Poliovirus neutralizing antibody levels among individuals in three regions of Ghana

Introduction: Ghana was declared polio-free in 2015 after the last polio case in 2008. We determined the poliovirus neutralizing antibody levels among individuals to identify possible immunity gaps. Methods: A cross-sectional, hospital-based study was undertaken in Northern, Ashanti and Greater Accra regions of Ghana. Individuals referred for haematology at the teaching hospitals' laboratories were invited to participate in our study. Neutralizing-antibody titers to poliovirus serotypes 1,2 & 3 were assayed by WHO-standards. Antibody titers of ≥8 were considered protective. Bivariate and multivariate analyses were conducted on subject characteristics to assess potential factors for failure to seroconvert. P-values < 0.05 were considered statistically significant. Results: Poliovirus (PV) neutralizing-antibody serotypes 1, 2 and 3 were detected in 86.0% (264/307), 84% (258/307) and 75% (230/307) of samples respectively. 60.1% (185/307) were seropositive for the three poliovirus serotypes. Neutralizing poliovirus antibodies for PV1 and PV2 were higher than for PV3. Seroprevalence of poliovirus-neutralizing antibodies among males (PV1=51.9%, PV2= 51.6% and PV3= 52.6%) were higher than in females. Seroprevalence rates of poliovirus-neutralizing antibodies (PV1, PV2, and PV3) were highest in the Northern region (90%, 81%, and 77%). Poliovirus neutralizing-antibodies (PV1and PV2) decreased with age [p< 0.001]. Low seroprevalence of poliovirus-neutralizing antibodies was significantly associated with low school attendance of mothers (p<0.001). Conclusion: Our study population has some protection from polio. However, immunity appears to be lower with a higher age or low Mother's education. This may suggest the need for young-adult booster-dose to minimize the risk of wild poliovirus infection

Bacterial Meningitis: A Review in the Upper East Region of Ghana 2010-2014.

Introduction: Meningitis is an acute inflammation of the protective membranes covering the brain and the spinal cord. It can cause severe brain damage and is fatal in 50% of cases if untreated. The Upper East Region (UER) of Ghana recorded 70 case-patients in 2014 with a case fatality of 10%. Furthermore, there have been series of out outbreaks of bacterial meningitis in the region. The study reviewed meningitis surveillance data to assess the progress towards interruption of meningitis transmission and identified opportunities for surveillance improvement in the UER. Methods: This involved records review and secondary data analysis of all reported meningitis cases in the Region from 2010 to 2014. Data quality was assessed: described by person, place, time, causative agents involved and identified opportunities for system improvement. Results: Of 1142 suspected cases of meningitis recorded at the health facilities and communities in the UER, 352(30.8%) were confirmed cases of various forms of Bacterial meningitis. Majority of the cases (50.7%) were males. The age group 0-9 years was mostly 491(43.0%) affected. There were 146 deaths, giving a case fatality rate of 13.0%. The identified etiological agents were Neisseria meningitides (Nm W135) 50.3%, Streptococcus pneumonia (41.7%), Neisseria meningitides (Nm A) 1.7%, Neisseria meningitides (Nm Y 5%), Haemophilus Influenzae Type B1.5%. Majority of the case-patients were observed in 2010 (34.7%) and 2012 (44.2%) between February and April (%). The Kassena Nankana Municipal recorded the highest number of cases 234(20.5%) and the Bulsa South District recorded no case of bacterial meningitis cases. 69 (6%) of case-patients had no lumber puncture done. Time spent before presentation of case-patients to the health facilities had no significant association with the outcome of the infection (p= 0.319). Conclusions: There has been a consistent outbreak of Bacterial meningitis in the Upper East Region that involved many cases-patients with some mortality. More bacterial meningitis cases were recorded in children compared to adults. Lumber puncture was not performed in all casepatients. Many case-patients were recorded in the first quarter of the year with the majority in the Kassena Nankana District. There is an urgent need to review the management of meningitis, coupled with enhanced strategies in prevention of occurrences of the disease in the Upper East Region of Ghana.

Prevalence of Hypertension and Associated Risk Factors in Adults from a Semi Urban District in Ghana: A Population Based Survey.

Objectives: Given the paucity of community based surveys on hypertension and other non-communicable diseases in the Akwapim North District (AKND) of Ghana’s Eastern-Region (ER), we conducted a population survey to determine the prevalence of hypertension and its associated determinants. Methods: We recruited 519 adults age ≥ 25years in a multi-stage sample of enumeration centres over a one-month period. We measured body weight, waist and hip circumference, height, blood pressure (BP) and obtained demographic and risk factor information. Univariate and bivariate-analysis determined the prevalence of hypertension, significant difference and predictors of known risk factors (p <0.05). Results: Among the 519 participants, 62.8% were women. The mean age and body mass index (BMI) were 48.6±16.8 years and 23.2±5.2 kg/m2 respectively. Prevalence of hypertension was 32.2% with a male-to-female distribution of 27.5% and 35.0% respectively. The prevalence of alcohol use was high at 65.6% (340/519). Age and waist circumference were predictors of diastolic BP. Conclusions: There is a high prevalence of hypertension in the AKND of Ghana. Stakeholders should structure interventions on hypertension to promote healthier-lifestyles.

Community Knowledge and Perceptions on Malaria and Its Prevention and Control in the Akwapim North Municipality, Ghana.

Background: Malaria is an important cause of morbidity and mortality especially among children less than five years in the Akwapim North Municipality of the Eastern Region of Ghana. Knowledge of community members in malaria is a major factor that can influence malaria prevention and control. In 2012, the municipality was enrolled onto the home-based management of malaria programme in the region using the community based health volunteers. We assessed the knowledge and level of understanding of the people about the disease prior to the introduction. This is to enhance the control of malaria in the Municipality. Methods: A cross sectional study involving 616 adults, were selected from households using a simple random selection method. Information on age, marital status, levels of education, occupation, awareness, knowledge and perceptions on malaria were obtained using a questionnaire. Univariate analyses were expressed as frequencies, percentages and means. Bivariate analysis ascertained the relationship between gender, age, educational level and knowledge on prevention of malaria (p<0.05). Results: Among the 616 respondents, 58.6 % were females. The median age was 33.0 years old (range 14-81). Respondent’s awareness of malaria was 96.7% but rather a poor knowledge of malaria etiology (1.6%). 64.2% of the respondents knew that mosquitoes transmit malaria. Knowledge on the classical symptoms of uncomplicated malaria was moderate (7.6 – 48.7%). The respondent’s knowledge of danger signs of severe malaria was low (5.6-16.2%). Myths regarding causes of malaria such as filth, flies were mentioned by 20.9% and 4.2% of the respondents. 81% perceived malaria is preventable and the use of an insecticide treated bed net among respondents was 39.0%. Females were more likely (p-value 0.003) to have more knowledge on prevention of malaria. Conclusion: Although awareness of malaria in the Akwapim North Municipality is high, there is a serious knowledge gap in identifying the dangers signs associated with the disease. Many community members do agree that malaria is preventable but still harbour myths regarding its etiology. Health education should therefore be reviewed and intensified in the communities.

Gastroenteritis Outbreak in a Senior High School, Akwapim North District, Eastern Region-Ghana, 2012.

Background: On the 28th of October, 12 students from a Senior-High-School (SHS) in the Akwapim North-District-Ghana, reported to the district hospital with abdominal cramps, diarrhea and vomiting. We investigated to identify the cause, the source of infection and to recommend control measures. Methods: We conducted a descriptive investigation; with active case-search and a retrospective cohort-study. A case-patient was a student presenting with abdominal cramps, diarrhea and or vomiting from the 28th of October to the 2nd of November in the SHS. We interviewed students and reviewed medical records. Stool from case-patients and water samples were taken from known sources of drinking water and associated boreholes for laboratory diagnosis. We performed univariate analysis by person, place and time and assessed risk factors through relative risk 95% confidence level. Results: Aeromonas-spp and Eschericia-coli were isolated from stool and water samples respectively. The overall attack rate was 8.0 (101/1254) /1000 with no fatalities. The index case, a 15 yr-old female student reported on october 28th and case-patients peaked (16/101) 24hours later. The mean age of case-patients was 17 years (±1.2) with females 77% (78/101) mostly affected. Eating waakye [RR=3.13(CI 2.35-4.17)], banku [(RR= 2.21(CI 1.33-3.69)], kenkey [RR=1.39 (CI 1.03- 1.87)] and drinking borehole water [( RR=7.60 (CI 6.26-9.25)] were associated with the gastroenteritis. Conclusions: Drinking Eschericia coli-contaminated-bore hole water was the most likely cause of this point-source outbreak. Chlorination of the boreholes water coupled with education on food safety and personal hygiene were initiated based on our recommendations and these measures were temporally associated with containment of the outbreak.