Below, three residents and alumni of the Ghana Field Epidemiology and Laboratory Training Program (GFELTP) share stories of successful interventions undertaken during their COVID-19 response experience. GFELTP residents and alumni involved in investigating this pandemic have encountered several challenges in the field but have been able to implement measures, such as these, to resolve them.
Success Story: Using Community Engagement for Effective Case Isolation and Contact Tracing
By Oxygen Gershon Wullar, Field Epidemiologist
The Accra Metropolitan District is one of the districts in the Greater Accra Region which first reported community transmission of COVID-19 on March 25, 2020. As the number of cases kept increasing and stigmatization became more apparent, the challenges of case isolation and contact tracing also worsened. A few of the challenges we encountered whilst on the field were:
- Refusal of case-patients to accept their results
- Community resistance to isolation of case-patients which was manifested through agitation and harassment of health workers
- Stigmatization of persons who tested positive for COVID-19
In order to overcome these challenges, we strategized to use the community members as the main agents for change. We identified the community leaders and engaged them to understand the nature of the disease and the need for case isolation and contact tracing. We identified a community opinion leader who bought into our plan and served as a translator to the health team. We educated the community in their local language using health workers from the community and the opinion leader as the focal persons. As part of educating and sensitizing the community on the COVID-19 pandemic, we provided the community with hand washing facilities (Veronica Buckets, soap, and paper towels).
The result of our engagement with the community yielded very positive results and made our work relatively seamless. The community members formed a task force under the leadership of their leaders to locate persons who test positive and persuade them to comply with isolation measures. The community members have since gained confidence in the health workers and have willingly volunteered to test, accept the test results and comply with isolation measures. Overall, community acceptance of COVID-19 surveillance has increased as evident in percentage acceptance of test results from 15 percent to 90 percent.
Success Story: A Three-pronged Approach to Addressing the Reluctance of Confirmed Cases to Cooperate with Surveillance Staff
By Abdul Gafaru Mohammed, Resident Epidemiologist
At the beginning of the COVID-19 pandemic in Ghana, the Okaikoi North Municipal Health Directorate responded positively to help contain the virus. As a resident epidemiologist of the GFELTP, I assisted the municipality with their surveillance activities. A lot of challenges were encountered in the course of executing the surveillance activities.
The major challenge faced on the field was the reluctance of confirmed cases of COVID-19 and their identified case contacts to cooperate with surveillance staff. This became a challenge as a result of increasing levels of stigmatization of cases and their contacts in the communities.
Confirmed cases refused to answer calls from surveillance staff and some even refused to give out the direction to their place of residence. There were numerous reports of contact tracers being denied access to certain parts of the communities because of their engagement in COVID-19 related activities.
In addressing this challenge, three measures were taken in the municipality. These included the organization of community-based sensitization and educational programs, the involvement of opinion leaders in the community to help in locating confirmed cases, and the referral of non- cooperative cases to the Bureau of National Investigation (BNI). Below is a description of these measures.
Organization of community-based sensitization and educational programs: In addressing stigmatization in the community, I spearheaded the organization of educational tours to different parts of the municipality with a special interest in areas with increasing reports of stigmatization. Our target population in the area for the exercise included market women, food vendors and transport officers.
Involvement of opinion leaders and key persons in the community: The second step that was taken in addressing the challenge was the involvement of opinion leaders and key persons in the community in locating confirmed cases and their contacts. The unit committee members, assembly members, and the sub-chiefs of the area came to our aid and assisted in finding cases and contacts that were not cooperative.
Involvement of the Bureau of National Investigation (BNI): The third step implemented was the referral of all confirmed cases whom we still could not contact to the BNI. The BNI assisted in establishing contact with these cases.
The community sensitization and educational programs positively influenced the contact tracing and case search activities in the area. Contacts began availing themselves for testing and cases became very cooperative in providing their details a week after the sensitization program.
The other measures taken such as the involvement of the opinion leaders and the BNI also yielded positive results by reducing the number of cases and contacts that escaped surveillance measures.
Success Story: Stopping COVID-19 Transmission at a Food Processing Factory
By Eunice Baiden Laryea, Resident Epidemiologist
On April 15, 2020, the Greater Accra Region of Ghana recorded a positive COVID-19 case who was an employee in a food processing factory. As a resident epidemiologist at the Ghana Field Epidemiology and Laboratory Training Program, I was assigned to support the district responding to this event.
I was part of the team that visited the factory to assess the level of exposure at the workplace, support contact tracing and institute preventive and control measures. We met with the factory’s management team to obtain information on the situation and discussed measures to stop current and future transmission at the workplace. We collected data on the event, the contacts of the case- patient including the GPS coordinates of their residences, and collected nasopharyngeal and sputum samples of the factory workers for laboratory testing.
At the factory, we observed handwashing facilities at the entrances of the factory. All the workers were wearing cloth face masks. All factory workers were made to self-quarantine at home while awaiting their results. With support from the Environmental Protection Agency, the factory and its staff buses were fumigated. The contacts were followed up for 14 days after last day of exposure to the case patient. Of 118 persons tested, 22 (19 percent) who were positive for COVID-19 were linked to case management teams for management.
Prior to reopening of the factory, we worked with the factory’s management team to ensure that the working area had floor markings indicating where each worker should stand to work in order to achieve physical distancing. Temperature check points were also instituted at the entrances of the factory whilst hand sanitizers were placed at vantage points. All workers were provided with nose masks. The duty roster was readjusted to ensure only a third of the employees would be at work at any time. The buses used to convey employees were also made to load one third of their capacities to ensure physical distancing.