assessment and searched for cases. The case definition was any person living in Jirapa District and reporting with or without fever of acute onset with neck stiffness, poor sucking (in infants), bulging fontanelles (in infants), altered consciousness, other signs of meningeal irritation/inflammation from 1st January to 25th March, 2017. Descriptive analysis was performed and expressed as frequencies and proportions with Microsoft Excel, 2016. Results: Sixty-one cases were recorded, of which 10 were confirmed with seven deaths (CFR=70%). Most were female 32 (53.33%) and majority, 21 (34.4%) below age 10 years. Streptococcus pneumoniae was the causative organism in all the 10 samples. Although the number of reported meningitis cases and the CFR were high, the epidemic threshold of 10 suspected cases per 100,000 population per week was not crossed. There was an active surveillance and effective rapid response team in the district conducted health education and contact tracing when the number of cases were increasing. Conclusion: Jirapa District saw an increase in the number of reported meningitis cases in 2017. An active surveillance system and effective rapid response team in the district prevented a potential outbreak. Communities were educated on risk factors, preventive measures to reduce spread and the need for early reporting

Outbreak investigation and enhanced contact tracing of novel coronavirus disease 2019 (COVID-19), Ablekuma North Municipality, Greater Accra, Ghana

Introduction: After Ghana recorded its first two cases of COVID-19, other cases were subsequently identified in other parts of the country. The Ablekuma North Municipal Health Directorate was notified of a resident who reported to Korle-Bu Teaching Hospital on March 29, 2020 with fever, shortness of breath, general weakness, cough, chest pain. We investigated the report to estimate the magnitude of cases, to determine the secondary infection rate and to institute control and preventive measures. Methods: We conducted active case search using Ghana Health Service interim guideline for COVID-19 case investigation and management in Ablekuma North Municipality from April-July 31, 2020. We interviewed and collected samples of contacts and at-risk groups in affected households using collector for ArcGis and case investigation form. We summarized information of COVID-19 cases on our line list after samples have been confirmed. We analyzed data using Microsoft Excel 2016 and Stata 15, and presented as frequency and proportions. Results: The municipality recorded 213 cases with four deaths (Case fatality Rate=1.88%). The attack rate was 111.47 per 100,000 (213/ 191,075). Males were 135 (63.38%). The median age of case-patients was 27 years (interquartile range: 19 - 36years). Majority were students; 64 (30.05%). Most of the cases 89.20% (190/213) were asymptomatic. The median time between sample collection and release of laboratory results was 15 days (range: 4 - 22days). This response was a multi-sectorial approach, involving the Ministry of Health and the Ghana Health Service, Municipal Assembly, National Security Ministry, Ministry of Communication, Ministry of Information, and other government agencies. Conclusion: All confirmed cases were investigated. The attack rate was relatively high but low case fatality rate in the municipality. Strengthening laboratory capacity to test, to early report results is recommended. Lessons in handling cases indicate the need to sustain multi-sectorial collaboration to fight the outbreak

Outbreak of rabies among humans, dogs and livestock, Awutu-Senya East Municipality, Ghana, 2019

Introduction: Rabies is a neglected zoonotic disease caused by the Rabies virus (RABV). Ninety-percent of human rabies are dog-mediated. Globally there are 59,000 human rabies annually. On June 16 2019, a 4-year-old girl from the Awutu-Senya East Municipal of Ghana, died following symptoms of aggression, hyper-salivation and hydrophobia. She had a dog scratch five weeks prior. We confirmed the outbreak, determined its magnitude, identified associated factors and implemented control measures. Methods: We interviewed community members to understand potential exposures to RABV. We reviewed the animal bite records, clinical notes of human rabies cases and initial line-list. We conducted community-based rabies surveillance for animal bites and confirmed RABV by Polymerase Chain Reaction of brain tissue of dead human and animals. We updated the line-list with demographic, exposure, and outcome variables of bite victims. Quantitative data was analyzed descriptively, and findings presented as frequencies and proportions. Results: Overall, 155 dog bites were identified, among which six human rabies deaths were recorded (Attack rate=3.9%). Males were 51.6% (80/155) of bite victims, whiles children 5-14 years constituted 27% (40/147). About 86.5% (134/155) of bites were by unvaccinated dogs, and stray dogs bit 80.6% (125/155) of individuals. Category III bites were 35% (50/141). RABV was isolated from 16.7% (1/6) of human deaths and 30% (3/10) of rabid dog. We suspected rabies infection in a goat. Dogs roamed unattended within communities. Conclusion: This rabies outbreak was dog-mediated. Poor pet ownership and limited vaccination of dogs were associated factors. Mass dog vaccination, prompt post-exposure prophylaxis and risk communication were critical interventions implemented

Universal coverage and utilization of free long-lasting insecticidal nets for malaria prevention in Ghana: a cross-sectional study

BackgroundMalaria continues to be one of the leading causes of mortality and morbidity, especially among children and pregnant women. The use of Long-Lasting Insecticide Nets (LLINs) has been recognized and prioritized as a major intervention for malaria prevention in Ghana. This study aims to establish the factors influencing the universal coverage and utilization of LLINs in Ghana.MethodsThe data used for this study was from a cross-sectional survey carried out to assess LLINs ownership and use in 9 out of the 10 old regions of Ghana from October 2018 to February 2019 where free LLIN distribution interventions were implemented. The EPI “30 × 7” cluster sampling method (three-stage sampling design) was modified to “15 × 14” and used for the study. A total of 9,977 households were interviewed from 42 districts. Descriptive statistics using percentages as well as tests of associations such as Pearson Chi-square and the magnitude of the associations using simple and multivariable logistic regression were implemented.ResultsOf the 9,977 households in the study, 88.0% of them owned at least one LLIN, universal coverage was 75.6%, while utilization was 65.6% among households with at least one LLIN. In the rural and urban areas, 90.8% and 83.2% of households, respectively, owned at least one LLIN. The was a 44% increase in universal coverage of LLINs in rural areas compared to urban areas (AOR: 1.44, 95% CI: 1.02–2.02). There were 29 higher odds of households being universally covered if they received LLIN from the PMD (AOR: 29.43, 95% CI: 24.21–35.79). Households with under-five children were 40% more likely to utilize LLIN (AOR: 1.40, 95% CI: 1.26–1.56). Respondents with universal coverage of LLIN had 25% increased odds of using nets (AOR: 1.25 95% CI: 1.06–1.48). Rural dwelling influences LLIN utilization, thus there was about 4-fold increase in household utilization of LLINs in rural areas compared to urban areas (AOR: 3.78, 95% CI: 2.73–5.24). Household size of more than 2 has high odds of LLINs utilization and awareness of the benefit of LLINs (AOR: 1.42, 95% CI: 1.18–1.71).ConclusionAbout nine in 10 households in Ghana have access at least to one LLIN, three-quarters had universal coverage, and over two-thirds of households with access used LLIN. The predictors of universal coverage included region of residence, rural dwellers, and PMD campaign, while households with child under-five, in rural areas, and with universal coverage were positively associated with utilization

Dietary diversity and nutritional adequacy of under-fives in a fishing community in the central region of Ghana

BACKGROUND: The irreversible effect of malnutrition on children as a result of micronutrient deficiency is of great public health concern. Micronutrient malnutrition is caused by the chronic lack of vitamins and minerals in diets. Dietary assessment is one of the ways in assessing micronutrient malnutrition. This assessment provides information about the quality of food consumed in terms of nutrient adequacy of children under five years in Ekumfi Narkwa, a fishing community along the Central regional coastline using the dietary diversity assessment method. METHODS: A cross-sectional study involving 250 caregiver-child pairs was conducted. A pre-tested dietary diversity questionnaire was used to collect information on dietary consumption over 7 day period. The caregiver was asked whether the child had eaten foods from the seven (7) main food groups over the past seven days and the number of days they had consumed foods from each of the food groups. The individual dietary diversity score (IDDS) and minimum dietary diversity of the children in the community were calculated independently. RESULTS: The main food group consumed daily was from flesh foods group 79.8% (namely; meat and fish consumption). Daily fish consumption was 78% (195 of 250), accounting for the high consumption of flesh foods. One-tenth of the children (27 of 250) consumed vitamin A rich foods daily. Almost half (118 of 250) of the children met the minimum dietary requirements with the average dietary diversity score of 2.28 ± 1.33. CONCLUSION: The dietary diversity of children under five in Ekumfi Narkwa is low. Though the consumption of flesh foods was very high, that of fruits and vegetables especially Vitamin A rich plant source foods was poor. Health workers need to educate parents on the importance of ensuring their wards consume food from all the various food groups including fruits and vegetables which provide essential vitamins and minerals

Lacking in abundance: undernutrition in a Peri-urban fishing community in Coastal Ghana

Abstract Background Malnutrition is a major problem in the world, especially in developing countries such as Ghana. Malnutrition is directly and indirectly responsible for over a million deaths in under-fives worldwide. In spite of the abundance of protein from fish and other staples in fishing communities, they are not spared of the problem of undernutrition. The study sought to assess the prevalence undernutrition among children under-five years in a fishing community in Ghana. Methods We conducted a community-based cross-sectional study in Ekumfi Narkwa. We assessed the nutritional status of 250 children aged 6–59 months using anthropometric methods. A structured questionnaire was also used to gather socio-demographic data on the children. We generated nutritional indices with Microsoft Excel 2010 and WHO Anthro software version 3.2.2. We generate frequencies and percentages and ran a simple logistic regression to determine factors associated with malnutrition using STATA software version 13. Results About 80%(198/250) of the children were reported to have consumed fish products more than three times in the past week whiles 85%(214/250) consumed staples more than three times in the past week. More than one-quarter (26.4%) of the children were under-nourished. The prevalence of stunting, wasting and underweight were 17.6% (44/250), 4.4% (11/250) and 12% (30/250) respectively. Age of caregiver was found to be associated with a child being underweight. The age group of the caregiver was found to be associated with undernutrition (OR:1.53; 95%CI:1.07–219). Conclusions These findings suggest a high prevalence of under-five undernutrition in the fishing community in spite of the abundance of fish and its presence in their diet. Malnutrition interventions should therefore be extended to these communities. These interventions in fishing communities need to be tailored towards caregiver utilization of fish and other food sources available in order to improve nutrition of the children

Predictors of Adverse TB Treatment Outcome among TB/HIV Patients Compared with Non-HIV Patients in the Greater Accra Regional Hospital from 2008 to 2016

Introduction. The convergence of TB and HIV dual epidemics is a major public health challenge in Ghana as well as many developing countries. Treatment outcome monitoring is a vital part of the surveillance needed to successfully eliminate TB. The impact of HIV status and demographic and treatment-related factors on adverse TB treatment outcome has not been studied in the Greater Accra Regional Hospital. This study determined factors associated with TB treatment outcome in patients with TB-HIV coinfection and TB-only infection in the hospital. Method. A cross-sectional study was carried out in the Greater Accra Regional Hospital. We reviewed TB treatment cards of patients who received treatment for tuberculosis in the hospital from 2008 to 2016. Data on treatment outcome and sociodemographic and clinical characteristics were extracted on TB-only-infected and TB/HIV-coinfected patients. The chi-squared test and binary and multiple logistic regression models were used to assess factors associated with adverse treatment outcome. Results. Out of the 758 patient records analyzed, 174 (22.9%) were TB-HIV-coinfected patients. Overall treatment success for all TB patients was 88.1% (668/758). About 11.9% (90/758) of the patients had an adverse treatment outcome, including treatment failure 0.9% (7/758), defaulting 0.9% (7/758), and death 10.0% (76/758). TB-HIV-coinfected patients’ treatment success was 78.1% (136/174). TB-only patients’ treatment success was 91.4% (532/582). Independent predictors of adverse treatment outcome were found to be as follows: being HIV positive (aOR: 3.85, 95% CI: 2.19-6.75; p<0.01); aged 65 and above (aOR: 1.76, 95% CI: 1.44-1.54; p=0.01); and previously failed TB treatment (aOR: 5.02, 95% CI: 2.09-28.87; p<0.01). Conclusion. Treatment outcome for TB-HIV-coinfected patients is below the WHO target. HIV status, age, and category of patient of the TB patients were associated with adverse treatment outcome. Strengthening the TB/HIV collaborative efforts by stakeholders is required for good treatment outcomes