Acute flaccid paralysis surveillance system evaluation in the Adentan Municipality of the Greater Accra Region, Ghana, 2025

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Introduction Acute flaccid paralysis (AFP) surveillance is an important component of the Global Polio Eradication Initiative and helps identify poliovirus in children under 15 years of age. In Ghana, it is implemented through the IDSR system, which includes reporting, stool sample collection, and laboratory confirmation. Wild poliovirus is not present in Ghana, however, there is a risk of circulating vaccine-derived poliovirus type 2 (cVDPV2). AFP surveillance in Adentan Municipality was assessed to identify areas for improvement and to evaluate its usefulness and key attributes, such as simplicity, flexibility, sensitivity, data quality, and timeliness. Methods A cross-sectional evaluation was conducted using CDC’s updated guidelines and WHO performance standards for AFP surveillance. Data from 2020–2024 were drawn from SORMAS, structured checklists, and interviews with key health staff. Analyses were conducted in Excel and Stata v17, with findings presented using tables, graphs, and charts. Results Twenty-four surveillance stakeholders participated in the evaluation. The system demonstrated strong stability (84.7%) and moderate simplicity (62.1%). However, only 42% of facilities had complete AFP toolkits, and 60% had inadequate staff training. Timely reporting and 60-day follow-up were inconsistent. GPS coordinates were documented in just 13.5% of cases in the region, limiting geospatial analysis. All districts, including Adentan, had AFP cases, indicating widespread coverage. The predictive value was 0.0 because no lab-confirmed AFP cases were available. Conclusion The Adentan AFP surveillance system is operationally stable and structurally sound, but faces challenges in data completeness, sensitivity, and timeliness. The system needs targeted staff training, improved logistics for specimen collection, enforcement of GPS documentation, and the use of feedback dashboards to improve performance. These actions are vital to strengthen early detection and rapid response capacity in support of polio eradication goals.