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.

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 to 10th 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).

Using quality improvement methods to test and scale up a new national policy on early post-natal care in Ghana.

INTRODUCTION: The first week of life presents the greatest risk of dying for a young infant. Yet, due to the sociocultural, financial, geographical and health system barriers found in many resource-poor settings, infants do not access health care until much later. To reduce neonatal mortality, the Ghana Health Service proposed a new policy that promotes skilled care during the first week of life. We report the results of an initiative that uses quality improvement (QI) methods to test the feasibility and effectiveness of the new early post-natal care (PNC) policy and its subsequent scale-up throughout northern Ghana. METHODS: Over a 10-month period, 30 networked QI teams from 27 rural health facilities developed and tested both facility-based and community-based changes to their processes of maternal and neonatal care. Coverage and outcome data were analysed using an interrupted time-series design. RESULTS: Over 24 months, early PNC increased from a mean of 15% to 71% for visits within the first 48 h, and from 0% to 53% for visits on Day 6 or 7. We observed a slower increase in skilled delivery (mean of 56% to 82%) over a longer period of time (35 months). Facility-based neonatal mortality remained unchanged: mean of 5.1 deaths per 1000 deliveries. Using the most effective change ideas developed in the 27 test facilities, the early PNC policy was scaled up over the subsequent 2 years to 576 health facilities in all 38 districts of northern Ghana. CONCLUSIONS: This initiative demonstrates the utility of a QI approach in testing, implementing and subsequent scaling up a national policy for early PNC in a resource-constrained setting. This approach provides a model for improving the implementation of other national health policies to accelerate the achievement of the Millennium Development Goals in Ghana and other resource-poor countries.