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Update on the outbreak of  meningitis in Ghana.
Paediatric Surgery Public Health

Update on the outbreak of meningitis in Ghana.

Cases of meningitis were reported in Nsokow in the Tain district and its surrounding environment in the later parts of 2015. Nsokow is a small town in the Tain district, Brong Ahafo Region of Ghana. The main economic activity is farming and trading. It has a population of about 100000. Nsokow is about 2hours drive from the regional capital , Sunyani. The town has a district hospital with bed capacity of 100. The district health director,  Dr Michael Adjei Rockson described an alarming trend of meningitis for which the cerebrospinal fluid cultures yielded Pneumococcus. Patients were usually children ages ranging from 5 to 13years.The illness was preceeded by prodromal symptoms of headache,  fever, sore throat and general malaise. Patients were managed with ceftriaxone, intravenous infusion after lumber punctures. Due to the unusual organism , (Pneumococcus) the public health workers in nearby subdistricts were put on high alert.
Pneumococcal meningitis  has a high morbity and mortality and this was a second time public health workers were reporting it in epidemic proportions. The first time such an outbreak was reported was years ago in the northern part of the country. The country has since then recorded several cases of meningitis with lumbar taps yielding both meningococcus and pneumococcus. Towns in the three Northern regions, Ashanti , Eastern and Brong Ahafo have documented cases with high case fatality rates especially in patients affected by pneumococcus. Public healthworkers and clinicians have been sensitized to pick early symptoms in order to commence treatment. Out of 200 cases documentated across the country 50 mortalities had occurred.
The disease is spread through droplet infection when affected individuals cough or sneeze . The bacteria get released into the air and when inhaled can lead to infection. Incubation period is about two weeks. Affected patient complain of severe headache,  fever,  impaired consciousness,  neck stiffness, general malaise. Patient put in a lateral recumbent position to perform a lumbar tap for cerebrospinal fluid for culture and sensitivity.  Patients are treated with intravenous antibiotics, intravenous fluids, nutritional support. Treatment outcome very much depends on the type of organism, time of presentation and early commencement of therapy. Early presentation and prompt institution of treatment protocols present a better outcome.
The country is currently collaborating with WHO officials in the country on how best to manage the outbreak.  The public is advised to report early to nearby hospitals to be evaluated when symptoms of headache,  fever, malaise become apparent.  Good cough etiquette that involves covering the nose and mouth when sneezing or coughing is also advised.

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