Ghana
Cholera overview in country
Cholera was first reported in Ghana in 1970. Since 1990 and up to 2010, the overall yearly trend showed a decrease over time in incidence. However, since 2011, there have been large outbreaks in and cases have been reported almost every year. 2014 was the year of an unprecedented outbreak with more than 28,000 cases in the last quarter of the year.
Between 2004 and 2016, epidemiological surveillance reported 60,645 cases with 681 fatalities (case fatality rate ≈ 1.12%).
Main outbreaks were reported in the densely populated regions of Greater Accra and Ashanti, and in bordering coastal regions.
A multi-disciplinary team composed of doctors, researcher on microbiologic and WASH professionals conducted a study to improve the understanding of cholera dynamics in the region and define adequate long-term cholera prevention plan. A total of 412 samples of V. Cholerae isolates from recent epidemics in Ghana, DRC, Zambia, Guinea and Togo were subjected to analyses using molecular biology. The analysis found that the isolates from Ghana, Togo and Guinea compose a group different from the one of Central Africa.
Since the cholera was brought to West Africa, cases have been notified each year and the frequency of the epidemic episodes have increased in Ghana since 2011. By analysing the epidemiologic data between 2011 to 2014, Greater Accra Region was identified as the area with the highest risk of cholera in Ghana and for the sub region as well (Ghana – Togo- Benin). Following the first introduction of the Vibrio Cholerae toxigenic O1 in the city, cholera outbreaks spread quickly throughout the metropolitan area. The 2014 epidemic happened after one year without a case, even if the rainfall was as high as usual in 2013. The team observed and characterized the profile of the affected population, and their results suggest that the epidemic quickly reached the heart of the households and subsequently affected children and elderly. Field investigation also revealed that outbreaks subsequently occurring in other regions of Ghana (such as Ho and Ketu South) as well as neighbouring countries were linked to the epidemic in Accra.
Ghana is indeed a country regularly affected by cholera outbreaks. Due to its high risk for cholera, Ghana was finally included in a regional approach aiming at studying the epidemiological dynamic, so as to propose coherent action plans for each context to sustainably prevent cholera epidemics. The methodology applied was: i) to identify the key localities linked to the spread of cholera, ii) to establish their WASH context and the health facilities capacity to deal with an alleged future outbreak.
The results of these various studies are available for download online, as well as other recommended documents in the section below.
Finally, understanding cholera epidemiology and being informed on outbreaks and dynamics is critical for the neighbouring countries. Outbreaks in Ghana usually spread towards neighbouring countries from the south of Cameroon to Guinea Bissau through migrant fishermen and commercial trade: Nigeria, Bénin, Togo, Côte d\'Ivoire.
En savoir plus : Cholera Fact Sheet - Ghana
REPUBLIC OF GHANA-CHOLERA ELIMINATION OPERATIONAL STEPS
Step 1 - Expression of commitment :
Step 2 - Situation analysis :
- Ghana - High priority areas / hotspots
- Ghana - WASH study in cholera hotspots in Ghana: Review and propositions for actions to prevent cholera in the most affected areas: the greater Accra metro area, Ghana (2014)
Step 3 - Establishment of national cholera coordination mechanism or program :
STEP 4 - DEVELOP THE NATIONAL CHOLERA PLAN FOR CONTROL OR ELIMINATION :
STEP 5 - IMPLEMENTATION AND MONITORING & EVALUATION OF THE NCP AT COUNTRY LEVEL :
Other resources :
Integrated approach to understand the dynamics of cholera epidemics in Ghana, Togo and Benin (2015)