NAME

NAME: JUSTINA ADDAI
I.D: 10446047
NAME: FRANK BOACHIE-MENSAH
I.D: 10277652
GEOG619: MEDICAL GEOGRAPHY- ASSIGNMENT.

NEGLECTED TROPICAL DISEASE IN GHANA (RABIES)

TABLE OF CONTENTS PAGE NUMBER
Background of Study ………………………………………………
Symptoms of Rabies…………………………………………………

Spatial Variation of Rabies in Ghana………………………………
Maps and Tables Interpretation…………………………………….

Treatment of Rabies…………………………………………………

Government Policies ………………………………………………
Recommendation and Conclusion………………………………….

Refernces……………………………………………………………

NEGLECTED TROPICAL DISEASES IN GHANA (RABIES)
Background
Rabies is an infectious viral disease with an almost 100% case fatality rate in humans. (Takayama N. 2008). Rabies virus is a single stranded RNA from a family Rhabdoviridae and genus Lyssavirus which come from the Greek word lyssa which means ‘violent’ and Rabies which means ‘madness’ (Bourhy et al., 2008; Jackson, 2013). Rabies is caused by lyssavirus which causes an acute viral encephalomyelitis. It is spread when an infected animal bites or scratches another animal or human. Saliva from the infected animal can also transmit rabies when it comes into contact with the eyes, nose or mouth (WHO, 2013). The disease was confirmed in dogs for more than 4000 years (Both et al., 2012). In 1885 Luis Pasteur was able to develop a vaccine which treated a nine years old boy who was having deep bitten wound; the nature of virus at that time was still unknown (Bourhy et al., 2010).
Species such as dogs, cats, cows, bats, horses, monkeys among other mammals are mostly the reservoirs of the virus. Species vary depending on country and continent (WHO, 2013). In Asia, India has the highest rate of human rabies in the world because of stray dogs since a 2001 law forbade the killing of dogs (Gardiner, 2012). Africa has Democratic Republic of Congo leading rabies cases. In North America, rabies is common among bats, raccoons and foxes which accounts for almost all reported cases in the United States. Rabid bat bites are attributed to most cases (CDCP, 2011). Australia, Europe and South America have very few cases or no case reported each year; cases are contracted during travels on ecotourism trips, cave exploration, etc. Antarctica is the only continent free of rabies (CDCP, 2011).

Globally, about 15.69million people are exposed to the rabies virus annually with an estimated 59,000 human deaths. (Depani S.J. et al. 2012). Rabies remain a public health treat particularly in developing countries like Africa and Asia, which accounts for more than 95% of all human rabies cases. (Fooks AR et al. 2014).

Symptoms
Rabies is clinically diagnosed when person who is suspected to have had a contact with a rabid animal develops one or more of the following: headache, neck pain, nausea, fever, fear of water, anxiety, agitation, abnormal tingling sensations or pain at the wound site (Punguyire et al., 2017). The symptoms are divided into two forms; which are dumb (paralytic) form and furious/prodromal (encephalitic form). Dumb form is characterized by flaccidity muscle weakness where there is ascend paralysis and duration of illness is longer within 14 days compared to the furious form (Both et al., 2012; Jackson, 2013)
Rabies is a neglected tropical disease of the poor and vulnerable population, especially children between the ages of 4-15years, and death normally occurs due to rabies often not reported. About 99% of rabies transmission to humans is through the bite or scratch of infected dogs. Rabies has been in the dog population of Ghana for decades. (Belchar et.al 1976). In Ghana, rabies is endemic, and cases of human rabies are under reported as in other developing countries. (WHO 2013).

It is also believed that some of the virus of rabies entered Ghana from some West Africa countries and again rabies viruses from Ghana clearly from two lineages. Africa 1 (49viruses) Africa 2 (27viruses). Africa 2 viruses appear to have been present within the dog population of West Africa including Ghana for decades. Due the historical dominance of Africa 1 viruses in the Northern, Eastern and Southern parts of Africa, there is a belief that Africa 1 viruses have entered Ghana from those regions and that transmissions has not been from Ghana to those regions.
Between 1970 and 1974, an average of 72cases of canine rabies was reported annually throughout the country. (Blechar et.al 1976). Between 1977 and 1981, the number increased to over 100cases annually with an incidence of human rabies cases rising to 27 in 1981.After, there have been no further published reports of rabies in Ghana. Despite this, 123 clinically-confirmed human cases were recorded by public health officials between 2000 and 2004 (unpublished results).

In 1993, when Ghana had anti-rabies vaccination campaign there were only 5 outbreaks as against 41 in 1994, where there was no mass vaccination the outbreak cases rose to 108. In 2002, 56 rabies positive cases were diagnosed in the laboratories, 2003 61cases, 2004 72cases, 2005 78cases, and 2006 84cases. The increase is in the incidence of rabies in several parts of Ghana lately has been blamed on the unwillingness of pet owners to vaccinate their animals and the continuous presence of too many stray pets whose owners cannot be identified.

Spatial Variation of rabies in some selected areas across Ghana
In Greater Accra region, human rabies and dog bite reported from 2010 to 2014 were; 22 cases of human rabies from korle-bu teaching hospital and 233 dog bites from ridge hospital. The lowest number of dog bites was observed in 2011 and for human rabies was year 2013. The male-child (54.5%) less than fifteen years were more affected with dog bites than adult, while more adult 50% were affected by human rabies regardless of their age. In 2017 last year out of 39cases of human rabies recorded, Greater Accra recorded 6 cases.
In the Eastern region of Ghana, within the period of three years from 2013 to 2015, 4821 dog bites were reported; most of the cases were in children aged less than 10years. Fifteen cases of rabies were recorded in seven out of the 26 municipalities and districts, translating into rabies to dog bite ratio of 3:1000. 26 cases in 2013, 2,360 in 2014, 2,435 in 2015. Kwahu West district recorded the highest of 625cases followed by New Juaben municipality 380 cases; Kwahu North district recorded the lowest: 39 cases.

A total of 15cases of rabies were reported in the region from 2013-2015. In 2013, five cases were reported, seven cases in 2014 and three cases in 2015 and was reported in seven districts as follows; three each in New Juaben, Suhum, and West Akim, two each in Lower Manya Krobo, East Akim and one each in Akuapim North and Upper West Akim.
In the Ashanti Region, 24 cases of rabies were recorded in 2014 as compared to 13 cases in 2013, and the same time dog bites rose from 400 to 690. Clearly you can see that between 2013 and 2014 the incidence of dog bites and rabies was high in the Ashanti Region. Again 15 people died from rabies in the region in 2015 and as at September 2016, 15cases have been reported and out of it three deaths were also recorded.
In the Western region of Ghana, 12 cases of dog bites were recorded in 2017, out of this 11 of them died. Tarkwa-Nsuaem recorded 4 deaths, Ellembele had two cases, Ahanta West and Prestea Huni-Valley had a case each, whiles Sekondi/Takoradi had three.

In Brong Ahafo Region, specifically Techiman, in all 13 cases of human rabies were recorded at the holy family hospital from 2011 to 2016. Age was between (3-80yrs), out of it majority were males representing 60%. Out of the 13 cases recorded, data was available for 10, 8 of them came from rural communities. Four cases recorded in 2012 and 4 cases in 2014. 8 of the cases had previous history of dog bite ranging from two weeks to five months before onset of rabies symptoms. Out of the 8 cases 6 were domestic bites whiles 2 were from stray dog bite. In all 2012 recorded the highest number of suspected rabies dog bites and the lowest bites were recorded in 2015.

In Central region, in 2014, eight rabies cases were recorded. A total of 48dog bites cases were recorded, which eight rabies cases were confirmed with one death. In 2015, 10 dog bite with two rabies cases confirmed.

In Upper West region, fifteen people died of rabies in two years, out of which 9 of the deaths were recorded in 2015. In general, in the year 2017, 39 rabies cases were recorded, Upper East recorded 9 cases, Ashanti 8 cases, Greater Accra recorded 6 cases, Central Region 6 cases, Upper West recorded 3cases and Brong- Ahafo 2 cases.

THE TABLE BELOW SHOWS CASES OF RABIES, DOG BITES AND DEATHS IN GHANA, 2010-2017
REGION YEAR DOG BITE RABIES CASES NUMBER OF DEATHS
GREATER ACRRA 2010-2017 233 28 EASTERN 2013-2015 4821 15 ASHANTI 2013-2017 1090 52 18
BRONG-AHAFO 2011-2017 8 15 WESTERN 2017 12 12 11
CENTRAL 2014 & 2017 14 1
UPPER WEST 2014-2017 18 15
-619912490703Upper West No Data
Northern No Data
Brong Ahafo 8
Ashanti 1090
Upper East No Data
Eastern 4821
Central No Data
Volta No Data
Greater Accra 233
Western 12
00Upper West No Data
Northern No Data
Brong Ahafo 8
Ashanti 1090
Upper East No Data
Eastern 4821
Central No Data
Volta No Data
Greater Accra 233
Western 12

321213527407Upper West 18
Northern No Data
Brong Ahafo 15
Ashanti 52
Upper East No Data
Eastern 15
Central 14
Volta No Data
Greater Accra 28
Western 12
00Upper West 18
Northern No Data
Brong Ahafo 15
Ashanti 52
Upper East No Data
Eastern 15
Central 14
Volta No Data
Greater Accra 28
Western 12

-438460193725Fig 1. Map showing number of dog bites in Ghana (2010-2017)
00Fig 1. Map showing number of dog bites in Ghana (2010-2017)
3255264175031Fig 2. Map showing number of Rabies cases in Ghana (2010 – 2017)
00Fig 2. Map showing number of Rabies cases in Ghana (2010 – 2017)

2667635-491185Upper West 15
Northern No Data
Brong Ahafo No Data
Ashanti 18
Upper East No Data
Eastern No Data
Central 1
Volta No Data
Greater Accra No Data
Western 11
00Upper West 15
Northern No Data
Brong Ahafo No Data
Ashanti 18
Upper East No Data
Eastern No Data
Central 1
Volta No Data
Greater Accra No Data
Western 11

9287765314Fig 3. Map showing number of deaths in Ghana (2010-2017)

00Fig 3. Map showing number of deaths in Ghana (2010-2017)

Fig. 1, Shows the dog bites in Ghana in the year under review, which shows Ashanti Region experience more of the dog bites followed Eastern Region, Greater Accra and others. In other regions there was no data on dog bites.

Fig 2, Shows the number of rabies cases in Ghana in the same year. Clearly you can see that there were rabies cases in the entire regions under study.

Fig 3, Also shows the number of deaths in some of the regions. This shows that rabies can be treated if the victims are sent for treatment as early as possible.

Treatment of Rabies
Post –exposure prophylaxis is the immediate treatment after rabies exposure. This prevents the virus from entering the central nervous system which can result to death. These include extensive washing of wound for a minimum of 15 minutes with soap and water, detergent or iodine, effective rabies vaccines and administration of rabies immunoglobin (WHO, 2018).
Government of Ghana Policies on Rabies
Government of Ghana is trying its best to eradicate neglected tropical diseases from the society by the year 2020. There a lot of policies by the government as far as neglected tropical diseases are concern including rabies.
In terms of policy or initiative of elimination or eradication of these neglected tropical diseases which includes rabies, the government of Ghana through the Ministry of Health and its supporting partners in 2013 brought up a programme called Ghana Neglected Tropical Disease Masterplan 2013-2017. This was a five year strategic plan to work towards the prevention, control, elimination or even eradication of these diseases including rabies by 2020.
In the document on rabies, the national goals is to reduce morbidity and mortality from rabies to a level of no public health significance, the objectives is to determine the magnitude of rabies, to reduce the incidence of rabies, to strengthen collaboration with wildlife and strategies are to advocate for the control of rabies, strengthen the policy environment for the prevention and control of human rabies.
Another government policy was the setup of Veterinary Service which is under the Ministry of Food and Agriculture. Their mission is to ensure a stable animal health situation through the provision of quality animal health care services by both public and private sector Veterinary practitioners to enhance livestock, poultry and companion animal’s production and productivity. And one key objective is to protect public health by controlling animal diseases communicable to human beings, which basically talk about human rabies. And key function is to ensure that all animals coming into the country are quarantined and only those found healthy are allowed passage into the country, which also check transmission of rabies from animals like dogs to human beings.
The establishment of 30centers by veterinary service directorate which is backed by five private facilities to efficiently handle dog bites. Example is at the Ashanti Region.
We can also talk about the policy of government, by training of Veterinary doctors.

Recommendation and Conclusion
In conclusion, we can say that lack of regular vaccination of dogs in communities poses high risk of infection of dogs and its associated dangers to the populations and public health. Clearly from the articles, we saw that the year 1993 due to free vaccination for dogs reduced the spread of the diseases to a minimal figure.
So if the government can re-introduce free vaccination for dogs, and again dog owners must be force to inject their dogs every month to help check the disease. We also realised that slay dogs also play major role in spreading the diseases, so if dogs can also be banned from the streets, it can also help to minimise the spread of the disease if not total eradication.
Rabies is a vaccine preventable disease where dog vaccination is the most cost-effective strategy and human rabies vaccines exist for pre-exposure immunization as well (WHO, 2018).

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