Contributory factors to specimen rejection for measles and yellow fever testing at the National Public Health and Reference Laboratory, Accra, Ghana

Introduction: The National Public Health and Reference Laboratory (NPHRL) in 2024 reported an increase in measles and yellow fever specimen rejection which threatened timely outbreak detection and response. We conducted this study to systematically review and identify the root causes of these rejections at referring peripheral facilities to inform targeted public health interventions and strengthen the surveillance system. Methods: A mixed-methods study was conducted among six peripheral health facilities with the highest specimen rejection rates. These facilities are in the Upper West and Ashanti regions. A structured questionnaire was used to assess the knowledge and practices of health care workers within the facilities directly involved in measles and yellow fever specimen collection and handling. An independent onsite audit was also conducted using a structured checklist. Data was collected into a Microsoft Excel template, cleaned and analyzed using descriptive statistics and thematic comparison of self-reported practices versus audited realities. Participants comprised 14 laboratory personnel, laboratory managers, nurses, and disease control officers directly involved in measles and yellow fever specimen collection and handling. Results: A total of 15 health care workers were assessed. These consisted of 5 laboratory Scientists/Technicians,2 nurses, and 7 disease surveillance officers. Majority of staff 53.3% (8/15) had no training on specimen collection and handling. Up to 40.0% (6/15) of facilities lack effective sample transportation logistics and 86.7% (13/15) of facilities lacked temperature tracking tools during sample transportation. All facilities lacked specimen referral logs and a formal Corrective and Preventive Action (CAPA) system. Conclusion: High measles and yellow fever specimen rejection was due to lack of trained staff and sample management logistics at the selected facilities. Immediate remedial measure includes the establishment of a dedicated cold-chain logistics network to ensure specimen delivery within 72 hours and institution of a mandatory competency-based training linked to facility performance targets. Prioritizing these will improve specimen integrity and strengthen surveillance system.