Evaluation of cholera surveillance system, Kumasi Metropolis, Ashanti Region, Ghana, 2020

Introduction: In 2014, Ghana experienced a cholera outbreak with 28,975 cases and 247 deaths from the then 10 regions. To monitor, detect early, respond, and reduce the burden of cholera, a standard operating procedure was designed as a guide for cholera surveillance. We evaluated the cholera surveillance system in Ghana’s second most populated city – Kumasi metropolis, to determine whether the system is meeting its objectives, and assessed its attributes and usefulness. Methods: We reviewed 2015-2019 cholera surveillance data sourced from health facilities and the health directorate of the Kumasi Metropolis. Stakeholders were interviewed using a semi-structured questionnaire. The Centers for Disease Control Updated Guidelines for Evaluating Public Health Surveillance Systems, 2001 was used to assess the system’s attributes and usefulness. Data was entered and analyzed using Microsoft Excel and Epi Info. Findings were described in comparison with the CDC Guidelines and presented as frequencies, percentages and tables. Results: A total of eight confirmed cases of cholera were reported. Bantama South sub-metro recorded 75% (6/8) of the cholera cases. The system uses a simple case definition which is easy to understand and well-integrated with other systems. Missing values and incomplete data reporting were identified, with overall completeness calculated at 60%. The system had 45.7% timeliness and 47.4% acceptability, with adequate back-up for storage and power. Conclusion: The cholera surveillance system in Kumasi metropolis is sub-optimal. Data quality, timeliness and acceptability need improvement, to prevent future outbreaks. Personnel were guided to rectify gaps with data reporting and clinicians sensitized on cholera case definition. Keywords: Cholera, Evaluation, Surveillance, Ghana