Ghana Field Epidemiology and Laboratory Training Programme

2019 ANNUAL REPORT ACRONYMS AND ABBREVIATIONS AFENET African Field Epidemiology Network AFP Acute Flaccid Paralysis Basic FETP Basic Field Epidemiology Training Programme BFELTP Burkina Faso Field Epidemiology and Laboratory Training Programme CDC Centers for Disease Control and Prevention DG Director General DHMT District Health Management Team EPDC Epidemiology and Disease Control EPI Expanded Programme on Immunization FETP Field Epidemiology Training Programme GAR Greater Accra Region VISION GFELTP Ghana Field Epidemiology and Laboratory Training Programme To improve the health GHS Ghana Health Services of the people in Ghana GWER Ghana Weekly Epidemiological Report and beyond MHMT Municipal Health Management Team MHNP Maternal Health, Neonatology and Perinatology MOH Ministry of Health NCD Non Communicable Diseases MISSION NCDCP Non Communicable Disease Control Programme To contribute to NFELTP Nigeria Field Epidemiology Training Programme addressing Ghana’s NYU New York University public health needs PAM J Pan African Medical Journal and priorities through PMI President’s Malaria Initiative training and service RDHS Regional Director of Health Services provision in Applied RHD Regional Health Directorate Epidemiology SPH School of Public Health and Public Health UG-SPH University of Ghana School of Public Health Laboratory UHAS University of Health and Allied Sciences Management. VSD Veterinary Services Department WAHO West African Health Organization WHO World Health Organization Contents EDITORIAL TEAM Donne Ameme (Dr.) 2 FOREWORD Gladys Asumah-Karikari Adu (Mrs.) 3 ACKNOWLEDGEMENT Magdalene Odikro Delia Bandoh 4 BACKGROUND Charles Lwanga Noora 5 PROGRAM ACTIVITIES Tony Godi 5 Field work on Surveillance System Evaluation 6 Faculty Visit to the Field 6 Surveillance System Evaluation, Thesis and Surveillance Data Analysis 7 Faculty and residents exchange between the GFELTP and the Burkina Faso Field Epidemiology Training Programme (BFETP) 12 Field Work on Surveillance Data Analysis 13 Public Health Simulation Exercise In The Nsawam-Adoagyiri Municipality, Eastern Region 15 Polio Vaccination Campaign 16 Case Study Development on Chemical Preparedness For Environmental Epidemiology Module 17 GFELTP Gains TEPHINET Global Accreditation 18 MEETINGS, WORKSHOPS AND CONFERENCES 18 Meetings 18 Steering committee meeting for the GFELTP 18 Ecowas Regional Consultative meeting for Advanced Field Epidemiology 19 Workshops 19 FETP-Intermediate in Ghana 19 Pre-Admission Workshop 21 FETP-Intermediate Cohort 1 23 FETP-Frontline in Ghana 23 Cohort XIII Training in Ashanti Region 25 Frontline trainings in the University of Health and Allied Sciences, Hohoe 25 Cohort XIV Training in Northern Region 27 Cohort XV Training in Brong Ahafo Region 28 Chemical Preparedness Workshop 29 Conferences 29 68th Epidemiological Intelligence Conference International Night, Altanta – United States of America 29 5th International Epidemiological Association, Africa Regional Conference, Maputo - Mozambique 29 The 10th TEPHINET Global Scientific Conference 30 Ghana FELTP 2nd Scientific Conference and Competency Graduation Ceremony 33 OUTBREAK INVESTIGATIONS 33 Schistosomiasis Outbreak, Charikpong Sub-district, Nadowli-Kaleo District, Upper West Region, Ghana, 2019 33 Suspected Food Borne Illness Outbreak in Boamang-Kyerekrom D/A Primary School, Afigya Kwabre North District, Ashanti region. 34 Human Rabies Outbreak in Kojo-Oku, Gomoa East District, Central Region, 2019 35 Confirmed Human and Dog Rabies, Awutu Senya East Municipal-Ghana, 2019 38 Outbreak of Yellow Fever in Gbentanaa Sub-District, Adentan Municipal, Greater Accra Region 39 Outbreak of Circulating Vaccine Derived Polio Virus (cVDPV) Environmental Outbreak in Agbogbloshie, Accra Metro, Greater Accra Region 40 PUBLICATIONS FOREWORD Established in 2007, the Ghana Field Epidemiology and Laboratory Training programme (GFELTP) as part of its mandate has contributed immensely in increasing workforce development and capacity in the various Ministries of Health (MOH) in Ghana and beyond. The collaborative effort from University of Ghana School of Public Health (UGSPH), the Ghana Health Service (GHS) and the Veterinary Services Department (VSD) and partners capacitated the trainees and alumni from the Frontline, Intermediate and Advanced programme to respond timely to public health emergencies. The various Ministries of Health in the English Speaking West Africa are able to respond promptly and appropriately to public health emergencies due to competencies acquired by residents who enrolled on the programme since it became the hub for training field epidemiologists in English speaking West Africa (with the exception of Nigeria).

The team of dedicated, disciplined and results-oriented staff made 2019 a historical landmark for the programme, thus through their collective effort, GFELTP was one of the four countries which achieved TEPHINET Global Accreditation.

The GFELTP was the first programme to also graduate all the three tiers of the Field Epidemiology Training Programme (FETP) at a forum. The programme graduated trainees of the FETP-Frontline, FETP-Intermediate and residents of the Advanced FELTP at its 2nd Scientific Conference and Competency Graduation Ceremony held at the Noguchi Memorial Institute for Medical Research from December 11 – 12, 2019.

As the Team Lead, I thank all stakeholders and partners for their immense support in diverse ways to achieve the above successes. I also want to express my profound gratitude to the indefatigable team for working assiduously to achieve these great and incredible accomplishments. I know and believe together we will be able to achieve more successes together to improve the health of the people in Ghana and beyond.

I thank you for making time to read this document full of inspiration from audacious trainees and alumni.

Dr. Ernest Kenu Programme Director

2 | Ghana FELTP - 2019 Annual Report ACKNOWLEDGEMENT The Ghana Field Epidemiology and Laboratory Training Programme (GFELTP) is very much grateful to all partners and stakeholders for the influential roles and contribution they had played in making the year 2019 a success.

The programme has achieved all successes as a result of the sustainable partnership it has had with its partners and stakeholders such as;

• African Field Epidemiology Network (AFENET) • Centres for Disease Control and Prevention (CDC), Atlanta • Centres for Disease Control and Prevention (CDC), Ghana Country Office • West African Health Organization (WAHO) • World Health Organization (WHO) Country Office, Ghana • Veterinary Services Department, Ministry of Food and Agriculture (MOFA) • Ghana Health Services (GHS) • Ministry of Health (MOH), Ghana • National Public Health and Reference Laboratory (NPHRL) • Members of the GFELTP Steering Committee • The Regional Directors of Health Services • School of Public Health (SPH), University of Ghana • Epidemiology and Disease Control Department (EPDC) • Full and Part-Time Lecturers of the GFELTP • Noguchi Memorial Institute for Medical Research (NMIMR) • Field Epidemiology and Laboratory Alumni Network of Ghana (FELANG) • Mentors and Supervisors

Ghana FELTP - 2019 Annual Report | 3 BACKGROUND The Ghana Field Epidemiology and Laboratory Training Programme (GFELTP) evolved as a collaboration with the US Centers for Disease Control and Prevention (CDC), through cooperative agreements with the University of Ghana School of Public Health. It is a two-year competency based post graduate course of service and on- the- job learning in applied epidemiology and public health laboratory practice for scientists, physicians, veterinarians and other health professionals leading to the award of a Master of Philosophy (MPhil) degree in Applied Epidemiology and Disease Control. The vision of the programme is to train field epidemiologists, veterinary epidemiologists and public health laboratory scientists to respond to public health emergencies both within and outside the country. The GELTP is the hub for training English speaking West Africa (Exception of Nigeria) in field epidemiology. It is made up of a combination of a 30% didactic component and a 70% field component. Graduates of this programme have been involved in various public health activities in the country. Residents and alumni have responded to over 100 disease outbreak investigations in the various parts of the country. The GFELTP through its advanced programme run at University of Ghana School of Public Health trained 155 residents from Cohorts I to XIII comprising 46 (30%) females and 109 (70%) males, and 117 residents from Cohorts I to XI have graduated. Over 600 frontline health workers from the various regions of the country have been trained through its FETP- Frontline and FETP-Intermediate trainings. This report represents the various activities undertaken by the GFELTP in 2019, with the following objectives: • To strengthen public health capacity by developing a cadre of health professionals with advanced skills in applied epidemiology and laboratory management. • To contribute to research activities on priorities on public health problems. • To improve national capacity to respond to public health emergencies such as disease outbreaks, natural disasters and other unusual public health events including those that could be a result of chemical or biological terrorism. • Strengthen national surveillance systems through a team approach (physician, laboratorian and veterinarian) • Improve communications and networking of public health practitioners and researchers in the country and throughout the region.

4 | Ghana FELTP - 2019 Annual Report PROGRAM ACTIVITIES Field work on Surveillance System Evaluation Cohort XII residents of the GFELTP had their six weeks Surveillance System Evaluation from January 3 – February 8, 2019 in the Northern, Eastern, Brong Ahafo, Volta and Greater Accra Regions of Ghana.

Table 1: List of residents and diseases evaluated in the various regions of the country Name Topic District / Region Municipality 1 Jaygbah J. Mulbah Measles Techiman Brong Ahafo 2 David K. Kargbo Acute Flaccid Paralysis Sunyani 3 Desmond M. Maternal Death surveillance and Kangbai response 4 Musand M. Kromah Maternal Deaths Techiman 5 Jessica Asante Diarrhoea in children under five Techiman 6 Bonodong Guri Rabies Sunyani West 7 Alberta B. Corvah HIV New Juaben Eastern 8 Dr. Mary A.A Grey- Neonatal Deaths Johnson 9 Hawa M. Sherman Severe pneumonia among children Ga East Greater Accra under 5 10 Lizandra Cabral Dos Neonatal Deaths Ga West Reis 11 Felicia Alemna HIV Ga West 12 Eunice Baiden Adverse drug reactions Ga East 13 Gabriel B. Kassay Meningitis Karaga Northern 14 James S. Squire Cholera Savelugu 15 Momodou Kalisa Meningitis Karaga 16 Kassim Kamara Shigellosis Nadowli Upper West 17 Ernestina E. Malaria Regional Volta Agbemafle 18 Lily Sanvee-Blebo Tuberculosis Ho 19 Abdoulie Taal Measles 20 Baba Ceesay Pneumonia among children under 5 Regional 21 Anthony Baffour Severe pneumonia among children Savelugu Northern Appiah under 5 22 Richard Wodah- Malaria IRS Nadowli Upper West Seme 23 Richard W. Alogitega Port Health Karaga Northern

All residents shared their findings with the District, Municipal and Regional Health Directorates they worked in.

Ghana FELTP - 2019 Annual Report | 5 Dr. Guri Bonodong making a presentation of her Surveillance System Evaluation at the Sunyani West District Health Directorate, Brong Ahafo Region

Faculty Visit to the Field Surveillance System Evaluation, Thesis The objective of the field supervision was to enable and Surveillance Data Analysis faculty support residents to complete their field assignments and build the necessary capacity for public Faculty of the GFELTP paid a supervisory visit to Cohort health practice. The supervisory team also supported XII residents during their field work on Surveillance residents to address the various challenges they faced System Evaluation held from January 3 – February 8, on the field. 2019 in the Greater Accra, Eastern, Volta, Northern and Brong Ahafo Regions of Ghana. The supervisory visit took place from January 14 – 31, 2019.

Faculty of the GFELTP in a meeting with two residents in the Greater Accra Region during the supervisory visit

6 | Ghana FELTP - 2019 Annual Report Faculty of the GFELTP subsequently paid a supervisory Faculty and residents exchange between visit to Cohort XI and Cohort XII residents in Ghana from the GFELTP and the Burkina Faso Field June 10 – July 19, 2019 in the Greater Accra, Volta and Epidemiology Training Programme Upper West Regions. Cohort XI and XII residents were (BFETP) supervised on their thesis work and Surveillance Data To foster and strengthen collaboration between the Field Analysis respectively. The supervisory visit took place Epidemiology Training Programmes in the Anglophone from July 1-14, 2019. and Francophone West Africa, residents and faculty The supervisory team also had the opportunity to of both the Burkina Faso Field Epidemiology Training meet with the Regional, Districts and Municipal Programme (BFETP) and the GFELTP had an exchange Health Directors of Health Services to brief them on programme at the School of Public Health, University the objectives of the supervisory visit. The team also of Ghana and at the University of Ouagadougou. The informed them of the admissions for the 2019/2020 BFETP team was in Accra, Ghana from February 10, academic year and encouraged them to select suitable 2019 to March 5, 2019 whereas the GFELTP team went candidates to apply for the programme. The team on the exchange programme in Ouagadougou from further briefed the Directors on the 9-month Field September 9-20, 2019 Epidemiology Training Programe (FETP) – Intermediate The objectives of this exchange programme are to; in Ghana and the preparation towards the TEPHINET • Foster partnership Global Accreditation. • Improve collaboration between residents and faculty • Learn new teaching models from other member countries • Conduct short term research together eg. Joint one day field work, do data analysis together or Identify problem together and come out with appropriate solutions • Strengthen capacity on cross border/country collaboration among residents and; • Improve on working languages ( French and English) The BFETP team attended the exchange programme in three different groups. The first group made up of 12 residents came in from February 10 – 24, 2019.

Two faculty of the GFELTP in a meeting with the staff of the Regional Health Directorate, GHS, Brong Ahafo Region during the supervisory visit

Ghana FELTP - 2019 Annual Report | 7 Table 2: List of BFETP residents (Group 1) Name Profession Country 1. Conte Aboubacar Medical Doctor Guinea 2. Kourouma Maworia Biologist 3. Millimouno Tamba Jacques Biologist (Biomedical scientist) 4. Koivogui Enogo Medical Doctor 5. Conde Sory Medical Doctor 6. Correia Vesceslandia Medical Doctor Guinea Bissau 7. Papique Alberto Luis Medical Doctor 8. Victorino Martinho A. Medical Doctor 9. Gueye Ibou Medical Doctor & Biologist Senegal 10 Sow Kalidou Djibril Biologist 11. Sarr M. Moustapha Veterinarian 12. Karimou Sani Medical Doctor Niger

GFELTP residents, faculty and BFELTP residents (Group 1)

Residents were taken through courses such as Public Health Surveillance II, Management and Leadership, and Advanced Biostatistics. The BFETP residents together with the GFELTP residents had a joint one day fieldwork titled “Seat belt use among motorists passing all the entry gates of the University of Ghana campus” on February 18, 2019. Residents were divided into five groups and positioned at the various gates on campus to observe seat belt use among motorists as they entered the University of Ghana campus.

8 | Ghana FELTP - 2019 Annual Report (L-R) Groups 1 and 3 members conducting obstructive surveys at two of the gates on campus

Group 4 members conducting an obstructive survey at one of the gates on campus

The second group from the BFETP made up of 13 residents came in from February 24 – March 10, 2019. Residents were taken through courses such as Advanced Biostatistics, Laboratory Management, Policy and Systems Design.

Ghana FELTP - 2019 Annual Report | 9 Table 3: List of BFETP residents (Group 2) Name Profession Country 1. Tokpa Sompohi Jacques Medical Doctor Cote D’ivoire 2. Kouakou Yao Christophe Veterinarian 3. Bonzou Jeanne Adjoua Medical Doctor 4. M'lan-Britoh Alice Biologist 5. Alhassane Doudou Zeinabou Biologist Niger 6. Aboubakar Gandou Issiakou Medical Doctor 7. Mounkaila Issa Fatouma Medical Doctor 8. Sadji Adodo Yao Medical Doctor & Biologist Togo 9. Logonda Pangabou Veterinarian 10 Kpaikpai Pirénam Biologist 11. Alfa Essodina Potobawi Medical Doctor 12. Djossou Komlan Nurse 13. Bongono Emile Faya Veterinarian Guinea

GFELTP residents, faculty and BFETP residents (Group 2)

The BFETP team also had the opportunity to meet Rev. Prof. Patrick Ferdinand K. Ayeh-Kumi -Provost, College of Health Sciences, University of Ghana/Ag. Dean for the University of Ghana School of Public Health and Mr. Joseph Aidoo – Administrator, University of Ghana School of Public Health.

10 | Ghana FELTP - 2019 Annual Report Rev. Prof. Patrick Ferdinand K. Ayeh-Kumi – Provost, College of Health Sciences – University of Ghana/Ag. Dean - University of Ghana School of Public Health (arrow), Dr. Ernest Kenu, Director – GFELTP, Mr. Joseph Aidoo – Administrator, School of Public Health, GFELTP Cohort XII residents and the BFETP residents (Group 2) during the exchange programme

Residents took part in a Concept Development Field Project. They identified a Surveillance/Public Health Problem in their communities, described the problem and proposed ways of solving the problem. Residents made presentations of their findings to faculty on March 5, 2019 at the School of Public Health.

Table 4: List of topics presented by the various groups comprised of GFELTP and BFETP residents Group Name Topic 1 Wodah-Seme Richard Emergency preparedness towards 2 Jessica Asante fire outbreaks in University of 3 Abdoulie Taal Ghana School of Public Health 4 Aboubakar Gandou Issiakou 1 5 Hawa Sherman 6. Sadji Adodo Yao 7. Tokpa Sompohi Jacques 8 Kalissa Momodou 1 Lizandra Cabral dos Reis Facility in a single restaurant: A 2 Desmond Kangbai possible trans-student infection in 3 Mulbah Jaygbah University of Ghana 2 4 Kouakou Yao Christophe 5 Kpaikpai Pirénam 6 Djossou Komlan 7 Anthony Appiah Baffour

Ghana FELTP - 2019 Annual Report | 11 Group Name Topic 1 Felicia Alemna Flouting of road traffic regulation 2 Bonodong Guri by motorbike riders on the N4 3 Eunice Baiden Laryea High way, Accra – March 2019 3 4 Bonzou Jeanne Adjoua 5 Mounkaila Issa Fatouma 6. Logonda Pangabou 7. Richard Wewoliamo Alogitera 1 Lily Sanvee Blebo Improper waste disposal in 2 Baba Cessay Madina, Accra, Ghana 3 Alberta Corvah 4 4 Gabriel B. Kassey 5 Alhassane Doudou Zeinabou 6 Esinam Ernestina Agbemafle 7 Bongono Emile Faya 1 Mary Grey-Johnson Street vending and risk of road 2 David Kabba Kargbo traffic accidents in Accra – Ghana, 3 Kassim Kamara 2019 5 4 M'lan-Britoh Alice 5 Alfa Essodina Potobawi 6 Musand Melody Kromah 7 James Sylvester Squire

Field Work on Surveillance Data Analysis Cohort XII residents of the GFELTP had their six weeks field work on Surveillance Data Analysis from June 10 – July 19, 2019 in Ghana, Sierra Leone, Liberia and The Gambia. Residents shared findings of the field work with their respective facilities they worked with.

Table 5: List of residents and the relevant data analyzed in their respective countries Name Region/Country Topic 1 Jaygbah J. Mulbah Liberia Lassa Fever 2 Gabriel B. Kassay Liberia Measles 3 Musand M. Kromah Liberia Maternal Mortality 4 Lily Sanvee-Blebo Liberia Neonatal Mortality 5 David K. Kargbo Sierra Leone Ebola Virus Disease 6 Desmond M. Kangbai Sierra Leone Maternal Deaths 7 James S. Squire Sierra Leone Acute Flaccid Paralysis 8 Kassim Kamara Sierra Leone Lassa Fever 9 Jessica Asante Volta, Ghana Diabetes Mellitus 10 Bonodong Guri Greater Accra, Ghana Animal Rabies

12 | Ghana FELTP - 2019 Annual Report Name Region/Country Topic 11 Alberta B. Corvah Liberia Tuberculosis 12 Dr. Mary A.A Grey-Johnson The Gambia Measles 13 Hawa M. Sherman Greater Accra, Ghana Pneumonia in children under five 14 Lizandra Cabral Dos Reis Greater Accra, Ghana Buruli Ulcer 15 Felicia Alemna Greater Accra, Ghana Cause of Death 16 Eunice Baiden Layea Greater Accra, Ghana Immunization 17 Momodou Kalisa Greater Accra, Ghana Meningitis 18 Ernestina E. Agbemafle Volta, Ghana Malaria 19 Abdoulie Taal Volta, Ghana Malnutrition 20 Baba Ceesay Volta, Ghana Snake Bite

Dr. Guri Bonodong (left), a Ghanaian resident in a Mrs. Eunice Baiden Layea (arrow), a Ghanaian discussion with her field supervisor, Dr. Paul Polkuu resident collecting data during a home visit for the (arrow) during the field work on Surveillance Data aged and children under 5 years at Abokobi and Boi, Analysis Ga East District in the Greater Accra Region

Public Health Simulation This was part of efforts by the GHS to prepare its Exercise In The Nsawam- health workforce to adequately identify and manage Adoagyiri Municipality, public health threats in collaboration with all relevant Eastern Region agencies. As part of preparatory efforts, the GHS with The Ghana Health Service (GHS), in collaboration with support from WHO and CDC trained multi-sectoral the World Health Organization (WHO) Ghana Country rapid response teams (RRT) across the country in Public Office and the United States Centers for Disease Control Health emergency preparedness and response. This and Prevention (CDC), organized a simulation exercise simulation exercise was expected to further consolidate on July 18, 2019 at the Nsawam-Adoagyiri Municipality the training of District RRTs, assess the coordination of the Eastern Region to test the preparedness of the mechanisms in the response process and identify areas healthcare structures to rapidly detect and appropriately for improvement. respond to public health emergencies.

Ghana FELTP - 2019 Annual Report | 13 The exercise simulated an outbreak of a Viral Haemorrhagic Fever in the community and the reporting of a case to the hospital, and was not a real outbreak. It took place at different locations within the Municipality, and involved staff from the Nsawam Government Hospital, the Health Directorate of GHS, staff of the Eastern Regional Health Directorate and members of the Nsawam-Adoagyiri Community. The RRT training and the simulation exercise design and management was supported by alumni of the GFELTP. Mrs. Lizandra Cabral Dos Reis and Hawa M. Sherman, both Cohort XII residents of the GFELTP participated in the simulation exercise. Participants at the Public Health Simulation Exercise in the Nsawam-Adoagyiri Municipality, Eastern Region

Health workers attending to a case patient at the Simulation Exercise in the Nsawam-Adoagyiri Municipality, Eastern Region

14 | Ghana FELTP - 2019 Annual Report Polio Vaccination Campaign Residents and alumni of the programme supported national efforts of Polio Vaccination Campaign which commenced from August 3, 2019. The campaign was a response to circulating Vaccine Derived Polio virus Type 2 Outbreak in the Northern and Greater Accra Regions of the country. The residents and alumni served as supervisors in the Vaccination Campaign. They were responsible for collecting data on the number of children vaccinated using the OPEN DATA KIT (ODK) Software in a household survey approach. They also offered support to the field workers giving the vaccination and compiled supervision field reports at the end of the campaign.

(L-R): Mr. Charles Gyimah Gyamfi (Cohort XI resident) and Mr. Christopher Tamal (alumnus), both of the GFELTP on their way to visit a household in Tatale – Sangule in the Northern Region during the Round One of the Polio Vaccination Campaign

Children being vaccinated by staff of the Ghana A vaccinator marking the base of the finger of a child Health Service during the Round One of the campaign with indelible marker after being vaccinated

Ghana FELTP - 2019 Annual Report | 15 Case Study Development The faculty of the GFELTP, the GHS, and WHO reviewed on Chemical Preparedness the draft case studies to suite the local context. In For Environmental all, three case studies were reviewed. Reviewed case Epidemiology Module studies are: • Community exposure to health hazards and risks As part of efforts to integrate the Environmental from small scale gold mining in Ghana Epidemiology Module into the existing FELTP curriculum, • Occupational and community exposure to it was considered important to develop case studies mercury from small scale gold mining in Ghana that are more relevant to prevailing environmental • Environmental and human exposure to pesticides and chemical hazards and risks in Ghana. To this end, in Ghana in December 2018, learning visits were made to major The objectives of the case studies were to: small scale mining sites in Ghana to obtain first hand • Identify the chemical hazards and risks associated understanding of the hazards and risks posed to the with chemical events in small scale mining and miners and the larger non-mining populations within pesticide use and outside these mining areas. These case studies • Illustrate routes of occupational and population are being developed by the Public Health England and exposures the Norwegian Institute of Public Health (NIPH), in • Determine appropriate methods of exposure collaboration with the GFELTP - University of Ghana, measurements Ghana Health Service, and WHO - Ghana Country Office. • Discuss health outcomes of these risks and From July 30 - August 1, 2019, a team of consultants relevant data sources from the Norwegian Institute of Public Health joined • Design preventive and control measures for these the University of Ghana team to review and finalize chemical events. draft case studies.

(L-R): Dr. Basil Benduri Kaburi - Field Epidemiologist, GFELTP, Mr. Kristian Franer - (NIPH), Mr. Ceasar Nyadedzor (GHS), Prof. Col. Edwin Afari (Rtd.) – Coordinator, GFELTP, Ms. Elizabeth Peacocke (NIPH), Dr. Ernest Kenu – Director, GFELTP, Dr. Samuel Sackey – Field Coordinator, GFELTP and Mr. Patrick Avevor – WHO at the Case Study Development on Chemical Preparedness for Environmental Epidemiology Module

16 | Ghana FELTP - 2019 Annual Report The team of reviewers were; Mr. Kristian Franer (NIPH), GFELTP Gains TEPHINET Ms. Elizabeth Peacocke (NIPH), Mr. Ceasar Nyadedzor Global Accreditation (GHS), Prof. Col. Edwin Afari (Rtd.) – Coordinator, The GFELTP together with the China, Pakistan and GFELTP, Dr. Samuel Sackey – Field Coordinator, GFELTP, Morocco FETPs were accredited by the TEPHINET Global Dr. Ernest Kenu – Director, GFELTP, Dr. Basil Benduri Accrediting Body on November 1, 2019 at ththe 10 Kaburi - Field Epidemiologist, GFELTP, Mr. Patrick Avevor TEPHINET Global Scientific Conference held in Atlanta, and Dr. Akua Houphouet - WHO Ghana Country Office. United States of America from October 28 – November 1, 2019. The GFELTP was accredited after successfully going through the accreditation process of the fourth cycle of the TEPHINET Accreditation of FETPs. The accredited countries were awarded with plaques at the conference. Dr. Ernest Kenu – Director, GFELTP received the award on behalf of the GFELTP.

Dr. Ernest Kenu – Director, GFELTP (second person from right) received the plaque on behalf of the GFELTP

Ghana FELTP - 2019 Annual Report | 17 MEETINGS, WORKSHOPS AND CONFERENCES Meetings Steering committee meeting for the GFELTP The GFELTP held its steering committee meeting for 2019 on June 21, 2019 at the University of Ghana School of Public Health. Major issues discussed at the meeting were creation of epidemiologist position, the TEPHINET Accreditation visit and the 2019/2020 admissions. The meeting was attended by Dr. Badu Sarkodie, Director Public Health- GHS, Dr. Franklin Asiedu Bekoe, Head, Disease Surveillance Department- GHS, Dr. Ernest Kenu, Director, GFELTP. Also present at th e meeting were Members at the GFELTP Steering Committee held at representatives from the World Health Organization, the University of Ghana School of Public Health the Human Resource Division - GHS, Noguchi Memorial Institute for Medical Research and staff for the GFELTP. Regional Consultative Meeting for Advanced Field Epidemiology held at the Newton Park Hotel in Abuja Ecowas Regional Consultative meeting for – Nigeria from July 23-25, 2019. Advanced Field Epidemiology The objective of the workshop was to discuss the Dr. Ernest Kenu – Director, GFELTP, Dr. Samuel Sackey strategies of strengthening and sustaining Frontline, – Field Coordinator/Coordinator, FETP-Intermediate Intermediate and Advanced FELTP in the Ecowas region. and Dr. Donne Kofi Ameme – Resident Advisor/Senior The GFELTP team made presentations on the FETP- Epidemiologist, GFELTP participated in the Ecowas Frontline, Intermediate and the Advanced Programme.

Participants at the Ecowas Regional Consultative meeting for Advanced Field Epidemiology held in Abuja, Nigeria

18 | Ghana FELTP - 2019 Annual Report Workshops The objective of this pre-admission workshop was to select well-motivated candidates for the first cohort of FETP-Intermediate in Ghana the training. The FETP-Intermediate is a 9-month in-service A total of 27 health workers made of 10 Ghana Health programme focused on strengthening public health Service (GHS) staff, 5 Environmental Health Service surveillance, outbreak investigation and response, use Division (EHSD) staff and 6 each from Food and Drugs of survey data for decision-making and building research Authority (FDA) and Veterinary Services Department capacity at the middle level of the health system. The (VSD) were selected from the three regions for the pre- GFELTP with the support of AFENET and CDC rolled admission workshop. out the FETP-Intermediate in Ghana starting with the Trainees were taken through topics such as; Surveillance Northern zone (Northern, Upper East and Upper West interpretation and analysis, Outbreak investigation and Regions). response, public health surveillance, summary statistics, scientific presentations and powerpoint presentations Pre-Admission Workshop during the 3-day workshop. Trainees were examined The GFELTP in preparation to roll-out the FETP- and the final selection was done. Intermediate in Ghana, organized a 3-day pre-admission Of the 27 trainees who took part in the pre-admission workshop for governmental health workers from the workshop, 15 were selected for the first cohort of the Northern Zone (Northern, Upper East and Upper West FETP-Intermediate in Ghana. Of the 15 trainees selected Regions) of Ghana from February 20-22, 2019 at the for Cohort 1, 6 were from GHS, 3 from VSD, 3 from FDA Miklin Hotel, Accra – Ghana. and 3 from EHSD.

Table 6: List of the trainees selected for FETP-Intermediate Cohort 1 Name Cadre Institution Region 1 Aabalekuu Simon Public Health Officer Ghana Health Service Upper West 2 Cheyuo Gladys Public Health Nurse 3 Shamir A. Mohammed Regulatory officer Food and Drugs Authority 4 Nuo-Ire Y. Vitus Veterinary Officer Veterinary Services Department 5 Tugpiel Dominic Environmental Health Environmental Health Service Analyst Division 6 Akowuah George Health Information Officer Ghana Health Service Upper East 7 Baba Awuni Public Health Officer 8 Ernest Boateng Veterinary Officer Food and Drugs Authority 9 Clement Anyim Regulatory Officer Veterinary Services Department 10 Abdul-Rahaman Abdul-Aziz Environmental Health Environmental Health Service Officer Division 11 Fuseini Mahatma Disease Control Officer Ghana Health Service Northern 12 Asumah Augustine Disease Control Officer 13 Yolanda Ayamdooh Veterinary Officer Food and Drugs Authority 14 Sherifa Alhassan Regulatory Officer Veterinary Services Department 15 Anchaba Faustinus Environmental Health Environmental Health Service Officer Division

Ghana FELTP - 2019 Annual Report | 19 The pre-admission workshop was attended by Dr. Chastity Walker – Program Director, Global Health Securit, CDC Ghana who encouraged the trainees to give out their best so as to be part of the first cohort of the FETP-Intermediate in Ghana and also build their skills and competencies to contribute to the public health system in the country.

The workshop was also attended by staff of the GFELTP and mentors (of the GFELTP).

Dr. Chastity Walker – Program Director, Global Health Security, CDC - Ghana giving a remarks at the FETP- Intermediate pre-admission workshop held at the Miklin Hotel, Accra

Trainees, facilitators and mentors at the pre- admission workshop held at the Miklin Hotel, Accra -Ghana

Trainees of the pre- admission held at the Miklin Hotel, Accra -Ghana

20 | Ghana FELTP - 2019 Annual Report FETP-Intermediate Cohort 1 in Ghana. He challenged trainees to take the 9-month training very serious so as to build their capacity in The five didactic workshops for the FETP-Intermediate outbreak investigation and response to be useful to the Cohort 1 took place from March – October 2019. countries public health system. Trainings took place in the Greater Accra, Northern, Upper East and Upper West Regions. All 15 trainees The workshop was also attended by Ms. Hae Soo Park graduated at the end of the 9-month training. who represented the Country Director for KOICA – The FETP-Intermediate was divided into classroom Ghana. She said KOICA was excited the first Cohort of sessions/workshops and field projects. The classroom the training had commenced and was happy about the workshops prepared the trainees for their field projects importance the GHS had attached to make the training and reinforced the lessons they learnt during their a success. Ms. Park encouraged trainees to take the field assignments. Investigations and projects were training serious in order to build their capacity to help conducted under close supervision by the trainee’s respond to public health emergencies. field supervisor or, in cases of investigations outside of the trainee’s assigned region, by the appropriate authorities. Some of the topics trainees were taken through includes; Surveillance System Operations, Introduction to Descriptive Epidemiology, Ratios, Proportions and Rates, Summary Statistics, Surveillance System Evaluation, Overview of Epidemiological Study Design, Investigating an Outbreak, Role of Laboratory in Outbreak Investigation, Exercise on Role of Laboratory in Outbreak Investigation, Situational and Outbreak Investigation Report, Mentorship and case studies. The workshop was officially opened on March 11, Ms. Hae Soo Park who represented the Country 2019 where Dr. Franklin Asiedu-Bekoe – Head, Disease Director for KOICA – Ghana giving her remarks at Surveillance Department, GHS assured all stakeholders Workshop 1 of the FETP-Intermediate, Cohort 1 of the GHS maximum support for the FETP-Intermediate training held at the Miklin Hotel, Accra -Ghana

Mr. Joseph Asamoah Frimpong – Technical Advisor, Surveillance and Outbreaks – CDC who represented Dr. Chastity Walker – Program Director, Global Health Security, CDC – Ghana, Dr. Samuel Sackey – Field Coordinator/FETP-Intermediate Coordinator, GFELTP, Prof. Col. Edwin Afari (Rtd.) – Coordinator, GFELTP, Dr. Frederick Wurapa – Faculty Advisor, GFELTP, Dr. Donne Kofi Ameme – Senior Epidemiologist/Resident Advisor, GFELTP, facilitators and mentors were all at the ceremony.

Dr. Franklin Asiedu-Bekoe – Head, Disease Surveillance Department, GHS giving his welcome address and remarks at Workshop 1 of the FETP- Intermediate, Cohort 1 training held at the Miklin Hotel, Accra -Ghana

Ghana FELTP - 2019 Annual Report | 21 (L-R): Lenox Goulbourne - Consultant for Monitoring and Evaluation of FETP-Frontline and FETP-Intermediate in Ghana, Dr. Donne Kofi Ameme – Senior Epidemiologist/Resident Advisor, GFELTP, Mr. Joseph Asamoah Frimpong – Technical Advisor, Surveillance and Outbreaks – CDC who represented Dr. Chastity Walker – Program Director, Global Health Security, CDC – Ghana, Dr. Franklin Asiedu-Bekoe – Head, Disease Surveillance Department, GHS, Ms. Hae Soo Park who represented the Country Director for KOICA – Ghana, Dr. Samuel Sackey – Field Coordinator/FETP-Intermediate Coordinator, GFELTP, Prof. Col. Edwin Afari – Coordinator, GFELTP, Dr. Frederick Wurapa – Faculty Advisor, GFELTP, faciltators, mentors, and trainees at Workshop 1 of the FETP-Intermediate, Cohort 1 training held at the Miklin Hotel, Accra -Ghana

The fifteen FETP-Intermediate Cohort 1 trainees at the Workshop 1 at Miklin Hotel, Accra - Ghana

The Graduation ceremony took place at the GFELTP Awards were presented in three categories “Overall 2nd Scientific Conference and Competency Graduation Best Trainee”, “Best Trainee First Runner-up” and held from December 11-12, 2019 at the Noguchi “Best Trainee Second Runner up” were presented to Memorial Institute for Medical Research, University of Mr. George Akowuah, Mr. Simon Aabalekuu and Ms. Ghana – Accra, Ghana. Trainees made oral and poster Sheriffa Alhassan respectively. Mr. Baba Awuni was presentations at the conference. All residents were awarded the “Overall Best Oral Presenter – Advanced presented with certificates of completion. and Intermediate at the conference.

22 | Ghana FELTP - 2019 Annual Report FETP-Frontline in Ghana The workshop was attended by Dr. Emmanuel Tinkorang – Regional Director of Health Services, GHS, Ashanti Cohort XIII Training in Ashanti Region Region who assured the GFELTP, trainees and other The GFELTP organized the FETP-Frontline for Cohort XIII stakeholder present of the regions utmost support to in the Ashanti Region from March 4 – 8, 2019 to May help achieve the objectives of the training. 15-16, 2019. Twenty-seven participants, made of 20 health workers from GHS, 2 from FDA and 5 from the VSD took part in the training. Trainees were selected from the Asante Akim Central, Kumasi Metro, Obuasi Municipal, Ejisu-Juaben Municipal and Ahafo Ano South Districts of the Ashanti Region. Trainees were taken through topics such as; Introduction to public health surveillance, Surveillance cycle, Data collection, Case definitions, Line list, Data quality, Summarizing qualitative and quantitative data, Interpreting surveillance data and Monitoring and evaluation (M&E). Trainees had hands-on sessions on Dr. Emmanuel Tinkorang – Regional Director of Health Services, GHS, Ashanti Region giving his how to summarize and display surveillance data using remarks at the Cohort XIII FETP-Frontline held in the Microsoft Excel. Ashanti Region

(L-R): Dr. Ewudzi Yeboah - Deputy Director Public Health - GHS, Ashanti Region, Dr. Marlon George Mensah – Dep. Regional Veterinary Officer who represented the Regional Veterinary Officer, Dr. Samuel Sackey – Field Coordinator/FETP-Intermediate Coordinator, GFELTP, Dr. Emmanuel Tinkorang – Regional Director of Health Services, GHS, Ashanti Region, Mrs. Anita Owusu-Kuffour who represented the Head, Food and Drugs Authority – Ashanti Region, Mr. Joseph Asamoah Frimpong – Technical Advisor, Surveillance and Outbreaks – CDC who represented Dr. Chastity Walker – Program Director, Global Health Security, CDC – Ghana, Dr. Donne Kofi Ameme – Senior Epidemiologist/Resident Advisor, GFELTP, facilitators, mentors and trainees at Workshop 1 of the Cohort XIII FETP-Frontline held in the Ashanti Region

Ghana FELTP - 2019 Annual Report | 23 Also, in attendance were representatives of the Centres Awards were presented to four trainings whose for Disease Control and Prevention (CDC), Regional performance were outstanding at the training. Mr. Veterinary Officer, Ashanti Region and Head, Food and Agyei Fosu Yaw – Overall Best Trainee, Ms. Francisca Drugs Authority – Ashanti Region. The Deputy Director Senya – Most Improved Trainee, Mr. Godon Sakyi - Best Public Health - GHS, Ashanti Region, District Directors of Trainee First Runner Up and Ms. Ellen Owusu Aboagye Health Services from the participating districts, mentors – Best Trainee were awarded at the graduation and (alumni of the GFELTP) and faculty of the GFELTP. dissemination workshop. All 27 trainees who participated in the training graduated and were awarded certificates.

Graduates of the FETP-Frontline Cohort XIII displaying their certificates at dissemination and graduation workshop of the FETP-Frontline in Kumasi, Ashanti Region

Award winners at the FETP- Frontline Cohort XIII dissemination and graduation workshop; (L-R): Mr. Agyei Fosu Yaw – Overall Best Trainee, Ms. Francisca Senya – Most Improved Trainee, Mr. Godon Sakyi - Best Trainee First Runner Up and Ms. Ellen Owusu Aboagye – Best Trainee Second Runner up, Kumasi, Ashanti Region

24 | Ghana FELTP - 2019 Annual Report Frontline trainings in the University of Health and Allied Sciences, Hohoe The Ghana Field Epidemiology and Laboratory Training Programme (GFELTP) in collaboration with the School of Public Health, University of Health and Allied Sciences (UHAS) organized FETP-Frontline training for the M.Phil in Applied Epidemiology and Disease Control residents of UHAS. Workshops were held from May 6-10, 2019 to July 31-August 1, 2019 in Hohoe, Volta Region. The trainings were held at the School of Public Health, UHAS, Hohoe campus. (R-L): Mr. Gideon Kye-Duodu, a lecturer at UHAS/ The Cohort I of the M.Phil in Applied Epidemiology GFELTP alumnus presenting a certificate of and Disease Control Programme comprised of 17 participation to Ms. Rukaya Laryea at the FETP -Frontline dissemination and graduation workshop trainees made of four Disease Control Officers, two held at the School of Public Health, UHAS – Hohoe Nursing Officers, one Medical Laboratory Scientist, campus one Laboratory Technologist, one Nutrition Officer, one Physician Assistant, one Veterinary Technologist, Cohort XIV Training in Northern Region one Research Assistant and five other residents. Topics The training for the fourteenth Cohort (Cohort XIV) of covered in the training included; Introduction to public the FETP-Frontline took place from June 3 – 7, 2019 to health surveillance, Surveillance cycle, Data collection, August 21 - 22, 2019 in Tamale in the Northern Region. Case definitions, Line list, Data quality, summarizing The Cohort XIV trainees comprised of 31 trainees qualitative and quantitative data, Interpreting made of ten Disease Control Officers, seven Health surveillance data and Monitoring and Evaluation (M&E), Information Officers, two Public Health nurses, five presentation of PowerPoint slides, individual and group Laboratory Scientists, five Veterinary Technical Officers, exercises, case studies, discussions, experience sharing, and two officials from the Food and Drugs Authority. role-plays, hands-on practice and quizzes. Topics covered during the workshop one included; All residents graduated and were awarded certificates Introduction to public health surveillance, Surveillance of completion. The facilitation of the training was led by cycle, Data collection, Case definitions, Line list, Data alumni of the GFELTP and Lecturers of UHAS School of quality, Summarizing qualitative and quantitative data, Public Health with support from Faculty of the GFELTP. Interpreting surveillance data and Monitoring and

Facilitators, mentors, graduates and other stakeholders at the FETP- Frontline dissemination and graduation workshop held at the School of Public Health, UHAS – Hohoe campus

Ghana FELTP - 2019 Annual Report | 25 Evaluation (M&E). Workshop two covered topics such as Outbreak Investigation, Linking with Laboratory, Problem Analysis, Scientific Presentation, Creating PowerPoint presentations. Trainees were taken through hands-on sessions on the use of Microsoft Excel to summarize data and draw epi-curve. The workshops were attended by Dr. John B. Eleeza – Regional Director of Health Services, Northern Region, Dr. John Abenyeri – Deputy Director Public Health, Northern Region, Dr. Samuel Sackey – Field Coordinator, GFELTP, Dr. Martin Kusi – Head, Food and Drugs Authority (FDA), Northern Region, Dr. Evans Nsoh Ayamdooh – Mr. Adam Anas, Health Information Officer for East Mamprusi District making a presentation on Fishbone Regional Veterinary Head, Northern Region, faculty of analysis at workshop two of at the Cohort XIV of the the GFELTP, trainees, mentors and administrative staff FETP-Frontline, Tamale, Northern Region of GFELTP. A total of 27 out of 31 trainees who participated in the training graduated and were awarded certificates of completion.

(Seated from Left to Right): Dr. Martin Kusi – Regional Head, FDA, Northern, Ms. Florence Nzilanye- Mentor, Kpandai District, Brong Ahafo Region, Dr. John Abenyeri – Deputy Director Public Health, Northern Region, Dr. John B. Eleeza – Regional Director of Health Services, Northern Region, Dr. Samuel Sackey – Field Coordinator, GFELTP and Dr. Evans Ayamdooh – Head, VSD, Northern Region, mentors and trainees at the FETP-Frontline held in Tamale, Northern Region.

26 | Ghana FELTP - 2019 Annual Report Cohort XV Training in Brong Ahafo Region Dr. Samuel Sackey – Field Coordinator, GFELTP, Dr. Donne Ameme –Resident Advisor of GFELTP, trainees, The GFELTP organized the FETP-Frontline Cohort XV mentors and administrative staff of GFELTP. in Sunyani, Brong Ahafo Region from September 9-13, 2019. Thirty trainees made of four Disease Control All 27 trainees who participated in the training were Officers, six Health Information Officers, three Public awarded certificate of completion at the GFELTPnd 2 Health Nurses, three Public Health Officers, two Health Scientific Conference held from December 11 –12, Promotion Officers, five Laboratory Scientists, five 2019 in Accra, Greater Accra Region. Special awards Veterinary Technical Officers, and two officials from the were presented in four categories to the outstanding Food and Drugs Authority (FDA) were trained. trainees; Overall Best Trainee, Best Trainee First Topics covered in the training included; Introduction Runner-up, Best Trainee Second Runner-up and Most to public health surveillance, Surveillance cycle, Data Transformed Trainee were awarded to Mr. Achirem collection, Case definitions, Line list, Data quality, Nyarko Dennis, Mr. Osei-Wusu Sadick, Mr. Gideon Osei Summarizing qualitative and quantitative data, and Mr. Baka Paul were presented with the awards Interpreting surveillance data and Monitoring and respectively. evaluation (M&E) relating to public health surveillance. Additionally, Mr. Agyemang Duah and Ms. Serwaa The workshop was attended by Dr. Kofi Issah – Brong Ayiwa received the “Best Oral Presenter and “Best Ahafo Regional Director of Health Services, Dr. John Poster Presentation, FETP-Frontline” respectively at the Ekow Otoo – Brong Ahafo Regional Deputy Director conference. of Public Health, Mr. Savior Denueme –Brong Ahafo Regional Veterinary Officer, Ms. Akua Amponsaa Owusu – Ag. Head of the FDA in Brong Ahafo Region,

(Seated from Left to Right): Dr. Samuel Sackey -Field Coordinator, GFELTP, Ms. Florence Nzilanye Iddrisah – District Director Techiman, Dr. Donne Ameme – Resident Advisor, GFELTP, Dr. John Ekow Otoo – Deputy Director Public Health, BAR, Dr. Kofi Issah – Regional Director of Health Services, BAR, Ms. Akua Amponsaa Owusu – Head of FDA, BAR, Dr. Savior Denueme – Regional Veterinary Officer, BAR, mentors and Trainees at workshop one of the FETP-Frontline Cohort XV – Sunyani, Brong Ahafo Region, September 2019.

Ghana FELTP - 2019 Annual Report | 27 Chemical Preparedness Workshop Following Ghana’s Joint External Evaluation (JEE) results on chemical preparedness, the Norwegian Institute of Public Health is working with Ghana to develop a curriculum for Chemical Preparedness Module. The module will be used in training field epidemiologists in the Ghana Field Epidemiology and Laboratory Training Programme (GFELTP). A workshop on Chemical Preparedness Module was organized from July 22-26, 2019 for Cohort XII residents and other alumni of the GFELTP at the University of Ghana School of Public Health. The objective of the workshop was to build Dr. Mary A.A Grey-Johnson (standing) facilitating capacity for chemical preparedness in response to the Integrated Management of Severe Acute Ghana’s JEE recommendations. Malnutrition workshop at the North Bank West The Chemical Preparedness module would be rolled- Region, The Gambia. out as part of the courses for the programme in the next year.

Residents, facilitators and faculty at the chemical preparedness workshop

Integrated Management of Severe Acute The objectives of the workshop were to educate the Malnutrition Workshop nurses; Dr. Mary A.A Grey-Johnson, a Cohort XII resident • To identify the concepts of Integrated from The Gambia participated in the facilitation ofa Management of Severe Acute Malnutrition workshop on Integrated Management of Severe Acute • To identify the clinical features of Malnutrition Malnutrition from July 9 – 12, 2019 at the North Bank • To carry out anthropometric measurements West Region, The Gambia. A total of twenty-five nurses • In the admission of malnutrition patients into the were trained at the workshop. impatient facility • In the detection and management of complications

28 | Ghana FELTP - 2019 Annual Report Conferences M. Kangbai made a poster presentation on the topic “Maternal Death Surveillance System Evaluation, th 68 Epidemiological Intelligence Sunyani Municipal, Brong Ahafo Region, Ghana, 2019”. Conference International Night, Altanta – Mr. Gabriel B. Kassay and Mr. David K. Kargbo presented United States of America on the topics “Measles Surveillance System Evaluation, Mr. Ernest Akyereko (Cohort IX alumnus) and Mr. in Grand Bassa County, Liberia” and “Measles Outbreak Daniel Agudey (Cohort XI resident), both of the GFELTP Investigation & Response Koinadugu District, Sierra made poster presentations at the 68th Epidemiological Leone June – July, 2018” respectively. Intelligence Conference International Night from April 29 – May 2, 2019 in Atlanta, United States of America. Mr. Akyereko and Mr. Agudey made presentations on The 10th TEPHINET Global Scientific the topics; “Influenza A(H1N1)pdm09 outbreak in a Conference correctional facility, Central Region, Ghana, July-August, Residents and faculty of the GFELTP participated in 2018” and “Foodborne disease of undetermined etiology the 10th TEPHINET Global Scientific Conference held among patrons of a local eatery, Bibiani Township, in Atlanta, USA from October 28 – November 1, 2019. Western Region-2018” respectively. Abstracts of 7 advanced residents and an alumnus of the FETP-Frontline were accepted for presentations at the conference. Six oral and two poster presentations were made at the conference. The GFELTP was accredited by the TEPHINET Global Accreditation Board at this conference.

Mr. Daniel Agudey, a Cohort XI resident of the GFELTP making a presentation at 68th Epidemiological Intelligence Conference International Night in Atlanta, USA

5th International Epidemiological Association, Africa Regional Conference, Residents of the GFELTP at the TEPHINET Conference Maputo - Mozambique Dr. Desmond M. Kangbai from Sierra Leone, Mr. Gabriel B. Kassay - Liberia and Mr. David K. Kargbo – Sierra Leone, all Cohort XII residents of the GFELTP participated in theth 5 International Epidemiological Association, Africa Regional Conference held in Maputo – Mozambique from April 14-17, 2019. Dr. Desmond

Ghana FELTP - 2019 Annual Report | 29 Table 7: List of selected abstracts for the 10th TEPHINET Conference Name Abstract Title Type Programme 1 Mrs. Irene Foodborne outbreak linked to salad consumption in a Oral Advanced Amedzro Senior High School, Sekondi-Takoradi Metropolis, Western Region, Ghana-2019 2 Mr. Razak Mixed outbreak of influenza types A and B in a Basic Oral Advanced Raymond Mahama School, Greater Accra Region, Ghana – 2018 3 Ms. Vida Naana Foodborne gastroenteritis outbreak among patrons of a Oral Advanced Kwofie local eatery, Fijai, Western Region, Ghana-2018 4 Dr. Paul Dsane- Urogenital schistosomiasis outbreak in a Basic School, Oral Advanced Aidoo Ketu North District, Volta Region, Ghana-2018 5 Dr. Esther Dsani Occurrence and antimicrobial susceptibility patterns of Oral Advanced Escherichia coli isolates from raw meat in Ghana-2019 6 Mrs. Elsie Kissi- Investigation of maternal death, Manhyia North Sub Oral Frontline Appiah Metropolis, Ashanti Region, Ghana - 2019 7 Mr. Daron Davies Assessment of the biorisk management of a Public Health Poster Advanced A. Agboyie Reference Laboratory, Northern Region, Ghana-2018 8 Mr. Oxygen Influenza A (H1N1)pdm09 outbreak in a Senior High Poster Advanced Gershion Wullar School, Greater Accra Region, Ghana-2018

Ghana FELTP 2nd Scientific Conference and from the GHS, WHO, KOICA, CDC, AFENET, VSD, FDA and Competency Graduation Ceremony Environmental Health. Oral and poster presentations The Ghana FELTP held its 2nd Scientific Conference and were made by participants at the conference. Competency Graduation Ceremony from December The conference held plenary sessions on the topics 11 – 12, 2019 at the Noguchi Memorial Institute for below; Medical Research, University ofGhana, Accra – Ghana. • “Role of government, private, partners and The theme for the conference was “Building and institutions in building a sustainable workforce in Sustaining Field Epidemiology Workforce through Ghana”, which was facilitated by representatives Ghana FELTP: The Role of Government, Private Sector from “KOICA, CDC, WHO and GHS. and Institutional Partners”. The conference was • “Planning for Retirement: Investment, Good attended by key partners such as the Ghana Health Health and Will”, facilitated by seasoned resource Services (GHS), World Health Organization (WHO), Korea persons from law firms and reputable banks in International Cooperation Agency (KOICA), Centers for the country. Disease Control and Prevention (CDC), African Field • “The Role of FELTP in the Global Initiative of Epidemiology Network (AFENET), Veterinary Services Eradicating Polio”, which was facilitated by Department (VSD), Food and Drugs Authority (FDA) and representatives from the CDC, WHO and Sierra Environmental Health and Sanitation. Leone FELTP. Trainees made both oral and poster presentations at the The conference was attended by about 150 participants conference. All participants were awarded certificates made up of frontline, intermediate and advanced level of participation whereas special awards were presented graduates and alumni of the GFELTP and representatives to those who performed extremely well.

30 | Ghana FELTP - 2019 Annual Report Mr. Agyemang Duah and Ms. Serwaa Ayiwa received the Mr. Baba Awuni was awarded the “Overall Best “Best Oral Presenter” and “Best Poster Presentation”, Oral Presenter – Advanced and Intermediate at the FETP-Frontline” respectively at the conference. conference and Ms. Jessica Asante awarded the “Overall Best Poster Presenter – Advanced and Intermediate at the conference.

(L-R): Dr. Franklin Asiedu-Bekoe – Head, Disease (L-R): Dr. Franklin Asiedu-Bekoe – Head, Disease Surveillance Department, GHS presenting the Surveillance Department, GHS presenting the “Overall Best Oral Presenter Award, FETP-Frontline to Mr. Best Oral Presenter – Advanced and Intermediate Agyemang Duah at the GFELTP Conference Award” to Mr. Baba Awuni at the GFELTP Conference

(L-R): Dr. Franklin Asiedu-Bekoe – Head, Disease (L-R): Dr. Franklin Asiedu-Bekoe – Head, Disease Surveillance Department, GHS presenting the Best Surveillance Department, GHS presenting the Best Poster Presenter Award, FETP-Frontline to Ms. Poster Presenter Award – Intermediate and Advanced Serwaa Ayiwa at the GFELTP Conference to Ms. Jessica Asante at the GFELTP Conference

Ghana FELTP - 2019 Annual Report | 31 Citations were presented to the various stakeholders (Ten Regional Health Directorates of the GHS), FDA and VSD for their outstanding support in the implementation of the frontline, intermediate and advanced trainings in the country. Stakeholders and partners at the conference (R-L): Mr. Martin – District Director of Health Services for Konongo, Ashanti Region receiving a citation form Dr. Franklin Asiedu-Bekoe – Head, Disease Surveillance Department, GHS on behalf of the Ashanti Regional Health Directorate at the GFELTP Conference

Competency certificates were also awarded to the advanced residents for successfully completing the two year programme.

(L-R): Dr. Gifty Boateng – GFELTP alumnus presenting competency certificate to Ms. Vida Kwofie (Cohort XI Resident) at the Conference

32 | Ghana FELTP - 2019 Annual Report OUTBREAK INVESTIGATIONS Schistosomiasis Outbreak, Charikpong Sub-district, Nadowli-Kaleo District, Upper West Region, Ghana, 2019 Three alumni, 7 residents and 2 trainees (FETP- Intermediate) of the GFELTP supported with the investigation of the Schistosomiasis outbreak in the Charikpong Sub-district, Nadowli-Kaleo District in the Upper West Region from April 5-12, 2019. The outbreak was established in five communities of Charikpong Mr. Daron Davies A. Agboyie (in orange), a resident of Sub-district, Nadowli-Kaleo District, Upper West the GFELTP dispensing Praziquantel for the treatment Region. A total of 245 urine samples were collected of Schistosomiasis, at Charikpong sub-district, of which 79 (32.2%) tested positive for Schistosoma Nadowli-Kaleo District, Upper West Region, Ghana haematobium. The likely source of the outbreak is the Gabili dam where school going children and adults use Suspected Food Borne Illness Outbreak in for swimming, fishing, mining and other domestic/ Boamang-Kyerekrom D/A Primary School, recreational activities. Afigya Kwabre North District, Ashanti The investigation team made the following region. recommendations and took the following public health On June 6, 2019, the Afigya Kwabre North District actions. Health Administration received report of a suspected foodborne illness involving pupils of the Boamang Regional and District Health Directorate; Kyerekrom D/A Primary School. An online news portal • The health directorate in conjunction with the ghanaweb.com carried news on the situation with the health facilities intensifying active surveillance of caption “School feeding: 70 pupils hospitalized over schistosomiasis suspected food poisoning at Boamang. Seventy pupils • Conducted mass drug administration in the from the school were said to have been hospitalized with affected schools and communities complaints of abdominal pain, vomiting and diarrhoea after eating meals served by a caterer of the school Public Health Action Taken feeding programme. Five residents of the GFELTP and The team conducted health education at Mwindaali one FETP-Frontline graduate joined the Afigya Kwabre and Tanduori schools and the affected communities North District Health Directorate outbreak investigation and mass drug administration in the affected schools team to investigate the outbreak from June 11 – 14, and communities. 2019 with the following objectives;

• To determine the magnitude of the reported outbreak • To identify the source of the outbreak • To determine the risk factors of the outbreak • To implement control and preventive measures

Ghana FELTP - 2019 Annual Report | 33 Of the total student population of 312 currently in contact with her and the dog that bit the deceased. One school, 96 were affected resulting in an attack rate person was category III exposed; he was bitten by the of 30.8%. There was no fatality. The ages of affected suspected rabid dog that also bit the index case. It bit students ranged from 5 to 15 years, with age 10 being his left middle finger when he was killing the dog. He the most affected 26/96 (27.1%) and age 15, the least did not seek treatment at any health facility but instead affected. The mean age was 7.4 (±1.19) years. Females dipped the wound in local ethanol (Apketeshi). The were the most affected 50/96 (52.1%). Ninety-two dog was not vaccinated against rabies prior to biting its (95.8%) of the 96 ill pupils ate kenkey from food vendors. victims.

The investigation team took the following public health actions: Human Rabies Outbreak in Kojo-Oku, • The district assembly procured some anti-rabies Gomoa East District, Central Region, 2019 vaccines which were used to vaccinate both Five residents of the GFELTP and the Ghana College of category II and III human contacts. Physicians and Surgeons supported the District Health • Health education on rabies was conducted in Kojo- Management Team (DHMT) to investigate Human Oku community through a community durbar in Rabies Outbreak in Kojo-Oku, Gomoa East District in the churches, mosques and at victim’s home. Central Region from June 16-24, 2019. • Education of health workers on animal bite management protocol and also to involve the The investigation team were informed by the DHMT veterinarians to investigate all dog bite cases on arrival that one and half month ago, a fifty-two (52) year old woman, resident of Kojo-Oku was bitten by her own dog for which she reported at Kojo-Oku. She received two doses of anti-rabies vaccination one week apart. She was apparently well until the June 24, 2019 when she presented to Central Kasoa Clinic annex with complaints of fever, pain at the site of bite (leg) and was treated for malaria and discharged home. There was no improvement and she reported to the same clinic on the same day for which she was referred to the Kasoa Government Polyclinic. At the Kasoa Government Polyclinic she presented with hyperactivity, hyperventilation and hydrophobia. A diagnosis of suspected rabies was made and she was immediately The GFELTP team meeting with the DHMT for referred to Korle-bu Teaching Hospital, Accra. She died debriefing and planning during the outbreak on admission. The district team was able to locate the investigation house of victim and noticed they were two other dogs in house.

During the investigation, the team found that twenty- five (25) individuals came in contact with either the index case or the suspected rabid dog. The median age of those exposed was 27 years (Q1 = 20, Q3 = 32). Five persons who were relatives to the index case came into

34 | Ghana FELTP - 2019 Annual Report but no information was obtained about disposal of its carcass.

Record review and contact tracing at the Central Kasoa Clinic annex where the deceased first presented

Confirmed Human and Dog Rabies, Awutu The investigation team preparing the carcass of rabid Senya East Municipal-Ghana, 2019 dog from Community B for testing Three residents of the GFELTP supported the Awutu Senya East Municipal to investigate the outbreak of confirmed human and dog rabies at the Awutu Senya First case of human rabies from ‘Ghana Flag’ Community East Municipal, Ghana from June 28 – July 2, 2019. in the Awutu Senya East Municipal Details of the report below; The index case was bitten in the face on May 6, 2019. She was managed in a local private clinic as a case of dog Case of dog rabies presentation in ’94 Community in bite with oral antibiotics. No post-exposure prophylaxis the Awutu Senya East Municipal was given. The child had been well until June 14, 2019 On June 25, 2019, the Kasoa Polyclinic, the major when she had fever, headache, and general weakness. Municipal Health facility, was alerted about a cluster of The child struggled to swallow any liquid food. She was dog bites from another community in Kasoa called ‘94. managed at home until June 16, 2019 when she started Five children had been bitten in 24 hours by a dog in demonstrating hyperventilation, hyper-salivation and the community which was otherwise friendly. The dog, hydrophobia at home. She was taken to another private had suddenly become aggressive, attacking humans clinic where the diagnosis of suspected human rabies and other domestic animals. Out of the 5 children with was made and then referred to the Korle-Bu Teaching category 3 exposure to the dog, only 2 presented to the Hospital, Ghana. The case presented at 11:55am and health facility. died at 7:10pm on June 16, 2019.

The dog was eventually killed and the investigation secured the carcass for testing at the National Veterinary Laboratory and line listed all the contacts. The dog had been fighting with some neighbouring dogs; it also attacked and bit a pregnant goat. It also was saidto have chased another goat in the house, but it is unclear the category of exposure. Another puppy in the house was reported to have died suddenly on June 20, 2019,

Ghana FELTP - 2019 Annual Report | 35 Public Health Actions and Control Intervention

A. Meeting with Public Health Emergency Management Committee The committee meeting was convened and chaired by the Municipal Chief Executive. Among discussions for interventions on the outbreak were: • Procurement of post exposure vaccines for the exposed individuals • Mass vaccination of dogs in the municipal ata subsidized fee or for free • Possible destruction of stray dogs after the grace period of the vaccination exercise The investigation team meeting with the family of deceased rabid child • Supporting community education through community information systems Second case of human rabies presentation from Gomoa East District On June 24, 2019, a 52 year old woman who lived in an adjoining district presented to the Kasoa Polyclinic with the following symptoms: fever, hyperactivity, hyper- salivation, hyperventilation of 2 days duration. Patient was said to have been bitten 2 months ago by her own dog on the right leg. She had 2 shots of unknown injections from a Pharmacy shop in her neighborhood. She was well until the above symptoms started. She was also referred to the Korle-Bu Teaching Hospital where she died on June 28, 2019. The case was referred to the Gomoa East Municipal Health Directorate for Public Health Emergency Committee meeting at investigation. Awutu Senya East Municipal

Human contacts to rabid dogs and rabid human in the Awutu Senya East Municipal B. Meeting Community Elders The contacts had a median age of 12 years (IQR, 0.8- The team paid a courtesy call to the elders of the palace 84). The modal age group was 5-14 years followed by of the community where the team identified the rabid. children under 5 years constituting 24.05% (19/79). The meeting identified major areas of the community Females constitute up to 53.57% (45/84) of all the where health education should be prioritized. The contacts traced. Contacts were identified in 4 main elders also provided support for the contact tracing of communities within the municipal. Majority of pets in the community. contacts, 83.33% (70/84) were from the community called 94, followed by Ghana flag with 13.10% (11/84). Up to 95.24% (80/84) were exposed to a rabid dog, as opposed to 4.76% (4/84) who were exposed to a rabid human.

36 | Ghana FELTP - 2019 Annual Report The investigation team meeting with elders at the palace of the Community B

C. Community Durbars The investigation team engaged the communities of the Radio education shows were also arranged for municipal at several community durbars. The Parent- community sensitization on rabies prevention and Teachers’ Association of the school of the deceased child management of dog bites. These fora were used to was also visited and educated to look out for any dog encourage all dog bite cases in the town to report bites among their children to report. The investigation promptly to the government health facility for team also performed educational outreaches in 3 major assessment and management. The team also educated mosques in the community where the rabid dog was the community on responsible petting in the town. identified.

Community Durbar at the Kasoa central market on rabies education

Ghana FELTP - 2019 Annual Report | 37 Dr. Paul Dsane-Aidoo, a Cohort XI resident of the Residents of the GFELTP in an interview with food GFELTP on a local radio station educating the vendors in their homes during the investigation community on rabies

D. Clinical Trainings for Municipal Health Staff Clinical and public health staff within the rabies surveillance system were sensitized about the occurrences in the municipality and educated on the animal bite management protocols. The outbreak team disseminated printed copies of the management protocols as well as case definition of rabies.

Environmental scanning of okro farm by residents during the foodborne outbreak investigation

Gbentanaa Sub-District, Adentan Municipal, Greater Accra Region from August 8 - 14, 2019. The case was a 12-year-old female primary six (6) pupil attending the Victory Presbyterian Church. According to the Disease Control Unit, Ayawaso sub-metro in the Accra Metropolis, they were notified on August 6, 2019 Clinical training on case management of clinicians in by the Disease Control Unit of 37 Military Hospital of a the Awutu Senya East Municipal suspected case of Yellow Fever, who had died on July 30, 2019. Outbreak of Yellow Fever in Gbentanaa A total of 106 individuals who had direct or indirect Sub-District, Adentan Municipal, Greater contact with the case patient had been recorded with Accra Region no death or signs and symptoms suggestive of yellow Six residents of the GFELTP in Cohort XI participated in fever. The median age of contacts was 28.5 years (IQR= the Yellow Fever Outbreak Investigation in the 8 to 35). Majority of the contacts [45.2% (48/106)] were

38 | Ghana FELTP - 2019 Annual Report aged 30 years and above. Females constituted 64.1% participated in investigating Circulating Vaccine (68/106) of the contacts. About 34.9% (37/106) of the Derived Polio Virus (cVDPV) Environmental Outbreak in contact were caregivers (Nurses and Doctors), 33.9% Agbogbloshie, Accra Metro, Greater Accra Region from (35/106) were other patients that were admitted in August 27 - 30, 2019. the same ward with the case patient at the 37 Military There was the confirmation of a polio case due to cVDPV Hospital, Greater Accra Region. 2 in Chereponi, Northern Region with paralysis starting 23 July, 2019. The isolation of cVDPV in Agbogbloshie puts an estimated 247454 number of children under 5 years who are living in adjoining Submetros along the Agbogbloshie drain at risk of Polio. There is likelihood of continuation of the transmission, because of the following factors: • Very low immunisation coverage, less than 60% for OPV in the past 2 years and less than 71% since 2015. Vaccination coverage survey showed less than half (49%) of the children were fully immunized for age • Poor sanitation in the Agbogbloshie area The investigation team meeting with staff of the 37 • Highly mobile population; frequent travels to Military Hospital during the Yellow Fever Outbreak Investigation other parts of the country • Children under 5 years who spend more than 3 days in a week with their guardians in the market. They contribute of open defecation and particularly susceptible due to poor sanitation • Densely populated areas with most people living temporal structures which lack well organised sanitary facilities There is the further likelihood of missing undetected transmission due to the following factors; • Difficulty in accessing some parts of the communities • Health staff working at health facility level having Dr. Desmond Maada Kangbai, a Cohort XII resident inadequate knowledge on AFP surveillance and from Sierra Leone conducting environmental response Assessment in Adentan during the Yellow Fever • Inadequate Preparedness and Response Outbreak Investigation Structures at the Regional level Actions undertaken; Outbreak of Circulating Vaccine Derived In order to prevent occurrence of future outbreaks, a Polio Virus (cVDPV) Environmental polio vaccination campaign was launched. Rounds Zero Outbreak in Agbogbloshie, Accra Metro, and One of the polio vaccination campaign have been Greater Accra Region completed. Four residents of the GFELTP in Cohorts XI and XI

Ghana FELTP - 2019 Annual Report | 39 PUBLICATIONS A total of 4 manuscripts have been published in international journals. The journals include BMC journals series, CDC WMMR and many more

Table 8: List of publications Title Authors Date of publication Journal 1 Evaluation of the sentinel surveillance Nuvey FS, Edu-Quansah February 2019 PLoS One system for influenza-like illnesses EP, Kuma GK, Eleeza J, in the Greater Accra region, Ghana, Kenu E, Sackey S, et al. 2018 (2019) 2 Determinants of low birth weight in Adam et al. May 2019 BMC PCB neonates born in three hospitals in Brong Ahafo region, Ghana, 2016- an unmatched case-control study 3 Outbreak of scabies among preschool Kaburi et al. June 2019 BMC Public Health children, Accra, Ghana, 2017 4 Obstetric determinants of preterm Aseidu et al. July 2019 BMC PCB deliveryin a regional hospital, Accra, Ghana 2016

40 | Ghana FELTP - 2019 Annual Report

Ghana Field Epidemiology and Laboratory Training Programme School of Public Health College of Health Sciences University of Ghana

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