Spatial and demographic patterns of Cholera in Ashanti region - Ghana

BACKGROUND: Cholera has claimed many lives throughout history and it continues to be a global threat, especially in countries in Africa. The disease is listed as one of three internationally quarantinable diseases by the World Health organization, along with plague and yellow fever. Between 1999 and 2005, Africa alone accounted for about 90% of over 1 million reported cholera cases worldwide. In Ghana, there have been over 27000 reported cases since 1999. In one of the affected regions in Ghana, Ashanti region, massive outbreaks and high incidences of cholera have predominated in urban and overcrowded communities. RESULTS: A GIS based spatial analysis and statistical analysis, carried out to determine clustering of cholera, showed that high cholera rates are clustered around Kumasi Metropolis (the central part of the region), with Moran's Index = 0.271 and P < 0.001. Furthermore, A Mantel-Haenszel Chi square for trend analysis reflected a direct spatial relationship between cholera and urbanization (χ(2 )= 2995.5, P < 0.0001), overcrowding (χ(2 )= 1757.2, P < 0.0001), and an inverse relationship between cholera and order of neighborhood with Kumasi Metropolis (χ(2 )= 831.38, P < 0.0001). CONCLUSION: The results suggest that high urbanization, high overcrowding, and neighborhood with Kumasi Metropolis are the most important predictors of cholera in Ashanti region.