Retrospective Study of an Epidemic Vibrio Cholerae in the Central Region of Ghana; An Evidence from Surveillance Data

Background In the Central region of Ghana, cases of cholera were detected in October 2016, in the Cape Coast Metropolis. The number of cases detected in the peri-urban communities rose exponentially indicating a high transmission potential of infections. We conducted a descriptive analysis of surveillance data of the 2016 cholera outbreak in the Central Region with the aim of describing the epidemiological features of the outbreak. Methods A retrospective analysis of cholera cases between October and December 2016 was conducted using variables including date of onset of symptoms, age, sex, rapid diagnostic test (RDT) results and district of residence of cases. Cases were descriptively characterized in terms of time, place, and person, attack rates were computed, and an epidemic curve was constructed using the date of onset of symptoms of cases. Pearson’s chi-square/Fisher’s exact tests were used to determine associations among selected variables of cases. Results A total of 731 cases of cholera were reported with an overall attack rate of 67 cases per 100,000 population; no fatalities were recorded. The epi-curve showed multiple progressive peaks denoting a propagated type of outbreak driven by person-to-person transmission of infections. The mean age was 23 years, with 40% of cases occurring in the age group 15-24 years. The difference between the number of cases for males and females was not significant (p-value = 0.619 ). Close to 90% of all cases were reported from the Cape Coast Metropolis. Abura-Asebu-Kwamankese (AAK) and Komenda-Edina-Eguafo Abirem (KEEA) had a combined number of 64 cases (10%). There was a significant association between RDT results and the bacterial culture test (p<0.001), as well as that between sex and final case classification (p=0.004) . Conclusion The cholera outbreak affected a total of 731 people, with the highest number of cases reported in the 15-24 year age group. The outbreak was driven by person-to-person transmission and contaminated food and water sources. Rampant open defecation, open roadside food and water vending, and poor personal hygiene practices including hand washing were identified as major risk factors. The Cape Coast Metropolis and the KEEA were the most affected with the highest number of cases and the highest attack rate. The outbreak was predominantly confirmed through rapid diagnostic tests and culture confirmation. Current and future development projects must be geared towards effective town planning and decongestion, provision of designated dumping sites, toilet facilities and more water treatment plants. It is also imperative that district health officials also explore the issues of poor health-seeking behavior and access to care as possible factors contributing to high morbidities. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement The authors have no funding sources to report. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: An ethical waiver and a subsequent approval for access to existing data on all cholera cases in the Central Region during the outbreak was obtained from the Disease Surveillance Department of the Ghana Health Service. All information obtained for the study (age, sex, date of onset of illness, district of residence, diagnostic test and culture results) was safeguarded within the database of the programme of the Disease Surveillance Department of the Ghana Health Service. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors