Tuberculosis surveillance system evaluation, Ho Municipality. Volta Region – Ghana, 2019

Background: Tuberculosis (TB) remains a major cause of morbidity and mortality worldwide with an estimated 10 million new (incident) TB cases in 2017. In Ghana, prevalence was estimated at 356 per 100,000 population and incidence of 160 per 100,000 population, mortality rate of 7.5 per 1000 infected people. The TB surveillance system exists to monitor TB burden in Ho and to improve the clinical outcomes of TB case patients. We evaluated the surveillance system at the Ho Municipality, Volta Region from 2014–2018 to determine its performance, usefulness and assess it system's attributes. Methods and materials: We extracted and reviewed data from reporting form and DHIMS 2 covering the period 2014–2018. We interviewed stakeholders at Ho Municipality using a semi structured questionnaire for information on case detection and clinical outcomes. We assessed the system attributes using the CDC updated guidelines for evaluating public health systems (2006). Summary descriptive statistics was performed on quantitative data and results were presented in tables and graphs. Results: Overall, 428 case of pulmonary TB were recorded in Ho Municipality for the evaluation period. The annual incidence of tuberculosis ranged from 1.6/100,000 in 2012 to 62.6/100,000 in 2014. The average case fatality rate was 8.3%. The predictive value positive was 1.2% (63/5876) in 2014 and 3.5% (958/1635) in 2018. Data inconsistency in reporting ledgers 100% (60/60) and DHIMS 40% (24/60). Conclusion: The TB surveillance system was found to be useful and partially meeting its objectives. The system was complex and acceptable with good data quality. However, there is a need to improve data validation in the DHIMS 2 and laboratory capacity for timely results.