Evaluation of tuberculosis surveillance system, Hohoe Municipality, 2024

Abstract

Introduction: Tuberculosis (TB) remains the leading cause of death from infectious diseases globally after the COVID-19 pandemic. In Ghana, 44,000 people suffered from the disease with an estimated 14,000 deaths in 2020. Robust surveillance systems with regular evaluation are therefore critical for TB control. We evaluated the Tuberculosis surveillance system in the Hohoe Municipality to determine if its objectives are being met, assessed its attributes, and the usefulness. Methods: We interviewed surveillance personnel, and extracted data between 2019 and 2023 from the District Health Information Management System DHIMS2, the TB register, and case-based forms. The Center for Disease Control and Prevention (CDC) updated guidelines for evaluating public health surveillance systems were adapted to assess system attributes. Qualitative data were analyzed thematically, while quantitative data were analyzed descriptively. Results: The evaluation revealed that 83.3% (15/18) of healthcare workers found surveillance forms easy to complete, and 90% (18/20) of facilities submitted reports on time. However, only 28% (5/18) of respondents accurately identified case definitions, and just 21.4% of TB reporting forms were completely filled, and sensitivity of system been 60.1%(382/630). A total of 4,121 cases were suspected between 2019 and 2023, with 382 (9.3%) confirmed. Respondents reported changes in the surveillance system from Paper-based reporting to an electronic reporting, however, traditional beliefs affected testing, and lack of funds limited contact tracing, affecting system stability. Surveillance data informed public education, 90%(18/20) facilities reported monthly and on time, nonetheless, private facilities were not integrated into the DHIMS2 in Hohoe Municipal. Conclusion: The surveillance system partially met its objectives, and was timely, sensitive, flexible, simple, acceptable and useful, but low PVP. However, data quality, representativeness, and stability require improvement. Hohoe municipal health directorate should include private facilities into DHIMS2, provide funds for contact tracing, and education of public on the traditional beliefs affecting TB diagnoses.