The state of laboratory diagnosis, surveillance, and response to outbreaks of bacterial Meningitis, Brong Ahafo Region, Ghana, 2019

Abstract

Background: One goal of WHO and Global Health Security Agenda (GHSA), is to prevent, rapidly detect, diagnose, notify and respond to infectious diseases, in order to contain them at source, and prevent spread. We assessed cerebrospinal fluid (CSF) sample management, referral, laboratory diagnostics, notification, response, and surveillance capacity in relation to bacterial meningitis in Brong Ahafo Region(BAR), Ghana. Methods and materials: We conducted a cross-sectional study in BAR in September 2019. We reviewed Meningitis case-based forms, laboratory registers, from January to August 2019, and interviewed laboratory personnel. We collected data on sample quality, type of sample container, time of collection, receipt, and outcome of culture and PCR results at the Brong Ahafo Regional Hospital Laboratory (BARHL), and the PCR Zonal Public Health Reference Laboratory (ZPHRL), in the Northern Region, respectively Results: A total of 87 CSF samples were received at BARHL, between January–August 2019, from peripheral districts in BAR. The median time for samples receipt was; 1 day;(range; 1–4). Eight, (9.2%) tested culture-positive; Streptococcus pneumoniae. Sixty-nine (79.3%) samples met the criteria for adequacy and PCR analysis at the ZPHRL. It took 21 days to receive PCR results feedback. In all, 21 (30.4%) of the 69 samples were positive by PCR; (Streptococcus pneumoniae-20, Neisseria meningitidis-1). More than half; 13(62%) of the 21 positives by PCR, had been previously declared; ‘Culture Negative’ at BARHL. Across districts, there was lack of Gram stain and rapid latex agglutination test kits. Standard sample collection tubes such as dry cryo-tubes and trans-isolate bottles (meant to sustain the viability of CSF pathogens whilst in transit) was inadequate, and often yielded contaminated results due to inappropriate handling techniques. Conclusion: Poor specimen management and weak laboratory capacity possibly accounted for the low yield of culture results at BARHL. Observation suggests a high potential of failure to rapidly diagnose, notify, respond, and contain infectious outbreaks at source. Strengthening laboratory capacity at local and district levels in Brong Ahafo Region is crucial.