Surveillance of Bacterial Pathogens of Diarrhoea in Two Selected Sub Metros Within the Accra Metropolis.

BACKGROUND: In recent years, many localities within the Greater Accra Region (GAR) have witnessed several episodes of cholera outbreaks, with some deaths. Compared to previous epidemics, which usually followed heavy rains, recent outbreaks show no seasonality. OBJECTIVES: To investigate infective bacterial diseases in selected sub metros within the GAR. METHODS: We used existing disease surveillance systems in Ghana, and investigated all reported cases of diarrhoea that met our case-definition. A three-day training workshop was done prior to the start of study, to sensitize prescribers at the Korle-Bu Polyclinic and Maamobi General hospital. A case-based investigation form was completed per patient, and two rectal swabs were taken for culture at the National Public Health and Reference Laboratory. Serotyping and antibiogram profiles of identified bacteria were determined. Potential risk factors were also assessed using a questionnaire. RESULTS: Between January and June 2012, a total of 361 diarrhoeal cases with 5 deaths were recorded. Out of a total of 218 rectal swabs cultured, 71 (32.6%) Vibrio cholerae O1 Ogawa serotypes, and 1 (0.5%) Salmonella (O group B) were laboratory confirmed. No Shigella was isolated. The Vibrio cholerae isolates were susceptible to ciprofloxacin and tetracycline. Greater than 80% of patients reported having drank sachet water 24 h prior to diarrhoea onset, and many (144/361) young adults (20-29 years) reported with diarrhoea. CONCLUSION: Enhanced surveillance of diarrhoeal diseases (enteric pathogens) within cholera endemic regions, will serve as an early warning signal, and reduce fatalities associated with infective diarrhoea.

The first cases of Lassa fever in Ghana.

Lassa fever is a zoonotic disease endemic in West Africa but with no previous case reported in Ghana. We describe the first two laboratory confirmed cases of Lassa fever from the Ashanti Region of Ghana detected in October and December, 2011.

Quality-quantity trade-off of human offspring under adverse environmental conditions.

A central paradigm in life-history theory is the trade-off between offspring number and quality. Several studies have investigated this trade-off in humans, but data are inconclusive, perhaps because prosperous socio-cultural factors mask the trade-off. Therefore, we studied 2461 offspring groups in an area under adverse conditions in northern Ghana with high fertility and mortality rates. In a linear mixed model controlling for differences in age and tribe of the mother and socioeconomic status, each additional child in the offspring group resulted in a 2.3% (95% CI 1.9-2.6%, P < 0.001) lower proportional survival of the offspring. Furthermore, we made use of the polygamous population structure and compared offspring of co-wives in 388 households, thus controlling for variation in resources between compounds. Here, offspring survival decreased 2.8% (95% CI 2.3-4.0%, P < 0.001) for each increase in offspring number. We interpret these data as an apparent quality-quantity trade-off in human offspring.

Socio-economic status by rapid appraisal is highly correlated with mortality risks in rural Africa.

Socio-economic status is an important determinant of health and survival in rural Africa and necessitates a practical and valid instrument to implement in health studies. Our objective was to investigate the validity of the rapid appraisal method to assess socio-economic status and its ability to identify individuals at risk. Among 1573 households in rural northern Ghana, we calculated the Demographic Health Survey (DHS) wealth index and conducted two rapid appraisal methods: self-reported wealth and interviewer-reported wealth. In addition we followed the 25,184 participants from these households for survival with a mean follow-up of 3.9 years, during which 885 participants died. The DHS wealth index was moderately correlated to self-reported wealth (Spearman's rho 0.59, P<0.001) and interviewer-reported wealth (Spearman's rho 0.75, P<0.001). Mortality risks were significantly higher for people with lower than average self-reported wealth [hazard ratio (HR) 1.30 (95% CI 1.11-1.51)] and lower interviewer-reported wealth [HR 1.40 (95% CI 1.21-1.62)]. Mortality risks were lower for people with higher self-reported wealth [HR 0.81 (95% CI 0.32-2.03)] and higher interviewer-reported wealth [HR 0.84 (95% CI 0.58-1.21)]. Similar discriminative mortality risks were assessed when using tertiles of the DHS wealth index (Ptrend<0.001).

Evaluation of invermectin distribution in Benin, Côte d'Ivoire, Ghana and Togo: estimation of coverage of treatment and operational aspects of the distribution system.

Invermectin distribution by the Onchocerciasis Control Programme (OCP) was assessed in Benin, Côte d'Ivoire, Ghana and Togo, in terms of the proportion of villages which had been treated and the proportion of villagers in each village treated in the last round who had actually received treatment. These proportions were evaluated both for treatment in the last round of ivermectin distribution and for treatment since the beginning of the drug's distribution in each country. During the last treatment round, 97 (74.6%) of the 130 selected villages investigated in the four countries had received ivermectin treatment, and 67.2% of the members of these 97 treated communities had taken ivermectin. In general, higher percentages of the members of treated villages in Côte d'Ivoire and Ghana had been treated [with mean (S.D.) percentage values of 72.0 (5.2) and 71.6 (4.6), respectively] than in those of Togo [61.8 (5.6)] or Benin [64.2 (4.6)]. Overall, 893 (26.1%) of those interviewed had never received treatment since the beginning of ivermectin distribution but 29.4% had received all the annual treatments. The main reason for non-treatment during the last treatment round was absence from village (54.5% of those not treated), followed by non-eligibility (i.e. pregnant women and young children; 12.2%), refusal to take treatment (2.6%), and shortage of drugs (1.9%). Community approval for the programme was demonstrated when all treated individuals, including those who were absent at the last treatment round, said they would take the ivermectin during the next treatment. During the last treatment round, members of the community assisted in the distribution of the ivermectin tablets in 69 (71.1%) of the 97 treated villages which were investigated. Although only 26 (26.8%) of these 97 villages preferred community-based distribution of ivermectin to the 'mobile' method, it is believed that, with good education and efficient organization, the communities could be encouraged to undertake community distribution.

Introducing insecticide impregnated bednets in an area of low bednet usage: an exploratory study in north-east Ghana.

To find out the acceptability of the use of insecticide impregnated bednets before launching a large-scale trial to evaluate their impact on child mortality, 96 permethrin impregnated bednets were distributed in 4 communities within the Kassena Nankana district of the Upper East Region of Ghana, where previously only 4% of the people had owned a mosquito net. The nets were readily accepted and used by the recipients. The major benefit perceived by the users was the reduction of the nuisance effect of mosquitoes and other insects. The people in the study area normally sleep on mats in either an open courtyard or a sleeping room depending on the weather but this did not deter them from using the nets. The white nets distributed for this study became dirty with use, and users thought they needed to be washed. In order to discourage this, it is recommended that dark coloured nets be used in the main intervention trial. After having used the nets for a year, the community members expressed willingness to buy the nets if they were made available after the harvest season when they had sold their crops and had enough money to pay for them. The results of this study have been used to plan and conduct a large intervention trial.

Urinary and intestinal schistosomiasis in the Tono Irrigation Scheme, Kassena/Nankana District, upper east region, Ghana.

Human- and snail-related aspects of transmission of urinary and intestinal schistosomiasis were studied in the Tono Irrigation Scheme in northern Ghana. The scheme became operational in 1977. In some schools, prevalences and intensities of both Schistosoma mansoni and S. haematobium infection were alarmingly high, pointing to human schistosomiasis being at least focally a health problem of major public health concern. Positive correlations between intensity of schistosome infection, as measured by egg output, with frequency of visible haematuria and history of haematuria point to opportunities for community-based assessment of morbidity and identification of high risk population subgroups. Bulinus globosus is the most important snail host for S. haematobium while Biomphalaria pfeifferi serves as host for S. mansoni. While transmission of S. mansoni is taking place only in the main canal, transmission of S. haematobium takes place in all parts of the irrigation system (lateral canal, night storage dam, main reservoir). Transmission of both S. mansoni and S. haematobium is rather focal and a seasonal pattern of transmission is indicated with peak transmission taking place during the beginning of the dry season. The high endemicity and the transmission patterns described in this study call for an integrated approach to schistosomiasis morbidity control in the area.