Acute Flaccid Paralysis Surveillance System Evaluation, Ho Municipality, Volta Region, Ghana, 2022

Abstract Background Ghana reported the last native Wild Poliovirus that causes poliomyelitis in 1999. However, Ghana experienced another outbreak when cases were imported into the country in 2003 and 2004. The decade-long polio-free status ended in 2019 following the detection of circulatory Vaccine-Derived Polio Virus type 2 (cVDPV2) through Environmental Health Surveillance (EHS). Ghana is currently free from cVDPV2 but is at risk of potential outbreaks. 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 of health workers and key stakeholders, observations, records review, and administration of semi-structured questionnaires were made. 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 was analyzed using summary statistics and presented in percentages and frequencies. The qualitative interviews were audio recorded, transcribed, and narratively analyzed. Results Ten AFP cases were reported from January 2017 to December 2021. Six of these (28.57%) were detected based on actions taken on AFP surveillance data. The average NP-AFP was 2.14/100,000 with a minimum of 1.09/100,000 and a maximum of 4.12/100,000 under 15 population. One (10.0%) of the specimens reached the reference lab within 72 hours and an overall completeness of 68.04%. Three (30.0%) cases were follow-up after 60 days from the onset of the paralysis. Conclusion The AFP surveillance system in Ho municipality is partially meeting its objectives. It is useful, partially stable, and sensitive. The system is acceptable, representative, flexible, and accurate but poor in timeliness. The District Health Management Team should ensure specimens are sent to the reference laboratory within 72 hours after the case investigation.