Participatory epidemiology as an innovative approach in animal health systems research

This paper provides information on a recent innovative approach in animal health research termed “participatory epidemiology”. It seeks to present participatory epidemiology as a tool for research in Ghana, and presents some case studies of the use of participatory epidemiology in Ghana andelsewhere

Perceived quality of healthcare delivery in a rural District of Ghana

Objective: The study aimed at finding out clients’ perceptions of the quality of healthcare delivery at the district level in rural Ghana, using the Komenda-Edina- Eguafo-Abrem District as a case study.Design: 803 patients were purposively selected and interviewed after visits to health facilities using a pretested questionnaire, while focus group discussions were held in 13 communities. The study was done between October 2003 and August 2004. Results: The majority of respondents (70%) were females. The mean expected maximum waiting time for seeking medical help was 1 hr. About 98% said they were asked to explain their problem. However, lower proportions, 74%, 43% and 46% were physically examined, told what was wrong, or given advice about their illness, respectively. About 90% of the respondentswere satisfied or very satisfied with the care given during their visit to the health facility. The participants perceived poor attitude of some health workers, long waiting times, high cost of services, inadequatestaff, policy of payment for health services, frequent referrals to hospitals, and lack of ambulances at facilities as being detrimental to effective delivery of quality healthcare. Conclusions: The study found that generally the quality of healthcare delivery was perceived to be high for most of the indicators used. There were, however, some concerns that patients were not told the diagnosis or informed about the management of their illness. These need to be addressed. The level of satisfaction with quality of healthcare was high

Qualitative release assessment for the re-introduction of HPAI H5N1 virus from neighboring countries into Ghana

By December 2007, there was a continuum of Highly Pathogenic Avian Influenza (HPAI) H5N1 affected countries along the West African coast from Côte d’Ivoire to Cameroon. Eight West African countries (Nigeria, Niger, Cameroon, Burkina Faso, Côte d’Ivoire, Ghana, Togo and Benin) have all reported outbreaks. Benin, Nigeria and Togo reported new outbreaks on May 1, 2008, July 25, 2008, and November 13, 2008, respectively (OIE 2008). The risk of virus circulation and re-infection/re-introduction is high in the sub-region. There is constant movement of people and goods and thus trade between them. Recently, a new virus strain was isolated in Nigeria, raising more concerns in the sub-region (OIE 2008). In November 2008, a risk assessment stakeholder workshop was held in Accra for Ghanaian participants. Participants identified re-introduction of the virus into Ghana as a major risk. The Veterinary Services Directorate (VSD 2007) gives an overview of the risk for HPAI introduction into Ghana: “Ghana borders Togo to the east, Burkina Faso to the north and Côte d’Ivoire to the west. All these four countries have recorded outbreaks of the HPAI H5N1 virus in their respective countries, starting in April 2006 in Burkina Faso and Côte d’Ivoire and in April 2007 and June 2007 in Ghana and Togo, respectively. There are approved entry points between the countries and there exists a very high level of movement of both goods, including live animals and animal products, and people of the four countries. There are also unapproved routes, involving the illegal movement of animals and animal products across the sub-region. These unapproved routes can act as channels for the introduction of trans-boundary animal diseases into any of the four countries. Uncontrolled movement of live poultry and poultry products across the borders poses a serious threat to the animal health, especially [via] avian influenza, of any of the countries in the sub-region. Due to the artificial boundaries and the mix of socio-cultural ties of citizens of these countries, it is always very difficult to enforce quarantine measures in the event of outbreaks of trans-boundary animal diseases in any of the above countries.”Non-PRGRP40; IFPRI

Qualitative release assessment of the risk of re-introduction of HPAI H5N1 virus from neighbouring countries into Ghana

By December 2007, there was a continuum of Highly Pathogenic Avian Influenza (HPAI) H5N1 affected countries along the West African coast from Cote d’Ivoire to Cameroon. In all, 8 countries in West Africa had recorded HPAI H5N1 (Niger, Burkina Faso, Cote D’Ivoire, Ghana, Togo, Benin, Nigeria, and Cameroon). There is concern about the danger posed by circulation of the virus as these countries are members of ECOWAS and there is constant movement of people and goods and trade between them. At a workshop in Accra in November 2008, participants identified re-introduction of the virus into Ghana as a major challenge. The risk question posed was “What is the risk of re-introduction of HPAI H5N1 virus from neighbouring countries (Burkina Faso, Cote d’Ivoire and Togo) into Ghana via cross-border trade and movements involving live birds, poultry products and fomites?“. Three release risk pathways involving Cote d’Ivoire, Burkina Faso and Togo were developed. A questionnaire was developed to elicit responses from identified experts to provide information. Credible information was received from Cote d’Ivoire and Burkina Faso. There was no response from Togo. A qualitative risk assessment following the OIE framework was undertaken to address the risk question. The qualitative risk estimates for the release pathways ranged from negligible to very low with high uncertainty. During outbreaks in neighbouring countries when birds are infected, the risks will vary and are likely to be higher. The highest risk of re-introduction of HPAI H5N1 virus to Ghana is the pathway involving cross-border trade and movement of poultry, poultry products, people and fomites from Cote d’Ivoire with risk estimates being negligible to medium. This is because poultry and poultry products are illegally sent into Ghana (despite a ban on poultry and poultry products) and the existence of farms along the border in the two countries under similar management and therefore sharing facilities. The steps of the pathway for the re-introduction from Cote d’Ivoire to Ghana associated with higher risks included the probabilities of introduction of live birds, eggs and egg trays, and day-old chicks and the probabilities of contamination of traders and poultry workers on small farms. From Burkina Faso, the steps with higher risks posing a threat for re-introduction of HPAI to Ghana included the probabilities of introduction of live household birds; the probability of transporting guinea fowl eggs; the probabilities of contamination and transporting of baskets used for live birds and egg containers; the probability of traders using vehicles to markets and the probability of maize being imported for use as poultry feed. From Togo, the steps with higher risks posing a threat for reintroduction of HPAI to Ghana included the probability of introduction of live household birds; the probability of contamination of poultry workers and the probability of importing frozen turkey tails and carcasses. These could be targeted as preventive or critical mitigation points. The high level of uncertainty associated with most of the risk estimates point to significant gaps in knowledge of the epidemiology of HPAI and/or poultry production or trade in West Africa. Therefore the risk estimates have to be interpreted with extreme caution. There is the need for targeted data collection to fill some of the relevant knowledge gaps. The particular areas are the prevalence of HPAI in household birds and wild and scavenging birds, and movement patterns of people and poultry and poultry products across the borders.Non-PRIFPRI2; DCA; GRP40MTI