Responding to the COVID-19 pandemic in Ghana

On 12 January 2020, the World Health Organization (WHO) confirmed that a novel coronavirus was the cause of a respiratory illness in a cluster of people in Wuhan City, Hubei Province, China. The disease was christened COVID-19 and the pathogen (an RNA virus) identified as SARS-Coronavirus-2 (SARS-CoV-2).1,2 The virus is primarily spread through contact with small droplets produced from coughing, sneezing, or talking by an infected person. While a substantial proportion of infected individuals may remain asymptomatic, the most common symptoms in clinical cases include, fever, cough, acute respiratory distress, fatigue, and failure to resolve over 3 to 5 days of antibiotic treatment. Complications may include pneumonia and acute respiratory distress syndrome.3 Over five million confirmed cases of COVID-19 has been recorded globally with more than 300,000 deaths as at 25th May 2020. The United States of America has recorded the highest number of cases with more than 1.5 million and over 100,000 deaths.4 In Africa, more than 90,0000 cases have been reported with about 3,000 deaths. South Africa has recorded the highest number of cases with 23,615 cases and 481 deaths. Ghana confirmed its first cases of COVID-19 on 12th March 2020 and had as at 25 May 2020 recorded over 7,000 cases with 34 deaths.5 &nbsp

Evaluation of access and utilization of EPI services amongst children 12-23 months in Kwahu Afram Plains, Eastern region, Ghana

Introduction: High vaccination coverage is required to successfully control, eliminate and eradicate vaccine preventable diseases (VPDs). In Ghana, access and utilization of vaccination services is generally good with complete vaccination coverage of 77%. However, sustaining high coverages in island communities such as Kwahu Afram Plains North (KAPN) is still a challenge.Methods: Study site and settings, an Island district. It targeted children aged 12–23 months. We used a modified WHO EPI 30 by 7 cluster sampling approach. Semi-structured questionnaires were employed for data collection. Wincosas and EpiInfo were used for data entry, management and analysis. The vaccination coverage, antigenspecific coverage calculated. The probability was set at 0.05 and  the value was calculated to determine statistical significance of association.Results: Of the 480 records of children analysed, fully vaccinated accounted 81.3%, partially 16.7% and not vaccinated at all 2.1%. Access was 97.3% and utilization 91.2% with Pentavalent 1-3 dropout rate of 8.8%. Coverage for specific antigens were: BCG (97.1%), OPV 1/Pentavalent 1/PCV 1/Rotarix 1 (97.3%), OPV2/ Pentavalent 2/PCV 2/Rotarix 2 (94.0%), OPV3/ Pentavalent3/PCV 3 (88.8%), MR (87.7%) and YF (87.7%). Vaccination card availability, higher educational level of mothers and lower parity levels were significantly associated (p < 0.05) positively with childhood vaccination status. Invalid doses were 21.6% of childhood total vaccinations. Key reasons accounting for non-vaccination were: distant place of immunization 34.4 % (31/90), mother being busy 14.4% (13/90), vaccine unavailability 10.0% (9/90) and fears of side reactions 8.9% (8/90).Conclusion: EPI childhood vaccination coverage for January, 2016 in KAPN District was high. There is the need to focus on counteracting the reasons identified to account for vaccination failure. This would improve and sustain vaccination coverage.Keywords: Immunization Programs, Utilization, Program Accessibility, coverage, vaccination, EP

Building the required skillsets for a resilient public health workforce: A decade of field epidemiology training in Ghana

The emergence and re-emergence of infectious and non-infectious diseases is a major issue of public health concern. The outbreak of Ebola, Lassa Fever, Meningitis and the ongoing COVID-19 pandemic has highlighted the need to have a multisectoral public health workforce with the requisite skillsets to effectively address these situations.As part of the strategies to build these skillsets for public health professionals, the United States Centers for Disease Control and Prevention (US CDC) has assisted countries and territories to establish Field Epidemiology Training Programs. The aim of the FETP training is to provide the public health workforces with the ability to prevent, early detect and respond to threats with the skills to collect, analyse and interrupt disease information so that prompt action can be taken to save live

Are risk factors for non-communicable diseases in adolescents a problem in senior high schools in Accra?

Background: We assessed risk factors of noncommunicable diseases (NCDs) among adolescents in a senior high schoolDesign: We conducted a cross-sectional study in 2016Setting: Senior High School in AccraParticipants: Adolescents in senior high schoolInterventions: Adolescents were interviewed with a structured questionnaire designed using the WHO STEPS framework. Data on tobacco use, alcohol consumption, physical activity and physical measurements of respondents were taken.Main outcome measures: risk factors of noncommunicable diseases among adolescentsResults: A total of 360 adolescents in the school were assessed. Mean age was (17±1.21) years with minimum age being 13 and maximum 19 years. Females were 51% (184/360). About 75% (271/360) reported low physical activity, 15% (55/360) were overweight or obese (95%CI: 0.0317-0.078), 7.0% (25/360) consumed alcohol (95%CI: 0.054-0.111) and 2.5% (9/360) smoked tobacco (95%CI: 0.013- 0.048). Majority of the respondents (346/360) were exposed or at risk of developing at least one risk factor. However, no one was found to be at risk of all five risk factors assessed. Females were three times more likely to be overweight or obese compared to their male counterparts (OR:3,95%CI:1.581-5.624)Conclusion: We found that majority of the children had low physical activity and more than 90% of the respondents had at least one NCD risk factor.Keywords: noncommunicable diseases, risk factors, physical activity, tobacco use, consumption of alcoholFunding: This work was funded by the author

Evaluation of surveillance system for pneumonia in children below five years, Tema Metropolis, Ghana, 2012 – 2016

Background: We evaluated the pneumonia surveillance system in Tema Metropolis to determine whether it is meeting its objectives and to assess its attributes.Design: Descriptive primary and secondary data analysisData Source: We interviewed health staff on the system’s operation and resources. We also extracted 2012-2016 surveillance dataset for under-five pneumonia cases and deaths from the District Health Information Management System for review.Participants: Health staffIntervention: The Centers for Disease Control (CDC) updated guidelines for evaluating surveillance systems was used to assess system attributes. Main outcome measure: state of the pneumonia surveillance system in TemaResults: A suspected case was defined as fast breathing in any child < 5 years old. The case definition was easy to apply, even at the community level. From 2012 to 2016, a total of 3,337 cases and 54 deaths (case fatality rate 1.6%) was recorded from 13 (23.6%) of 55 health facilities. Two epidemics were missed by the district because data were not being analysed. There were no laboratory data on antimicrobial resistance. Although reporting timeliness increased from 28.1% in 2012 to 83% in 2016, data inconsistencies existed between reporting levels.Conclusion: The surveillance system for under-five pneumonia in Tema Metropolis is simple, stable, flexible, timely,but of low sensitivity and acceptability, and only partly meeting its objectives. Major shortcomings are lack of laboratory data, non-use of data and low representativeness.Keywords: Under-five Pneumonia, Surveillance System Evaluation, Tema, GhanaFunding: The study was supported by a grant to author DB by the President’s Malaria Initiative (PMI) -CDC CoAg 6NU2GGH00187

Factors contributing to road crashes among commercial vehicle drivers in the Kintampo North Municipality, Ghana in 2017

Objective: The study assessed driver, vehicular and road-related factors associated with road crashes (RC) in the Kintampo North Municipality.Design: Cross-sectional studySetting: Kintampo North MunicipalityData source: Demographics, vehicular and road usage information on registered drivers at Ghana Private Road and Transport Union (GPRTU) and Progressive Transport Owners Association (PROTOA) in Kintampo North MunicipalityMain outcome: involvement in road crashes and related factorsResult: A total of 227 drivers were approached for this study. None of them declined participation. They were all males. Most were between 28-37 years (30%). The proportion of drivers that reported RC ever involvement in at least one RC was 55.5% (95% CI: 8.0%, 62.1%). In the bivariate analysis, drink and drive changed lane without signalling, ever bribed police officer, drove beyond the maximum speed limit, paid a bribe at DVLA for driving license, violation of traffic signals were found to be associated with RC involvement (p<0.05). Drivers who violated traffic signals had 2.84 odds of being involved in road crashes compared to those who did not [aOR; 2.84 (95%CI:1.06,7.63)]Conclusion: The proportion of drivers ever involved in road crashes was high. The major factor that is associated with RC involvement was a violation of the traffic light signals. Continuous driver education and enforcement of road traffic regulations by the appropriate authorities could curb the road crash menace in the Municipality.Keywords: commercial drivers, road crashes, vehicle, road signs, traffic light signalFunding: The authors funded this work

Compliance with the WHO strategy of test, treat and track for malaria control at Bosomtwi District in Ghana

Background: We reviewed malaria morbidity data to assess compliance to malaria T3 strategy in Bosomtwi District, Ashanti Region, Ghana.Design: The study was descriptive secondary data analysisSetting: Bosomtwi DistrictData source: District Health Information Management Systems (DHIMS2)Main outcome: Proportion of recorded cases tested, proportion of tested cases treated and proportion of cases trackedResults: Data for suspected and tested malaria cases was complete for only 3 years (2014-2016). Malaria testing reduced from 84.4% in 2015 to 76.8% in 2016 (national average 77.3%; regional average 70%). The proportion of untested but treated malaria cases declined from 46.3% in 2015 to 4.9% in 2016. Proportion of confirmed malaria cases put on antimalarial drugs was highest in 2016 at 63.9%. Pramso sub-district although home to largest facility in the district, under prescribed antimalarial drugs. Reports generated on malaria showed information on only confirmed suspected cases, under five, and above five malaria mortalities. The district did not determine their malaria thresholds.Conclusion: The malaria-testing rate in the Bosomtwi District is higher than the regional average and close to the national average. About a third of confirmed malaria cases missed getting appropriate antimalarial drugs. Limited analysis on malaria data reduced the information required to inform policy.Keywords: Malaria, Test, Treat and Track (T3), DHIMS2, Bosomtwi, Ghana.Funding: Author GO was fully sponsored by President’s Malaria Initiative (PMI)-CDC CoAg 6NU2GGH00187

Evaluation of viral haemorrhagic fever surveillance system with focus on Ebola virus disease, Bawku municipality- Upper East Region, Ghana, 2011- 2015

Background: We evaluated the Viral haemorrhagic fever (VHF) surveillance system from 2011 to 2015 in the Bawku Municipality, Upper East region, Ghana to determine whether the goals of the surveillance system are being met and to assess the performance of the system attributes.Design: Descriptive secondary data analysis.Setting: Bawku MunicipalityData Source: Review VHF surveillance records, interviewed community-based surveillance volunteers (CBSVs) and reviewed vital events registers. We also assessed the system attributes by reviewing records and interviewing key stakeholders involved in VHF surveillance system with focus on Ebola using checklist and semi structured questionnaire developed based on the Centers for Disease Control and Prevention (CDC) guidelines.Main outcome measure: System attributes of the VHF surveillance systemResults: Population under surveillance was 105,849. The system required detail information about suspected cases. However, it had a simple and clear standard case definitions, and was well integrated with the IDSR. There is a regular and timely flow of information. The system captured 155 suspected cases nationwide from 2011 to 2015 and all tested negative. Of these, Upper East Region reported 10 suspected cases including 4 suspected cases from Bawku Municipality.Conclusion: The VHF surveillance system achieved its objectives. However, poor data quality, inadequately trained surveillance officers, and inadequate financial support are threats to the effectiveness of the system.Keywords: Viral haemorrhagic fever, surveillance system evaluation, attributes, Bawku Municipality, GhanaFunding: This work was supported by Ghana Field Epidemiology and Laboratory Training Program (GFELTP), University of Ghan

Sexual experiences of adolescents and young adults living with HIV attending a specialized clinic in Accra, Ghana

Background: We assessed sexual experiences among adolescent and young adults living with HIV (AYALHIV) attending the adolescent HIV care clinic in Korle Bu Teaching Hospital (KBTH)Design: Cross-sectional study conducted in 2015.Setting: HIV clinic at KBTHParticipants: AYALHIV who attended the adolescent HIV care clinicInterventions: AYALHIV were interviewed with a structured questionnaire to obtain data on their socio-demographic characteristics and sexual experiences. The data was analyzed with STATA version 13.Main outcome measures: sexual experiences of adolescents and young people living with HIVResults: Of 101 participants, 60.4% (61/101) were males. The mean age of respondents was (18±3.2) years with an average age at sexual debut (16.2±4.2) years. A third of the respondents (34/101) had had sex before and out of them 76.5% (26/34) were males. Seventeen percent (4/23) had multiple sexual partners and 38.1% (8/21) of sexually active use condom at last sexual intercourse. Eighty-six percent (87/101) of respondents knew their HIV status, 66.7% (58/87) of them were males. There was a significant association (p<0.05) between being male and knowledge of HIV positive status. Knowledge of a respondents’ HIV positive status was found to be positively associated with ever using condom.Conclusion: Sexual experience prevalence is high among AYALHIV. More males were sexually active, not using condom and had multiple sexual partners. Safer sexual practices such as consistent use of condoms, need to be intensifiedespecially during counselling sessions. This could contribute to the reduction in prevalence of HIV among the adolescents in the country.Keywords: adolescents; young people; HIV; sex education; sexual experienceFunding: This work was funded by the author

Evaluation of timeliness of treatment initiation among smear positive pulmonary tuberculosis patients in Brong Ahafo Region, Ghana, 2015

Background: We evaluated timeliness and factors influencing treatment initiation (TI) among smear positive pulmonary tuberculosis (PTB+) patients in Brong Ahafo Region (BAR), Ghana.Design and Setting: We conducted a cross-sectional study in health facilities (HF) in six districts in BAR, from November 2014 to May 2015. Newly diagnosed smear positive PTB patients were selected randomly proportionate to size of facility cases. Timeliness of symptoms, diagnosis, TI and factors for delay were assessed using structured questionnaire. Patient delay was defined as presentation to a health care provider after 21 days of the onset of TBrelated symptoms and TI delay as therapy initiated after 30-days of onset of TB-related symptoms. We determined median patient timeliness, HF, and TI timeliness. We identified factors associated with TI delay using logistic regression.Results: There were a total of 237 PTB+ patients; median patient timeliness of 30 days (IQR:14, 60). The median health facility timeliness was 8 days (IQR:4, 10); and the median TI timeliness was 36 days (IQR:25, 69). Majority (58.7%) of patients delayed in seeking treatment. TI delay was associated with: unemployment [aOR=7.4, 95%CI(1.9–28.8)], fear of losing job [aOR=3.4, 95%CI(1.3–8.5)], traditional healer as first port of call [aOR=10.6, 95%CI(13.0-66.8)], and initially being treated for HIV [aOR=4.9, 95%CI(1.6-14.8)].Conclusion: There were delays in treatment initiation and patient treatment seeking timeliness. One-third of patients would prefer traditional healers/self-treatment/drug store as an option. A concerted effort by stakeholders is needed toimprove behaviour change communication on good health seeking behaviour for persons living with TB to reduce delays in seeking treatment.Keywords: Pulmonary tuberculosis; timeliness, delay; Brong Ahafo Region; GhanaFunding: The study was funded by the author