MINISTRY OF HEALTH

• 403 staff in 60 Districts trained on Rapid Response

• All regions achieve the annualized Non- Polio AFP rate of 2.0 per 100,000 population VOLUME 4 less than 15 years WEEK

24 16th June, 2019

The Weekly Epidemiological Report is a publication of the Ghana Health Service and the Ministry of Health, Ghana © Ghana Health Service 2019 ISSN - 2579-0439

i Ghana Weekly Epidemiological Report Vol. 4 Week 24 16 June 2019

Acknowledgement

This publication has been made possible with technical and financial support from the Bloomberg Data for Health Initiative (www.bloomberg.org), the CDC Foundation and the World Health Organisation.

ii Ghana Weekly Epidemiological Report Vol. 4 Week 24 16 June 2019 Rapid Response Team Training in Selected Districts in Ghana

Rapid Response Team Training in Selected Districts in Ghana

Introduction Globalization, population growth and migration have increased the challenges that are faced by health services in the event of any public health crises. Public health emergencies and threats have no borders, and this highlights the need to enforce health security at the global, national, regional and sub-regional levels. As part of a continuous effort to build capacity for epidemic preparedness and response, Ghana Health Service (GHS) with support from the Center for Disease Control and Prevention (CDC), and the World Health Organization (WHO), conducted RRT trainings in early 2017 across the northern and southern sectors of Ghana for all regions. Training has also been completed at the district level for 60 selected districts from all regions. The training programs are to support the long-term workforce development requirements for establishing and maintaining rapid response teams at national and sub-national levels. The trainings follow an initial 4-Day Training of Trainers (T.O.T.) involving 40 participants comprising Epidemiologists/Surveillance Officers, Clinicians, Laboratory Scientists and Health Promotion Officers from all the ten (10) regions of country in January 2019. The objective was to train health emergency workforce at the district levels (including facilities) involved in outbreak investigation and deployment to be able to act immediately and adequately respond to any public health emergency in Ghana and support the West Africa Region. Additionally, a data repository for multisectoral rapid response team members, which will be periodically updated to serve as the core technical pool of individuals to be reached during health emergencies, was to be developed.

Methods Health Promotion Officer, Epidemiologist, Biomedical A total of 60 districts were selected from all regions (6 Scientist, and Environmental Health Officer. In selected districts each per region) [Figure 1]. Selection was done regions, (6 regions), DDHSs were part of the trainees. A in consultation with the regional directorate and were total of 403 staff from the selected districts were trained based on a combination of the following criteria, viz: [Table 1]. The trainings covered a duration of five days Epidemic-prone district; Border districts; Districts that in each region. The WHO rapid response-training had poorly managed (a) previous outbreak(s); Districts package was adapted for the trainings. The methods that had not been trained in outbreak response; High employed included lectures, case study, demonstrations mobility districts (e.g. districts with big markets); and table top simulation. Pre-test and post-test Districts with poor surveillance indicators; Districts with assessments were conducted at the beginning and closure well-motivated workforce. Each District team trained respectively for all the trainings. All content used in all comprised primarily of 6 members. Participants from regional trainings was adapted from the WHO rapid each district comprised a Clinician, Veterinary Officer, response team training package. The content encouraged participant participation in all sessions

Table 1: Summary of Participants Trained by Region Region Sex Grand Total Female Male

Ashanti 9 27 36

Brong Ahafo 5 35 40

Eastern 9 33 42

Greater Accra 18 28 46

Northern 2 41 43

Upper East 10 30 40

Upper West 3 35 38

Volta 10 31 41

Western Region 5 31 36

Central 11 30 41

Grand Total 82 321 403 Figure 1: Selected Districts for RRT Training

Ghana Weekly Epidemiological Report Vol. 4 Week 24 16 June 2019 1

Rapid Response Team Training in Selected Districts in Ghana

Conclusion Next Steps All trainings to improve emergency workforce at the • Development of a national database of all trained regional/ district levels (including facilities) in the 10 RRT members from all districts regions have been successfully completed. Participants • Coordination and organization of regular simulation have been equipped with the knowledge and skill to be exercise to maintain and sharpen skills and monitor and adequately respond to public health knowledge gained during training emergencies. A pool of trained experts has been created to • Preparation and submission of rapid response plas by support public health emergency activities in Ghana and districts to the regional surveillance officers also the West African Sub Region.

Ghana Weekly Epidemiological Report Vol. 4 Week 24 16 June 2019 2

Summary of Weekly Epidemiological Data, Week 24, 2019

Summary of Weekly Epidemiological Data for Week 24, 2019

Highlights: • All regions achieve the annualized Non-Polio AFP rate of 2.0 per 100,000 population less than 15 years

1% 1% SUMMARY OF PRIORITY Adverse events following

DISEASES AND EVENTS - 1% 2… immunization

WEEK 24, 2019 4% Meningitis

The total all-cause notifiable disease 5% morbidity for the week (as per IDSR AFP (suspected polio) Weekly Summary Reporting Form) was 2,412 with four maternal deaths. Diarrhoea with blood Acute watery diarrhoea in persons aged 5 years and above was the Yellow fever (suspected) 28% highest proportion of cases reported, 58% contributing to approximately 73% of Measles the notifiable diseases’ caseload during Week 24 [See Figure 1 and Influenza-like illness Annex 1] Acute watery diarrhoea in persons aged ≥5 years

Figure 1: Reported notifiable disease conditions, Ghana, Week 24, 2019

REGIONAL PERFORMANCE BASED ON REPORTING The best performing region in Week 24 was Upper West Timeliness and Completeness of reporting for all region with a mean score of 99.6% whilst Central region notifiable conditions for the Week were 96.5% and 99.0% had the lowest mean score of 77.3% [Table 1]. All regions respectively. All regions but Central scored above 90% achieved the expected targets (36.9%) for percentage of for both indicators [Table 1]. districts reporting at least a suspected case of Measles or . Yellow Fever.

Table 1: Ranking of Regional Performance based on selected Surveillance reporting indicators, Ghana, Week 24, 2019 Region Timeli- Complete- Measles YF Average ness (%) ness (%) Cum. Annualized AFP % % Score % Position Week Week AFP Non-Polio Score District District 24 24 Cases AFP Rate (%) reporting reporting (A+B+C+ A B Week 24 C D E D+E)/5 Upper West 98.6 99.4 28 16.8 100 100.0 100.0 99.6 1st Western 98.8 98.8 33 4.9 100 100.0 95.5 98.6 2nd Brong-Ahafo 99.3 99.9 36 6.2 100 100.0 88.9 97.6 3rd Greater Accra 89.3 100 41 3.4 100 100.0 93.8 96.6 4th Eastern 99.5 100 22 3.1 100 100.0 80.8 96.1 5th Ashanti 98.2 98.9 40 2.9 100 93.3 86.7 95.4 6th Volta 99.8 100 25 4.6 100 96.0 80.0 95.2 7th Northern 98.8 100 45 6.3 100 88.5 84.6 94.4 8th Upper East 99.7 100 18 7.6 77.0 92.3 76.9 93.8 9th Central 93.4 93.1 21 3.7 100 55.0 45.0 77.3 10th Ghana 96.5 99.0 309 4.6 100 92.6 82.9 94.2

Ghana Weekly Epidemiological Report Vol. 4 Week 24 16 June 2019 4

Summary of Weekly Epidemiological Data, Week 24, 2019

INFLUENZA-LIKE ILLNESS (IDSR Weekly Report) MEASLES A total of 516 cases with no deaths were reported through During the Week, 46 suspected cases of Measles were IDSR weekly reporting [Table 2]. Laboratory samples recorded across the country [Table 4]. Samples were were sent from sentinel sites to Noguchi Memorial Institute taken and sent to the National Public Health and Reference for Medical Research (NMIMR) with results awaited. Laboratory [NPHRL] for testing.

Table 2: Reported Influenza-Like Illness cases by Region Table 4: Suspected Measles cases by Region and District,

and District, Ghana, Week 24, 2019 Ghana, Week 24, 2019

Region Districts Cases Deaths Region Districts Cases Deaths

Ashanti Adansi South 13 0 Ashanti Asante –Akim South 1 0 Asante Akim South 13 0 Kumasi 1 0 Bosomtwe 1 0 Brong- Ejisu Juaben 62 0 Ahafo Asutifi South 1 0 Brong-Ahafo Sunyani 7 0 Jaman North 2 0 Eastern New Juaben 110 0 Jaman South 1 0 Greater Accra Accra 33 0 Techiman South 4 0 Adentan 8 0 Eastern Akwapim North 1 0 Ga Central 20 0 Akyemansa 1 0 Ga East 30 0 Asuogyaman 1 0 Ga West 44 0 Birim South 1 0 La-Dade-Kotopon 26 0 East Akim 1 0 1 0 Lower Manya Krobo 1 0 Shai Osudoku 85 0 Yilo-Krobo 2 0 Tema 46 0 Greater- Upper East Bolgatanga 5 0 Accra Accra 1 0 Volta Ketu South 7 0 Ga East 1 0 Western Sekondi Takoradi 5 0 Ga South 4 0 Total 516 0 Kpone Katamanso 2 0 La-Nkwantanang Madina 1 0 Upper YELLOW FEVER West Nadowli-Kaleo 1 0 Twenty-six suspected cases of Yellow Fever were reported Sissala East 1 0 across the country [Table 3]. Samples were sent to the National Upper Public Health and Reference Laboratory for testing. East Binduri 1 0 Volta 1 0

Ho 5 0 Table 3: Suspected Yellow Fever cases by Region, Ghana, Kadjebi 1 0 Week 24, 2019 Ketu South 2 0 Region District Cases Deaths Western Ahanta West 3 0 Ashanti Amansie West 1 0 Sekondi Takoradi 2 0 Brong-Ahafo Asutifi South 3 0 Wassa Amenfi East 1 0 Wassa Amenfi West 1 0 Nkoranza South 2 0 Pru 1 0 Total 46 0 Eastern Nsawam Adoagyiri 1 0 Yilo Krobo 1 0

Northern Bole 1 0 Mion 1 0 HUMAN RABIES Saboba 1 0 Upper West Lawra 1 0 No case of Human Rabies was recorded in Week 24

Wa West 1 0 Volta Adaklu-Anyigbe 3 0 Central Tongu 2 0 Ho 2 0 MATERNAL DEATHS South Dayi 1 0 During Week 24, four maternal deaths were Western Ahanta West 1 0 recorded across the country [Table 5]. Prestea Huni-Valley 1 0 Wassa Amenfi East 1 0 Table 5: Maternal deaths by Region and District, Wassa Amenfi West 1 0 Total 26 0 Ghana, Week 24, 2019 Region Districts Deaths

Eastern East Akim 1 CHOLERA New Juaben 1 No cholera case was reported during the Week. Greater-Accra Kpone-Katamanso 1 Ga West 1 NEONATAL TETANUS Total 4 No case of Neonatal Tetanus was recorded during the week

Ghana Weekly Epidemiological Report Vol. 4 Week 24 16 June 2019 5

Summary of Weekly Epidemiological Data, Week 24, 2019

MENINGITIS A total of 12 cases of meningitis were recorded with no death during week 24. Nandom district crossed the alert threshold recording 4 cases and an attack rate of 7.5 cases per 100,000 population. Lumbar Punctures were done for all 12 cases with none confirmed positive for meningitis [Table 6].

Table 6: Meningitis cases and deaths by Region, Ghana, Week 24, 2019 Cerebrospinal Cerebrospinal CFR District District in Region Cases Fluid (CSF) Lab Deaths Fluid (CSF) (%) in Alert Epidemic Test Positive Ashanti 0 0 0 0 - 0 0 Brong-Ahafo 0 0 0 0 - 0 0 Central 0 0 0 0 - 0 0 Eastern 4 4 0 0 - 0 0

Greater Accra 0 0 0 0 - 0 0

Northern 0 0 0 0 - 0 0 Upper East 2 2 0 0 0 0 0 Upper West† 4 4 0 0 0 0 0 Volta 1 1 0 0 0 0 0 Western 1 1 0 0 0 0 0

Total (Ghana) 12 12 0 0 0 0 0

† Attack Rate per 100,000 population [District; Nandom; 4 cases (AR= 7.5)]

ACUTE FLACCID PARALYSIS (SUSPECTED POLIOMYELITIS)

Thirteen cases of Acute Flaccid Paralysis (AFP) were reported in Week 24 Summary on Acute Flaccid Paralysis [Table 7]. The stool specimens tested at the Polio Laboratory at NMIMR (AFP) Indicators, Week 1 – 24, 2019 were negative for wild poliovirus. A total of 309 AFP cases have been

recorded from all regions at week 24 with Table 7: Suspected Polio cases by Region and District, Ghana, Week 24, an annualized Non-Polio AFP rate of 4.6 2019 for the country. All regions achieved the Region Districts Cases Deaths annualized Non-Polio AFP rate of 2.0 per Ashanti Kwabre 1 0 100,000 population less than 15 years as Brong-Ahafo Asutifi North 1 0 at the end of Week 24 [Table 8]. Greater Eastern Birim South 1 0 Greater Accra Accra 1 0 Accra (73.2%) remains the only region

Ga Central 1 0 that failed to achieve the expected target La-Dade-Kotopon 1 0 stool adequacy of > 80%. Northern Central Gonja 1 0 Nanumba North 1 0 Zabzugu 1 0 Upper East Kassena Nankana 1 0

Upper West Daffiama-Bussie-Issa 1 0 Sissala East 1 0

Volta South Dayi 1 0 Total 13 0

Table 8: Summary on Acute Flaccid Paralysis Surveillance, Ghana, Week 1 – 24, 2019

Expected Population Non- Annualized Reported % Timely % Adequate Region Under 15 Polio Compatible Discarded Non-Polio AFP Stools Stools years AFP for AFP Rate the year Ashanti 2,559,248 52 40 1 34 2.9 90.0 85.0 Brong-Ahafo 1,199,191 24 36 0 34 6.2 86.1 86.1 Central 1,216,036 25 21 0 21 3.7 100.0 100.0

Eastern 1,345,144 27 22 0 19 3.1 95.5 90.9

Greater Accra 2,148,065 43 41 0 34 3.4 73.2 73.2 Northern 1,348,239 27 45 0 39 6.3 91.1 91.1 Upper East 498,068 10 18 0 18 7.6 100.0 100.0 Upper West 353,090 7 28 0 28 16.8 100.0 100.0 Volta 1,116,490 23 25 0 24 4.6 92.0 92.0

Western 1,204,310 24 33 0 27 4.9 81.8 81.8

Ghana 12,987,880 260 309 1 278 4.6 89.3 88.3

Ghana Weekly Epidemiological Report Vol. 3 Week 24 16 June 2019. 6

Summary of Weekly Epidemiological Data, Week 24, 2019

ANNEX 1: SUMMARY OF REPORTED CASES/ EVENTS: WEEK 24 (WEEK ENDING 16 JUNE 2019)

Disease/Health Event Week 23 Week 24 Cumulative to Week 24 (suspected/confirmed) Cases Deaths CFR Cases Deaths CFR Cases Deaths CFR (susp) (%) (susp) (%) (susp) (%) AFP (suspected polio) 16 0 0 13 0 0 309 0 0 Acute haemorrhagic 0 0 - 0 0 - 0 0 - fever syndrome Adverse events 12 0 0 12 0 0 140 0 0 following immunization Anthrax 0 0 - 0 0 - 0 0 - Acute watery diarrhoea 610 0 0 1,755 0 0 23,234 0 0 in persons aged ≥5 years

Cholera 0 0 - 0 0 - 0 0 -

Dengue fever 0 0 - 0 0 - 0 0 - Diarrhoea with blood 26 0 0 32 0 0 988 0 0 Dracunculiasis (Guinea 0 0 - 0 0 - 0 0 - worm) Influenza-like illness 263 0 0 516 0 0 10,701 0 0 Maternal deaths - 3 - - 4 - - 56 - Measles 35 0 0 46 0 0 1,224 0 0

Meningitis 9 0 0 12 0 0 690 21 3.0

Neonatal tetanus 0 0 - 0 0 - 7 2 28.6 Plague 0 0 - 0 0 - 0 0 - Public health event of 0 0 - 0 0 - 0 0 - international concern (PHEIC) Human rabies 0 0 - 0 0 - 2 2 100 SARS 0 0 - 0 0 - 0 0 - Smallpox 0 0 - 0 0 - 0 0 - Yellow fever (suspected) 23 0 0 26 0 0 2,510 0 0 NATIONAL TOTAL 994 3 0 2,412 4 0 39,805 81 0.1 *CFR does not include maternal deaths

This report and subsequent ones should be shared with regional and district heads as well as heads of other agencies. A feedback addressed to the Editor-In-Chief is welcome

Ghana Weekly Epidemiological Report Vol. 4 Week 24 16 June 2019 7

District Cases Deaths Nandom 91 5 Jirapa 79 5 Nadowli-Kaleo 64 4 Bole 46 3 Lawra 46 5 New Juaben 44 1 Lambussie 43 5 Jaman North 39 5 Bongo 31 3 Wa 24 0 West Gonja 23 7 Bolgatanga 22 1 Talensi 19 1 Dafiama-Bussie-Issa 19 1 Nkoranza South 16 0 Builsa North 14 1 Wa West 14 1 Sawla-Tuna-Kalba 12 2 Builsa South 11 0

Summary of Weekly Epidemiological Data, Week 24, 2019

Editorial Board Editorial Team

Dr. Anthony Nsiah-Asare Editor Dr. Badu Sarkodie Mr. Gideon Kwarteng Acheampong Dr. Michael Adjabeng Dr. Emmanuel Kofi Dzotsi Managing Editor Dr. Kwame Amponsa-Achiano Mr. Kwame Acheampong Owusu Dr. David Opare Dr. Franklin Asiedu-Bekoe Editor-In-Chief Mr. Kwame Kodom Achempem Dr. Kenneth Ofosu-Barko Mr. James Addo Mr. Isaac Baffoe-Nyarko Prof. Kwadwo Koram Dr. Ivy Frances Osei

Dr. Ernest Kenu Dr. Phyllis Antwi Ms. Selina Ababio Dr. Dennis Laryea Dr. Sally-Ann Ohene Dr. Chastity Walker

Ghana Weekly Epidemiological Report Vol. 4 Week 24 16 June 2019 8