An evaluation of tuberculosis surveillance system in a health district in Ghana

Naziru T. Mohammed, Salifu Bawa, Michael R. Adgei, Paulina Appiah, Annick Gladzah, Moses D. Barima, Alfred E. Yawson


Background: Tuberculosis remains a major global health problem. It is one of the top 10 causes of death worldwide. In Africa, there were estimated 2.7 million new cases of tuberculosis and 450 thousand deaths in 2014. In Ghana, incidence rate of TB was estimated to be 152 per 100,000 populations in 2017 according to the WHO estimates. We evaluated a health district (Ejisu-Juaben) Tuberculosis surveillance system to describe its operations, attributes, determine its usefulness and whether its objectives were being met.

Methods: This descriptive study was conducted using the Center for Disease Control and Prevention updated guidelines for evaluating public health surveillance systems and the Ghana Health Service Standard Operating Procedures for priority diseases and conditions (2012). Study participants who were purposively sampled were interviewed with a semi-structured questionnaires and dataset from January 2016 to December 2018 were reviewed at various levels of the surveillance system. Data was collected and analyzed with Epi Info 7.2 between 1st February, 2019 and 30th April, 2019.

Results: The surveillance system was useful and partially met its objectives and targets. It was well structured, simple, stable, flexible and of good data quality. It was also averagely acceptable and representative. However, it recorded poor sensitivity of 15.12% and poor predictive value positive (PVP) of 12.27% in 2018. The yearly total cost of operation of the TB surveillance system was ¢79,950.76 ($16,316.44 USD).

Conclusions:The surveillance system was useful and met its objectives partially. The sensitivity, PVP, acceptability and representativeness need improvement in order to justify its relevance. 



Ejisu- Juaben, Evaluation, Ghana, Surveillance, Tuberculosis

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Government of Ghana, National Surveillance Unit Ministry of Health. Technical Guidelines Integrated Disease Surveillance and Response Ghana; 2011:1-174.

Lönnroth K, Jaramillo E, Williams BG, Dye C, Raviglione M. Drivers of tuberculosis epidemics: The role of risk factors and social determinants. Soc Sci Med. 2009;68(12):2240-6.

Lin HH, Ezzati M, Murray M. Tobacco smoke, indoor air pollution and tuberculosis: A systematic review and meta-analysis. PLoS Med. 2007;4(1):45-52.

World Health Organization. Global tuberculosis report; 2016:43.

World Health Organisation. Global Health TB Report; 2018.

Melinda Gates Foundation. independent assessment of National TB prevalence surveys. 2016:85-138.

World Health Organization (WHO). TB and MDR-TB Country Profile (Ghana); 2019.

DHMT. 2018 Annual Report Ejisu-Juaben Municipal; 2018:17-18.

DAMT. Ejisu Juaben District Assembly Annual Progress Report; 2017.

Choi C-HR, Al-Bakir I. UC Surveillance. Biomarkers. Inflamm Bowel Dis. 2019;53:155-67.

López-Toledano MA, Shelanski ML. Neurogenic effect of β-amyloid peptide in the development of neural stem cells. J Neurosci. 2004;24(23):5439-44.

Robert RG, Greg A, Guthrie SB, John MH, Lisa ML. Updated Guidelines for Evaluating Public Health Surveillance Systems. Recommendations from the Guidelines Working Group. MMWR Recomm reports Morb Mortal Wkly report Recomm reports. 2001;50(13):1-35.

Bonsu FA, Hanson-Nortey NN, Afutu FK, Kulevome DK, Dzata F, Ahiabu MA O-CJ. The National tuberculosis health sector strategic plan for Ghana 2015-2020. Accra: Ghana Health Service/Ministry of Health; 2014.

Kasu ES. Evaluation of tuberculosis surveillance system in Akatsi District of Ghana. Int J Nov Res Healthc Nurs. 2012;2(2):1-11.

Bonsu FA, Hanson-Nortey NN, Afutu FK, Kulevome DK, Dzata F, Ahiabu. MA, et al. Debriefing TB Situation in Ghana, National TB Control Programme; 2016.

Frimpong-Mansoh RP, Calys-Tagoe BNL, Therson-Coffie EF, Antwi-Agyei KO. Evaluation of the tuberculosis surveillance system in the Ashaiman municipality, in Ghana. Pan Afr Med J. 2018;31:1-10.

Heidebrecht CL, Tugwell PS, Wells GA, Engel ME. Tuberculosis surveillance in Cape Town, South Africa: An evaluation. Int J Tuberc Lung Dis. 2011;15(7):912-8.

Greene JJ. Evaluation of the surveillance system of the National Tuberculosis Control Programme, Sierra Leone, 2012. Int J Infect Dis. 2014;21:1-460.

Aruna O, Nsofor I, Oyediran K. Tuberculosis in Nigeria: rapid assessment of infectious disease surveillance and reporting. Measure Evaluation, USAID; 2018.

Bonsu F. National TB prevalence survey design and implementation: Lessons from the field Ghana. 2013:5-30.

Adomako BY, Nana Yaw P, Kezia M. Evaluation of the Ga West Municipality Tuberculosis Surveillance System in the Greater Accra Region of Ghana. Ghana Wkly Epid Rep. 2017;2(37):18-22.