Evaluation of the environmental polio surveillance system-Northern Region, Ghana, 2021.

BACKGROUND: Acute Flaccid Paralysis (AFP) surveillance is the gold standard in the polio eradication initiative. The environmental component of polio surveillance can detect circulating Polioviruses from sewage without relying on clinical presentation. The effectiveness of the Environmental Surveillance (ES) is crucial to global polio eradication. We assessed the usefulness and attributes of the ES system in the Northern region and determined if the system is meeting its objectives. METHODS: We conducted a descriptive cross-sectional evaluation in the Northern region from 2019 to 2020 using the updated US Centers for Disease Control and Prevention guideline. We interviewed stakeholders, reviewed records, and observed surveillance activities from 29th March to 7th May, 2021. Quantitative data were analyzed manually as frequencies and proportions whiles thematic analysis was used for the qualitative data. RESULTS: One of 48 (2.1%) samples collected tested positive for circulating vaccine-derived Poliovirus (cVDPV). The cVDPV detection triggered enhanced AFP surveillance that resulted in the identification of a case of AFP. Three rounds of polio vaccination campaigns were organized. All surveillance officers interviewed were willing to continue providing their services for the ES. Reporting form has few variables and is easy to complete. The completeness of forms was 97.9% (47/48). Samples collected were dispatched on the same day to the testing laboratory. The system's data was managed manually. CONCLUSION: The system was useful in detecting polio outbreaks. Data quality was good, the system was simple, flexible, acceptable, representative, and fairly stable. Sensitivity was high but predictive value positive was low. Timeliness in reporting was good but feedback from the national level could not be assessed. There is a need to improve on the feedback system and ensure that, the surveillance data is managed electronically.

Evaluation of surveillance system for post market activities on pre-packaged foods in Greater Accra Region, Ghana, 2021.

Objectives: This evaluation was to assess the usefulness and attributes of the surveillance system for post market activities on pre-packaged foods in the Greater Accra Region of Ghana and also to determine if the systems objectives are being met. Methods: A descriptive cross-sectional design was used for the evaluation. Data/records on Food Market Surveillance collected between 2018 and 2020 was reviewed and key stakeholders involved in the Food Market Surveillance interviewed using a semi-structured questionnaire. Surveillance operations were also observed. Quantitative data was analyzed using descriptive summary statistics. Information gathered from interviews were put under themes. Result: Some policy decision taken were based on analysis of data from the surveillance system. The system is useful in detecting trends signaling changes on label of registered prepackage food products. The system can permit assessment of the compliance of levels of importers/manufacturers; however, such analysis was not done. The system involves single step notification and processing steps and can incorporate data from other systems. Some retailers perceived the system as a hindrance to business. Completion of notification forms takes 2-5 min and 1-5 working days to process and take regulatory action. The surveillance system had a data accuracy and completeness of 94.6% (194/205) and 94.1% (193/205) respectively with less than 0.1% (3/95) double entries. The system did not have any data validation process or team in place. Conclusion: The system was partially meeting its intended objectives and found useful despite some gaps and challenges observed. The system is simple, flexible, accepted by most of the stakeholders and covers almost the entire districts in the Greater Accra Region. We recommend that data validation process or team be instituted to ensure reliability of data generated for policy and regulatory decisions.

Evaluation of the adverse events following immunization surveillance system, Ghana, 2019.

BACKGROUND: With over 80% of children worldwide vaccinated, concerns about vaccine safety continues to be a public health issue. Ghana's Adverse Events Following Immunization surveillance started in 1978 with the objective to promptly detect and manage AEFI cases either real or perceived. Periodic evaluation of the surveillance system is critical for optimal performance; hence we evaluated the system to assess its attributes, usefulness and system's performance in meeting its objectives. METHODS: A case of AEFI was defined as any untoward medical event occurring within 28 days after vaccination and may not necessarily have causal relationship with the vaccine use. We reviewed surveillance data and procedures for the period 2014 to 2018 and interviewed key stakeholders. Adapting the CDC's Updated Guidelines for Evaluating Public Health Surveillance Systems, we assessed the system's attributes and usefulness. We performed summary descriptive statistics on quantitative data and directed content analysis on information gathered from interviews. RESULTS: In all, 2,282 AEFI cases including 476 (21%) serious cases (life threatening events) were reported for the period. The highest case detection rates of 61.45 AEFIs per 100,000 surviving infants was recorded in 2018. Reporting forms were modified to accommodate new indicators without any disruption in the function of the system. At the national level, completeness of 100 randomly sampled reporting forms (100%) and was higher than the region (27%) but timeliness (50%) was lower than the region (83%). All (16/16) Community Health Nurses interviewed indicated "fear of being victimized" as the reason for underreporting, nonetheless, the system was useful as it made them cautious when vaccinating children to prevent reactions. Data on AEFI surveillance was also useful in guiding training needs and provision of vaccination logistics. CONCLUSION: The AEFI surveillance system is useful at all levels but partially meeting its objective due to underreporting. We recommend training and supportive supervision to improve timeliness of reporting, data completeness and acceptability.