Ghana's Fight Against Polio: A Comprehensive Review

Poliomyelitis, commonly known as polio, is an infectious disease caused by the poliovirus. It primarily affects children under the age of 15. The virus spreads through contact with contaminated feces, making good hygiene crucial. Once the virus enters the body, it can travel to the spinal cord and may cause paralysis. Fortunately, there is an effective vaccine that can provide lifelong immunity against this disease.

#The Global Status of Polio

In recent years, the number of polio cases globally has significantly decreased. For instance, in 2020, there were 245 reported cases of Wild Polio Virus Type 1 (WPV1) worldwide. By 2021, this number plummeted to just 6 cases. Most cases in 2020 were found in the Eastern Mediterranean Region, and this region still reported the majority of cases in 2021. Despite this progress, there is still a risk of polio returning to areas where the virus has been eliminated.

In addition to WPV1, another type of the virus, called Circulating Vaccine-Derived Polio Virus Type 2 (cVDPV2), has also been detected. There were 1,067 cases of cVDPV2 in 2020, and 659 in 2021. While these numbers are lower than in previous years, they still show that the virus can circulate in regions with low immunity levels.

#Polio in Ghana

Ghana had not reported any cases of indigenous WPV since 1999. However, the country faced outbreaks due to imported cases in 2003 and 2004. Ghana was declared polio-free for a decade until 2019, when cVDPV2 was identified, leading to renewed fears of outbreaks. Between 2019 and 2020, 12 cases of cVDPV2 were reported, contributing to a total of 31 cases detected since the outbreak began.

Polio only affects humans, so vaccination is key to controlling the disease. The available vaccines, including the Inactivated Poliovirus Vaccine (IPV) and Oral Poliovirus Vaccine (OPV), are effective in immunizing against polio. In Ghana, the government has aimed to maintain high immunization coverage and robust surveillance systems to keep track of any potential cases.

#What is Acute Flaccid Paralysis (AFP)?

Acute Flaccid Paralysis (AFP) refers to the sudden onset of weakness in the muscles, which can signal polio or other viral infections. Surveillance for AFP is essential for detecting polio cases. Health workers check for AFP in children under 15 years old, as they are the most affected age group.

When a case of AFP is detected, health workers collect stool samples to test for the poliovirus. It’s essential to collect these samples quickly to provide accurate results. The performance of the AFP surveillance system relies on several factors, including the ability to report cases, the thoroughness of investigations, and the quality of lab results.

#Evaluating the AFP Surveillance System

An evaluation was conducted to assess how well the AFP surveillance system worked in Ho Municipality, located in the Volta Region of Ghana. The evaluation focused on whether the objectives were being met and whether the system was performing effectively.

#The Evaluation Process

The evaluation looked at the period from January 2017 to December 2021. Researchers used guidelines from the Centers for Disease Control and Prevention (CDC) to create a questionnaire. They interviewed healthcare workers and examined case reports for accuracy and completeness. Observations were also made at various health facilities to verify that the system was functioning effectively.

#Setting for the Evaluation

Ho Municipality has a population of about 184,209 people, with more than half being children under 15. The area has multiple health facilities and hospitals, all of which are engaged in routine immunization efforts. The evaluation’s goal was to ensure that the AFP surveillance system in this region was operating effectively.

#How the System Works

When an AFP case is suspected, health workers must act quickly. They collect two stool samples from the suspected case within 14 days. These samples are then sent to a laboratory for testing. Results are expected within 21 days, and the findings are sent to relevant health authorities for follow-up action, if needed.

The system relies on teamwork. From local health facilities to national health offices, everyone plays a part in ensuring that the reporting and feedback loop is smooth. However, it has been noted that challenges may arise, such as delays in testing or limited access to healthcare, which can affect the efficiency of the surveillance.

#Data Collection and Analysis

In the evaluation, six health facilities and one hospital were randomly selected for assessment. Staff members were interviewed, and structured questionnaires were administered to gather necessary data. This data included how quickly cases were reported, the completeness of reports, and the overall effectiveness of the system in tracking AFP.

#Key Findings from Data Collection

The data revealed several insights into the AFP surveillance system:

• Objectivity: The system was able to detect and report cases of AFP effectively. While there were some delays in receiving lab results, all cases were investigated promptly.
• Usefulness: Healthcare workers found the AFP surveillance system to be beneficial. The data collected helps shape public health decisions, although there were gaps in documented meeting minutes. Meetings are essential for discussing trends and taking action.
• Simplicity of the Process: Most healthcare workers understood the case definition and how to fill out necessary forms. However, the system had recently expanded its reporting requirements, which may have made the process slightly more complex.

#Data Quality Challenges

Data quality is vital for effective surveillance. The completeness of data reported by healthcare facilities was generally acceptable, but there is room for improvement. For example, there were instances where information regarding the date samples were sent to the lab was missing. This can be critical for tracking cases accurately.

The evaluation found that nearly all reported cases were investigated on time, and stool specimens were collected according to protocol. However, the speed at which specimens were sent to laboratories for analysis varied. Ensuring timely transportation of samples is crucial for isolating the virus effectively.

#Challenges Faced by the System

Some of the challenges highlighted during the evaluation included:

• Staff Motivation: Health workers expressed that they sometimes lacked motivation to participate fully in the surveillance system. Training and support could boost their confidence.
• Community Awareness: In urban areas, community participation in health initiatives was lower than expected. Conversely, rural areas showed more engagement.
• Equipment and Resources: Some facilities reported needing better tools for collecting specimens and managing data, which can hinder smooth operations.

#The Road Ahead for AFP Surveillance in Ghana

Based on the evaluation findings, several recommendations were proposed to enhance the AFP surveillance system in Ho Municipality:

• Follow-up on Lab Results: Healthcare providers should be encouraged to actively seek feedback on laboratory results. Consistent communication can lead to better tracking of cases and quicker responses.
• Timely Specimen Transport: It’s vital to ensure that specimens reach reference laboratories within the required time frame. Strategies to improve logistics can help in this area.
• Community Engagement: Efforts to raise awareness in the community about the importance of polio surveillance and vaccination can lead to higher participation rates.

#Conclusion

The evaluation of the AFP surveillance system in Ho Municipality provided valuable insights into its functioning. While the system shows promise, several areas need improvement to ensure it operates at peak efficiency. By addressing challenges and following the recommendations, Ghana can work towards a future free from polio and protect its younger population from this preventable disease.

With a mix of teamwork, community involvement, and a strong health monitoring system, the goal is to keep polio at bay—for good! After all, who wouldn’t want to celebrate a world without polio? Cheers to clean hands and vaccines!