Table 3 Summary of evaluation of cholera outbreak response in KEEA
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 Cholera task force involving the Municipal Chief Executive, the District Health Management Team, the District Assembly, District Environmental Officer (EO), Ghana Education Service (GES), National Commission for Civic Education, media, fire service, police and National Disaster Management Organization was activated. • A district Cholera emergency plan was developed and implemented. • Health education with media collaboration including radio discussions and community FM announcements was undertaken. • Field investigations conducted in Abee and Kissi-Kumasi were documented in a written report. • Central Region Health Administration paid supportive visits and supplied logistics for the response. • Rapid response to contain outbreak | • No end of epidemic report with analysis of cases by time, person and place nor evaluation with recommendations to guide future preparedness and planning activities |
Surveillance and laboratory confirmation | • Rapid notification of DHMT by hospital staff when initial cases reported (within 24 h) • Carrie Blair media were available for sample transport • Samples were transported to laboratory for confirmation of cholera in timely manner • The facility registers were reviewed daily for new cases to facilitate community follow up. • Cholera data was transmitted to the Regional level and also shared with the sub-districts • A line list of cases was compiled | • Hospital staff were not informed about lab results when cholera was confirmed • Discrepancy in number of cases reported to national level and number on line list • Late reporting of deaths in community level suggests gaps in community-based surveillance |
Case management | • Cholera treatment center set up for isolation of cases in Ankaful Hospital • Good management: no deaths in the hospital during outbreak • Staff trained in management • Infection prevention and control measures observed: adequate water ensured, proper disposal of waste and disinfection of linen & clothes • Supplies were available and replenished when stocks became low • Emergency stock of supplies available in hospital at the time of assessment | • No case definition, assessment protocols nor management flow charts were made available to health workers • A patient admitted on 31 Oct 2012 with diarrhea and vomiting and died same day was probably a suspected cholera case that was missed. |
Control of the environment | • Water sources and public toilets were disinfected with chlorine • The overflowing pit latrine in Abee was emptied following outbreak • Dead bodies were fumigated before supervised burial by environmental health officers | • The overflowing latrine had been reported to the District Assembly earlier but no action had been taken before the cholera outbreak |
Control of the spread in the community | • Education on food safety, hand washing, waste disposal was undertaken in schools, communities and markets • Byelaws against open defecation were instituted • Prophylaxis given to contacts of cases • A community survey was conducted to assess the effectiveness of the health education • Community volunteers were mobilized to participate and support in education • The Hospital Public Health Unit (PHU) participated in social mobilization campaign in the communities | • Practically all the deaths occurred in the community suggesting inadequate community knowledge about: o early initiation of oral fluid replacement on onset of symptoms; and o early reporting to health facilities |