Preponderance of Vaccine Preventable Diseases Hotspots in Northern Ghana: A Spatial and Space-Time Clustering Analysis from 2010 to 2014

Background: National immunization programs around the world have seen massive improvements in the last few decades especially, in vaccinations coverage. This notwithstanding, vaccine-preventable diseases (VPDs) have persisted globally with a disproportionately high burden in Low and Middle-Income Countries (LMICs). Perhaps, a more nuanced understanding of VPD transmission beyond vaccination coverage may help optimise VPDs control efforts. This study set out to first identify VPDs hotspots in Ghana, and subsequently, explore how ecology, ubanicity and land-use variations (Artisanal and Small-scale Gold Mining (ASGM) activities) may influence the spatial distribution hotspots. Methods: The study used district-level disease count data from 2010 to 2014 from the Ghana Health Service (GHS) and population data from the Ghana Population and Housing Census (PHC) in determining the clustering patterns for six VPDS (Measles, Meningitis, Mumps, Otitis media, Pneumonia and Tetanus). Purely spatial and space-time cluster analyses were implemented in SaTScan using the discrete Poisson model and the default settings which calculate pp = 0.045), incidence of the other five VPDs did not differ across the urban-rural divide. The relationship between ASGM activities and VPDs was ambivalent. Whereas spatial analysis suggested that some VPD hotspots (tetanus and otitis media) occur more frequently in mining districts in the southern part of the country, a Mann-Whitney U test revealed a higher incidence of meningitis in non-mining districts (p = 0.019). Interpretation: Taken together, this study presents evidence of a preponderance of VPDs hotspots in the northern parts of Ghana. It also highlights differences in VPD clustering patterns and its implications for integration VPDs control activities into a unified framework. Further studies will be needed to clarify the relationship between ASGM activities and VPD transmission in Ghana. Funding Information: This study was partly supported by funding from Pure Earth. Declaration of Interests: We declare no competing interests.