{
  "abstract": "Objectives To evaluate the performance of the acute flaccid paralysis (AFP) surveillance system in Ghana’s Upper West Region between 2021 and 2023 against WHO benchmarks in order to identify strengths and weaknesses and sustain Ghana’s progress towards a polio-free future.Design Retrospective analysis of routinely collected AFP surveillance data.Setting The Upper West Region of Ghana, a remote and resource-limited border region with high vulnerability to poliovirus importation and circulation.Participants All 213 AFP cases reported in the Upper West Region between January 2021 and December 2023.Main outcome measures WHO-recommended AFP surveillance indicators, including non-polio AFP (NP-AFP) rate, stool adequacy rate, timeliness of case notification and investigation, stool specimen transport and condition and non-polio enterovirus (NPENT) isolation rate.Results A total of 213 AFP cases were reported in the Upper West region between 2021 and 2023, with an average age of 24 months. The NP-AFP rate was consistently above the WHO target, averaging 26.7 per 100 000 population under 15 years. However, stool adequacy rates varied, averaging 73%, with a notable increase from 51% in 2021 to 97% in 2022 and a decline to 70% in 2023. The proportion of districts meeting both NP-AFP and stool adequacy targets fluctuated, with 64% in 2022 but dropping to 27% in 2023. Timeliness of case reporting remained high (≥94%), while investigations within 48 hours declined to 74% in 2023. Stool specimen transport was weak, with only 6% reaching the laboratory within 3 days of collection in 2023. NPENT isolation exceeded the WHO benchmark of ≥10% throughout the study period, with rates of 12% in 2021, 31% in 2022 and 11% in 2023, confirming specimen integrity and laboratory sensitivity despite transport challenges.Conclusion The AFP surveillance system in the region demonstrated high sensitivity, as reflected by the NP-AFP rate, but challenges remain in maintaining stool adequacy and sample transportation standards. Strengthening sample transportation and logistics, as well as addressing district-level disparities in surveillance performance, will be essential to improving the overall quality of AFP surveillance in the region.",
  "authors": [
    {
      "affiliations": [
        "Ghana Health Service, Upper West Regional Health Directorate, Wa, Ghana",
        "School Of Public Health, Faculty of Public Health, University of Port Harcourt, Port Harcourt, Nigeria",
        "CK Tedam University of Technology And Applied Sciences, Wa, Ghana"
      ],
      "name": "Aabalekuu Simon"
    },
    {
      "affiliations": [
        "Ghana Health Service, Upper West Regional Health Directorate, Wa, Ghana"
      ],
      "name": "Damien Punguyire"
    },
    {
      "affiliations": [
        "Ghana Health Service, Upper West Regional Health Directorate, Wa, Ghana"
      ],
      "name": "Justine Bangniyel"
    },
    {
      "affiliations": [
        "Ghana Health Service, Upper West Regional Health Directorate, Wa, Ghana"
      ],
      "name": "Linus Baatiema"
    },
    {
      "affiliations": [
        "Ghana Health Service, Upper West Regional Health Directorate, Wa, Ghana"
      ],
      "name": "Ambrose Naawa"
    },
    {
      "affiliations": [
        "Ghana Field Epidemiology and Laboratory Training Programme (GFELTP), School of Public Health, University of Ghana, Accra, Ghana",
        "Municipal Hospital, Wa, Ghana"
      ],
      "name": "Ishmael Kunateh Alhassan"
    },
    {
      "affiliations": [
        "Ghana Health Service, Upper West Regional Health Directorate, Wa, Ghana",
        "Ghana Field Epidemiology and Laboratory Training Programme (GFELTP), School of Public Health, University of Ghana, Accra, Ghana"
      ],
      "name": "Clement Akampege"
    },
    {
      "affiliations": [
        "Ghana Health Service, Upper West Regional Health Directorate, Wa, Ghana"
      ],
      "name": "Barnabas Bessing"
    }
  ],
  "title": "Evaluation of the acute flaccid paralysis surveillance system performance in the Upper West Region of Ghana from 2021 to 2023: a retrospective descriptive study",
  "uid": "74186828-b2d7-572a-aba9-7ea459bcecbb"
}