Cholera surveillance system evaluation, at La Nkwantanang Madina Municipal, Greater Accra Region, Ghana 2025

Introduction: Cholera is a global public health concern, with an annual estimated 1.3-4.0 million cases and 21,000-143,000 deaths. Ghana, including Greater Accra region, has experienced outbreaks in 2024-2025. We evaluated the cholera surveillance system’s objectives, attributes, and usefulness in guiding timely interventions and informing public health policy. Methods: The evaluation was conducted at La Nkwantanang Madina Municipal, from March-April, 2025. We assessed the operations, attributes and performance using the CDC guidelines 2001. District health facilities surveillance records from 2020-2024 were reviewed, 15 key informants were interviewed using a questionnaire. The responses were scored from 1-5, expressed in percent and interpreted as Poor ≤49%, Good 50-69% and Excellent ≥ 70%. Results: All respondents (100%) reported that the case-based and investigation forms were simple to complete. However, 71.4% of facilities lacked case definition posters and were unable to describe the standard case definition. Rapid diagnostic tests were unavailable in all facilities. The system was considered flexible as 80% of the respondents agreed it can be integrated with other systems. Most facilities (71.4%) used the system for reporting. All (100%) respondents indicated that patients sought care and accepted the system. Timeliness was adequate, with all (100%) respondents confirming that samples and reports were submitted promptly to the next level. However, 73.3% reported challenges in receiving feedback on results. All (100%) facilities maintained records, 20% reported missing data, including the district health directorate. Conclusion: The system achieved its objectives, demonstrated high level of simplicity, acceptability, timeliness and flexibility, and proved useful. Nonetheless, challenges with data quality and feedback were identified. Staff were trained on the standard case definition and encouraged to conduct regular data analysis. We recommend district and facilities to display analyzed data and ensure timely feedback, the region should provide cholera RDT kits and other essential logistics to strengthen the system.