Outbreak of Cholera, Greater Accra Region, Ghana, 2014

Abstract

Aims: In 2014, a cholera outbreak occurred in Greater Accra region, affecting more than 1733 people, and 20 individuals died. We investigated to verify the diagnosis, identify risk factors and recommended control measures. Study Design: The study was both descriptive and un-matched community-based 1:2 case control study. Place and duration of study: The investigations were done between 24th July and 3rd August 2014 in the Greater Accra region of Ghana. Methods: We conducted a descriptive investigation, active case-search and conducted risk factor assessment of the cases and environmental assessment of the communities. Standardized questionnaire was used to collect demographic, clinical and exposure history from the cases and controls and described the outbreak by place, age and sex. Rectal swabs from patients admitted in the Cholera Treatment Centres at health facilities were collected and tested by culture and antimicrobial sensitivity. Bivariate analysis was used to compare cases and controls and calculated odds ratio and 95% confidence interval. Results: We found 1733 cases with 20 deaths (CFR=1.2%) with an overall attack rate of approximately 25 per 100,000 population with sex specific attack rates of 31.2% and 19.6% for males and females respectively. The most affected districts were Osu Klottey Sub-Metropolis of the Accra Metropolis with an attack rate of 111 per 100,000 and La Dadekotopon with an attack rate of 76 per 100,000. Ninety stool samples yielded V. cholera O1 Ogawa with Ciprofloxacin and Tetracycline being sensitive to the cholera strains. Epidemiologic data suggested that the outbreak was due to drinking of vended sachet water [odds ratio = 6; 95 confidence interval: 1.7-20.9, p-value: 0.00]. Conclusion: The lack of personal hygiene, safe drinking water, open defecation, poor sanitation and consumption of street vended sachet water and food were some of the causes of the recent cholera outbreak in Greater Accra. We recommend the Ministries of Local Government and Rural Development, Works and Housing and Water Resources to ensure proper liquid and solid waste disposal systems and provide adequate potable water to the populace.