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

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

Evaluation of the environmental polio surveillance system-Northern Region, Ghana, 2021.

BackgroundAcute Flaccid Paralysis (AFP) surveillance is the gold standard in the polio eradication initiative. The environmental component of polio surveillance can detect circulating Polioviruses from sewage without relying on clinical presentation. The effectiveness of the Environmental Surveillance (ES) is crucial to global polio eradication. We assessed the usefulness and attributes of the ES system in the Northern region and determined if the system is meeting its objectives.MethodsWe conducted a descriptive cross-sectional evaluation in the Northern region from 2019 to 2020 using the updated US Centers for Disease Control and Prevention guideline. We interviewed stakeholders, reviewed records, and observed surveillance activities from 29th March to 7th May, 2021. Quantitative data were analyzed manually as frequencies and proportions whiles thematic analysis was used for the qualitative data.ResultsOne of 48 (2.1%) samples collected tested positive for circulating vaccine-derived Poliovirus (cVDPV). The cVDPV detection triggered enhanced AFP surveillance that resulted in the identification of a case of AFP. Three rounds of polio vaccination campaigns were organized. All surveillance officers interviewed were willing to continue providing their services for the ES. Reporting form has few variables and is easy to complete. The completeness of forms was 97.9% (47/48). Samples collected were dispatched on the same day to the testing laboratory. The system's data was managed manually.ConclusionThe system was useful in detecting polio outbreaks. Data quality was good, the system was simple, flexible, acceptable, representative, and fairly stable. Sensitivity was high but predictive value positive was low. Timeliness in reporting was good but feedback from the national level could not be assessed. There is a need to improve on the feedback system and ensure that, the surveillance data is managed electronically

AFP cases by month, Northern Region, 2019–2020.

BackgroundAcute Flaccid Paralysis (AFP) surveillance is the gold standard in the polio eradication initiative. The environmental component of polio surveillance can detect circulating Polioviruses from sewage without relying on clinical presentation. The effectiveness of the Environmental Surveillance (ES) is crucial to global polio eradication. We assessed the usefulness and attributes of the ES system in the Northern region and determined if the system is meeting its objectives.MethodsWe conducted a descriptive cross-sectional evaluation in the Northern region from 2019 to 2020 using the updated US Centers for Disease Control and Prevention guideline. We interviewed stakeholders, reviewed records, and observed surveillance activities from 29th March to 7th May, 2021. Quantitative data were analyzed manually as frequencies and proportions whiles thematic analysis was used for the qualitative data.ResultsOne of 48 (2.1%) samples collected tested positive for circulating vaccine-derived Poliovirus (cVDPV). The cVDPV detection triggered enhanced AFP surveillance that resulted in the identification of a case of AFP. Three rounds of polio vaccination campaigns were organized. All surveillance officers interviewed were willing to continue providing their services for the ES. Reporting form has few variables and is easy to complete. The completeness of forms was 97.9% (47/48). Samples collected were dispatched on the same day to the testing laboratory. The system’s data was managed manually.ConclusionThe system was useful in detecting polio outbreaks. Data quality was good, the system was simple, flexible, acceptable, representative, and fairly stable. Sensitivity was high but predictive value positive was low. Timeliness in reporting was good but feedback from the national level could not be assessed. There is a need to improve on the feedback system and ensure that, the surveillance data is managed electronically.</div

Questionnaire.

BackgroundAcute Flaccid Paralysis (AFP) surveillance is the gold standard in the polio eradication initiative. The environmental component of polio surveillance can detect circulating Polioviruses from sewage without relying on clinical presentation. The effectiveness of the Environmental Surveillance (ES) is crucial to global polio eradication. We assessed the usefulness and attributes of the ES system in the Northern region and determined if the system is meeting its objectives.MethodsWe conducted a descriptive cross-sectional evaluation in the Northern region from 2019 to 2020 using the updated US Centers for Disease Control and Prevention guideline. We interviewed stakeholders, reviewed records, and observed surveillance activities from 29th March to 7th May, 2021. Quantitative data were analyzed manually as frequencies and proportions whiles thematic analysis was used for the qualitative data.ResultsOne of 48 (2.1%) samples collected tested positive for circulating vaccine-derived Poliovirus (cVDPV). The cVDPV detection triggered enhanced AFP surveillance that resulted in the identification of a case of AFP. Three rounds of polio vaccination campaigns were organized. All surveillance officers interviewed were willing to continue providing their services for the ES. Reporting form has few variables and is easy to complete. The completeness of forms was 97.9% (47/48). Samples collected were dispatched on the same day to the testing laboratory. The system’s data was managed manually.ConclusionThe system was useful in detecting polio outbreaks. Data quality was good, the system was simple, flexible, acceptable, representative, and fairly stable. Sensitivity was high but predictive value positive was low. Timeliness in reporting was good but feedback from the national level could not be assessed. There is a need to improve on the feedback system and ensure that, the surveillance data is managed electronically.</div

Map of Northern Region showing the location of the two ES sites and the location of the cVDPV2 AFP.

Map of Northern Region showing the location of the two ES sites and the location of the cVDPV2 AFP.</p

ES information flow chart.

BackgroundAcute Flaccid Paralysis (AFP) surveillance is the gold standard in the polio eradication initiative. The environmental component of polio surveillance can detect circulating Polioviruses from sewage without relying on clinical presentation. The effectiveness of the Environmental Surveillance (ES) is crucial to global polio eradication. We assessed the usefulness and attributes of the ES system in the Northern region and determined if the system is meeting its objectives.MethodsWe conducted a descriptive cross-sectional evaluation in the Northern region from 2019 to 2020 using the updated US Centers for Disease Control and Prevention guideline. We interviewed stakeholders, reviewed records, and observed surveillance activities from 29th March to 7th May, 2021. Quantitative data were analyzed manually as frequencies and proportions whiles thematic analysis was used for the qualitative data.ResultsOne of 48 (2.1%) samples collected tested positive for circulating vaccine-derived Poliovirus (cVDPV). The cVDPV detection triggered enhanced AFP surveillance that resulted in the identification of a case of AFP. Three rounds of polio vaccination campaigns were organized. All surveillance officers interviewed were willing to continue providing their services for the ES. Reporting form has few variables and is easy to complete. The completeness of forms was 97.9% (47/48). Samples collected were dispatched on the same day to the testing laboratory. The system’s data was managed manually.ConclusionThe system was useful in detecting polio outbreaks. Data quality was good, the system was simple, flexible, acceptable, representative, and fairly stable. Sensitivity was high but predictive value positive was low. Timeliness in reporting was good but feedback from the national level could not be assessed. There is a need to improve on the feedback system and ensure that, the surveillance data is managed electronically.</div

Suspected and confirmed cases.

BackgroundAcute Flaccid Paralysis (AFP) surveillance is the gold standard in the polio eradication initiative. The environmental component of polio surveillance can detect circulating Polioviruses from sewage without relying on clinical presentation. The effectiveness of the Environmental Surveillance (ES) is crucial to global polio eradication. We assessed the usefulness and attributes of the ES system in the Northern region and determined if the system is meeting its objectives.MethodsWe conducted a descriptive cross-sectional evaluation in the Northern region from 2019 to 2020 using the updated US Centers for Disease Control and Prevention guideline. We interviewed stakeholders, reviewed records, and observed surveillance activities from 29th March to 7th May, 2021. Quantitative data were analyzed manually as frequencies and proportions whiles thematic analysis was used for the qualitative data.ResultsOne of 48 (2.1%) samples collected tested positive for circulating vaccine-derived Poliovirus (cVDPV). The cVDPV detection triggered enhanced AFP surveillance that resulted in the identification of a case of AFP. Three rounds of polio vaccination campaigns were organized. All surveillance officers interviewed were willing to continue providing their services for the ES. Reporting form has few variables and is easy to complete. The completeness of forms was 97.9% (47/48). Samples collected were dispatched on the same day to the testing laboratory. The system’s data was managed manually.ConclusionThe system was useful in detecting polio outbreaks. Data quality was good, the system was simple, flexible, acceptable, representative, and fairly stable. Sensitivity was high but predictive value positive was low. Timeliness in reporting was good but feedback from the national level could not be assessed. There is a need to improve on the feedback system and ensure that, the surveillance data is managed electronically.</div

Sewage samples collected.

BackgroundAcute Flaccid Paralysis (AFP) surveillance is the gold standard in the polio eradication initiative. The environmental component of polio surveillance can detect circulating Polioviruses from sewage without relying on clinical presentation. The effectiveness of the Environmental Surveillance (ES) is crucial to global polio eradication. We assessed the usefulness and attributes of the ES system in the Northern region and determined if the system is meeting its objectives.MethodsWe conducted a descriptive cross-sectional evaluation in the Northern region from 2019 to 2020 using the updated US Centers for Disease Control and Prevention guideline. We interviewed stakeholders, reviewed records, and observed surveillance activities from 29th March to 7th May, 2021. Quantitative data were analyzed manually as frequencies and proportions whiles thematic analysis was used for the qualitative data.ResultsOne of 48 (2.1%) samples collected tested positive for circulating vaccine-derived Poliovirus (cVDPV). The cVDPV detection triggered enhanced AFP surveillance that resulted in the identification of a case of AFP. Three rounds of polio vaccination campaigns were organized. All surveillance officers interviewed were willing to continue providing their services for the ES. Reporting form has few variables and is easy to complete. The completeness of forms was 97.9% (47/48). Samples collected were dispatched on the same day to the testing laboratory. The system’s data was managed manually.ConclusionThe system was useful in detecting polio outbreaks. Data quality was good, the system was simple, flexible, acceptable, representative, and fairly stable. Sensitivity was high but predictive value positive was low. Timeliness in reporting was good but feedback from the national level could not be assessed. There is a need to improve on the feedback system and ensure that, the surveillance data is managed electronically.</div

ES surveillance performance, Northern Region, Ghana, 2019–2020.

ES surveillance performance, Northern Region, Ghana, 2019–2020.</p