Ghana - Cholera factsheet
Cholera overview
Cholera was first reported in Ghana in 1970. Since 1990, large-scale epidemics have occurred in 1991, 1999, 2011, 2012 and 2014, with the latter representing the largest epidemic to affect the country during the seventh pandemic1 (Fig. 1). Between 1998 and 2017, epidemiological surveillance reported 82,754 cases with 519 deaths (case fatality rate ≈ 0.6%)2. The majority of cases (58.5%) were reported in the Greater Accra Region2 (Table 1). Cross-border cholera outbreaks have occurred between Ghana, Ivory Coast and Togo, especially along the Guinea coast3.
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Strategic recommendations
Cross-border outbreaks often occurred between Ghana, Ivory Coast, and Togo3 (Table II, Table III). Genetic analysis of clinical isolates of Vibrio cholerae has shown that strains from Ghana during the 2010 and 2011 epidemics were closely related to clinical strains in Togo isolated during the same period5, thus stressing the importance of a cross-border early warning system as well as coordinated control and prevention activities.
In regularly affected districts, preparedness and response plans should include (1) strengthened early warning and rapid response systems including community-based surveillance and cross-border alerts; (2) the establishment of cross-sectoral and cross-border coordination mechanisms; (3) epidemic management capacity building; (4) targeted supply prepositioning; and (5) communication plans and messages (targeting hotspots Type 1 – Type 4). Sustainable access to water, sanitation and hygiene programs should be prioritized in Type 1 hotspots (Fig. 5, Table II, Table III).
An epidemiological study conducted in 2014 found that Greater Accra Region appears to be the epicenter of cholera at the national level. Due to rapid uncontrolled urbanization in Accra and the establishment of vast slum areas, the public water network fails to safely serve the entire population, thus rendering many communities highly vulnerability to disease transmission. Outbreaks in Accra often spread to other regions of Ghana (such as Ho and Ketu South) as well as neighboring countries including Ivory Coast3,5. A WASH assessment conducted in parallel to the epidemiological study stressed the need for urban planning in Accra to ensure access to safe water to reduce the risk for cholera outbreaks. Operational recommendations included strengthened post-chlorination by installing dosing chlorine pumps at strategic points along the water network in Accra, identification of hotspots within Accra using GPS, and implementation of WASH activities at the community level6.
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