title: Foodborne disease outbreak in a resource-limited setting: a tale of missed opportunities and implications for response.
abstract: BACKGROUND
  Foodborne diseases (FBD) have emerged as a major public health problem worldwide. Though the global burden of FBD is currently unknown, foodborne diarrhoeal diseases kill 1.9 million children globally every year. On 25th September 2014, health authorities in Eastern Region of Ghana were alerted of a suspected FBD outbreak involving patrons of a community food joint. We investigated to determine the magnitude, source and implement control and preventive measures.
  
  
  METHODS
  A retrospective cohort study was conducted. We reviewed medical records for data on demographics and clinical features. A suspected foodborne disease was any person in the affected community with abdominal pain, vomiting and or diarrhea between 25(th) and 30(th) September 2014 and had eaten from the food joint. We conducted active case search, descriptive data analysis and calculated food specific attack rate ratios (ARR) and their corresponding 95% confidence intervals.
  
  
  RESULTS
  Of 43 case-patients, 44.2% (19/43) were males; median age was 19 years (interquartile range: 17-24 years). Overall attack rate was 43.4% (43/99) with no fatality. Case counts rose sharply for four hours to a peak and fell to baseline levels after 12 hours. Compared to those who ate other food items, patrons who ate "waakye" and "shitor" were more likely to develop foodborne disease [ARR = 4.1 (95% CI = 1.09-15.63)]. Food samples and specimens from case-patients were unavailable for testing. Laboratory diagnostic capacity was also weak.
  
  
  CONCLUSIONS
  A point source FBD outbreak linked to probable contaminated "waakye" and or "shitor" occurred. Missed opportunities for definitive diagnosis highlighted the need for strengthening local response capacity.
authors.affiliation: Ghana Field Epidemiology and Laboratory Training Programme (GFELTP), School of Public Health, University of Ghana, Accra, Ghana.
authors.forename: Donne Kofi
authors.initials: DK
authors.lastname: Ameme
authors.affiliation: Ghana Field Epidemiology and Laboratory Training Programme (GFELTP), School of Public Health, University of Ghana, Accra, Ghana.
authors.forename: Marijanatu
authors.initials: M
authors.lastname: Abdulai
authors.affiliation: Ghana Field Epidemiology and Laboratory Training Programme (GFELTP), School of Public Health, University of Ghana, Accra, Ghana.
authors.forename: Eric Yirenkyi
authors.initials: EY
authors.lastname: Adjei
authors.affiliation: Ghana Field Epidemiology and Laboratory Training Programme (GFELTP), School of Public Health, University of Ghana, Accra, Ghana.
authors.forename: Edwin Andrews
authors.initials: EA
authors.lastname: Afari
authors.affiliation: Ghana Field Epidemiology and Laboratory Training Programme (GFELTP), School of Public Health, University of Ghana, Accra, Ghana.
authors.forename: Kofi Mensah
authors.initials: KM
authors.lastname: Nyarko
authors.affiliation: Upper West Akim District Health Directorate, Adeiso, Ghana.
authors.forename: Dwamena
authors.initials: D
authors.lastname: Asante
authors.affiliation: School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana.
authors.forename: Gideon
authors.initials: G
authors.lastname: Kye-Duodu
authors.affiliation: Noguchi Memorial Institute for Medical Research, Legon, Accra, Ghana.
authors.forename: Mona
authors.initials: M
authors.lastname: Abbas
authors.affiliation: Ghana Field Epidemiology and Laboratory Training Programme (GFELTP), School of Public Health, University of Ghana, Accra, Ghana.
authors.forename: Samuel
authors.initials: S
authors.lastname: Sackey
authors.affiliation: Ghana Field Epidemiology and Laboratory Training Programme (GFELTP), School of Public Health, University of Ghana, Accra, Ghana.
authors.forename: Fred
authors.initials: F
authors.lastname: Wurapa
mesh_terms: D015746:Abdominal Pain / Q000453:epidemiology / Q000209:etiology; D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003967:Diarrhea / Q000453:epidemiology / Q000209:etiology; D004196:Disease Outbreaks / Q000517:prevention & control / Q000706:statistics & numerical data*; D005260:Female; D005506:Food Contamination; D005517:Foodborne Diseases / Q000453:epidemiology* / Q000517:prevention & control; D005869:Ghana / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D008875:Middle Aged; D012147:Restaurants; D012189:Retrospective Studies; D013997:Time Factors; D014839:Vomiting / Q000453:epidemiology / Q000209:etiology; D055815:Young Adult
keywords: Foodborne disease; investigation; outbreak; retrospective cohort