CHOLERA IN GHANA WHAT DO I NEED TO KNOW!! Evelyn Kwofie, MPH student Walden University PUBH 6165

1. CHOLERA IN GHANA WHAT DO I NEED TO KNOW!! Evelyn Kwofie, MPH student Walden University PUBH 6165 Instructor : Dr Patrick A. Tschida Quarter 3, 2011

2. WHAT IS CHOLERA? * An acute disease caused by ingestion of food or water contaminated by a bacterium called Vibrio cholerae * Feces contaminated water is the reservoir of infection and vehicle of transmission * Bacteria infects the small intestines resulting in large amount of watery diarrhea * Onset is typically sudden (2-3 days) (CDC,2011; WHO, 2011)

3. CHOLERA FACTS IN GHANA Last and first pandemic in 1970/71 Now cholera is endemic in Ghana

4. Now cholera is endemic with outbreaks every 3-7 years Coastal sanitation poor along beaches Number of major breakout decreased from 6-7 years to 3-4 years between 1971 and 2011 (Ghana government, 2011)

5. CHOLERA FACTS IN GHANA cont.. Last outbreak Sept 2010 Peaked March 2011 Regions affected the most were Greater Accra, Eastern region and Central region. The three regions accounted for 98% of cumulative total of 8,494 cases and over 99.8% of the 94 deaths as of May 14, 2011 Overall case fatality rate is 1/1% (Ghana government, 2011)

6. WHO GETS CHOLERA? * Both adults and children living in places overcrowded with inadequate water treatment and poor sanitation * People with low immunity i.e. people living with HIV and malnourished children are high risk (CDC, 2011).

7. HOW DO I GET CHOLERA • By ingesting feces contaminated water and food • Flood leading to contamination of domestic water * Ingesting raw shellfish or raw oysters from contaminated waters • It is not from person to person (CDC,2011; WHO,2011)

8. WHAT ARE THE SYMPTOMS? *Profuse painless diarrhea also known as rice water stools * Vomiting of clear fluid * Dehydration (up to 1000ml/hr diarrhea may be produced) * Low blood pressure and lethargy * Dry skin, dry mucus membrane or mouth * Sunken eyes and no tears * Rapid pulse * Muscle and abdominal cramps * Restless, irritability, tiredness and unusual sleepiness (CDC,2011;WHO,2011)

9. HOW DO I KNOW ITS CHOLERA? * Stool or rectal swab sample are collected in early stage to the laboratory for diagnosis (confirm cholera bacterium)

10. WHEN DO I GET HELP? * IMMEDIATELY !!! * Use Oral rehydration salts (ORS) * If unable to get help right away or in absence of ORS homemade solution can be given. * Home made solutions consist of half a teaspoon of salt and six level teaspoon of sugar dissolved in one liter of safe water. * Plain water and rice water can be given if homemade solution is unavailable. * Remember to use safe water. If not sure boil the water before use and store it safely. (WHO,2011)

11. HOW IS CHOLERA TREATED? • Immediate fluid and electrolytes replacement • Oral rehydration solution • Pre-packaged mixture of sugar and salt to be mixed with water (drink large amounts) • In severe cases intravenous fluid replacement • Antibiotics • Continue nutritious safe food and breastfeeding for infants and young children. (CDC,2011; WHO,2011)

12. COMPLICATIONS? • Acute renal failure • Severe electrolyte imbalance • Arrhythmias (Abnormal hearth rhythms) • Coma • Severe dehydration leading to shock • Death (CDC,2011; WHO,2011)

13. HOW DO I PREVENT CHOLERA? • Drink safe water • Frequent hand washing with soap and water • Appropriate disposal of feces • Boil, cook, and peel vegetables and fruits • Keep your living area clean • Sterilization of contaminated materials (CDC,2011; WHO,2011)

14. THE GOVERNMENT. • Continued public awareness and preventative measures teaching • Strengthen environmental surveillance • Evaluate preparedness programs for readiness for outbreaks • Monitor and investigate bacteriology cases • Encourage and enforce symptoms or case reporting • Possibly distribute ORS as part of emergency preparedness

15. GOVERNMENT cont.. • Ghana government has developed : • - A national cholera prevention and control plan (2010-2011) and has been disseminated to key stakeholders. • National Task force has been formed • Government provided extra funds • Developed short to long term multi-sectoral plan (Ghana government,2011)

16. THE WORLD. • Update unaffected countries with latest information on the disease • Provide travelers with information regarding risks and symptoms of cholera • WHO enforce reporting of cases as per protocol • WHO supports and audit countries • Continue WHO global Task Force on Cholera control and prevention. (WHO,2011)

17. FACTS !! • Cholera is fatal if left untreated • 80% cases of cholera can be treated with oral dehydration salts • Prevention, preparedness and response are essential. • 3 – 5 million cholera cases annually • 100 000 to 120 000 death due to cholera (CDC,2011; WHO,2011)

18. FACTS CONT.. • New variant strains detected in Africa and Asia • Cholera is an endemic in Ghana (WHO,2011)

19. QUESTIONS!!! • Thank you ladies and gentleman for your attention on this important matter.

20. USEFUL RESOURCES • Public education 24 hotline open to public 0244727958 (Director of Public Health, Ghana Health Service)

21. REFERENCE Centre for Disease Control and Prevention. (2011). Cholera. Retrieved on July 19,2011 from http://cdc.gov/cholera/disease.html Ghana Government. (2011). Press briefing on Cholera Outbreak In Ghana by Hon. Deputy Minister of Health. Retrieved on July 22, 2011 from http://www.ghana.gov.gh/index.php WHO. (2011). Cholera. Retrieved on July 23, 2011 from http://www.who.int/mediacentre/factsheets