Direct observation of outpatient management of malaria in a rural ghanaian district

Introduction: in Ghana, malaria continues to top outpatient morbidities; accounting for about 40% of all attendances. Effective case-management is key to its control. We evaluated case-management practices of uncomplicated malaria in Kwahu South District (KSD) health facilities to determine their conformity to guidelines. Methods: we conducted a cross sectional survey at all public health facilities in three randomly selected sub-districts in KSD. A non-participatory observation of suspected malaria consultations was conducted. Suspected malaria was defined as any person with fever (by history or measured axillary temperature > or equal 37.5 oC) presenting at the selected health facilities between 19th and 29th April 2013. Findings were expressed as frequencies, relative frequencies, mean (± standard deviation) and median. Results: of 70 clinical observations involving 10 prescribers in six health facilities, 40 (57.1%) were females and 16 (22.9%) were below five years. Median age was 18 years (interquartile range: 5-33). Overall, 63 (90.0%) suspected case-patients had diagnostic tests. Two (3.6%) were treated presumptively. All 31 confirmed and 10 (33.3%) of the test negative case-patients received Artemisinin-based Combination Therapies (ACTs). However, only 12 (27.9%) of the 43 case-patients treated with ACT received Artesunate-Amodiaquine (AA). Only three (18.8%) of the under-fives were examined for non-malarial causes of fever. Mean number of drugs per patient was 3.7 drugs (± 1.1). Only 45 (64.3%) patients received at least one counseling message. Conclusion: conformity of malaria case-management practices to guidelines in KSD was suboptimal. Apart from high rate of diagnostic testing and ACT use, prescription of AA, physical examination and counseling needed improvement

Secondary analysis of snake bite data in the Western Region of Ghana: 2006- 2010

Background: A snake bite is an injury caused by a bite from a snake, often resulting in puncture wounds, amputations and sometimes envenomation. Envenoming resulting from snake bite is a particularly important public health problem in rural areas of tropical and sub-tropical countries in Africa. This paper reports the incidence of snake bites and its associated mortality in the Western Region of Ghana.Method: The study was a descriptive cross-sectional review of 2006 - 2010 snake bite secondary data generated by the Western Regional Health Information Office in Ghana. Data was extracted from the District Health Information Management System (DHIMS) database. Data was managed and analyzed using SPSS Version 16.0. Univariate analyses were expressed as percentages and graphs.Results: The year 2009 recorded the highest incidence of Snake bites in the Western Region with Juabeso district recording the highest incidence of snake bites over the study period. Over the period about 55% of the incidence was between 50 – 100 per 100,000 population. The total number of snake bites recorded in the region for the period was 7,275, of which 52% (3,776) were males. About 60% of the patients were of the age group 15-49 years. A total of 12 reported snake bite deaths were recorded, of which 67% were men. This study recommends to the Districts Health Directorates in the Western Region to regularly organize community education on snake bite and the use of protective clothing by the farmers.Funding: None declaredKeywords: Snake bite, Envenomation, Incidence, District Health Information Management System, Western Region, Ghan

The genesis and evolution of the African Field Epidemiology Network

In an effort to contain the frequently devastating epidemics in sub-Saharan Africa, the World Health Organization (WHO) Regional Office for Africa launched the Integrated Disease Surveillance and Response (IDSR) strategy in an effort to strengthen surveillance and response. However, 36 sub-Saharan African countries have been described as experiencing a human resource crisis by the WHO. Given this human resource situation, the challenge remains for these countries to achieve, among others, the health-related Millennium Development Goals (MDGs). This paper describes the process through which the African Field Epidemiology Network (AFENET) was developed, as well as how AFENET has contributed to addressing the public health workforce crisis, and the development of human resource capacity to implement IDSR in Africa. AFENET was established between 2005 and 2006 as a network of Field Epidemiology Training Programs (FETPs) and Field Epidemiology and Laboratory Training Programs (FELTPs) in Africa. This resulted from an expressed need to develop a network that would advocate for the unique needs of African FETPs and FELTPs, provide service to its membership, and through which programs could develop joint projects to address the public health needs of their countries. A total of eight new programs have been developed in sub-Saharan Africa since 2006. Programs established after 2006 represent over 70% of current FETP and FELTP enrolment in Africa. In addition to growth in membership and programs, AFENET has recorded significant growth in external partnerships. Beginning with USAID, CDC and WHO in 2004-2006, a total of at least 26 partners have been added by 2011. Drawing from lessons learnt, AFENET is now a resource that can be relied upon to expand public health capacity in Africa in an efficient and practical manner. National, regional and global health actors can leverage it to meet health-related targets at all levels. The AFENET story is one that continues to be driven by a clearly recognized need within Africa to develop a network that would serve public health systems development, looking beyond the founders, and using the existing capacity of the founders and partners to help other countries build capacity for IDSR and the International Health Regulations (IHR, 2005).Pan Afr Med J. 2011; 10(Supp 1):

Uncommon mixed outbreak of pneumococcal and meningococcal meningitis in Jirapa District, Upper West Region, Ghana, 2016

Objective: The Jirapa District in Ghana falls within the African meningitis belt where over 500 million people are at risk of epidemic meningitis. The district suffered an outbreak of Neisseria meningitides, W (NMW) in 2012 and a mixed outbreak of Streptococcus pneumonia and NMW in early 2016. We investigated the outbreak to identify the source, causative agents, and magnitude and assess health facility preparedness and propose control measures.Design and Setting: We conducted a descriptive study in all sub-districts of Jirapa, between 28th February to10th April 2016. We reviewed records at health facilities, assessed health facility preparedness, searched for cases, traced contacts of case to administer chemoprophylaxis and collect CSF for laboratory analysis. Data were entered in Microsoft excel cleaned, and exported to stata-13 for analysis by person place and time.Results: A total 233 meningitis cases were reported with mean age of 22.4years and standard deviation 21.6. Males were (57%), females (43%) and 60.8% were less than 19 years. Attack rate of meningitis was 214/100,000 with case fatality rate (CFR) of 12.4% (29/233). Causative agents were NMW (69.5%) and streptococcus pneumonia (27.1%), mainly serotype STN1 and H. influenza (3.4%). The index case had travel history to dollar power, close to Tain District which is the epicentre for the 2016 meningitis outbreak in Ghana.Conclusion: The Jirapa district experienced a mixed outbreak of streptococcal and meningococcal meningitis in early 2016, facilitated by migration. Active surveillance and mass vaccination with multivalent vaccines is required to protect the population.Funding: Ghana Field Epidemiology and Laboratory Training Programme (GFELTP)Keywords: Meningitis, outbreak, surveillance, Jirapa, CS

Foodborne disease outbreak in a resource-limited setting: a tale of missed opportunities and implications for response

Introduction: Foodborne diseases (FBD) have emerged as a major public health problem worldwide. Though the global burden of FBD is currently unknown, foodborne diarrhoeal diseases kill 1.9 million children globally every year. On 25th September 2014, health authorities in Eastern Region of Ghana were alerted of a suspected FBD outbreak involving patrons of a community food joint. We investigated to determine the magnitude, source and implement control and preventive measures. Methods: A retrospective cohort study was conducted. We reviewed medical records for data on demographics and clinical features. A suspected foodborne disease was any person in the affected community with abdominal pain, vomiting and or diarrhea between 25th and 30th September 2014 and had eaten from the food joint. We conducted active case search, descriptive data analysis and calculated food specific attack rate ratios (ARR) and their corresponding 95% confidence intervals. Results: Of 43 case-patients, 44.2% (19/43) were males; median age was 19 years (interquartile range: 17-24 years). Overall attack rate was 43.4% (43/99) with no fatality. Case counts rose sharply for four hours to a peak and fell to baseline levels after 12 hours .Compared to those who ate other food items, patrons who ate “waakye” and “shitor” were more likely to develop foodborne disease [ARR=4.1 (95% CI=1.09-15.63)]. Food samples and specimens from case-patients were unavailable for testing. Laboratory diagnostic capacity was also weak. Conclusion: A point source FBD outbreak linked to probable contaminated “waakye” and or “shitor” occurred. Missed opportunities for definitive diagnosis highlighted the need for strengthening local response capacity.Pan African Medical Journal 2016; 2

Dog Bites and Rabies in the Eastern Region of Ghana in 2013-2015: A Call for a One-Health Approach.

BACKGROUND: A One-Health approach is advocated to ensure effective rabies surveillance in sub-Saharan Africa. Information is needed to assess the current state of dog bites and rabies in Ghana. We analyzed data on reported events in the Eastern Region of Ghana from 2013 to 2015 to generate information that can be used for rabies elimination in Ghana through the One-Health approach. METHOD: We extracted data on dog bites and rabies from the database of the regional health service and performed descriptive analysis using Epi Info version 7™. We followed up with interviews with three key informants from the health and veterinary services on issues related to surveillance and data quality. RESULTS: Overall, 4821 dog bites were reported over the three-year period. This translated into an annual incidence of 172 cases per a population of 100,000. Most of cases were in children aged less than 10 yrs. Fifteen (53.3% males) cases of rabies were recorded in seven out of the 26 municipalities and districts, translating into a rabies to dog bite ratio of 3: 1000. The median age of victims was 9 years (range: 3-72 years). A parallel and uncoordinated system of rabies surveillance is maintained by the health and veterinary services, with gross disparities in the number of reported events and overall impression of underreporting. CONCLUSION: Rabies remains an important cause of preventable deaths in this region. An integrated approach to surveillance based on the One-Health concept needs to be adopted

Molecular characterization of human parainfluenza virus type 1 in infants attending Mbagathi District Hospital, Nairobi, Kenya

Background. Human parainfluenza virus type 1 (HPIV-1), a Paramyxovirus, is a leading cause of paediatric respiratory hospitalizations globally. Currently, there is no HPIV-1 vaccine. Hence, there is need to characterize circulating strains of this virus to establish the feasibility of developing a vaccine against the virus. The variable HPIV-1 Hemagglutin-neuraminidase (HN) protein is found in the envelope of HPIV-1 where it initiates the infection process by binding to cellular receptors. HN is also the major antigen against which the human immune response is directed against. The present study focused on identifying mutations in the HN gene that would be useful in understanding evolution of HPIV-1. Methods. 21 HPIV-1 isolates were obtained after screening nasopharyngeal samples from patients with influenza-like-illness. The samples were collected from Mbagathi District Hospital Nairobi from the period June 2006- December 2010. RT-PCR was carried out on the isolates using HN-specific primers to amplify a 360nt in the most polymorphic region and the amplicons sequenced. Genomic data was analysed using a suite of bioinformatic software. Results. Forty-eight polymorphic sites with a total of 55 mutations were identified at the nucleotide level and 47 mutations at 23 positions at the amino acid level. There was more radical non-synonymous amino acid changes (7 positions) observed than conservative non-synonymous changes (1 position) on the HN gene fragment. No positively selected sites were found in the HN protein. Conclusion

Outbreak of foodborne gastroenteritis in a senior high school in South-eastern Ghana: a retrospective cohort study

Abstract Background On 4th February 2015, a group of Senior High School students from Fanteakwa district presented to the emergency unit of the district hospital with complaints of abdominal pain, vomiting and diarrhoea. All the students had eaten from a specific food vendor and had neither eaten any other common meal that day nor the previous day. A foodborne disease outbreak was suspected. We investigated to verify the outbreak, determine its magnitude, identify the source and implement control measures. Methods A retrospective cohort study was conducted. We reviewed medical records and interviewed patrons of the food vendor. We collected data on age, sex, signs and symptoms, date of illness onset, date of admission, date of discharge, treatments given and outcome. A case of foodborne disease was any person in the school with abdominal pain, vomiting and or diarrhoea from 4th to 11th February 2015 and had eaten from the food vendor. We conducted active case search to identify more cases. We conducted environmental assessment and collected clinical and food samples for laboratory testing. Descriptive and inferential statistical analyses were performed using Stata 12.0. Results A total of 68 cases were recorded giving overall attack rate of 35.79 % (68/190) with no death. Of these, 51.47 % (35/68) were males. Mean age of case-patients was 17.8 (standard deviation +/-1.62). The index case, a 17-year-old female student ate from the food vendor on 4th February at 9:00 am and fell ill at 3:40 pm later that day. Compared to those who ate other food items, students who drank water from container at the canteen were more likely to develop foodborne disease at statistically significant levels [RR = 2.6, 95 % CI = (2.11–3.15)]. Clostridium perfringens (C. perfringens) and Salmonella species (Salmonella spp) were isolated from water and stew respectively. Clinical features of case-patients were compatible with both organisms. Conclusion A foodborne gastroenteritis outbreak occurred in a Senior High School in Fanteakwa District from 4th to 7th February 2015. The most probable aetiologic agent was C. perfringens with contaminated water at canteen as the vehicle of transmission. Concurrent Salmonella spp infection could not be ruled out. Rapid outbreak response helped in controlling the outbreak