Gastroenteritis Outbreak in a Senior High School, Akwapim North District, Eastern Region-Ghana, 2012
Joseph K. L. Opare *
Ghana Field Epidemiology and Laboratory Training Programme, School of Public Health, University of Ghana, P. O. Box LG13, Legon, Ghana and District Health Directorate, Box 107, Akwapim North Mampong, Ghana.
Edwin Afari
Ghana Field Epidemiology and Laboratory Training Programme, School of Public Health, University of Ghana, P. O. Box LG13, Legon, Ghana.
Fred Wurapa
District Health Directorate, Box 107, Akwapim North Mampong, Ghana.
Chima Ohuabunwo
Morehouse School of Medicine, 720 West View Drive Atlanta, GA 30310, USA.
Samuel Sackey
Ghana Field Epidemiology and Laboratory Training Programme, School of Public Health, University of Ghana, P. O. Box LG13, Legon, Ghana.
George Kye-Duodu
Ghana Field Epidemiology and Laboratory Training Programme, School of Public Health, University of Ghana, P. O. Box LG13, Legon, Ghana.
Donne Ameme
Ghana Field Epidemiology and Laboratory Training Programme, School of Public Health, University of Ghana, P. O. Box LG13, Legon, Ghana.
Joseph Abankwa
District Health Directorate, Box 107, Akwapim North Mampong, Ghana.
Dorcas Kyeiwa Asante
District Health Directorate, Box 107, Akwapim North Mampong, Ghana.
Kofi Tornyeli
District Health Directorate, Box 107, Akwapim North Mampong, Ghana.
Praise Boamah
District Health Directorate, Box 107, Akwapim North Mampong, Ghana.
James Amankwah
District Health Directorate, Box 107, Akwapim North Mampong, Ghana.
Olivia Serwaa Opare
Ghana Education Service, Box 25, Akropong-Akwapim, Ghana.
*Author to whom correspondence should be addressed.
Abstract
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.
Keywords: Food-borne, gastroenteritis, outbreak, Akwapim North District, Ghana