ArticleBMJ open2025
Evaluation of the acute flaccid paralysis surveillance system performance in the Upper West Region of Ghana from 2021 to 2023: a retrospective descriptive study.
Article in BMJ open, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesTo evaluate the performance of the acute flaccid paralysis (AFP) surveillance system in Ghana's Upper West Region between 2021 and 2023 against WHO benchmarks in order to identify strengths and weaknesses and sustain Ghana's progress towards a polio-free future.
designRetrospective analysis of routinely collected AFP surveillance data.
settingThe Upper West Region of Ghana, a remote and resource-limited border region with high vulnerability to poliovirus importation and circulation.
participantsAll 213 AFP cases reported in the Upper West Region between January 2021 and December 2023.
main outcome measuresWHO-recommended AFP surveillance indicators, including non-polio AFP (NP-AFP) rate, stool adequacy rate, timeliness of case notification and investigation, stool specimen transport and condition and non-polio enterovirus (NPENT) isolation rate.
resultsA total of 213 AFP cases were reported in the Upper West region between 2021 and 2023, with an average age of 24 months. The NP-AFP rate was consistently above the WHO target, averaging 26.7 per 100 000 population under 15 years. However, stool adequacy rates varied, averaging 73%, with a notable increase from 51% in 2021 to 97% in 2022 and a decline to 70% in 2023. The proportion of districts meeting both NP-AFP and stool adequacy targets fluctuated, with 64% in 2022 but dropping to 27% in 2023. Timeliness of case reporting remained high (≥94%), while investigations within 48 hours declined to 74% in 2023. Stool specimen transport was weak, with only 6% reaching the laboratory within 3 days of collection in 2023. NPENT isolation exceeded the WHO benchmark of ≥10% throughout the study period, with rates of 12% in 2021, 31% in 2022 and 11% in 2023, confirming specimen integrity and laboratory sensitivity despite transport challenges.
conclusionThe AFP surveillance system in the region demonstrated high sensitivity, as reflected by the NP-AFP rate, but challenges remain in maintaining stool adequacy and sample transportation standards. Strengthening sample transportation and logistics, as well as addressing district-level disparities in surveillance performance, will be essential to improving the overall quality of AFP surveillance in the region.
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