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