Table 2 Summary of evaluation of cholera outbreak in Akatsi
From: Assessment of the response to cholera outbreaks in two districts in Ghana
Activities and strengths | Weaknesses/Areas for improvement | |
|---|---|---|
Organization of the response | • Multi-sectoral Emergency Preparedness committee activated and divided into 5 teams with assigned roles. Members included DHMT, District Hospital Medical Superintendent, District Assembly, pharmacist, District Chief Executive, District Environmental Officer, Ministry of Food and Agriculture (MOFA) director, security forces, education director, Member of Parliament) • Daily meetings were held to review activities and re-assign roles • There was documentation of activities conducted including outbreak investigation, interim and end of outbreak reports. | • There was no epidemic preparedness plan • Available reports lacked adequate analyses of affected persons in time, person and place and spot map |
Surveillance and laboratory confirmation | • The DHMT was rapidly notified by hospital staff when initial cases reported • The line list of cases was compiled at facilities, updated at close of day and data transmitted to regional level daily by call and to lower levels to keep them on the alert • There was availability of sample transport medium which facilitated early laboratory confirmation • Water samples from 5 communities were tested with drug sensitivity testing conducted for isolated organisms | • Considering late reporting and deaths in community, the performance of the community-based surveillance system was sub-optimal • Poor communication channels with North Tongu DHMT so that the news of the cholera outbreak was not transmitted |
Case management | • Cholera treatment centers were set up away from other operations of the health facilities • No deaths from Cholera occurred in the health facilities • Outreach to support case management in Wute Health Center (HC) was undertaken by doctor from the District Hospital • Infection prevention and control measures were ensured in district hospital with adequate water, proper disposal of waste and disinfection of linen & clothes • Logistics were available and replenished when stocks became low • Private facilities participated in case management • Cases from hard to reach areas were transported to health facilities for treatment | • No case definition, assessment protocols nor management flow charts were made available to health workers • No refresher training of staff in case management • Waste disposal facilities at Wute HC was inadequate |
Control of the environment | • Water sources in affected communities and public toilets were chlorinated • Faulty boreholes were repaired • Dead bodies and their homes were fumigated before supervised burial by environmental health officers • Dead bodies were not released to families for funerals but buried under supervision of environmental health officers | • There was no coordination with North Tongu District in environmental disinfection |
Control of the spread in the community | • Education on food safety, hand washing, waste disposal in schools, communities and markets was undertaken • There were regular radio health education and mobile van announcements in the communities • Food stuff from affected communities were barred from the market • Faulty boreholes repaired and toilet facility built in communities lacking them and people were informed to use them instead of open defecation. • Prophylaxis given to contacts of cases • Restrictions on the movement of animals was enforced with strays being confiscated | • Inadequate community sensitization regarding contaminated drinking water as the source of cholera. One death was attributed to re-infection from contaminated water |