An Epidemiological Study on an Outbreak of Gastroenteritis Linked to Dinner Served at a Senior High School in Accra

Background: An outbreak of gastroenteritis occurred in December 2019 after students of a Senior High School in Accra were served with kenkey and fish during their dinner. An investigation was conducted to characterize the affected people, the source of contamination, the etiologic food and agent. Methods: An epidemiological study was conducted with cases selected from the student population who were ill. Controls were selected from among students who also ate from the school canteen during dinner but were not ill. Food history of each case and control was taken to assess their exposure status. Epi Info 7 was used to analyze the data obtained from the outbreak. Attack rates and odds ratios were calculated to determine the risk of foodborne infection for each of the foods consumed by the population. The source of contamination of the foods was ascertained by conducting an environmental risk assessment at the school. Results: Data were obtained from 126 students, out of which 57 (45.2%) were cases and 69 (54.8%) were controls. The cases presented with symptoms such as diarrhea (85.96%), abdominal cramps (66.67%), vomiting (50.88%), headache (21.05%), fever (17.86%) and nausea (3.51%). The peak incubation period was 18 hours with a minimum and maximum incubation periods of 6 and 50 hours respectively. From the incubation period, duration of illness and the symptoms, non-typhoidal salmonellosis was suspected. Multivariate analysis indicated that the illness was associated with the consumption of the fried fish served, however this was statistically insignificant (AOR 3.1.00, P = 0.159). No stool, blood or food samples were available for organism isolation and confirmation of suspected etiologic agent. The environmental risk assessment indicated poor hand washing practices on the part of both the food handlers and students. Conclusion: The outbreak could probably be due to the consumption of the fried fish that might have been contaminated with Salmonella sp. as a result of poor hand washing practices in the school.

Description of Reported Foodborne Diseases in Selected Communities within the Greater Accra Region-Ghana: Epidemiological Review of Surveillance Data

Background: Acute gastroenteritis is one of the frequently reported Out-Patient Department (OPD) cases. However, the causative pathogens of these cases are rarely identified at the OPD due to delay in laboratory results or failure to obtain specimens before antibiotics is administered. Method: A retrospective review of surveillance data from the Adentan Municipality, Accra, Ghana that were recorded in the National foodborne disease surveillance system of Ghana, was conducted with the main aim of describing the epidemiology and food practice of cases reported from the Adentan Municipality. The study involved a retrospective review of surveillance data kept on patients who visited health facilities that are involved in foodborne disease surveillance in Ghana, from January 2015 to December 2016. Results: A total of 375 cases were reviewed and these were classified as viral hepatitis (hepatitis A and E), cholera (Vibrio cholerae), dysentery (Shigella sp.), typhoid fever (Salmonella sp.) or gastroenteritis. Cases recorded were all suspected case and the average cases recorded per week was 3. Typhoid fever and dysentery were the two main clinically diagnosed foodborne illnesses. The highest number of cases were observed during the late dry season (Feb to April), which marks the end of the dry season and the beginning of the rainy season. Relatively high number of cases was also observed during the late wet seasons (Jul to Oct) when the rainfall is the heaviest. Home-made food and street vended food were the major sources of suspected etiological food, recording 49.01% and 34.87% of the cases respectively. Conclusion: Majority of cases recorded were classified as gastroenteritis due to the absence of laboratory confirmation. Few cases were classified as typhoid fever and dysentery based on clinical symptoms presented. Patients reporting with foodborne diseases were found to consume home meal and street vended foods as their predominant source of food.

Evaluation of Food Safety Management Systems of Food Service Establishments within the Greater Accra Region

Food contaminated with biological, chemical and physical hazards usually leads to foodborne illnesses which in turn increase the disease burden of developing and developed economies. Restaurants play a key role in the food service industry and violations in application of standardized food safety management systems in these establishments have been associated with foodborne disease outbreaks. This study was undertaken to assess the level of compliance to the Code of practice that was developed and implemented after conducting needs assessment of the food safety management systems employed by the Food Service Establishments in Ghana. Data on pre-licence inspections were reviewed to assess the compliance of the Food Service Establishments. During the period under review (2012-2016), 74.52% of the food service facilities in the hospitality industry were in compliance with the FDA’s code of practice. Main violations observed during the study bordered on facility layout and fabrication (61.8%) and this is because these facilities may not have been built for use as a food service establishment. Another fact that came to the fore was that the redesigning of the facilities to bring them into compliance required capital intensive investments, which some establishments are not prepared for. Other challenges faced by the industry regarded issues on records and documentations, personnel facilities and hygiene, raw materials acquisition, storage and control, and cold storage.

A Retrospective Cohort Study on an Outbreak of Gastroenteritis Linked to a Buffet Lunch Served during a Conference in Accra

On 21st November, 2016, an outbreak of foodborne illness occurred after a buffet lunch served during a stakeholders’ consultation meeting held in Accra. An investigation was conducted to characterise the affected people, determine the etiologic food, the source of contamination and the etiologic agent and to implement appropriate public health measures to prevent future occurrences. A retrospective cohort study was conducted via telephone interviews, using a structured questionnaire developed from the buffet menu. A case was defined as any person suffering from symptoms of foodborne illness e.g. diarrhoea and/or abdominal cramps after eating food served during the stakeholder consultation meeting in Accra on 21st November, 2016. The exposure status of all the members of the cohort was assessed by taking the food history of each respondent during the telephone interview. The data obtained was analysed using Epi Info 7. An environmental risk assessment was conducted to ascertain the source of the food contamination. Risks of foodborne infection from the foods eaten were determined using attack rates and odds ratios. Data was obtained from 54 people who consumed food served during the stakeholders’ meeting. Out of this population, 44 people reported with symptoms of food poisoning representing 81.45% (overall attack rate). The peak incubation period was seven hours with a minimum and maximum incubation periods of four and 17 hours, respectively. The commonly reported symptoms were diarrhoea (97.73%, 43/44), vomiting (84.09%, 37/44) and abdominal cramps (75.00%, 33/44). From the incubation period, duration of illness and the symptoms, toxin-mediated food poisoning was suspected. The environmental risk assessment of the implicated catering facility indicated a lack of time/temperature control, inadequate knowledge on food safety among workers and sanitation issues. Limited number of food samples was received for microbiological analysis. Multivariate analysis indicated that illness was significantly associated with the consumption of the snacks served (OR 14.78, P < 0.001). No stool and blood or samples of etiologic food were available for organism isolation; however, the suspected etiologic agent was Staphylococcus aureus or Clostridium perfringens. The outbreak could probably be due to the consumption of unwholesome snack (tuna sandwich or chicken. The contamination and/or growth of the etiologic agent in the snack may be due to the breakdown in cleanliness, time/temperature control and good food handling practices. Training of food handlers in basic food hygiene and safety is recommended.

Determination of the Optimal DG PV Interconnection Location Using Losses and Voltage Regulation as Assessment Indicators Case Study: ECG 33 kV Sub-Transmission Network

In this paper, CYME Distribution software has been used to assess the impacts of solar Photovoltaic (PV) distributed generation (DG) plant on the Electricity Company of Ghana (ECG) 33 kV sub-transmission network at different PV penetration levels. As ECG begins to encourage DG PV interconnections within its network, there has been the need to assess the impacts on the sub-transmission losses and voltage contribution. In Tema, a city in Accra - Ghana, ECG has a 33 kV sub-transmission network made up of 20 No. 33 kV buses that was modeled. Three different locations were chosen: The source bus, a bus along the sub-transmission radial network and a bus at the tail end to determine the optimal location for DG PV interconnection. The optimal location was determined based on sub-transmission technical losses and voltage impact. PV capacities at different penetration levels were modeled at each location and simulations performed to determine the optimal PV penetration level. Interconnection at a bus along (or in the middle of) the sub-transmission network offered the highest benefits at an optimal PV penetration level of 80%. At that location, the maximum voltage improvement of 0.789% on the neighboring 33 kV buses and maximum loss reduction of 6.033% over the base case scenario were recorded. Hence, the optimal location for DG PV integration within the 33 kV sub-transmission utility network is at a bus along the sub-transmission radial network.