"Prevalence of Inflammatory Gastrointestinal Disease, Amebiasis, Giardia, and Cryptosporidium in Select Populations of Ghana"
Ghana Health Service Centre for Health Information Management, Report of Health and Disease Analysis Taskforce, 2001, showed steadily increasing numbers of diarrhea-related diseases between 1995 and 2000, and showed it was the third most prevalent disease category in the country. A common mode of transmission of gastroenteric diseases is through unsafe drinking water and food, which has been contaminated. The United Nations Population Fund State of the World Population 2006 states 79% of people in Ghana have access to improving water sources; however, there is still a substantial portion of the population that is suffering because of these communicable diseases. The study was designed to assess the prevalence of inflammatory and infectious diarrhea in three different populations within Ghana by using diagnostic assays over a six-week study period.
Patients presenting with diarrhea to the Manna Mission Hospital (Teshie Nungua/Accra), the Volta River Authority Hospital (Akosombo) and in the ten villages visited by the Hospital Ship, the Onipanua (Volta River Area) were asked to provide a stool sample. The samples were diluted and analyzed for the presence of white blood cells (TECHLAB® T5002 -LEUKO-TEST lactoferrin assay), Amebiasis (TECHLAB® T5017 - E. HISTOLYTICA II test), Cryptosporidium (TECHLAB® PT5014 - CRYPTOSPORIDIUM II) and Giardia (TECHLAB® PT5012 -GIARDIA II).
There were stratified health situations between the populations being served by the Manna Mission Hospital, the Volta River Authority Hospital, and the Onipanua Hospital Ship. At Manna Mission Hospital, there was a relatively low frequency of diarrhea samples available. In the eighty-one stool samples that were analyzed by the Manna laboratory from June 11 - July 23, 2007, it was documented by the lab that: 14.8% contained red blood cells, 35.8% contained white blood cells, 12.3% contained E. histolytica, 2.5% contained Giardia, 0% contained Cryptosporidium and 7.4% contained bacteria. During the study at Manna seven of the eighty-one samples were tested with TECHLAB® assays, resulting in two samples positive for lactofferin and one sample positive for Giardia. The diagnostic assay results agreed with the findings, both positive and negative, found by the laboratory in those seven samples. The tests were also used on other samples not tested by the lab, which resulted in two more stool samples positive for lactoferrin.
The Volta River Authority Hospital (VRA) is situated in a more prosperous area of the country than Manna, with less overpopulation, better access to clean water, and more consistent electricity. During the study period at VRA there was only one child that presented with watery stools and he was unable to provide a sample throughout his five hours at the hospital, suggesting a lack of diarrhea/dysentery illness. Neither diagnostic tests nor laboratory results were obtained at the VRA hospital.
The population being seen by the Onipanua Hospital Ship staff had a much higher percentage of patients presenting with infectious illnesses (substantial diarrhea, schistomoniasis infections, malaria, respiratory tract infections and skin infestations including tinea) than either Manna Mission or VRA. The patients being seen through the Hospital trip were given empirical treatment with clinical evaluations, without the facilities for laboratory tests. Malaria, schistomoniasis and infectious enteritis were treated according to symptoms without blood films or stool analysis. Despite the high level of diarrhea illness amongst other things in these populations, most people were unable to provide stool samples. Among the four that were obtained on the ship, one was positive for both lactoferrin and Giardia.
The diagnostic tests were meant to quantify where in Ghana patients were most afflicted with the diarrhea-related diseases. There was a clear difference in the frequency of infectious diarrhea-related diseases depending on the region of Ghana. The population in Akosombo (VRA Hospital) had the best access to clean water and lowest levels of infectious diarrhea, while the villages on the Volta River with the least access to clean water and healthcare had the highest prevalence of diarrhea-related diseases.