title: Assessment of the usefulness of integrated disease surveillance and response on suspected ebola cases in the Brong Ahafo Region, Ghana.
abstract: BACKGROUND
  This study assessed the quality, core and support functions of the integrated disease surveillance and response (IDSR) system relating to 18 suspected cases of Ebola virus disease (EVD) in the Brong Ahafo Region, Ghana.
  
  
  METHODS
  Data was collected on selected indicators of the surveillance system relating to 18 suspected cases of EVD, from epidemiological week 19 to 45 of 2014. We conducted in-depth interviews with seven medical directors and two district directors of health services, and also reviewed documentation on the implementation of the core, support and quality functions of the IDSR system. We also monitored news in the media and rumours about EVD within the community as well as in health facility surveillance registers.
  
  
  RESULTS
  The study identified gaps in the implementation of IDSR relating to 18 suspected cases of EVD. Health staff heavily relied on haemorrhage as the only symptom for detection of suspected EVD cases. Twelve blood samples and a swab of secretions from the mouth of the thirteenth patient (who died) tested negative for EVD using PCR assay in laboratory confirmation. The blood samples of three patients were discarded, as they did not fit the case definition for suspected cases, whilst two refused for their blood samples to be taken. The community-based surveillance (CBS) system has not been given a prominent role in EVD surveillance and response, as demonstrated by CBS volunteers and health staff not receiving any training in these processes. There was intense public interest in EVD in August and September 2014. That interest has since waned for reasons that have to be formally ascertained. Unfounded fear of and anxiety about EVD still remain challenges due to a lack of in-depth knowledge about the disease in Ghana.
  
  
  CONCLUSIONS
  Ghana has been one of the pioneers in the implementation of IDSR in Africa. Despite this, gaps have been identified in the implementation of IDSR relating to EVD in the Brong Ahafo Region. To address these gaps, the CBS system has to actively partner with health facility surveillance to achieve effective IDSR in the region.
authors: Ghana Health Service, Regional Health Directorate, P.O. Box 145, Sunyani, Brong Ahafo Region Ghana.
authors: Kofi
authors: K
authors: Issah
authors: Ghana Health Service, Regional Health Directorate, P.O. Box 145, Sunyani, Brong Ahafo Region Ghana.
authors: Kennedy
authors: K
authors: Nartey
authors: Ghana Health Service, Regional Health Directorate, P.O. Box 145, Sunyani, Brong Ahafo Region Ghana.
authors: Richard
authors: R
authors: Amoah
authors: Ghana Health Service, Regional Health Directorate, P.O. Box 145, Sunyani, Brong Ahafo Region Ghana.
authors: Emmanuel George
authors: EG
authors: Bachan
authors: Ghana Health Service, Regional Health Directorate, P.O. Box 145, Sunyani, Brong Ahafo Region Ghana.
authors: Jacob
authors: J
authors: Aleeba
authors: Kintampo Health Centre, Ghana Health Service, Kintampo, Brong Ahafo Region Ghana.
authors: Enuamah
authors: E
authors: Yeetey
authors: Ghana Health Service, Regional Health Directorate, P.O. Box 145, Sunyani, Brong Ahafo Region Ghana.
authors: Timothy
authors: T
authors: Letsa
keywords: Brong Ahafo; Disease surveillance; Ebola; Ghana