Evaluation of surveillance system for pneumonia in children below five years, Tema Metropolis, Ghana, 2012 – 2016

Background We evaluated the pneumonia surveillance system in Tema Metropolis to determine whether it is meeting its objectives and to assess its attributes. Design Descriptive primary and secondary data analysis. Data Source We interviewed health staff on the system's operation and resources. We also extracted 2012-2016 surveillance dataset for under-five pneumonia cases and deaths from the District Health Information Management System for review. Participants Health staff. Intervention The Centers for Disease Control (CDC) updated guidelines for evaluating surveillance systems was used to assess system attributes. Main outcome measure state of the pneumonia surveillance system in Tema. Results A suspected case was defined as fast breathing in any child < 5 years old. The case definition was easy to apply, even at the community level. From 2012 to 2016, a total of 3,337 cases and 54 deaths (case fatality rate 1.6%) was recorded from 13 (23.6%) of 55 health facilities. Two epidemics were missed by the district because data were not being analysed. There were no laboratory data on antimicrobial resistance. Although reporting timeliness increased from 28.1% in 2012 to 83% in 2016, data inconsistencies existed between reporting levels. Conclusion The surveillance system for under-five pneumonia in Tema Metropolis is simple, stable, flexible, timely, but of low sensitivity and acceptability, and only partly meeting its objectives. Major shortcomings are lack of laboratory data, non-use of data and low representativeness. Funding The study was supported by a grant to author DB by the President's Malaria Initiative (PMI) -CDC CoAg 6NU2GGH001876.