Acute flaccid paralysis surveillance system evaluation, Ho Municipality, Volta Region, Ghana

Introduction: Ghana reported the last indigenous case of wild poliovirus causing poliomyelitis in 1999. However, Ghana experienced another outbreak when cases were imported into the country in 2003 and 2004. Ghana’s decade-long polio-free status ended in 2019 with the detection of circulating vaccine-derived polio virus type 2 (cVDPV2) through environmental surveillance. This evaluation describes the usefulness and attributes of an acute flaccid paralysis (AFP) surveillance system and whether the system meets its objectives. Methods: A descriptive evaluation of the AFP surveillance system from January 2017 to December 2021 was conducted in Ho Municipality, Volta Region. Interviews with health workers and key stakeholders, observations, review of records, and administration of semi-structured questionnaires were conducted. The Centres for Disease Control and Prevention updated guidelines for evaluating public health surveillance systems were used as a reference for developing a checklist. The quantitative data were analysed using summary statistics and presented in percentages and frequencies. The qualitative interviews were audio recorded, transcribed, and narratively analysed. Results: Ten AFP cases were reported from January 2017 to December 2021. The average Non-Polio Acute Flaccid Paralysis (NP-AFP) rate was 2.14 per 100,000, with a minimum of 1.09 and a maximum of 4.12 per 100,000 population under 15 years. One (10.0%) of the specimens reached the reference lab within 72 hours, and an overall completeness of 68.0%. The non-polio enterovirus (NPENT) detection rate was 0% from 2018 to 2021. Overall, only 20% (2/10) had NPENT in the stool. Conclusion: The AFP surveillance system in Ho municipality is partially meeting its objectives. It demonstrates partial sensitivity but is poor in timeliness and completeness. The District Health Management Team should ensure specimens are sent to the reference laboratory within 72 hours after the case investigation.