Factors influencing the achievement of core acute flaccid paralysis indicators in the Western North Region, Ghana, 2022

Background: In response to polio outbreaks, Ghana enhanced its Acute Flaccid Paralysis (AFP) surveillance system, revising the target for the Non-polio AFP (NP-AFP) rate for children under 15 years from at least 2 to 3 cases per 100,000 population. However, some districts in the Western North Region (WNR) continue to fall short of achieving both the NP-AFP rate and stool adequacy targets. This study examined factors influencing the achievement of core AFP indicators in the WNR. Methods: An analytical cross-sectional study was conducted from 4th to 31st October 2022 using a multistage sampling technique. Data were collected on demographic characteristics, achievement of NP-AFP rate and stool adequacy targets from January 2019 to June 2022, AFP surveillance knowledge and practices, and availability of resources. A multivariable logistic regression analysis was performed using Stata to identify factors associated with achievement of the core indicators. Results: A total of 62 health workers with median age of 34 years (IQR: 29 – 39.75) completed the survey. Only 43.6% (27/62) had worked in facilities that met both core AFP indicators during their period of service. Adequate knowledge of AFP surveillance was demonstrated by just 21.0% (13/62), and 37.1% (23/62) had both good surveillance practices and adequate resources. Notably, access to adequate resources was significantly associated with higher odds of achieving both indicators (aOR = 4.5, 95% CI: 1.1–19.8, p = 0.045), while working in a health centre was associated with significantly lower odds (aOR = 0.05 95% CI: 0.0–0.44, p = 0.007) Conclusions: Achievement of core AFP surveillance indicators in the WNR remains suboptimal. Inadequate knowledge, poor surveillance practices, insufficient resources and lower level health facilities were major contributors. To strengthen early detection and improve performance, the WNR Health Directorate should prioritize health centers, training and ensure consistent provision of logistics such as vehicles, fuel, stool containers, and specimen carriers.