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Introduction: Surveillance data completeness and timeliness is critical for effective outbreak response notably in the advent of increasing of infectious diseases of pandemic proportions. Ghana enhanced screening at Points of Entry by intensifying the usage of health declaration forms in response to the emergence of the global threat of COVID-19. Here, we assess the completeness of health declaration form information submitted by travellers and determine predictors of data completeness and demographic variables as a measure to improve data quality at Points of Entry. Methods: A retrospective cross-sectional study was employed and involved collection of information (age, sex, date of arrival) from the health declaration forms submitted by travellers between the period of March 7-19, 2020 at Ghana’s International Airport. Flights which harboured travellers infected with COVID-19 virus and exhibited clinical symptoms prior to or within 2 days from the arrival date were included in the analysis. Descriptive analyses were expressed in the form of frequencies and percentages. Association and Regression tests using STATA statistical Package were carried out between travellers’ age, sex, nationality, arrival date and form completeness. Results: A total of 2,374 travellers from 7 flights were included in the study for the period under review. Travellers provided 82.9% and 80.6% complete basic contact and critical information respectively with significant associations between the completeness of travellers’ basic contact and critical information and the travellers’ age, nationality, and arrival date. Travellers’ age, nationality, and date of arrival were found to be strong predictors of completeness of contact and critical information on the health declaration form with younger age categories (

Background Influenza is an acute viral respiratory tract infection caused by influenza virus and transmitted from person to person. Though usually seasonal in temperate climates, influenza occurs throughout the year in the tropics with outbreaks occurring at irregular intervals. On February 6, 2018, a number of students from a Senior High School (SHS) in Accra reported to a district hospital with cough, fever and other respiratory symptoms. An influenza-like illness (ILI) outbreak was suspected. We investigated to determine the magnitude and source of the outbreak and implement control and preventive measures. Methods We interviewed health workers, staff and students of the school as well as case-patients and reviewed health records to collect data on demographic characteristics, signs and symptoms, date of illness onset and outcome. We defined ILI case as “any person in the SHS with fever (measured axillary temperature of ≥ 37.5 °C or history of fever) and cough with or without sore throat or runny nose from January 21 to February 26, 2018”. We conducted active case search to identify more cases and took oropharyngeal samples for laboratory testing. We performed descriptive and inferential analysis by calculating attack rate ratios (ARR) and their exact 95% confidence intervals (CI). Results Of the 3160 students, 104 case-patients were recorded from January 25, 2018 to February 13, 2018 (overall attack rate of 3.3%). Mean age of case-patients was 16.1 (±2.3) years with males constituting 71.2% (74/104). Sex specific attack rates were 5.6% (74/1331) and 1.6% (30/1829) for males and females respectively. Compared to females, males were 3.4 times as likely to be ill [ARR =3.4, 95%CI = (2.23–5.15)]. Nine oropharyngeal samples from 17 suspected case-patients tested positive for influenza A (H1N1)pdm09. Conclusion Outbreak of influenza A (H1N1)pdm09 occurred in a SHS in Accra from January to February, 2018. Even though source of the outbreak could not be determined, prompt case management and health education on hand and personal hygiene as non-pharmacological factors probably contributed to the outbreak control. The outbreak ended with a scheduled mid-term break. This underscores the need for more evidence on the effect of school closure in influenza outbreak control.

Objective: To assess the progress made towards the actualization of the 80% reduction in incident cases, monitor trends and to assess the quality of GWM TB surveillance data from 2012 to 2016.Design: The study was descriptive secondary data analysisData Source: Tuberculosis cases recorded in the District Health Information Management Systems (DHIMS) and municipal TB registers. The Municipal TB Coordinator was interviewed for clarification on the data. A TB patient was defined as one who coughed persistently for two weeks or more.Main outcome measure: Trend of TB cases in Ga West MunicipalityResults: A total of 441 TB cases were registered of which 68.9% were smear positive. Males were (67%). Age group 35-44 years were the most affected (28.6%). The incidence rose from 21.5 (2012) to 41.6 (2015). The 2016 incidence was 40.7 (± 5.63) per 100,000 population. This is significantly different from the current national incidence of 156 (p < 0.05). Data was 95% complete. Discrepancies existed between data in registers compared to the DHIMS but were not statistically significant.Conclusion: The 80% reduction in incident cases target may not be attained by the GWM due to the rising number of incident cases. However, data quality is good.Keywords: Tuberculosis, data analysis, DHIMS 2, tuberculosis, incident casesFunding: The study was funded by the authors

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 2017Data 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.Keywords: meningitis outbreak, geospatial clustering, Upper East Region, meningitis incidence, GhanaFunding: Author EA was supported by the West Africa Health Organization (Ref.: Prog/A17IEpidemSurveillN°57212014/mcrt).

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 Ghana

Objective: On 24th October 2016, the Central Regional Health Directorate received report of a suspected cholera outbreak in the Cape Coast Metropolis (CCM). We investigated to confirm the diagnosis, identify risk factors and implement control measures.Design: We used a descriptive study followed by 1:2 unmatched case-control study.Data source: We reviewed medical records, conducted active case search and contact tracing, interviewed case-patients and their contacts and conducted environmental assessment. Case-patients' stool samples were tested with point of care test kits (SD Bioline Cholera Ag 01/0139) and sent to the Cape Coast Teaching Hospital Laboratory for confirmation.Main outcomes: Cause of outbreak, risk factors associated with spread of outbreakResults: Vibrio cholerae serotype Ogawa caused the outbreak. There was no mortality. Of 704 case-patients, 371(52.7%) were males and 55(7.8%) were aged under-five years. The median age was 23 years (interquartile range: 16-32 years). About a third 248(35.2%) of the case patients were aged 15-24 years. The University of Cape Coast subdistrict was the epicenter with 341(48.44%) cases. Compared to controls, cholera case-patients were more likely to have visited Cholera Treatment Centers (CTC) (aOR=12.1, 95%CI: 1.5-101.3), drank pipe-borne water (aOR=11.7, 95%CI: 3.3-41.8), or drank street-vended sachet water (aOR=11.0, 95%CI: 3.7-32.9). Open defecation and broken sewage pipes were observed in the epicenter.Conclusion: Vibrio cholerae serotype Ogawa caused the CCM cholera outbreak mostly affecting the youth. Visiting CTC was a major risk factor. Prompt case-management, contact tracing, health education, restricting access to CTC and implementing water sanitation and hygiene activities helped in the control.Keywords: Cholera outbreak, Vibrio cholerae serotype Ogawa, Cholera treatment center, Water sanitation and hygiene, Cape Coast MetropolisFunding: This work was supported by Ghana Field Epidemiology and Laboratory Training Program (GFELTP), University of Ghana

Background: Malaria prevention and control interventions have been scaled-up in the last decade in Ghana. We analysed the malaria surveillance data to assess the trends and the association between some malaria prevention interventions and malaria incidence in Kintampo North Municipality (KNM). Methods: We extracted data on malaria indicators and interventions from the District Health Information Management System 2 database for 2012–2016. Proportions and cumulative incidence of malaria episodes were computed using STATA 14 software. We performed correlation analysis between malaria interventions and malaria morbidity. We used linear regression models to determine the association between Long-Lasting Insecticide-treated Nets (LLINS) distribution, Intermittent Preventive Treatment in Pregnancy (IPTp) and episodes of malaria in children

Background Avian Influenza is a highly contagious viral infection that mainly affects domesticated birds. On June 21, 2018, the Kwahu-West Municipal Veterinary Office was notified of sudden deaths of birds on a poultry farm. Seven days later, a second farm sited 100 meters from the index case-farm also recorded bird deaths. We investigated to confirm the causative agent, identify its source, and implement control measures. Methods We conducted a survey of six poultry farms and human contacts of affected farms in Nkawkaw. A suspected case-farm of HPAI was any farm in Nkawkaw with sudden death of bird(s), with or without clinical signs of HPAI from June 1 to July 10, 2018. Six bird carcasses were collected on affected farms for laboratory analysis. We interviewed owners of affected farms and assessed the farm environments, as well as clinical status of human contacts. Results A total 2,280 birds were affected on two adjacent farms. HPAI-H5N1 was confirmed for all samples investigated. The index case-farm with 1,438 birds, reported 30 bird deaths on June 16, 2018, 24 hours after receiving a consignment of birds from an HPAI-H5N1 confirmed farm in a neighboring region of Ghana. The second case-farm recorded bird deaths 7 days later. Both farms operated aluminum sheet-roofed metallic mesh pens without fencing. Beddings in pens were not regularly changed. Four poultry farms located within an 6km radius of the affected farms did not report sick or dead birds. All twenty-three human contacts were asymptomatic of flu, after 14-days follow-up. Conclusions This HPAI-H5N1 outbreak was likely imported through the introduction of birds from a neighboring region due to lax livestock movement regulations, and poor biosecurity measures on farms. Disinfection and depopulation exercises effectively controlled the outbreak. We recommend strict implementation of biosafety measures on farms and at entry points in the district

Background Despite being preventable, maternal sepsis continues to be a significant cause of death and morbidity, killing one in every four pregnant women globally. In Ghana, clinicians have observed that maternal sepsis is increasingly becoming a major contributor to maternal mortality. The lack of a consensus definition for maternal sepsis before 2017 created a gap in determining global and country-specific burden of maternal sepsis and its risk factors. This study determined the incidence and risk factors of clinically proven maternal sepsis in Ghana. Methods We conducted a prospective cohort study among 1476 randomly selected pregnant women in six health facilities in Ghana, from January to September 2020. Data were collected using primary data collection tools and reviewing the client’s charts. We estimated the incidence rate of maternal sepsis per 1,000 pregnant women per person-week. Poisson regression model and the cox-proportional hazard regression model estimators were used to assess risk factors associated with the incidence of maternal sepsis at a 5% significance level. Results The overall incidence rate of maternal sepsis was 1.52 [95% CI: 1.20–1.96] per 1000 person-weeks. The majority of the participants entered the study at 10–13 weeks of gestation. The study participants' median body mass index score was 26.4 kgm−2 [22.9—30.1 kgm−2]. The risk of maternal sepsis was 4 times higher among women who developed urinary tract infection after delivery compared to those who did not (aHR: 4.38, 95% CI: 1.58–12.18, p p p p Conclusions Our findings show a low incidence of maternal sepsis in Ghana compared to most Low and Middle-Income Countries. Nonetheless, Maternal sepsis remains an important contributor to the overall maternal mortality burden. It is essential clinicians pay more attention to ensure early and prompt diagnosis. Factors significantly predicting maternal sepsis in Ghana were additional maternal morbidity, urinary tract infections, dysuria, and multiple symptoms. We recommend that Ghana Health Service should institute a surveillance system for maternal sepsis as a monthly reportable disease.

Introduction:in the absence of a vaccine and definitive treatment, non-pharmacological measures of physical distancing, regular hand hygiene and wearing of face covering remain the mainstays of mitigating coronavirus disease 2019 (COVID-19). In Ghana, these measures are mandatory in public places and underpin COVID-19 infection prevention and control (IPC). We assessed adherence and appropriate performance of these measures among patrons of community convenience shops in selected hotspots. Methods:we conducted a non-intrusive observation of patrons of convenience shops in COVID-19 burden hotspots. We observed patrons as they entered and exited the shops and collected data on their gender, adherence and appropriate use of face covering and hand hygiene facilities. Data were analyzed descriptively and inferentially to determine factors associated with adherence to IPC guidelines. Results:of 800 patrons observed from eight community shops, 481 (60.1%) were males. Of these, 653 (81.6%) wore face covering and 98 (12.3%) performed hand hygiene; with 92 (11.5%) adhering to both measures. Patrons who wore face mask appropriately were 578; comprising 299 (92.3%) of patrons who wore face mask before entering the shops. Of 89 patrons who washed their hands, appropriate handwashing was recorded among nine (10.1%). Compared to inappropriate handwashing, appropriate handwashing was negatively associated with adherence to IPC guidelines [aOR=0.1 (95% CI=0.01-0.59)]. Conclusion:adherence to and appropriate performance of IPC measures of handwashing and use of face covering in the selected shops was low. There is the need to complement availability of IPC measures with intensification of risk communication messaging targeted at ensuring their appropriate use.

Background: Evaluate the Tuberculosis (TB) surveillance system in the Ga West Municipality to determine if it is achieving its objectives, and to assess its attributes and usefulness.Design: Descriptive analysis of primary and secondary dataData source: Stakeholder interviews and record reviews on the objectives and operation of the surveillance system at all levels of the system.Intervention: We evaluated the system’s operation from 2011-2015 using the Centers for Disease Control and Prevention (CDC) updated guidelines for evaluating public health surveillance systems and the World Health Organisation (WHO) TB surveillance checklist for assessing the performance of national surveillance systems.Results: The TB surveillance system in the municipality was functional and operated at all levels for timely detection of cases, accurate diagnosis, and case management. The system improved management of TB/HIV co-infections. The average time taken to confirm a suspected TB case was one day. The registration of a confirmed case and subsequent treatment happen immediately after confirmation. The municipality detected 109 of 727 TB cases in 2015 (case detection rate=15%). The positive predictive value (PPV) was 6.4%. There was one diagnostic centre in the municipality. Private facilities involvement in TB surveillance activities was low (1/15).Conclusion: The Tuberculosis surveillance system in the Ga West Municipality is well structured but partially meeting its objectives. The system is timely, stable and acceptable by most stakeholders and useful at all levels. It has no major data quality issues. Private health facilities in the municipality should be well incorporated into TB surveillance.Keywords: tuberculosis, evaluation, surveillance system, system attributes, Ga WestFunding: This work was supported by Ghana Field Epidemiology and Laboratory Training Program (GFELTP), University of Ghana through the support of the West Africa Health Organization (Ref.: Prog/A17IEpidemSurveillN°57212014/mcrt) to B-YA

Introduction: The hospital laboratory exists to provide accurate and reliable results to physicians for effective management of patients. The Quality Management System (QMS) in the laboratory must be effective and efficient so that reliable results will be produced for patient care. Quality System Essentials together with International Organization for Standardization (IOS) 15189 are the core components used to establish a QMS in the Laboratory. Laboratory assessments are an effective means to determine whether a laboratory is providing accurate and reliable results and adhering to good laboratory practices. We assessed the Suhum Hospital laboratory to identify gaps in the components of Quality System Essentials. Method: This exploratory study investigated the practice of QMS in Suhum Hospital laboratory, a public district hospital laboratory in Ghana, in January 2016. Data collected comprised activities by laboratory staff during onsite visits and evidence of documentation. Permission to collect data was sought from the Hospital Management and Laboratory Manager. We used the WHO-AFRO laboratory Strengthening Checklist to assess the laboratory. We reviewed the records to verify if the laboratory quality manuals, policies, logs, Standard Operating Procedures (SOPs) were complete, current, accurate, and annually reviewed. Finally, we interviewed staff of the laboratory and clinicians to obtain information to learn their perspective on the laboratory’s performance. Results: The undepartmentalized laboratory is headed by a manager with a staff strength of 13 trained professionals. It receives averagely 100 patient samples daily and runs 30 different tests. The main strengths of the laboratory in terms of Quality System Essentials were information management 15/18 (83%), process control 25/33 (77%), internal audit 6/10 (60%), facilities and safety 25/43 (58%), purchasing and inventory 17/30 (57%). However, equipment management 8/30 (27%), occurrence management 3/12 (25%), documents and records 7/25 (28%), organization and personnel 8/20 (40%), corrective actions 5/12 (42%) and client management 5/17 (29%) required improvement. Conclusion: Findings from the laboratory audit pointed to an overall weak laboratory QMS based on WHO/AFRO laboratory strengthening checklist and rating. Concerted efforts are therefore required to improve the laboratory QMS rating to improve quality of care to clients in all district hospital laboratories in Ghana.

Background: This study assessed some demographic and socio-cultural factors that influence contraceptive uptake among reproductive-aged women in Tamale Metropolis of the Northern Region, GhanaDesign: This was a cross-sectional study conducted from February to March 2015Setting: All three sub Metropolis in TamaleParticipants: All community members and women of reproductive age (15-49years)Intervention: The study used cluster sampling to recruit women who were interviewed using a structured questionnaire. Nine focus group discussions (FGDs) were also held among community members who were purposively selected.Main outcome measures: contraceptive uptake (use of contraceptive)Results: The mean age of the women was 26 years. The prevalence of contraceptive uptake among reproductive-age women was 36.8% (165/448). Women with secondary school education [AOR=4.4(95%CI:1.6-12.4)], and those in homes where decisions on having children were made by both partners [AOR=2.1(95%CI:1.1-04.42)] were more likely to use contraceptives. Unemployed women [AOR=0.3(95%CI:0.1-0.8)], women whose husbands were unaware of their contraceptive use [AOR=0.4(95%CI:0.2-0.9)] and those having a culture or religion that frowns on contraceptive use [AOR=0.4(95%CI:0.2-0.8)] were less likely to use contraceptive among women in the Tamale Metropolis.Conclusion: The study found a contraceptive prevalence rate (CPR) in Tamale Metropolis, Northern Ghana to be 36.8%. Education and living in a home where childbearing decisions are made together were identified as positive factors influencing contraceptive uptake.Keywords: Contraceptive Uptake; Tamale Metropolis; Reproductive-aged women; socio cultural factors; Contraceptive prevalenceFunding: This work was funded by the authors

Introduction:Neonatal Sepsis (NNS) is a public health problem which causes death or disability unless appropriate antibiotic treatment is given promptly. Globally, sepsis is an important cause of morbidity and mortality in neonates despite recent progress in health care delivery. We assessed the factors associated with culture proven sepsis among neonates in the Ho Municipality, Ghana. Methods:a cross-sectional study was conducted in two public hospitals in the Ho Municipality between January and May, 2016. All neonates who were clinically suspected with sepsis in the Neonatal Intensive Care Unit (NICU) and their mothers were recruited. A 2ml blood sample was taken aseptically and dispensed into a mixture of thioglycollate and tryptone soy broth in a 1:10 dilution and microbiological procedures performed. Case notes of both neonates and their mothers were reviewed and interviews conducted to collect both clinical and socio-demographic data. We determined the factors associated with culture proven neonatal sepsis using logistic regression model and statistical significance was determined at 95% confidence intervals. Results:out of 150 neonates, 26 (17%) had laboratory confirmed sepsis. The most common pathogen isolated was Staphylococcus epidermidis 14, (54%). Neonates whose mothers were primigravida (OR=2.74; 95% CI:1.12-6.68), and those who attended antenatal clinics (ANC) fewer than three schedules (OR=2.90; 95% CI:1.06-7.96) had higher odds of developing culture proven sepsis. Conclusion:neonates who were the first babies of their mothers were more likely to develop laboratory confirmed sepsis. Also, neonates of mothers who attended ANC less than 3 times were more likely to develop laboratory confirmed sepsis. High index of suspicion is required to diagnose neonatal sepsis among neonates of primigravida mothers and mothers who attend fewer than three ANC schedules.

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. Electronic supplementary material The online version of this article (10.1186/s12889-018-5529-z) contains supplementary material, which is available to authorized users.

Background Globally, 4 million neonates die annually, with one-third of such deaths occurring as a result of infections. In 2011, there were 7.2million deaths in children below 5 years globally, and a proportion of 40% of these deaths occurred in neonates. Sepsis was reported to account for one-third of these deaths. Presently, multidrug antibiotic resistance is rapidly increasing in Neonatal Intensive Care Units (NICUs), particularly in developing countries and poses a threat to public health. The change in these organisms has been reported to vary across regions, between health facilities and even within the same facility. Continuous surveillance is required to inform antibiotic choice for neonatal sepsis management. We identified the common causative organisms of neonatal sepsis and their antibiotic susceptibility pattern in the Ho municipality. Method A cross sectional study was conducted in the Ho municipality from January to May, 2016. A semi-structured questionnaire was used to collect socio-demographic data from mothers of neonates with clinically suspected of sepsis. Clinical data of both mothers and neonates were extracted from case notes. A 2 ml volume of blood was also taken from neonates and dispensed into a 20 ml mixture of thioglycollate fluid broth and tryptone soy broth for culture and antibiotic susceptibility pattern determined. Results Out of the 150 clinically suspected neonatal sepsis cases, 91 (60.7%) were males. The Median gestational week was 38 (IQR: 36–39) and Median birthweight was 3.0 kg (IQR 2.5–3.4). The prevalence of culture positive sepsis was 17.3% of the 150 suspected cases. A total of 26 different pathogens were isolated, of which gram positive organisms had a preponderance of 18 (69%) over gram negative organisms 8 (31%). Staphylococcus epidermidis was the most common 14 (53.8%) isolate identified. There was a single isolate (4%) each of Proteus mirabilis and Escherichia coli identified. All the isolates identified showed 100% resistance to ampicillin. Conclusion The prevalence of culture proven sepsis was 17.3% and Staphylococcus epidermidis was the most common isolate identified. Pathogens isolated were resistant to the first line drugs for management of neonatal sepsis. Hence, the need for a review of first line drug for empirical treatment in neonatal sepsis. Electronic supplementary material The online version of this article (10.1186/s40748-017-0071-z) contains supplementary material, which is available to authorized users.

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.

Background Agriculture represents the mainstay of African economies and livestock products are essential to the human population’s nutritional needs. However, in many developing countries, including Ghana, livestock production fails to meet demand due to population growth and negative effects of climate change. One of the challenges to production is livestock loss affecting farmers. However, despite stressful events experienced, livestock farmers’ mental health is poorly documented. This study aims to identify the root causes of livestock losses and their influence on pastoralists’ mental health. Methods We conducted a mixed methods study in two districts in the Northern and Southern Belts of Ghana. Using the Depression Anxiety and Stress Scale–21 and guided interviews, we collected quantitative and qualitative data from 287 livestock farmers and 24 key-informants respectively. Mental health scores were categorized using standard guidelines. We evaluated the factors that explained variations in mental wellbeing using general linear models (α = 0.05). Results About 85% (240/287) of the livestock farmers lost cattle within 1 year. Of these, 91% lost cattle to animal diseases, 50% to theft and 27% to pasture shortages. Qualitative findings reveal that due to poor access to veterinary services, farmers treat livestock diseases themselves with drugs from unregulated sources and often sell diseased cows for meat to recover losses. Findings showed that 60% of livestock farmers had poor mental health. Of those, 72% were depressed, 66% anxious and 59% stressed. Mental wellbeing was negatively associated with the number of adverse events experienced, proportion of livestock lost to most of the major loss factors, emotional attachment to livestock and self-reported physical illnesses in farmers, but positively associated with increasing herd size [F (8,278) = 14.18, p R2 = 0.29]. Conclusions Livestock diseases are the leading cause of losses to livestock farmers, whose mental wellbeing is negatively affected by these losses. Although an adaptive strategy by farmers to compensate for poor veterinary services, the arbitrary use of veterinary drugs and sale of diseased cattle pose health risks to the public. Further research to evaluate the performance of veterinary services in Ghana, mental health problems and risk to human health due to potential high-risk meat entering the food chain, is needed.

Background Scabies occurs worldwide with a prevalence between 0.3 and 46.0%. In Ghana, even though a 5.1% proportion of scabies was reported in a retrospective review of skin diseases at the Korle Bu Teaching Hospital, the nationwide prevalence of scabies is unknown. Overall, its burden is higher in tropical regions. Scabies outbreaks mostly occur among children, the elderly in nursing homes, and prison inmates. Even though primary scabies hardly results in mortalities, the pain, itch, and systemic complications from secondary bacterial infections account for about 1.5 million years lived with disabilities. We investigated a scabies outbreak among school children in Ghana to determine its magnitude, stop the outbreak, and institute preventive measures to minimize risks of future outbreaks. Methods The investigation was conducted between March 14 and May 17, 2017 among pupils of Presbyterian Secondary Staff Basic School in Accra. We defined a case as a school child who on clinical examination, had an intensely pruritic rash on at least one typical predilection site with or without a burrow, or positive skin scrapings on microscopy. We screened and line listed cases, performed laboratory investigations on skin scrapings and wound swaps, and conducted an environmental assessment. We performed descriptive statistics on data, and calculated attack rate ratios (ARR) at 95% confidence level. Results Of 823 preschool children screened, 92 were cases. Median age of cases was 4 years (range 2–7 years) and their modal age was 3 years. The overall attack rate was 11.2% (92/823). The sex specific attack rate was 11.5% for males, and 10.8% for females (ARR: 0.93; CI: 0.67–1.28). Compared with the least affected class (crèche), the nursery one class was worst affected (ARR: 5.14; CI: 3.44–7.50). On microscopy, all skin scrapings were negative for scabies. Staphylococcus aureus and Streptococcus spp. were isolated from secondarily infected scabies lesions. Conclusions A scabies outbreak with a propagated source occurred among preschool children. The 3-year-old pupils were most affected. It was controlled by mass treatment with benzyl benzoate and health education. Classrooms and sleeping mats were disinfected. We recommended the decongestion of classrooms and discouraged sharing of sleeping mats. Electronic supplementary material The online version of this article (10.1186/s12889-019-7085-6) contains supplementary material, which is available to authorized users.

Background Each year, about 20 million Low Birth Weight (LBW) babies are born with very high proportion (96.5%) occuring in developing countries. In the last decade, the incidence of LBW in Ghana has not declined. Brong Ahafo Region of Ghana recorded a LBW prevalence of 11% which was higher than the the national average of 10%. This study identifed determinants of LBW delivery in the Brong Ahafo Region. Methods We conducted a 1:2 unmatched case control study among mothers with singleton deliveries in 3 major health facilities in the Brong Ahafo Region. A case was defined as a mother who delivered a baby weighing less than 2500g in any of the three selected health facilities between 1st December, 2015 and 30th April, 2016. A control was defined as a mother who within 24 h of delivery by a case, delivered a baby weighing at least 2500g and not exceeding 3400g in the same health facility. Deliveries that met the inclusion criteria for cases were selected and two controls were randomly selected from the pool of deliveries that meet criteria for controls within 24 h of delivery of a case. A total of 120 cases and 240 control were recruited for the study. We computed odds ratios at 95% confidence level to determine the associations between low birth weight and the dependent factors. Results After controlling for confounders such as planned pregnancy, mode of delivery, parity and previous LBW in stepwise backward logistic regression, first trimester hemoglobin

Introduction Field Epidemiology Training Programmes (FETPs) are functional ways of strengthening epidemiology, surveillance and outbreak response capacity in countries. However, sustainability of FETPs is a major challenge facing most countries especially in Africa. The Ghana Field Epidemiology and Laboratory Training Program (GFELTP) started in 2007 in the University of Ghana School of Public Health as a solution to gaps in the public health workforce. This paper assessed the sustainability strategies embedded in the Ghana Field Epidemiology and Laboratory Training Programme. Methods We assessed the sustainability of GFELTP by document reviews and interviews with programme staff and stakeholders to identify sustainability structures (programme, financial and institutional) that were in place. We grouped information into the following headings: programme structure, institutional, financial and political structures. Results As of July 2017, a total of 350 public health experts have been trained in both frontline and advanced courses since the programme's inception. For funding structures, the programme is funded mainly by its partners and stakeholders who are local government organisations. They provide resources for running of programme activities. Under institutional and political structures, the programme was established as a Ministry of Health/Ghana Health Service programme based in the University of Ghana. The programme steering committee which is currently chaired by the Director Public Health of Ghana Health Service, jointly ensures its implementation. Other structures of sustainability observed were involvement of stakeholders and alumni in human resource of the programme; use of stakeholders as faculty for the programme. These stakeholders include staff from University of Ghana School of Public Health, Ghana Health Service and Veterinary Service Department, World Health Organization and Centers for Disease Control and Prevention. The programme showed evidence of stable sustainability strategies in all four structures evaluated. Conclusion The assessment found the GFELTP to be sustainable. The main factors that contributed to rendering it sustainable were funding, programme, institutional and political structures embedded in the programme. One remarkable sustainability element observed was the strong collaboration that existed between stakeholders of the programme who worked hand in hand to ensure the programme runs smoothly. However, more sources of funding and other essential resources need to be considered to help the programme obtain a pool of resources for carrying out its activities.

BackgroundInfluenza-like Illness (ILI) is a medical diagnosis of possible influenza or another respiratory illness with a common set of symptoms. The deaths of four schoolchildren, during a pandemic influenza outbreak in December 2017 in Ghana, raised doubts about the ILI surveillance system's performance. We evaluated the ILI surveillance system in the Greater Accra region, Ghana, to assess the system's attributes and its performance on set objectives.MethodsCDC guidelines were used to evaluate the data of the ILI surveillance system between 2013 and 2017. We interviewed the surveillance personnel on the system's description and operation. Additionally, routinely entered ILI data from the National Influenza Center provided by the six sentinel sites in Accra was extracted. We sampled and reviewed 120 ILI case-investigation forms from these sites. Surveillance activities were examined on system's performance indicators, each being scored on a scale of 1 to 3 (poorest to best performance).ResultsAll population and age groups were under ILI surveillance over the period evaluated. Overall, 2948 suspected case-patients, including 392 (13.3%) children under-five were reported, with 219 being positive for influenza virus (Predictive value positive = 7.4%). The predominant influenza subtype was H3N2, recorded in 90 (41.1%) of positive case-patients. The system only met two out of its four objectives. None of the six sentinel sites consistently met their annual 260 suspected case-detection quota. Samples reached the laboratory on average 48 hours after collection and results were disseminated within 7 days. Of 120 case-investigation forms sampled, 91 (76.3%) were completely filled in.ConclusionsThe ILI surveillance system in the Greater Accra region is only partially meeting its objectives. While it is found to be sensitive, representative and timely, the data quality was sub-optimal. We recommend the determination of thresholds for alert and outbreak detection and ensuring that sentinel sites meet their weekly case-detection targets.

INTRODUCTION: The proportion of antenatal attendants in Ghana who had at least four antenatal visits increased from 78% in 2008 to 87% in 2014. However, it is not known whether these visits followed the recommended timing of focused antenatal clinic attendance in Ghana. We sought to assess the adherence to the clinic schedule and its determinants in the Accra Metropolis. METHODS: a cross-sectional study was conducted. Face-to-face interviews were conducted with postpartum women. Multiple logistic regression was used in the analysis of determinants of adherence to the recommended timing of clinic attendance. A p-value of

Objective To investigate risk factors for ectopic pregnancy among pregnant women attending the Korle-Bu Teaching Hospital, Accra, Ghana. Methods In an unmatched case-control study from September to November 2015, 104 women with ectopic pregnancy (cases) were compared with 208 women with intrauterine pregnancy (controls). Data were collected by interviewer-administered questionnaire and record review. Bivariable analysis was used to compare characteristics. Multivariate logistic regression was used to assess associations between risk factors and ectopic pregnancy. Adjusted odds ratios (aORs) and 95% confidence interval (CIs) were reported. Results Risk factors for ectopic pregnancy were being single (aOR, 5.5; 95% CI, 2.15-14.65), sexual debut at younger than 15 years (aOR, 36.4; 95% CI, 2.49-532.49), multiple sexual partners (aOR, 4.8; 95% CI, 1.76-13.36), previous instrumental evacuation of uterus (aOR, 5.8; 95% CI, 1.20-27.99); previous diagnosis of infertility (aOR, 6.1; 95% CI, 1.36-27.28), being uninsured (aOR, 11.8; 95% CI, 4.23-32.74), and condom use (aOR, 6.1; 95% CI, 1.36-27.28). Conclusion Women who were single with early sexual intercourse, multiple partners, instrumental evacuation of the uterus, and diagnosis of infertility were at risk of ectopic pregnancy. Identification of these factors should facilitate early diagnosis and treatment of ectopic pregnancy.

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.

Background Globally, prematurity is a major determinant of morbidity and mortality contributing 30–40% of neonatal mortality. The consequences of preterm deliveries are enormous with developmental and childhood complications as well as high economic and psycho-social burden on the parents (family) and society. Some risk factors include ever having preterm delivery, multiple births and some medical conditions like sexually transmitted infection and urinary tract infections but these have not been ascertained in our study area. Much research into these risk factors is needed in Ghana. We assessed the obstetric determinants of preterm delivery. Methods We conducted a 1:2 unmatched case-control study in Greater Accra Regional Hospital (GARH) -Ridge, a secondary referral facility in Accra, Ghana (from October, 2015 -May, 2016). A case was a mother who delivered between 28 and 36 weeks of gestation (preterm) and a control was a mother who delivered after 37 to 42 completed weeks (term). We used structured questionnaire to collect data, reviewed maternal and foetal records using a checklist. Categorical variables were analysed and expressed as frequencies and proportions. We determined the association between obstetric factors and preterm delivery with multiple logistic regression. Significance level of the strength of association was determined at 95% CI and p-value

Introduction : diarrhoea is the frequent and excessive discharge of bowels caused by a wide range of agents. Rotavirus is the most common agent that causes acute watery diarrhoea in children Under Five Years (U5). Globally, Diarrheal Diseases (DD) account for 1 in 9 deaths in children U5. In Ghana, rotavirus vaccine is administered in two doses at six and ten weeks. DD in children U5 from Brong Ahafo Region (BAR) were analyzed to establish trends and long-term changes, describe reasons for changes, determine where cases were occurring, detect aberrations in the patterns and determine the data quality.

Introduction : globally, preterm delivery contributes about 30% to 40% of neonatal mortality and 20% to 30% of infant and under-five mortality. The world’s preterm birth rate has been on the rise since the last two decades; with an increase of 20% since 1990 in high-income countries. Accurate data on prevalence and determinants of preterm delivery from low-income countries are not readily available. We assessed prevalence and determinants of preterm delivery in an inner city referral hospital in Ghana. Methods : a descriptive study followed by 12 unmatched case-control study was conducted from October 2015 to May 2016. A case of preterm was a baby in the hospital delivered during the study period at a gestational age between 28 and 36 weeks and a control was a baby delivered after 37 completed weeks of gestation. We interviewed mothers of cases and controls and reviewed maternal and fetal health records. Univariable analysis of categorical variables was expressed as frequencies and relative frequencies. At 95% confidence level, bivariable analysis and multiple logistic regression were done to determine associations between selected independent variables and preterm delivery. Results : of 5,215 deliveries, 796(15.3%) were preterm with 361(45.4%) of preterm babies being males. Mean gestational age was 32(+/-2.4) weeks. Determinants of preterm delivery were hypertensive complications in pregnancy [Odds ratio (OR)= 2.1, 95%CI 1.1-4.5], antepartum hemorrhage in index pregnancy (OR = 2.1, 95%CI 1.1-4.5), premature rupture of membranes (OR = 1.7, 95%CI 1.1-2.6) and Caesarean section delivery (OR = 1.4, 95%CI 1.2-4.6). Compared to controls, preterm babies were less likely to be delivered by mothers who had more than four antenatal clinics (ANC) attendance (OR = 0.2, 95%CI 0.0-0.1) and those with partner support (OR = 0.4, 95%CI 0.2-0.9) Conclusion : the proportion of preterm delivery was high, more likely in complicated pregnancies and less likely in ANC attendees and women with partner support. We educated mothers on need for ANC attendance and partner support.

Introduction: evaluation of outbreak response is an often-overlooked step in outbreak investigations. This deprives response teams of valuable knowledge to guide future outbreak investigations. Ghana recorded a major outbreak of meningitis in 2016 involving several districts. This outbreak was controlled with a lot of difficulty by a coordinated multidisciplinary team. We evaluated the response to this outbreak using a smartphone technology. Methods : the evaluation was conducted from 2nd-19th August 2016. Kobo collect was used to develop a questionnaire covering outbreak response and assessment. The questionnaire was imported to the Android phones of investigators who then visited the outbreak districts. We interviewed key stakeholders and reviewed outbreak data and records. Data were analyzed using SPSS, MS-Excel 2016 and presented as frequencies, proportions, and graphs. Results : a total of 23 districts were assessed in 5 regions of Ghana. Total number of meningitis cases reported in all districts within the period was 424 with case fatality rate of 10.61%. Six (6) out of the 23 outbreaks were not laboratory confirmed. The median time for laboratory confirmation of an outbreak was 2.5 days (interquartile range 1-4). The control measures employed by the districts were case management (100%), chemoprophylaxis (39%), contact tracing (78.2%) and environmental assessment (13%). Major challenges during the outbreaks were late reporting of affected persons to a health facility (78%), and lack of transportation for outbreak response activities (83%). In addition, shortages of laboratory reagents led to delays in laboratory confirmation (34.7%). Conclusion : the median time for laboratory confirmation of outbreaks was long and led to delays in outbreak response. Logistics constraints made it difficult to control the outbreak. Adequate logistics should be provided to district health directorates and laboratories to support outbreak management.

Introduction : the incidence of measles is still very common, assuming epidemic proportions in some parts of the world. A dose of measles vaccine at 9 months protects 85% of those vaccinated. To protect individuals and the community at large, it is important to ensure that all children at 18 months receive a second dose of measles vaccination. This is because, the older the person, the better the immunogenicity after receiving the vaccine. The national coverage for the first dose of measles is 95% but that for the second dose is 73%. This study investigated the level of awareness of measles -2 vaccination among caregivers attending child welfare clinics. Methods : a cross sectional study was conducted among caregivers with children less than 3 years at three Child Welfare Clinics in Accra as part of a one-day field work. A total of 396 caregivers were interviewed using well-structured questionnaires. We analyzed the data descriptively into frequencies and percentages as well as median and for continuous data. Data were analyzed using Microsoft Excel and Stata version14. Results : of the 396 study participants, 46.96% had good awareness level of measles 2 vaccination, while 34.34% of the participants were not aware of the existence of measles 2 vaccination. 168 (42.42%) of the care givers had children 18 months and above who had qualified for measles-2 vaccination. Majority of these caregivers, 124(73.81%) had their children vaccinated for measle-2. Marital status, educational status, parity and occupation were significantly associated with caregivers awareness level of measles- 2 vaccination (p Conclusion : our study found the awareness level of care gives for measles-2 vaccination to be insufficient. Community education on the need for a second dose of measles vaccination is highly recommended.

Introduction : rabies is a zoonotic disease caused by the rabies virus. Domestic dogs are the most common reservoirs of the virus. Dog bites are responsible for over 95% of human rabies deaths. Rabies has the highest case-fatality rate of all infectious diseases of humans. About 95% of rabies cases are reported in Asia and Africa. In Ghana, rabies cases and deaths are under-reported. Hence, the true burden of the disease is usually underestimated. We analyzed data in Eastern Region of Ghana to characterize the trend of dog bites and human rabies and identify discrepancies in data for reporting cases. Methods : we analyzed recorded dog bites and human rabies cases from 2011 to 2015 in the Eastern Region. Data were collected from DHIMS, Regional Disease Control Unit and Regional Veterinary Unit. The results were expressed in frequencies, percentages and incidences. We used Stata version 13 for data analysis. Results : a total of 4821 dog bites/suspected rabies cases were recorded from 2011 to 2015. Children 5 to 9 years old were most affected. Males were more affected (51.2%) than females. Kwahu West District recorded the highest incidence of cases (625/100,000). Eighteen deaths from human rabies were recorded from 2011-2015. New Juaben Municipality recorded the highest number of deaths (6 deaths). Majority of rabies deaths (73%) occurred in urban areas. Eighty-two percent of those who died from rabies did not receive post exposure prophylaxis (PEP) also the vaccination status of the rest were unknown. The number of cases recorded for New Juaben Municipality at the Regional Health Directorate was 5.5 times that recorded at the veterinary unit for the same period. Conclusion : the burden of dog bites and human rabies is a public health problem in the Eastern Region and Ghana as a whole. The data underline the need for improved availability and timely administration of PEP in the treatment of dog bite victims. There is also the need for improved collaborative effort and effective communication between the various units within the health system of Ghana.

Introduction : though ubiquitous, scabies presents a major public health threat to developing countries. Post-infective complications from secondary infections cause renal and cardiovascular morbidities. Globally, its prevalence varies from 0.3% to 46%; with an estimated 1.5 million years lived with disability. Its prevalence in Ghana is estimated at 5.1%. We report the findings of a scabies outbreak investigation among schoolchildren in Ghana that aimed at stopping the outbreak and instituting preventive measures to minimize the risk of future outbreaks. Methods : between March 14 and May 17, 2017, we conducted an outbreak investigation of scabies in Presec Staff Basic School situated in an urban community in Accra. A case was defined as a schoolchild who on clinical examination, had an intensely pruritic rash on at least one typical predilection site with or without a burrow or positive skin scrapings on microscopy. We line listed cases and captured data which included socio-demographic and other risk factors, body parts affected and complications of scabies. We conducted an environmental assessment and performed descriptive statistics on the data. Results : a total of 823 school children were screened. Overall attack rate was 11.2% (92/823). The attack rate among the nursery category was 25.1% (52/207). Their ages ranged from one to seven years; with a modal age of 3 years. Males affected were 51% and frequently affected body parts were: face (77.2%) and neck (54.3%). Nearly 10.0% of cases had pyoderma from secondary infection. Pupils sat close together in pairs and share sleeping mats. Conclusion : a scabies outbreak affecting mostly children aged 3 years occurred in a basic school in Accra. We recommend avoidance of sharing of sleeping mats by school children. Benzyl benzoate mass treatment, disinfecting of classrooms and sleeping mats, and health education were done.

Introduction : urinary schistosomiasis is a parasitic Neglected Tropical Disease caused by blood flukes called Schistosoma haematobium and characterized by terminal hematuria.School-aged children get infested through habits such as swimming and fishing in infested water bodies. Schistosomiasis is endemic in Ghana. On September 28, 2016, La Madina Nkwantanang Municipality (LaMNM) reported clusters of suspected schistosomiasis in a basic school. We investigated to determine the extent and risk factors of the outbreak and implement control and preventive measures. Methods : we screened all pupils with a questionnaire followed by testing urine of those with a history of hematuria. We conducted 14 case control study to determine the risk factors for schistosomiasis. A case of urinary schistosomiasis was any pupil from the affected school with Schistosoma ova identified in the urine. We interviewed case patients and their controls to obtain data on socio-demographic characteristics and their social play habits. We conducted an environmental assessment. Descriptive and inferential data analyses were done. Risk factors were assessed using adjusted odds ratio (AOR) and their corresponding 95% confidence intervals. Results : of 753 students, 81 case-patients were identified (attack rate 10.8%). Sex specific attack rates were 17.0% (68/401) for males and 3.7% (13/352) for females. Median age of case-patients was 13 years (IQR 11-14 years). Compared to controls, case-patients were more likely to be males [AOR=5.8 (CI=3.04; 11.96)]. After controlling for possible confounders, swimming in Silver land pond [AOR=9.0, 95%CI (2.18-33.55)] and swimming in Quotam pond [AOR=3.2, 95%CI (1.10-9.41)] were independent risk factors for contracting schistosomiasis. Conclusion : urinary schistosomiasis outbreak mainly affecting males occurred in LaMNM. Swimming in infested ponds was the major risk factor. Following our investigation, health education, mollusciciding and clearing of weeds in ponds, and preventive chemotherapy using Praziquantel were carried out.

Introduction : diarrhea is the third leading cause of hospital morbidity in children under five years in the War Memorial Hospital (WMH). With the current changes in climate, little is known about the seasonal and spatial distribution of diarrhoeal diseases in the WMH. We determined trends of diarrhoeal diseases in children under five years in the WMH. Methods : we reviewed secondary data of children under five years who attended the WMH and were diagnosed of diarrhoea. Diarrhoea was defined as a clinician’s diagnosis of the passage of three or more watery stools a day in a child under five years in the WMH. Descriptive data analysis was done and expressed as frequencies and relative frequencies. Monthly proportions of diarrhoea and rainfall figures were presented to show seasonal distributions of cases. Geographical distribution of cases was determined using Epi Info and Arc GIS. Results : a total of 865 diarrhoeal cases in children under five years reported to the hospital. Out of this, 425 (49.13%) were female children with 346 (40%) aged 0-11 months. The highest peak occurred in the rainy season from May to August. However, there was a weak negative relationship between diarrhoeal diseases and rainfall for the whole study period. Cases were clustered in the northeastern part of the Kassena Nankana Municipality (KNM). Conclusion : the most affected age group was in 0-11 months. Majority of cases were from the North Eastern part of the Municipality. There was seasonal variation of diarrhoeal diseases. Diarrhoeal diseases have the highest occurrence in the rainy season but an increase in rainfall does not necessarily lead to an increase in diarrhoeal cases. Intervention to reduce diarrhoea should be intensified before the rainy season and in the northeastern parts of the municipality.

Introduction : globally, the use of electronic database is increasingly becoming important for public health surveillance. Ghana adopted the web-based District Health Information Management System (DHIMS2) platform as its nation-wide health information system software for collection, collation, analysis, and dissemination of public health surveillance data. Since 2012, Integrated Disease Surveillance and Response (IDSR) data has been reported through DHIMS2. We evaluated the performance of the DHIMS2 system using completeness and timeliness of reporting. The DHIMS2 system attributes too were assessed. Methods : we assessed trends in completeness and timeliness before and after the introduction of DHIMS2. We retrieved 2012-2016 monthly IDSR reporting rates in the DHIMS2 system for all 216 districts in Ghana. We generated percent completeness and timeliness for all reporting districts as well as the ten regions of the country using the DHIMS2 pivot table module. Timely reports were reports received in the DHIMS2 system at the national level on or before the stipulated deadline while completeness was defined as the number of reports received at the national level as a proportion of the number of reports expected from reporting units. For the period before the introduction of DHIMS2, IDSR reporting rates were computed from data retrieved from available archived paper-based monthly summary sheets. The system’s simplicity, flexibility, acceptability, and stability were assessed using CDC guidelines for evaluating public health surveillance systems. Results : a total of 12,960 monthly IDSR reports were received from 216 districts of the 10 regions of the country for the period. Compared to the 18% highest annual timeliness before adoption of DHIMS2, timeliness of reporting improved to 84% in 2016. Completeness of reporting improved from maximum of 60% for the period before DHIMS2 to 91% in 2016. Of the ten regions, six (60.0%) had completeness above 90% for each year after adoption of DHIMS2 platform. DHIMS2 was found to be simple, flexible, stable, and well accepted by stakeholders. Conclusion : though not optimal, use of DHIMS2 has improved IDSR report completeness and timeliness. We recommended a special study to assess the system’s data quality, sensitivity, predictive value positive and representativeness to enhance surveillance indicators under the IDSR strategy.

Introduction : globally, estimated 2.9 million newborns die annually within the first 28 days of life. Most deaths (99%) occur in low-and-middle-income countries. Neonatal Mortality Rate (NMR) in Kintampo North Municipality (KNM) is high. The aim mof the Neonatal surveillance system is to estimate and monitor neonatal death rates, identify risk factors and high risk areas for neonatal deaths to inform program actions. This surveillance system is part of the Integrated Disease Surveillance and Response in Ghana. This system has not been evaluated in the past six years. We evaluated the system to determine its usefulness and whether it is meeting stated objectives. Methods : we reviewed the 2012-2016 neonatal death surveillance data in the KIntampo North Municipality. Surveillance staff were interviewed using semi-structured questionnaire. Registers and reporting forms at reporting sites were inspected and compared to the aggregate data in the District Health Information Management System (DHIMS 2) for data consistency. We assessed system attributes including sensitivity, data quality, representativeness and completeness. Descriptive analysis was done with Stata 14 and complemented with the interviews and record inspection to describe the systems attributes. Results : between 2012 and 2016, a total of 175 neonatal deaths occurred. Most deaths (90.8%) occurred in the early neonatal period (0-6 days). The NMR in the Municipality within the five years ranged from 13-21 deaths per 1000 live births with 2015 recording the highest rate. Less than ten variables are required to complete a neonatal death report. The municipal hospital recorded > 90% of deaths. None of the four private facilities in the municipality reports to the health directorate. There was no evidence of action by the health directorate to address the high NMR. Data inconsistencies and missed reporting exist at community, sub-district and facility levels. Conclusion : the system is not meeting its objectives and also not useful in decision-making in the municipality. The Municipal Health Directorate has planned to train key health staff and periodically supervise them to improve on the performance of the system in the Municipality. We sensitized the private facilities owners to report neonatal deaths to the health directorate.

Introduction : the Integrated Disease Surveillance and Response (IDSR) and District Health Information Management System II (DHIMS2) approaches were introduced and implemented in 2002 and 2012 respectively in Ghana to improve surveillance data submission rate and data quality. Timeliness of reporting is the proportion of all expected IDSR summary reports that were actually submitted on the DHIMS2 on time (reports received before a specified deadline). Completeness of reporting is the proportion of all expected IDSR summary reports that were actually submitted on the DHIMS2. Timely and complete data submission are used by health managers to pre-empt major outbreak, detect changes in trends of diseases and permit assessment of implemented control programs. We evaluated the timeliness and completeness of reporting of the IDSR system in the Western Region of Ghana. Methods : we conducted a cross-sectional study to evaluate IDSR system of reporting timeliness and completeness in the Western Region from 2012 to 2016. We assessed two urban districts; Tarkwa Nsuaem Municipality and Sekondi Takoradi Metropolis and two rural districts of BIA West and Juabeso, and their 145 health facilities representing public, private and mission providers were assessed. Weekly and monthly disease surveillance reports on timeliness and completeness were extracted from DHIMS2 database and analyzed using Epi Info. Univariate analyses were expressed as frequencies and proportions. Results : the IDSR monthly reporting timeliness increased from 21% in 2012 to 91.9% in 2016 whilst completeness increased from 67.5% in 2012 to 99.1% in 2016. The IDSR weekly reporting timeliness increased from 4.6% in 2012 to 55% in 2016 whilst weekly report completeness increased from 39.7% in 2012 to 84.6% in 2016. Lower timeliness and completeness of reports from private health facilities was identified. Conclusion : there has been an improvement in the reporting of disease surveillance through DHIMS2 at the regional level. Challenges with timeliness and completeness of reporting from private health facilities were identified. Training and sensitization was conducted for private health facilities on timeliness and completeness of reporting of IDSR to DHIMS 2 based on our recommendation. This contributed immensely to improved timeliness and completeness from private health facilities.

Introduction : laboratory confirmation of etiologic agents of meningitis is important for disease classification, treatment decisions, and surveillance. In 2016, there was a major outbreak of meningitis in the Brong Ahafo Region (BAR), with 968 cases and 87 deaths (CFR 9.0%). Most of the Cerebro-spinal fluid (CSF) samples collected during the outbreak were sent to Brong Ahafo Regional Hospital Laboratory (BARHL), for the confirmation of etiologic agent(s). We analyzed laboratory data for meningitis at the BARHL to establish the predominant causative agent(s), their distribution and antibiotic susceptibility profiles. Methods : we conducted a retrospective descriptive study. We extracted and reviewed meningitis data from the BARHL registers and meningitis case-based forms for the 2016 outbreak. Variables collected included the district of residence, sex, age, etiologic agent, and antibiotic results. Univariate analyses were done to generate frequencies, ranges, percentages, and proportions. These were presented as text and graphs. Results : samples were received from 20 (74%) of 27 districts in BAR. Of 608 samples, 537(88.3%) had confirmed results. Majority of confirmed cases were females, 297(55.3%), and, ages ranged from 7days to 98years (modal age 18years). A total of 125 (23.7%) were positive for bacterial pathogens. The distribution of pathogens were Streptococcus pneumonia, 97 (77.6%), Neisseria meningitides, 27 (21.6%), Haemophilus influenza type B, 2(1.6%) and Group B Streptococcus, 1 (0.8%). Majority of pathogens, 46(36.8%) were isolated from age-group, 10-19years. Over 80% of the pathogens were susceptible to Ciprofloxacin and Ceftriaxone, but resistant to co-trimoxazole, (77.4%) and tetracycline, (91.0%). Of the districts, Jaman North, 36 (28.8%), Wenchi, 16 (12.8) and Tain, 13 (10.4) had the highest proportion of confirmed meningitis pathogens Conclusion : predominant pathogen identified during the outbreak was Streptococcus pneumoniae. Most were susceptible to Ceftriaxone and Ciprofloxacin. Majority of identified pathogens were amongst age-group 10-19years and from Jaman North District. We recommend the use of Ceftriaxone antibiotic during meningitis outbreaks and vaccination of at risk populations in BAR.

introduction : cerebrospinal meningitis is an inflammation of the meninges around the brain and spinal cord, characterized by sudden onset headache, fever, neck stiffness and sensitivity to light. The most common form of meningitis is bacterial which includes Neisseria meningitides, Haemophilus influenza, and Streptococcus pneumonia . Epidemics occur annually between late November and June in the African belt and constitutes a major health threat. Beginning 2017, Ghana reported 69 suspected cases with 9 deaths in Ashanti and Upper West Region. By the 8 th epidemiological of 2017, Jirapa District in the Upper West Region reported 41 suspected cases of meningitis with six deaths. We investigated to verify the diagnosis, identify risk factors and implement control measures. Methods : we conducted a descriptive study. A case-patient was anybody living in Jirapa and its environs and reporting with or without fever of acute onset and with one or more of the following signs; neck stiffness, poor sucking (in infants), bulging fontanelles (in infants), altered consciousness, irritability, seizures, and other meningeal signs. We reviewed medical records, conducted active case search and contact tracing. We interviewed case-patients and contacts and conducted an environmental search. We reviewed laboratory records for CSF examinations. We analyzed data by person, place and time. Results : of 61 case-patients, 32 (53.3%) were female. The case fatality was 6/61 (9.8%). Median age was 16.5 years (interquartile range: 1-86 years). Most affected age group were below 10 years. Conclusion : streptococci pneumonia was responsible for the upsurge in cases. Children were mostly affected.

Introduction : childhood pneumonia remains a major health problem especially in developing countries with an annual death toll of 473,000 in Africa and 6,450 in Ghana. The pneumonia surveillance system in Ghana is a facility-based system, requiring health facilities to routinely submit monthly summaries to the national database. We described the trend and distribution of pneumonia in children under five years over a five-year period in Tema Metropolis. Methods : we reviewed 2012-2016 surveillance dataset, laboratory registers and medical cause of death certificates. A case of pneumonia is clinically diagnosed by fever and fast breathing with characteristic x-ray changes and confirmed by microbiological testing. We assessed reporting completeness, calculated annual incidence and mortality rates, and performed descriptive analysis. We identified outbreaks by displaying case frequencies against C2 thresholds. Results : from 2012 through 2016, there were 3337 cases and 54 deaths (CFR = 1.6%) reported by 24% (13/55) of facilities which even reported infrequently. Females accounted for 48% (1625/3337) of reported cases. There were higher rates observed in infants (mean incidence = 21/1000 12) than 1-4-year group (mean incidence=8/1000 2.8). Between the period of review, the highest incidence (15/1000) was recorded in 2012 and the lowest (5/1000) in 2016, with a mean incidence of 10.8/1000 (SD = 4). Incidence peaked in June-July and October-November. The highest mortality rate (104/100,000) was recorded in 2015 by one sub-district which also persistently recorded highest incidence rates. Two outbreaks occurred during the five-year period. Conclusion : generally, there was a decline in childhood pneumonia incidence and mortality over the study period in the district. The data is however interpreted with caution as erratic facility reporting may distort the real trend. Following our recommendations, community-based health education on pneumonia by health workers has been intensified, specifically targeting mothers of infants, and data providers have been sensitized on frequent reporting.

Introduction : cholera is an acute illness with profuse watery diarrhea with high case fatality rate is left untreated. It is caused by Vibrio cholera serogroups O1 or O139. The disease is transmitted fecal-orally through ingesting contaminated food or water. In 2014, 16,527 cases including 128 deaths (CFR 0.8%) were reported from 8 out of 10 regions in Ghana. Greater Accra region recorded 73% of the cases (12,120 cases with 97 deaths (CFR 0.7%). We evaluated the cholera surveillance system to describe operation of the system, and assess its attributes to determine whether the system is meeting the objectives. Methods : this was a cross-sectional study. We used the CDC Updated Guidelines for Evaluating Public Health Surveillance System. We interviewed key stakeholders using a structured questionnaire to collect information about the system and its attributes. We reviewed cholera data from 2011- 2015 from the Health Information System at district and regional levels. The system attributes were assessed and scored for description and comparison on a Likert scale from 1 to 4. Data was analyzed using Epi-info and Microsoft Excel. Results : the Cholera surveillance system was included in the Integrated Disease Surveillance and Response with a clear case definition and laboratory support at all levels. The system was simple and flexible as it is able to adapt to changes. It was also acceptable by all and was stable, and highly sensitive due to the

Introduction : pertussis is a vaccine preventable respiratory disease caused by Bordetella pertussis. Globally, an estimated 16-million pertussis cases with about 195,000 deaths occur annually. In Ghana, pertussis vaccine is a component of pentavalent vaccine administered in three doses during infancy. On 4th August 2016, Dormaa Municipality (DM) received report of suspected pertussis outbreak in Duasidan, a Ghanaian community sharing borders with Cote d’Ivoire. We investigated the outbreak to establish its existence, magnitude and implement control measures. Methods : we conducted a descriptive study from 4th to 26th August 2016. We reviewed medical records, interviewed case-patients and their caretakers, traced and administered Azithromycin prophylaxis to contacts and took nasopharyngeal swabs for laboratory confirmation. A suspected pertussis case was any person in Duasidan, presenting with cough or coughing fits with or without whoop, vomiting, red-eye, fever, sneezing or runny nose from 1st July to 26th August 2016. Descriptive data analysis was done and categorical data presented as frequencies and relative frequencies. Median and interquartile range was calculated for continuous data. Results : of 1040 residents, 123 were case-patients giving overall attack rate of 11.8% with no deaths. Sex-specific attack rates were 12.7% (58/457) for males and 11.1% (65/583) for females. Attack rate among children age less than three years was 53.6% (67/125). All case-patients were from Duasidan community. Median age was three years (IQR: 1,7 years) and modal age was two years. Of the case-patients, 94(76.4%) had three doses of pentavalent vaccines. Third dose of pentavalent vaccination coverage in DM was 74% in 2016. Nasopharyngeal swab results from sub-regional reference laboratory could not be completed. Conclusion : a suspected pertussis outbreak occurred in Duasidan affecting mostly children aged less than three years. Pentavalent vaccination coverage was low in DM. Case-management, chemoprophylaxis and health education helped control the outbreak. Mop-up vaccination campaigns were justified preventive measures.