Epidemiological Link of the 2014 Cholera Outbreak in the Greater Accra Region

Abstract

Background Cholera is an intestinal disease caused by the bacterium vibro cholerae. The disease is characterized by severe watery diarrhoea with vomiting and severe dehydration. It is spread through faecal-oral route from an infected person and fomites (surfaces). In 1982, Ghana recorded as many as 15,032 cases considered as the highest in a single year. Since 1970, the trend of cholera outbreak has changed, from the usual occurrence of one in every 4 - 6 years to a more frequent type, usually a protracted form of outbreak. In Ghana investigations are done for almost every cholera outbreak but no systematic effort has been put in place to measure the link that may exist between the index cases. This study sought to describe the epidemiological link of the 2014 cholera outbreak in the Greater Accra region. Methods A descriptive cross sectional study was conducted in all affected districts in the Greater Accra region. Records of all the cases (line list) were reviewed while the index case for each district regardless of their demographic characteristics were investigated and linked to a source of the outbreak in the Greater Accra region. Data was analyzed using STATA version 13 and Arc GIS version 10. They were used to generate simple descriptive statistics regarding the cholera cases, draw epidemic curves and generate maps to show pattern and trend of current cholera outbreak distribution. Results Greater Accra region recorded a total of 20,199 cases with 121 deaths, an attack rate of 445 per 100,000 population with a CFR of 0.6%. About 52% of the total cases came from the Accra Metropolitan areas. The mean age of the cases was 29 years with SD of 6.87. About 60% of the total cases were between the age group 20-40yrs. Males form 58% of the total cases. The 2014 cholera outbreak in Greater Accra region can be linked to a point source; Accra Metropolis (a 10-year-old girl from Agbado). High urbanization and overcrowding in the region that results in insanitary conditions in the environment can be attributed to the cause of the outbreak. Conclusion The study has shown that the 2014 cholera outbreak was a point source epidemic that can be linked to the Accra metropolis. This was largely due to urbanization and overcrowding in the metropolis.