Pneumococcal meningitis outbreak and associated factors in six districts of Brong Ahafo region, Ghana, 2016.

BACKGROUND: Meningitis, a disease of the Central Nervous System is described as inflammation of the covering of the brain and spinal cord (meninges). It is characterised by fever, severe headache, nausea, vomiting, stiff neck, photophobia, altered consciousness, convulsion/seizures and coma. In December, 2015, twelve suspected cases of meningitis were reported in Tain district in Brong Ahafo region (BAR). Subsequently, dozens of suspected cases were hospitalized in five district hospitals in BAR. We investigated to determine the magnitude, causative agent and risk factors for the disease transmission. METHODS: A community-based 1:2 case-control study (with 126 individuals) was conducted form 10/12/15 to 26/4/16 in 27 districts of Brong-Ahafo Region, Ghana. We defined suspected meningitis cases as people presenting with sudden headache and fevers (Temp> 38.0 °C) in combination with one of the following signs: neck stiffness, altered consciousness, convulsions, bulging fontanelle (infants) and other meningeal signs. Controls were selected from the same neighbourhood and defined as individuals with no overt meningitis signs/symptoms. We collected CSF samples and performed serological testing using Pastorex-Meningitis-Kit and culture for bacterial isolation. Moreover, structured questionnaires were used to collect data on socio-demographics, living conditions, health status and other risk factors. We conducted univariate data analysis and logistic regressions to study disease-exposure associations using Stata 15. RESULTS: A total of 969 suspected cases with 85 deaths (CFR = 9.0%) were recorded between December, 2015 and March, 2016. Majority, 55.9% (542/969) were females aged between 10 months-74 years (median 20 years, IQR; 14-34). Of the 969 cases, 141 were confirmed by Laboratory test with Streptococcus pneumoniae identified as the causative agent. Cases were reported in 20 districts but 6 of these districts reported cases above threshold levels. The outbreak peaked in week 6 with 178 cases. Overall attack rate (AR) was 235.0/100,000 population. District specific ARs were; Tain; 143.6/100,000, Wenchi; 110.0/100,000, Techiman; 46.6/100,000, Jaman North; 382.3/100,000 and Nkoranza South; 86.4/100,000. Female and male specific ARs were 251.3/100,000 and 214.5/100,000 respectively. Age group 10-19 years were most affected 33.8% (317/940). We identified sore throat [aOR = 5.2, 95% (CI 1.1-26.1)] and alcohol use [aOR = 9.1, 95%(CI 1.4-55.7)] as factors associated with the disease transmission. CONCLUSION: Meningitis outbreak due to Streptococcus pneumoniae was established in BAR. Upper respiratory tract infection and alcohol use were associated with the outbreak. Mass campaigns on healthy living habits, signs and symptoms of meningitis as well as the need for early reporting were some of the control measures instituted. Moreover, we recommend Pneumococcal vaccination in BAR to prevent future outbreaks.

Meningitis Outbreak Caused by Vaccine-Preventable Bacterial Pathogens - Northern Ghana, 2016.

Bacterial meningitis is a severe, acute infection of the fluid surrounding the brain and spinal cord that can rapidly lead to death. Even with recommended antibiotic treatment, up to 25% of infected persons in Africa might experience neurologic sequelae (1). Three regions in northern Ghana (Upper East, Northern, and Upper West), located in the sub-Saharan "meningitis belt" that extends from Senegal to Ethiopia, experienced periodic outbreaks of meningitis before introduction of serogroup A meningococcal conjugate vaccine (MenAfriVac) in 2012 (2,3). During December 9, 2015-February 16, 2016, a total of 432 suspected meningitis cases were reported to health authorities in these three regions. The Ghana Ministry of Health, with assistance from CDC and other partners, tested cerebrospinal fluid (CSF) specimens from 286 patients. In the first 4 weeks of the outbreak, a high percentage of cases were caused by Streptococcus pneumoniae; followed by an increase in cases caused by Neisseria meningitidis, predominantly serogroup W. These data facilitated Ghana's request to the International Coordinating Group* for meningococcal polysaccharide ACW vaccine, which was delivered to persons in the most affected districts. Rapid identification of the etiologic agent causing meningitis outbreaks is critical to inform targeted public health and clinical interventions, including vaccination, clinical management, and contact precautions.

Modeling the economic burden of postpartum hemorrhage due to substandard uterotonics in Ghana.

Uterotonics are essential in preventing postpartum hemorrhage (PPH), the leading direct cause of maternal death worldwide. However, uterotonics are often substandard in low- and middle-income countries, contributing to poor maternal health outcomes. This study examines the health and economic impact of substandard uterotonics in Ghana. A decision-tree model was built to simulate vaginal and cesarean section births across health facilities, uterotonic quality and utilization, PPH risk and diagnosis, and resulting health and economic outcomes. We utilized delivery data from Ghana's maternal health survey, risks of health outcomes from a Cochrane review, and E-MOTIVE trial data for health outcomes related to oxytocin quality. We compared scenarios with and without substandard uterotonics, as well as scenarios altering uterotonic use and care-seeking behaviors. We found that substandard uterotonic use contributes to $18.8 million in economic burden annually, including $6.3 million and $4.8 million in out-of-pocket expenditures in public and private sectors, respectively. Annually, the National Health Insurance Scheme bears $1.6 million in costs due to substandard uterotonic use. Substandard uterotonics contribute to $6 million in long-term productivity losses from maternal mortality annually. Improving the quality of uterotonics could reduce 20,000 (11%) PPH cases, 5,000 (11%) severe PPH cases, and 100 (11%) deaths due to PPH annually in Ghana. Ensuring the quality of uterotonics would result in millions of dollars in cost savings and improve maternal health outcomes for the government and families in Ghana. Cost savings from improving uterotonic quality would provide financial protection and help Ghana advance toward Universal Health Coverage.

Impact of COVID-19 on the Use of Emergency Contraceptives in Ghana: An Interrupted Time Series Analysis.

The Coronavirus disease pandemic has disrupted reproductive health services including decline in the use of pre-coital contraceptives. However, evidence of its impact on the use of emergency contraceptives, often, post-coital methods, is limited in the emerging literature, hence this study. Data on total number of emergency contraceptive users from January 2018 to February 2020 (pre-pandemic) and March to December 2020 (during the pandemic) were extracted from the Ghana Health Service District Health Information Management System. Interrupted Time Series analysis was used to estimate the impact of the pandemic on the trend of emergency contraceptive use, adjusting for serial autocorrelation and seasonality. The results showed a gradual upward trend in emergency contraceptive use before the pandemic, increasing at a rate of about 67 (95% CI 37.6-96.8; p = 0.001) users per month. However, the pandemic caused a sudden spike in the use of emergency contraceptives. The pandemic and its related restrictions had an immediate effect on the use of emergency contraceptives, increasing significantly by about 1939 users (95% CI 1096.6-2781.2; p = 0.001) in March 2020. Following March 2020, the number of emergency contraceptive users continued to increase by about 385 users per month (95% CI 272.9-496.4; p = 0.001). The evidence shows that use of emergency contraceptives, often used as post-coital methods for unprotected sex was not negatively impacted by the pandemic. In fact, it is the opposite. Hence, in planning for similar situations attention should be given to the distribution of post-coital contraceptive methods.

Geospatial clustering of meningitis: an early warning system (hotspot) for potential meningitis outbreak in upper east region of Ghana.

OBJECTIVE: We mapped and generated hot spots for potential meningitis outbreak from existing data in Upper East region, Ghana. DESIGN: This was a cross-sectional study conducted in 2017. DATA SOURCE: Meningitis data in the Upper East Region from January 2007, to December 2016. MAIN OUTCOME MEASURE: We used spatial tools in Quantum Geographic Information System (QGIS) and Geoda to draw choropleth map of meningitis incidence, case fatality and hotspot for potential meningitis outbreak. RESULTS: A total of 2312 meningitis cases (suspected and confirmed) were recorded from 2016-2017 with median incidence of 15.0cases/100,000 population (min 6.3, max 47.8). Median age of cases was 15 years (IQR: 6-31 years). Most (44.2%) of those affected were 10 years and below. Females (51.2%) constituted the highest proportion. Median incidence from 2007-2011 was 20cases/100,000 population (Min 11.3, Max 39.9) whilst from 2012-2016 was 11.1cases/100,000 populations (Min 6.3, Max 47.8). A total of 28 significant hotspot sub-districts clusters (p=0.024) were identified with 7 High-high risk areas as potential meningitis outbreak spots. CONCLUSION: The occurrence of meningitis is not random, spatial cluster with high -high-risk exist in some sub-districts. Overall meningitis incidence and fatality rate have declined in the region with district variations. Districts with high meningitis incidence and fatality rates should be targeted for intervention. FUNDING: Author EA was supported by the West Africa Health Organization (Ref.: Prog/A17IEpidemSurveillN°57212014/mcrt).

Analysis of meningitis outbreak data, Jaman North District, Brong Ahafo Region, Ghana.

BACKGROUND: Descriptive analysis of meningitis outbreak in Jaman North districts of Brong Ahafo Region. DESIGN: Descriptive secondary data analysis. DATA SOURCE: records of meningitis cases were extracted from case-based forms and line list. MAIN OUTCOME MEASURE: The source and pattern of outbreak. RESULTS: A total of 367 suspected cases with 44 confirmed were recorded from Jaman North during the period of January to March 2016. The mean age of those affected was 58 ± 13 years. The case fatality rate was 0.82% and the proportion of males to females was 1:1.3 (160/207). The age group most affected was 15-29 years (54.7%) and the least was 45-49 years (3.0%). Streptococcus pneumoniae formed 77.3% of confirmed cases whilst Neisseria meningitides was 20.5%. Cases with Neisseria meningitides came from a border town in La Cote d'Ivoire. CONCLUSION: A protracted propagated meningitis outbreak occurred; and the predominant bacteria strain among confirmed cases was Streptococcus pneumoniae. Cases were mainly females and the most vulnerable group were people aged 15-29 years. FUNDING: This work was funded by the authors. Author BKD was sponsored under CDC (Frontline FETP)-CDC CoAg 6NU2GGH001876.

Factors influencing uptake of intermittent preventive treatment of malaria in pregnancy using sulphadoxine pyrimethamine in Sunyani Municipality, Ghana.

INTRODUCTION: Malaria continues to pose a public health challenge in Ghana particularly in pregnant women. Ghana adopted intermittent preventive treatment of malaria in pregnancy policy using sulphadoxine pyrimethamine. Despite its implementation, its coverage still remains low. This study sought to investigate factors that influence the uptake of intermittent preventive treatment of malaria in pregnancy in the Sunyani Municipality. METHODS: This was a cross sectional study which employed a quantitative method. The study was conducted in five selected facilities in the Sunyani Municipality within the period of January to June 2015. Structured questionnaires were administered to 400 pregnant women randomly sampled from antenatal clinics of selected health facilities. Descriptive, bivariate and multivariate analysis of quantitative data was done using Stata12. RESULTS: A total of 400 pregnant women at 36 weeks or more gestational age were studied. The study revealed that 98.5% of the pregnant women received at least one (1) dose of sulphadoxine pyrimethamine during the current pregnancy with 71% receiving optimal (at least 3 doses) doses of sulphadoxine pyrimethamine for intermittent preventive treatment of malaria in pregnancy at the time of study. The study revealed that women who attended ANC ≥4 times (Adjusted OR = 4.7, 95% CI 1.31-17.2), knowledge of malaria in pregnancy (Adjusted OR = 2.2, 95% CI 1.03-4.62) and knowledge of intermittent preventive treatment for malaria in pregnancy (Adjusted OR = 1.8, 95% CI 1.15-2.96) were found to be positively associated with the uptake of optimal doses of sulphadoxine pyrimethamine. CONCLUSION: This study has demonstrated that having a good knowledge of malaria in pregnancy and intermittent preventive treatment of malaria in pregnancy can significantly influence the uptake of optimal doses of sulphadoxine pyrimethamine. Encouraging women to attend antenatal care regularly (at least four visits) could also increase the optimal uptake of sulphadoxine pyrimethamine.

Large cholera outbreak in Brong Ahafo Region, Ghana.

BACKGROUND: A nationwide outbreak of Vibrio cholerae occurred in Ghana in 2014 with Accra, the nation's capital as the epi-center. The outbreak spread to the Brong Ahafo Region (BAR) which is geographically located in the middle of the country. In this region a review of data collected during the outbreak was carried out and analyzed descriptively to determine the hot spots and make recommendations for effective response to future outbreaks. METHODS: A review of patient records and line lists of cases of cholera reported in all hospitals during the period of the outbreak (July-December 2014) was conducted. Hospitals used IDSR (Integrated Disease Surveillance and Response system) standard case definitions to detect and report cases for management. The GPS coordinates of all districts and health facilities were collected and utilized in the construction of spot maps. We also obtained populations (denominators) from the BAR Health surveillance unit of the Ghana Health Service. All the data thus collected was analyzed descriptively and expressed as frequencies and rates. RESULTS: A total of 1035 cases were reported, 550 (53.4%) were males and the rest females. Their ages ranged from 1 to 95 years; (mean age of 28.2 ± 19.6 years). The most affected (23.5%) was the 20-29 year old age group. On the 30th July, 2014, a 26 year old male (recorded as the index case of the cholera outbreak in the Brong Ahafo region) with a history of travel from Accra reported to the Nkoranza district hospital with a history of symptoms suggestive of cholera. The reporting of cholera cases reached their peak (17.3%) in week 15 of the outbreak (this lasted 25 weeks). An overall attack rate of 71/100,000 population, and a case fatality rate of 2.4% was recorded in the region. Asutifi South district however recorded a case fatality of 9.1%, the highest amongst all the districts which recorded outbreaks. The majority of the cases reported in the region were from Atebubu-Amanten, Sene West, Pru, and Asunafo North districts with 31.1, 26.0, 18.2 and 9.9% respectively. Vibrio cholerae serotype O1 was isolated from rectal swabs/stool samples tested. CONCLUSION: Vibrio cholerae serotype O1 caused the cholera-outbreak in the Brong Ahafo Region and mainly affected young adult-males. The most affected districts were Atebubu-Amanten, Sene west, Pru (located in the eastern part of the region), and Asunafo North districts (located in the south west of the region). Case Fatality Rate was higher (2.4%) than the WHO recommended rate (<1%). Active district level public health education is recommended on prevention and effective response for future outbreaks of cholera.

Assessment of the usefulness of integrated disease surveillance and response on suspected ebola cases in the Brong Ahafo Region, Ghana.

BACKGROUND: This study assessed the quality, core and support functions of the integrated disease surveillance and response (IDSR) system relating to 18 suspected cases of Ebola virus disease (EVD) in the Brong Ahafo Region, Ghana. METHODS: Data was collected on selected indicators of the surveillance system relating to 18 suspected cases of EVD, from epidemiological week 19 to 45 of 2014. We conducted in-depth interviews with seven medical directors and two district directors of health services, and also reviewed documentation on the implementation of the core, support and quality functions of the IDSR system. We also monitored news in the media and rumours about EVD within the community as well as in health facility surveillance registers. RESULTS: The study identified gaps in the implementation of IDSR relating to 18 suspected cases of EVD. Health staff heavily relied on haemorrhage as the only symptom for detection of suspected EVD cases. Twelve blood samples and a swab of secretions from the mouth of the thirteenth patient (who died) tested negative for EVD using PCR assay in laboratory confirmation. The blood samples of three patients were discarded, as they did not fit the case definition for suspected cases, whilst two refused for their blood samples to be taken. The community-based surveillance (CBS) system has not been given a prominent role in EVD surveillance and response, as demonstrated by CBS volunteers and health staff not receiving any training in these processes. There was intense public interest in EVD in August and September 2014. That interest has since waned for reasons that have to be formally ascertained. Unfounded fear of and anxiety about EVD still remain challenges due to a lack of in-depth knowledge about the disease in Ghana. CONCLUSION: Ghana has been one of the pioneers in the implementation of IDSR in Africa. Despite this, gaps have been identified in the implementation of IDSR relating to EVD in the Brong Ahafo Region. To address these gaps, the CBS system has to actively partner with health facility surveillance to achieve effective IDSR in the region.

Maternal and neonatal survival and mortality in the Upper West Region of Ghana.

OBJECTIVE: To describe the health facility-based factors affecting maternal/neonatal health and the outcomes of maternal death notifications and audits in the Upper West Region of Ghana. METHODS: Maternal death notifications and audits were conducted at 6 hospitals and in communities in the Upper West Region of Ghana in 2009. Furthermore, a kangaroo mother care strategy was implemented at 5 health facilities in the region to improve neonatal survival. The results of these implementations were recorded between July and December 2009. RESULTS: Forty-seven maternal deaths were reported and audited, with 46.5% occurring within 24 hours after admission. Twenty-three deaths were linked to delays in receiving care and non-adherence to treatment protocols. Of 155 midwives expected to provide skilled care, 129 (83.2%) were between 46 and 59 years of age. The kangaroo mother care strategy resulted in 622 (89.5%) of 695 targeted infants surviving. At the end of 2009, only 30% of the recommendations of audit committees had been implemented. CONCLUSION: Maternal death notifications and audits are useful tools for improving quality of care and outcomes. With almost half of maternal deaths occurring within 24 hours of admission, emergency care in the Upper West Region of Ghana must be improved.