Northern have not reported a case. Table 1: Cases and Deaths of Cholera by Region, Ghana, as of 21 September 2014 No.of

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1 CHOLERA UPDATES, GHANA; AS OF 21 TH SEPTEMBER, 2014 The ongoing outbreak in the country has seen a further decline as compared to the previous week. However, during the week new outbreak was confirmed from Wa in the Upper West Region. The case was a student of UDS, Wa campus who just arrived from Accra. The case has since being treated and discharged. As of 21 st September 2014, cumulatively, 16,613 cases including 130 deaths (Case fatality rate of 0.8%) have been reported from 91 districts in 9 out of the 10 regions in the country (Table 1). The most affected district is La Dade-Kotopon with Attack rate of 712 per 100,000 population (Table 2). Northern have not reported a case. Table 1: Cases and Deaths of Cholera by Region, Ghana, as of 21 September 2014 No.of Region Cases Deaths CFR (%) Districts reporting Comments Adansi North, Adansi South, Ahafo Ano North, Ahafo Ano South, Amansie Central, Amansie West, Asante Akim Central, Asante Akim North, Asante Akim Ashanti South, Asante Mampong, Asokore Mampong, Atwima Kwanwoma, Bekwai, Bosome Freho, Bosomtwe, Ejura Sekyedumasi, Kumasi, Kwabre, Obuasi, Offinso, Offinso North, Sekyere Central, Sekyere Kumawu, Sekyere South Brong-Ahafo Asunafo North, Asutifi South, Nkoranza North, Nkoranza South, Techiman, Wenchi, Berekum, Atebubu-Amanten, Sunyani West, Kintampo North Central 1, Gomoa East, Gomoa West, Awutu-Senya West, Awutu-Senya East, Abura-Asebu-Kwamankese, Agona West, Efutu, Mfantseman, Cape Coast Eastern Akwapim North, Nsawan-Adoagyiri, Lower-Manya Krobo, New Juaben, Kwahu West, West Akim, Fanteakwa, Kwaku East, Upper Manya-Krobo, Birim Central, Birim South, Atiwa, Kwaebibrem, Upper West Akim, Kwahu East Greater Accra 14, Northern Upper East Bolgatanga Accra, Adenta, Ledzokuku-Krowor, La Dade- Kotopon, Ga East, Ga central, Ga South, Ga West, Tema, Ashaiman, Shai-Osudoku, La Nkwantanan- Madina, Kpone-Katamanso, Ada East, Ningo- Prampram Upper West Wa Volta Ho West, Nkwanta, Ketu North, Ketu South, Kadjebi Western Sekondi-Takoradi, Ellembelle, Ahanta West, Axim. Shama, Wassa East, Jomoro, Tarkwa-Nsuaem

2 Cases/Deaths Total (Ghana) 16, Table 2: Cholera Outbreak: Top Ten Most Affected Districts, 10 June to 21 September 2014 Attack Rate/100,000 District Population Cases Deaths Population CFR(%) La Dade-Kotopon 224, La-Nkwantanang-Madina 124, Shai Osudoku 58, Nsawam-Adoagyiri Accra 1,801, Ledzokuku-Krowor 249, Ga South 418, Ga West 287, Tema 335, Cape Coast 186, Fig 1: Weekly Trend of Cholera Cases and Deaths, Ghana, Week 1-38, 2014 Cases Deaths 3,500 3,000 2,500 2,000 1,500 1, Cases ,097 2,145 2,014 2,552 2,877 2,437 2, Deaths Epid Weeks

3 Cases/Deaths Fig 2: Weekly Trend of Cholera Cases and Deaths, Greater Accra Region, Week 1-38, 2014 Cases Deaths Cases Deaths Epid Week Cholera Cases by Districts, Ghana as of 21 September, 2014

4 Risk Factors The risk factors for cholera which are quite prevalent and require urgent attention include the following: Street water and food vendors are a major factor for cholera spread Poor sanitation Unsafe drinking water and poor access to safe water Floods leading to contamination of domestic water sources Increased person to person transmission Poor personal hygiene Poor food hygiene Poor environmental sanitation Broken down water and waste disposal systems Inadequate cholera treatment centres o Improvised sites were OPD, medical wards and unroofed uncompleted buildings with patients also managed on benches. Some Activities carried out during the Week National Level 1. NTCC meeting held to review the cholera situation 2. Drugs and supplies dispatched to the affected regions 3. Visit by UNICEF Cholera Expert to support response measures in the area of WASH 4. Meeting of WASH in Emergency Technical working group Regional and District Level 1. Regions to intensify diarrhoea surveillance 2. Press briefing has been issued to selected media houses in the region to carry out public education on prevention 3. Health education has started in the affected communities and is on-going 4. Cases are being managed at facilities according to national guidelines 5. Contacts are traced and immediate contacts given preventive treatment 6. District Health Management Teams (DHMTs) are working with District Assemblies to provide education on food hygiene and sanitation issues

5 Conclusions 1. Greater Accra, Eastern, Brong-Ahafo, Ashanti, Central, Western, Volta, Upper East and Upper West regions have confirmed cases of cholera outbreak. 2. Potential for cholera outbreak is high considering the continuous existence of the following risk factors: a. Inadequate supply of safe water b. Street vendoring of water and food c. Poor liquid and solid waste disposal, and choked drains d. Urban slums e. Poor food and personal hygiene Next Steps 1. Ministry of Water Resources/Ghana water company to continue supply of water to affected communities e.g. tanker supply to communities without water 2. MOH/National/Regional/Metropolitan/District Health Directorates to provide a. Cholera Treatment Centres (CTC) for case management, particularly at Accra Metropolis. b. Provide cholera beds to the treatment centres. c. Increase supply to regions with cholera logistics (infusions (5:4:1); Doxycycline / Tetracycline, ORS) 3. Intensify Mass Community Education and social mobilization with announcements on cholera prevention in the affected areas with the following key messages: a. Drinking of safe water-pipe water/treated water and avoid drinking of street vended sachet water b. Avoid eating street vended foods c. preparation and consumption of food under hygienic conditions d. Avoid defeacating in open, use toilet facilities e. Wash hands with soap and water after using toilet and before meals. 4. Distribute and educate households in affected communities in the use of Aqua tabs to treat drinking water 5. Metropolitan/Municipal/District Assemblies and Food and Drugs Authority to ensure that food and water vendors provide hygienic food and water eg preparation, storage and serving. 6. Ministry of Local Government and Food and Drugs Authority to enforce by-laws on environmental sanitation, water and food safety: target food and water vendors 7. Emergency National Technical Coordinating Committee (NTCC) meeting to bring on board other stakeholders and partners in the management of the outbreak and prevention of further outbreaks.