Assessment of the usefulness of integrated disease surveillance and response on suspected ebola cases in the Brong Ahafo Region, Ghana

Abstract

BackgroundThis study assessed the quality, core and support functions of the integrated disease surveillance and response (IDSR) system relating to 18 suspected cases of Ebola virus disease (EVD) in the Brong Ahafo Region, Ghana.MethodsData was collected on selected indicators of the surveillance system relating to 18 suspected cases of EVD, from epidemiological week 19 to 45 of 2014. We conducted in-depth interviews with seven medical directors and two district directors of health services, and also reviewed documentation on the implementation of the core, support and quality functions of the IDSR system. We also monitored news in the media and rumours about EVD within the community as well as in health facility surveillance registers.ResultsThe study identified gaps in the implementation of IDSR relating to 18 suspected cases of EVD. Health staff heavily relied on haemorrhage as the only symptom for detection of suspected EVD cases. Twelve blood samples and a swab of secretions from the mouth of the thirteenth patient (who died) tested negative for EVD using PCR assay in laboratory confirmation. The blood samples of three patients were discarded, as they did not fit the case definition for suspected cases, whilst two refused for their blood samples to be taken.The community-based surveillance (CBS) system has not been given a prominent role in EVD surveillance and response, as demonstrated by CBS volunteers and health staff not receiving any training in these processes.There was intense public interest in EVD in August and September 2014. That interest has since waned for reasons that have to be formally ascertained. Unfounded fear of and anxiety about EVD still remain challenges due to a lack of in-depth knowledge about the disease in Ghana.ConclusionGhana has been one of the pioneers in the implementation of IDSR in Africa. Despite this, gaps have been identified in the implementation of IDSR relating to EVD in the Brong Ahafo Region. To address these gaps, the CBS system has to actively partner with health facility surveillance to achieve effective IDSR in the region.Electronic supplementary materialThe online version of this article (doi:10.1186/s40249-015-0051-3) contains supplementary material, which is available to authorized users.

Assessment of surveillance core and support functions regarding neglected tropical diseases in Kenya

“…Focused efforts to improve speci c surveillance functions in connection with PC-NTDs are paramount for effective identi cation of disease foci to inform targeted treatment and halt disease transmission. However, a review of existing literature identi ed unwavering focus on noti able diseases in assessing the performance of surveillance systems [41,[47][48][49][50][51][52]. Therefore, comparable ndings to the current study were based mostly on assessment of surveillance functions within the IDSR system with a leaning to noti able conditions.…”

“…The idea of an integrated disease surveillance and response framework was propositioned by WHO based on the sub-optimal performance of vertical surveillance systems characterised by unstandardised case de nitions, numerous reporting forms, limited laboratory capacity and inadequately trained human resource [40]. Optimal functioning and implementation of the IDSR system requires consolidation of all strategic components including effective communication, enhanced laboratory capacity, improved training and sustainable resource provision [41,42]. A recent assessment of the regional IDSR system implementation status in Africa indicated that most countries had implemented the IDSR framework [43].…”

Detecting Ebola with limited laboratory access in the Democratic Republic of Congo: evaluation of a clinical passive surveillance reporting system

“…Although the effectiveness of surveillance systems for early EVD identification has been previously assessed , to our knowledge, this is the first study to examine the application of IDSR surveillance during EVD outbreaks, as well as to examine reporting trends of EVD differential diagnoses during EVD outbreaks. There are several limitations in this study.…”

Red Cross volunteers’ experience with a mobile community event- based surveillance (CEBS) system in Sierra Leone during-and after the Ebola outbreak- A qualitative study

“…As supported in the study by Ndiaye et al (28), including CBS in existing projects can be important to both engage the communities, but also for sustainability and to ensure volunteers do not perceive it as a stand-alone project with other expectations and requirements than the regular volunteer programs. As in Sierra Leone, where there was a need for full coverage quickly, this is not always possible, but should be something to consider when planning implementation.…”

“…This should be considered according to context when implementing CBS. As with a study conducted in Niger, the community members received basic education to motivate them to notify health workers about possible cases in a timely matter [28]. Some of the CBVs also described alternative solutions to address the heavy workload, like organizing sub-groups of community members and agreements with community leaders to report rumors.…”