Table 2 Summary of the adaptations to the Ghana trachoma pre-validation surveillance system
No | Challenges in surveillance | Recommendations from WHO (2008 guidance) | Adaptations introduced by Ghana Health Service |
|---|---|---|---|
1 | How to identify resurgence of active trachoma (TF) using the passive surveillance system | None, concentrate on identification of TF through active surveillance approaches | Monitoring of active infection is integrated as part of the passive surveillance approach; a non-specific case definition was used initially but all suspected cases were expected to be verified by ophthalmic nurses |
2 | Site selection for active surveillance that would ensure resurgence of active trachoma identified in a timely manner | Purposeful selection of two sites per district for monitoring of TF in school-aged children, biased to sites at the most risk of trachoma | Screening of children aged 1–9 years in two randomly selected communities and five schools per district per year |
3 | Identify and manage TT backlog, especially where failure to do so may threaten TT elimination thresholds | Countries to have an adequate system in place to be able to collect and analyse the number of TT cases identified and managed (operated on) per year. Methodologies for collecting these data include door-to-door TT case search either as a stand-alone activity or co-ordinated with other ophthalmic campaigns | Intensified TT door-to-door case search, led by ONs. This was targeted to specified districts that had failed to meet the TT elimination thresholds as determined through impact assessments or pre-validation surveillance surveys |
4 | Deskilling of staff and new staff entering a setting with few cases to acquire skills | None | Buddy system to support technical skills |