Evaluation of the Pneumonia under-five Surveillance system in Ahanta West District, Western Region – Ghana, 2019.

Abstract

Background: Pneumonia is the leading cause of under-five mortality globally. In Ghana, pneumonia ranks third in under-five mortality with 5,000 mortalities yearly. Surveillance is key to achieving a target of SDG 3, to reduce pneumonia deaths to < 3/1000 live births by 2025. The objective of the surveillance system in Ahanta West District is for early case identification and epidemics, antibiotic resistance monitoring, and reduction of severe pneumonia cases. We evaluated the system to assess its usefulness, attributes and whether it was meeting its objectives.

Methods: This was a cross-sectional design. Quantitative data were collected using semi-structured interviewer questionnaire. Quantitative data were by abstracting 2010-2017 under-five pneumonia data set from DHIMS-2 and reviewing outpatient registers. Qualitative data were analysed under themes, using CDC-updated guidelines for evaluating public health surveillance systems. Quantitative data were analysed descriptively using Epi-Info 7 to generate frequencies and proportions. The study was conducted between December 2017 and January 2018.

Results: The system generated data to guide public health interventions in the district. It detected 1,891 cases; no severe cases, and no epidemics. Cases were disaggregated in facility registers but not in DHIMS-2. There was no evidence of antibiotic monitoring. Case definition was easily applied and timeliness of reporting was 100%. Data quality was 66.8% (16/24) and 91.7% (22/24) at district and regional levels respectively.  All four sub-districts reported cases throughout the period.

Conclusion: The system was useful but partially met its objectives. It was sensitive, simple, timely, representative, and of good data quality. Lack of antimicrobial resistance monitoring threatens the systems’ effectiveness.