Risk factors associated with a gastroenteritis outbreak, Firestone District, Margibi County, Liberia, February 2018

Introduction: Gastroenteritis is an inflammation of the intestines that leads to diarrhoea and vomiting. It is one of the commonly reportable diseases in humans and primarily affects children under five years. Globally, gastroenteritis is estimated to result in 1.45 million deaths annually. The burden of gastroenteritis remains exceptionally high in developing counties, especially in areas characterized by poverty. On February 5, 2018, the Margibi County Surveillance Officer received a call from the District Surveillance Officer regarding an outbreak of severe acute diarrhoea from Division 15 and 17 communities of Firestone District. We investigated to confirm the existence of an outbreak, verify the diagnosis, identify risk factors, and institute appropriate control measures. Methods: In this study, we defined gastroenteritis as the acute passage of watery or bloody diarrhoea (AWD) of three or more loose or liquid stools within 24 hours (or more frequent passage than is normal for the individual) with or without blood We visited affected and surrounding communities and conducted active case search. The team conducted a 1:1 unmatched case-control study to identify risk factors for developing the illness. We inspected drinking water sources and household water storage facilities. We collected two swabs of freshly passed (< 1 hr) stool samples to identify the causative agent. We established a temporary mobile treatment site in affected communities to treat uncomplicated cases and referred severe cases to Du-side Hospital. We temporarily restrained community dwellers from consuming water from the creek and hand pump. Results: We identified and line listed 66 cases, 62 presented with diarrhea and vomiting, but no deaths. Males accounted for 63%, median age of 16 years (range: 2 - 64 years) while 65.1% were age-group over 20 years. Division 15 accounted for 60% of the total number of cases, and 34.8% were admitted at Du-side Hospital. Rubber tappers and students accounted for 36.4% and 31.8% respectively. Drinking water from the creek was 56.0% hand pump 37.9%, while pipe-borne water 6.1%. The overall attack rate was 68 per 1,000 inhabitants. All cases were seen within 24 hours. Community health volunteers identified 35% of the cases while conducting an active case. Drinking water sources, from creek (OR: 6.5 (2.0-21.7), p = 0.00) and hand pump (OR: 6.5 (2.0-21.7), p = 0.00), were significantly associated with being ill and having gastroenteritis. Other significant associated risk factors were working as rubber tapper (OR: 4.0 (1.4-11.7), p = 0.02) and having no formal education (OR: 3.1 (1.10-8.84), p = 0.08). Laboratory analysis isolated E. coli and Shigella sp in the creek water. Six jerry cans of safe drinking water, water guards, hand sanitizers and laundry soap were provided to each household. Conclusion: Our findings revealed that the outbreak was due to E.coli infection and Shigella. It was established that the consumption of unsafe drinking water from the creek and hand pumps led to the outbreak. Rubber tappers and no formal education were the possible drivers for the outbreak. However, the daily provision of safe drinking water, rapid case detection and management helped to contain the outbreak quickly without any mortality

Hand hygiene and face mask wearing practices for COVID-19 prevention: a non-intrusive observation of patrons of community convenience shops in Accra, Ghana

Introduction: in the absence of a vaccine and definitive treatment, non-pharmacological measures of physical distancing, regular hand hygiene and wearing of face covering remain the mainstays of mitigating coronavirus disease 2019 (COVID-19). In Ghana, these measures are mandatory in public places and underpin COVID-19 infection prevention and control (IPC). We assessed adherence and appropriate performance of these measures among patrons of community convenience shops in selected hotspots. Methods: we conducted a non-intrusive observation of patrons of convenience shops in COVID-19 burden hotspots. We observed patrons as they entered and exited the shops and collected data on their gender, adherence and appropriate use of face covering and hand hygiene facilities. Data were analyzed descriptively and inferentially to determine factors associated with adherence to IPC guidelines. Results: of 800 patrons observed from eight community shops, 481 (60.1%) were males. Of these, 653 (81.6%) wore face covering and 98 (12.3%) performed hand hygiene; with 92 (11.5%) adhering to both measures. Patrons who wore face mask appropriately were 578; comprising 299 (92.3%) of patrons who wore face mask before entering the shops. Of 89 patrons who washed their hands, appropriate handwashing was recorded among nine (10.1%). Compared to inappropriate handwashing, appropriate handwashing was negatively associated with adherence to IPC guidelines [aOR=0.1 (95% CI=0.01-0.59)]. Conclusion: adherence to and appropriate performance of IPC measures of handwashing and use of face covering in the selected shops was low. There is the need to complement availability of IPC measures with intensification of risk communication messaging targeted at ensuring their appropriate use

Hand hygiene and face mask wearing practices for COVID-19 prevention: a non-intrusive observation of patrons of community convenience shops in Accra, Ghana

Introduction:in the absence of a vaccine and definitive treatment, non-pharmacological measures of physical distancing, regular hand hygiene and wearing of face covering remain the mainstays of mitigating coronavirus disease 2019 (COVID-19). In Ghana, these measures are mandatory in public places and underpin COVID-19 infection prevention and control (IPC). We assessed adherence and appropriate performance of these measuresamong patrons of community convenience shops in selected hotspots.Methods:we conducted a non-intrusive observation of patrons of convenience shops in COVID-19 burden hotspots. We observed patrons as they entered and exited the shops and collected data ontheir gender, adherence and appropriate use of face covering and hand hygiene facilities. Data were analyzed descriptively and inferentially to determine factors associated with adherence to IPC guidelines.Results:of 800 patrons observed from eight community shops, 481 (60.1%) were males. Of these, 653 (81.6%) wore face covering and 98 (12.3%) performed hand hygiene; with 92 (11.5%) adhering to both measures. Patrons who wore face mask appropriately were 578; comprising 299 (92.3%) of patrons who wore face mask before entering the shops. Of 89 patrons who washed their hands, appropriate handwashing was recorded among nine (10.1%). Compared to inappropriate handwashing, appropriate handwashing was negatively associated with adherence to IPC guidelines [aOR=0.1 (95% CI=0.01-0.59)].Conclusion:adherence to and appropriate performance of IPC measures of handwashing and use of face covering in the selected shops was low. There is the need to complement availability of IPC measures with intensification of risk communication messaging targeted at ensuring their appropriate use

Maternal choices of delivery sites among recently delivered women in Liberia, 2017

Introduction: To reduce maternal mortality, many countries encourage women to deliver in health facilities, where complications can be handled more effectively. In Liberia, attempted home deliveries accounted for about 10% of maternal deaths in 2016/2017. It is therefore necessary to identify the factors influencing maternal choice of delivery site in Liberia. This study seeks to determine the preferred choice of delivery site and factors associated with the choice in Liberia. Methods: A cross-sectional design was used to study 630 women of reproductive age who had given birth less than one year before the survey. A two-stage cluster sampling method using a modified WHO 30 by 7 approach was used to select 30 communities (clusters) and 21 women within each cluster as respondents. A pre-tested interviewer-administered semi-structured questionnaire was used. Results: The mean age of study participants was 26 ± 6.8 years, with 84% between 18 and 35 years. The median number of births per woman was 5 (1 - 12). The proportion of mothers who preferred health facility over home delivery as their original choice of delivery site was 86%, four times greater than those who preferred home over health-facility delivery (22%), (POR= 3.8, 95% CI: 1.6 – 9.1). Mothers who attended < 4 antenatal visits were 30% less likely to originally choose health facilities as their preferred delivery site compared to those who had 4 or more antenatal visits (60% vs 86%) (POR= 0.7, 95% CI: 0.5 – 0.9). Women living in communities where the leaders had instituted sanctions against women who deliver at home were 10% more likely to choose health facility delivery, compared to those whose communities had no sanctions (POR= 1.1, 95% CI: 1.0 – 1.2). Conclusion: Health-facility deliveries are preferred to home deliveries. County Health Teams should sensitize the community on the benefits of delivering at the health facility and increase community involvement (local authorities)