Predictors of vaccination card retention in Tamale Metropolis, Ghana.

BACKGROUND: The home-based vaccination card is an important health record for determining vaccination status of children during surveys, particularly in low- and middle-income countries. However, there are limited evidence on the factors that influence its retention in Ghana. We assessed the predictors of vaccination card retention in Tamale Metropolis, Ghana. METHODS: We conducted a cross-sectional study from 21st December 2022 to 10th January 2023 among children aged 0-59 months in the Tamale Metropolis. Multi-stage sampling was used to select caregivers of children aged 0-59 months for enrolment in the study. Data were collected using validated questionnaire through face-to-face interviews of caregivers. A vaccination card was retained if it was presented for physical inspection by research assistants. The factors that influence vaccination card retention were determined in a multivariate logistic regression analysis at p<0.05. RESULTS: A total of 1,532 eligible children were enrolled in this study. Vaccination card retention was 91.5%. Negative predictors of card retention included: being resident in the Nyohini (AOR = 0.28; 95% CI = 0.15-0.50) and Tamale Central (AOR = 0.51; 95% CI = 0.29-0.90) sub-Metro areas and being caregivers of children aged 24-59 months (AOR = 0.39; 95% CI = 0.22-0.68). On the other hand, paying for the vaccination card (AOR = 5.14; 95% CI = 2.95-8.95) was a positive predictor of vaccination card retention. CONCLUSION: In this study, vaccination card retention among children aged 0-59 months was higher than national estimates. Vaccination card retention was mainly influenced by sub-Metro area, age of child and mode of acquisition of the card such as out-of-pocket payment. There is need to design and deliver tailored messages including the importance of vaccination card retention to caregivers of children based on geographic context. Additionally, the policy on sale of vaccination cards should be revised to allow for cost sharing to enhance its retention.

Ebola virus disease surveillance and response preparedness in northern Ghana.

BACKGROUND: The recent Ebola virus disease (EVD) outbreak has been described as unprecedented in terms of morbidity, mortality, and geographical extension. It also revealed many weaknesses and inadequacies for disease surveillance and response systems in Africa due to underqualified staff, cultural beliefs, and lack of trust for the formal health care sector. In 2014, Ghana had high risk of importation of EVD cases. OBJECTIVE: The objective of this study was to assess the EVD surveillance and response system in northern Ghana. DESIGN: This was an observational study conducted among 47 health workers (district directors, medical, disease control, and laboratory officers) in all 13 districts of the Upper East Region representing public, mission, and private health services. A semi-structured questionnaire with focus on core and support functions (e.g. detection, confirmation) was administered to the informants. Their responses were recorded according to specific themes. In addition, 34 weekly Integrated Disease Surveillance and Response reports (August 2014 to March 2015) were collated from each district. RESULTS: In 2014 and 2015, a total of 10 suspected Ebola cases were clinically diagnosed from four districts. Out of the suspected cases, eight died and the cause of death was unexplained. All the 10 suspected cases were reported, none was confirmed. The informants had knowledge on EVD surveillance and data reporting. However, there were gaps such as delayed reporting, low quality protective equipment (e.g. gloves, aprons), inadequate staff, and lack of laboratory capacity. The majority (38/47) of the respondents were not satisfied with EVD surveillance system and response preparedness due to lack of infrared thermometers, ineffective screening, and lack of isolation centres. CONCLUSION: EVD surveillance and response preparedness is insufficient and the epidemic is a wake-up call for early detection and response preparedness. Ebola surveillance remains a neglected public health issue. Thus, disease surveillance strengthening is urgently needed in Ghana.

The integrated disease surveillance and response system in northern Ghana: challenges to the core and support functions.

BACKGROUND: The integrated disease surveillance and response (IDSR) strategy was adopted in Ghana over a decade ago, yet gaps still remain in its proper functioning. The objective of this study was to assess the core and support functions of the IDSR system at the periphery level of the health system in northern Ghana. METHODS: A qualitative study has been conducted among 18 key informants in two districts of Upper East Region. The respondents were from 9 health facilities considered representative of the health system (public, private and mission). A semi-structured questionnaire with focus on core and support functions (e.g. case detection, confirmation, reporting, analysis, investigation, response, training, supervision and resources) of the IDSR system was administered to the respondents. The responses were recorded according to specific themes. RESULTS: The majority (7/9) of health facilities had designated disease surveillance officers. Some informants were of the opinion that the core and support functions of the IDSR system had improved over time. In particular, mobile phone reporting was mentioned to have made IDSR report submission easier. However, none of the health facilities had copies of the IDSR Technical Guidelines for standard case definitions, laboratories were ill-equipped, supervision was largely absent and feedback occurred rather irregular. Informants also reported, that the community perceived diagnostic testing at the health facilities to be unreliable (e.g. tuberculosis, Human Immunodeficiency Virus). In addition, disease surveillance activities were of low priority for nurses, doctors, administrators and laboratory workers. CONCLUSIONS: Although the IDSR system was associated with some benefits to the system such as reporting and accessibility of surveillance reports, there remain major challenges to the functioning and the quality of IDSR in Ghana. Disease surveillance needs to be much strengthened in West Africa to cope with outbreaks such as the recent Ebola epidemic.