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.

Highlights

  • This 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

  • We found that none of the 17 cases that reported at hospitals were promptly identified as suspected EVD cases on the Outpatient department (OPD) history table

  • This was done after they had undergone various medical and nursing procedures that demanded possible bodily contact with health staff and other patients

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Summary

Introduction

This 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. The outbreak of the Ebola virus disease (EVD) in West Africa has presented problems for disease surveillance systems in the sub-region, including in Ghana. The fact that only 12 countries have the requisite capacity to conduct laboratory confirmation of EVD within the context of IDSR for priority disease intervention show the limitations of surveillance systems in Africa, including those in West Africa [3]. Since 1998, the WHO Africa Region (WHO AFRO) adopted a strategy known as integrated disease surveillance and response (IDSR) aimed at strengthening public health surveillance and response to priority infectious diseases at district level [5]. Just like other disease surveillance strategies, IDSR has five components that can be monitored or evaluated using key indicators to assess their effectiveness (namely their structure, core functions, priority diseases for surveillance, surveillance quality and support functions) [6]

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