Evelyn Kwofie, MPH student
Walden University
PUBH 6165
Instructor : Dr Patrick A. Tschida
Quarter 3, 2011
* An acute disease caused by ingestion of
food or water contaminated by
a bacterium called Vibrio cholerae
* Feces contaminated water is the reservoir
of infection and vehicle of transmission
* Bacteria infects the small intestines
resulting in large amount of watery
* Onset is typically sudden (2-3 days)
(CDC,2011; WHO, 2011)
• Last and first pandemic in 1970/71
• Now cholera is endemic in Ghana
• Coastal sanitation poor along beaches
• Number of major breakout decreased
from 6-7 years to 3-4 years between 1971
and 2011
(Ghana government, 2011)
Last outbreak Sept 2010
Peaked March 2011
Regions affected the most were Greater
Accra, Eastern region and Central region.
The three regions accounted for 98% of
cumulative total of 8,494 cases and over
99.8% of the 94 deaths as of May 14, 2011
Overall case fatality rate is 1/1%
(Ghana government, 2011)
* Both adults and children living in places
overcrowded with inadequate water
treatment and poor sanitation
* People with low immunity i.e.
people living with HIV and malnourished
children are high risk (CDC, 2011).
• By ingesting feces contaminated water
and food
• Flood leading to contamination of
domestic water
* Ingesting raw shellfish or raw oysters from
contaminated waters
• It is not from person to person
(CDC,2011; WHO,2011)
*Profuse painless diarrhea also known as rice water stools
* Vomiting of clear fluid
* Dehydration (up to 1000ml/hr diarrhea may be produced)
* Low blood pressure and lethargy
* Dry skin, dry mucus membrane or mouth
* Sunken eyes and no tears
* Rapid pulse
* Muscle and abdominal cramps
* Restless, irritability, tiredness and unusual sleepiness
* Stool or rectal swab sample are collected
in early stage to the laboratory for
diagnosis (confirm cholera bacterium)
* Use Oral rehydration salts (ORS)
* If unable to get help right away or in absence of
ORS homemade solution can be given.
* Home made solutions consist of half a teaspoon of
salt and six level teaspoon of sugar dissolved in
one liter of safe water.
* Plain water and rice water can be given if
homemade solution is unavailable.
* Remember to use safe water. If not sure boil the
water before use and store it safely.
• Immediate fluid and electrolytes replacement
• Oral rehydration solution
• Pre-packaged mixture of sugar and salt to be
mixed with water (drink large amounts)
• In severe cases intravenous fluid replacement
• Antibiotics
• Continue nutritious safe food and breastfeeding
for infants and young children.
(CDC,2011; WHO,2011)
• Acute renal failure
• Severe electrolyte imbalance
• Arrhythmias (Abnormal hearth rhythms)
• Coma
• Severe dehydration leading to shock
• Death
(CDC,2011; WHO,2011)
• Drink safe water
• Frequent hand washing with soap and
• Appropriate disposal of feces
• Boil, cook, and peel vegetables and fruits
• Keep your living area clean
• Sterilization of contaminated materials
(CDC,2011; WHO,2011)
• Continued public awareness and preventative
measures teaching
• Strengthen environmental surveillance
• Evaluate preparedness programs for readiness
for outbreaks
• Monitor and investigate bacteriology cases
• Encourage and enforce symptoms or case
• Possibly distribute ORS as part of emergency
• Ghana government has developed :
• - A national cholera prevention and control
plan (2010-2011) and has been
disseminated to key stakeholders.
• National Task force has been formed
• Government provided extra funds
• Developed short to long term multisectoral plan
(Ghana government,2011)
• Update unaffected countries with latest
information on the disease
• Provide travelers with information
regarding risks and symptoms of cholera
• WHO enforce reporting of cases as per
• WHO supports and audit countries
• Continue WHO global Task Force on
Cholera control and prevention.
- Cholera is fatal if left untreated
- 80% cases of cholera can be treated with
oral dehydration salts
- Prevention, preparedness and response
are essential.
- 3 – 5 million cholera cases annually
- 100 000 to 120 000 death due to cholera
(CDC,2011; WHO,2011)
• New variant strains detected in Africa and
• Cholera is an endemic in Ghana
• Thank you ladies and gentleman for your
attention on this important matter.
• Public education 24 hotline open to public
0244727958 (Director of Public Health,
Ghana Health Service)
Centre for Disease Control and Prevention. (2011). Cholera.
Retrieved on July 19,2011 from
Ghana Government. (2011). Press briefing on
Cholera Outbreak In Ghana by Hon. Deputy Minister of
Health. Retrieved on July 22, 2011 from
WHO. (2011). Cholera. Retrieved on July 23, 2011 from

Cholera in Ghana - Environmental Public Health Today