Ghana Field Epidemiology and Laboratory Training Program, Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Accra, Ghana.
Ghana Health Service, Ministry of Health, Accra, Ghana.
PLoS One. 2019 Mar 14;14(3):e0213627. doi: 10.1371/journal.pone.0213627. eCollection 2019.
Influenza-like Illness (ILI) is a medical diagnosis of possible influenza or another respiratory illness with a common set of symptoms. The deaths of four schoolchildren, during a pandemic influenza outbreak in December 2017 in Ghana, raised doubts about the ILI surveillance system's performance. We evaluated the ILI surveillance system in the Greater Accra region, Ghana, to assess the system's attributes and its performance on set objectives.
CDC guidelines were used to evaluate the data of the ILI surveillance system between 2013 and 2017. We interviewed the surveillance personnel on the system's description and operation. Additionally, routinely entered ILI data from the National Influenza Center provided by the six sentinel sites in Accra was extracted. We sampled and reviewed 120 ILI case-investigation forms from these sites. Surveillance activities were examined on system's performance indicators, each being scored on a scale of 1 to 3 (poorest to best performance).
All population and age groups were under ILI surveillance over the period evaluated. Overall, 2948 suspected case-patients, including 392 (13.3%) children under-five were reported, with 219 being positive for influenza virus (Predictive value positive = 7.4%). The predominant influenza subtype was H3N2, recorded in 90 (41.1%) of positive case-patients. The system only met two out of its four objectives. None of the six sentinel sites consistently met their annual 260 suspected case-detection quota. Samples reached the laboratory on average 48 hours after collection and results were disseminated within 7 days. Of 120 case-investigation forms sampled, 91 (76.3%) were completely filled in.
The ILI surveillance system in the Greater Accra region is only partially meeting its objectives. While it is found to be sensitive, representative and timely, the data quality was sub-optimal. We recommend the determination of thresholds for alert and outbreak detection and ensuring that sentinel sites meet their weekly case-detection targets.
流感样疾病（ILI）是一种可能患有流感或其他呼吸道疾病的医学诊断，具有一组常见的症状。2017 年 12 月，加纳在大流行流感爆发期间，四名学童死亡，这引发了对 ILI 监测系统性能的质疑。我们评估了加纳大阿克拉地区的 ILI 监测系统，以评估该系统的属性及其在既定目标上的性能。
我们使用美国疾病控制与预防中心的指南评估了 2013 年至 2017 年 ILI 监测系统的数据。我们对监测人员进行了有关系统描述和运作的访谈。此外，还从阿克拉的六个哨点提供的国家流感中心提取了常规输入的 ILI 数据。我们从这些站点抽样并审查了 120 份 ILI 病例调查表格。我们根据每个系统的性能指标检查监测活动，每个指标的得分范围为 1 到 3（最差到最佳表现）。
在所评估的时间段内，所有人群和年龄组都接受了 ILI 监测。总体而言，报告了 2948 例疑似病例患者，其中包括 392 例（13.3％）五岁以下儿童，219 例流感病毒阳性（阳性预测值= 7.4％）。主要的流感亚型为 H3N2，在 90 例（41.1％）阳性病例患者中记录。该系统仅达到了四个目标中的两个。六个哨点中没有一个始终达到其每年 260 例疑似病例检测的目标。样本平均在采集后 48 小时到达实验室，结果在 7 天内传播。在所抽样的 120 份病例调查表格中，有 91 份（76.3％）填写完整。
大阿克拉地区的 ILI 监测系统仅部分达到其目标。虽然它被发现具有敏感性、代表性和及时性，但数据质量并不理想。我们建议确定警报和暴发检测的阈值，并确保哨点站点达到每周的病例检测目标。
