Foodborne Disease Outbreak Associated with Consumption of Asaana; a Local Maize Beverage in Ningo-Prampram, Ghana: A Case-Control Study.

On 14 April 2025, a cluster of acute illness was reported among students in Ningo-Prampram Municipality, Greater Accra Region, Ghana. We investigated the outbreak to determine its magnitude, identify the source, and implement control measures. We conducted an unmatched 1:2 case-control study. A case was defined as any person in Olowe who developed at least one of the following symptoms on 14 April 2025: abdominal pain, dizziness, diarrhoea, nausea, fever, headache, or profuse sweating. Food and beverage exposures were compared using crude odds ratios, 95% confidence intervals, and Fisher's exact tests. Environmental assessment and laboratory investigation of food and environmental samples were also conducted. Among the 37 cases, 36 were associated with two affected schools and one was identified in the Olowe community. The community case developed symptoms at approximately 08:30 after consuming Asaana before it was transported to the schools. Among the school-associated cases, the first onset occurred at approximately 10:05, shortly after the morning break began at 10:00, with most cases developing symptoms within the subsequent 30 minutes. Asaana, a locally prepared maize-based beverage, was consumed by 73.0% (27/37) of cases compared with none of the 74 controls (Fisher's exact p<0.001). Environmental assessment identified concerns during beverage preparation and storage, food-contact materials, water storage, and hygiene. Targeted toxicological analysis of six food and environmental samples did not detect any of the compounds included in the testing panel. Although the causative agent was not identified, the epidemiological and environmental evidence implicated Asaana as the likely vehicle of the outbreak. Strengthening food vendor certification and inspection, safe food preparation and storage practices, and water, sanitation, and hygiene facilities in schools may reduce the risk of similar outbreaks.