Evaluation of acute hemorrhagic fever syndrome surveillance system in Sawla Tuna Kalba District, Ghana, 2024

Abstract

Introduction: In 2022, Ghana recorded an acute hemorrhagic fever syndrome (AHFS) outbreak of Marburg disease, with reported cases in the Sawla Tuna Kalba district. The study therefore evaluated the AHFS surveillance system in Sawla Tuna Kalba district to determine whether it met its objectives, evaluate the performance of system attributes, and assess its usefulness. Methods: We conducted an evaluation of the AHFS surveillance system in Sawla Tuna Kalba District in 2024 for the period 2019-2023. The US-CDC Updated Guidelines for Evaluating Public Health Surveillance Systems was adapted for the evaluation. Semi-structured questionnaire, checklist and interview guides were used to collect data through observations, interviews and record reviews. Twenty-eight key stakeholders were interviewed. Attributes were scored based on key indicators classified into poor (<50%), moderate (50% – 70%) and good (>70%). Findings were presented in tables and text. Results: Two Marburg cases, 29% (2/7), were confirmed over the period. Only 14.2% (1/7) of cases were detected within the recommended 24-hour interval. Outbreak investigation, including follow-up of 88 contacts, was done. About 85% (24/28) of respondents knew the case definition. Timeliness of weekly reports was 91.1%, and data completeness on case-based forms was 93% (163/175). Unintegrated multiple data reporting systems existed, causing data inconsistencies. Seven sub-districts did not report on community-based surveillance activities. Attribute scores were simplicity (40%), acceptability (60%), data quality (67%), timeliness (50%), flexibility (100%), stability (100%) and representativeness (100%). Data generated from the system was used for planning community health education and awareness programs and simulation trainings for staff. Conclusion: The surveillance system was useful, partially met its objectives, but scored poorly on simplicity. Integration of the various reporting systems will help improve its operations.