Need to strengthen Public Health services in boarding institutions

In the last quarter of this year, Ghana has recorded four incidents of outbreaks and strange health occurrences. Three of these incidents occurred in the Eastern region and one in the Ashanti region of Ghana.

The first was in October when the Ghana Secondary School in Koforidua recorded an outbreak of foodborne disease. Although the exact source and causative agent of the outbreak could not be established, it affected more than 100 students with over 50 of them hospitalized. Fortunately there were no deaths. In the second week of this month, there was a report of the death of a student in the Koforidua Secondary & Technical Institute where preliminary findings suggested the death could be due to meningitis. In St. Martin’s High School in Nsawam about five students were reported to have suddenly collapsed under strange circumstances and were rushed to the hospital for treatment.

Arguably, of the four outbreaks the one that has raised huge public uproar and attention is the H1N1, otherwise called Swine flu. The outbreak occurred in the Kumasi Academy popularly called KUMACA. Four students reportedly died and more than 44 hospitalized. Parents, students and the general public became apprehensive following the announcement that preliminary investigations from the Noguchi Memorial Institute of Medical Research have ruled out meningitis which was initially thought to be the suspected cause of the outbreak. While the scientific procedures were being followed to unravel the cause of the outbreak, Ghanaians were all impatient to hear what the cause was rather than what it was not. The media space was also flooded with reports that a public figure had indicated that the students died of Ebola. Politicians equally waded into the discussion by trying to point accusing fingers at which party did not do right or that one party’s actions and inactions were the cause of the situation.

It took efforts of a team of health experts from Ghana Health Service, the World Health Organization and the School of Public Health, Legon and Veterinary Service to identify the cause of the outbreak and bring the disease under control to prevent further spread. H1N1 was first identified in 2009 to be caused by influenza type A group of viruses. The symptoms of H1N1 influenza include fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills, fatigue, nausea, diarrhea, and vomiting. The virus is transmitted from person to person through close contact.

Infection spreads mainly through droplet exposure of respiratory secretions from coughing or sneezing onto soft mucosal surfaces such as the nose, mouth, and eyes. It also spreads through contact with an infectious patient or a surface that is contaminated with secretions and subsequent self-inoculation of virus onto mucosal surfaces such as those of the nose, mouth, and eyes; and through small particle aerosols in the vicinity of the infectious individual. Transmission of influenza through the air over longer distances is, however, not usually common.
All respiratory secretions and bodily fluids, including diarrheal stools, of patients with H1N1 influenza are considered to be potentially infectious. Persons at risk for complications from influenza infection include pregnant women, the aged and people with chronic diseases such as asthma, heart disease and diabetes. Schools, Prisons and other institutionalized places are particularly at higher risk for disease outbreaks. Poor sanitary conditions and overcrowding are a common phenomenon in some of these institutions which facilitate disease outbreaks. Interestingly, the confined nature of these institutions make it less cumbersome to contain any outbreak and prevent widespread to the public.

Unfortunately, the public sometimes distract these natural quarantined environment and inadvertently jeopardize the health of others. Parents and guardians rush to the affected schools to pick their wards home. Parents become apprehensive and fear the worse may happen to their wards. These reactions are also fueled by inadequate public health knowledge, lack of trust for the systems put in place and an unquestioned spiritual connotations of sickness and ‘strange’ deaths in Ghanaian societies. Others have the conviction that their family doctors will better handle their wards when they are sent home. As emotionally plausible as these reactions may be, it makes control and prevention measures tedious. By the Public Health Act, ACT 851 2012,the Minister responsible for health, is the authorized person who shall, by executive instrument, declare a clearly defined area in which a communicable disease has occurred as an infected area, and may eventually order the evacuation of the infected area or otherwise. The Minister’s communication is often guided by information supplied him by the technocrats in health. This provision, therefore, makes it unlawful for anyone to forcefully remove a person from a place suspected to be under investigation for a suspected outbreak most especially when the disease is under control yet the cause is not yet unknown. It is feared that Ghana may be sitting on a time bomb for H1N1 epidemic judging from the fact that the school in which the outbreak was detected recently celebrated its 60th anniversary where people from all over the country attended the function.

It is somewhat refreshing to note that though people may harbour the organization longer before becoming sick, the usual incubation period is one to four days. Everyone should be health conscious especially as harmattan sets in. Flu – like symptoms are possible and affected persons should seek care from approved health facilities rather than resort to self - medication. Global warming and climate change has undoubtedly influenced disease dynamics all over the world and Ghana should brace itself for its share. Diseases which will hitherto not thrive and were virtually absent in parts of the country are now raring their ugly heads there.

Meningitis, which is one of the characteristics of hot and dry climatic regions like northern Ghana and parts of the Ashanti region is now drifting to south. Amidst the seemingly increasing number of disease outbreaks in second cycle institutions, there is the need to strengthen public health activities in the country. Ironically, in developing countries little attention is given to public health activities because the nation’s wellbeing in often measured using negative health indicators such as death rates, diseases and disabilities.

In Ghana, epidemiologists, who have the skills to predict, detect and curb outbreaks, have no career pathway in the Ghana Health Service. At the first Scientific Conference and 10th Anniversary of the Ghana Field Epidemiology and Laboratory Training Programme, speakers bemoaned the neglect of the huge potential of that critical human resource of the nation. There is the need for the government and other agencies to support the diagnostic institutions like the Reference and Research laboratories to ensure timely and accurate diagnosis of cause of disease outbreaks.

Public health departments should be well resourced to enable them conduct regular environmental assessment of schools and to also in collaboration with Food and Drugs Authority conduct periodic testing of food and water samples.

Prevention they say is better than cure.



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