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Operational adaptations of the trachoma pre-validation surveillance strategy employed in Ghana: a qualitative assessment of successes and challenges.
Infectious Diseases of Poverty ( IF 8.1 ) Pub Date : 2019-08-27 , DOI: 10.1186/s40249-019-0585-x
Laura Senyonjo 1, 2 , Agatha Aboe 3 , Robin Bailey 2 , David Agyemang 3 , Benjamin Marfo 4 , Seth Wanye 4 , Elena Schmidt 1 , James Addy 4 , Karl Blanchet 5
Affiliation  

BACKGROUND In 2009 Ghana began to design a trachoma pre-validation surveillance plan, based on then-current WHO recommendations. The plan aimed to identify active trachoma resurgence and identify and manage trichiasis cases, through both active and passive surveillance approaches. This paper outlines and reviews the adaptations made by Ghana between 2011 and 2016. The assessment will provide a learning opportunity for a number of countries as they progress towards elimination status. METHODS A mixed methods approach was taken, comprising in-depth interviews and documents review. Between January and April 2016, 20 in-depth interviews were conducted with persons involved in the operationalisation of the trachoma surveillance system from across all levels of the health system. A three-tier thematic coding framework was developed using a primarily inductive approach but also allowed for a more iterative approach, which drew on aspects of grounded theory. RESULTS During the operationalisation of the Ghana surveillance plan there were a number of adaptations (as compared to the WHO recommendations), these included: (i) Inclusion of surveillance of active trachoma in the passive surveillance approach, as compared to trichiasis alone. Issues with case identification, challenges in implementation coverage and a non-specific reporting structure hampered effectiveness; (ii) Random selection and increase in number of sites selected for the active surveillance component. This likely lacked the spatiotemporal power to be able to identify recrudescence in a timely manner; (iii) Targeted trichiasis door-to-door case searches, led by ophthalmic nurses. An effective methodology to identify trichiasis cases but resource intensive; (iv) A buddy system between ophthalmic nurses to support technical skills in an elimination setting where it is difficult to attain diagnostic and surgical skills, due to a lack of cases. The strategy did not take into account the loss of proficiency within experienced personnel. CONCLUSIONS Ghana developed a comprehensive surveillance system that exceeded the WHO recommendations but issues with sensitivity and specificity likely led to an inefficient use of resources. Improved targeted surveillance strategies for identification of recrudescence and trichiasis case searches, need to be evaluated. Strategies must address the contextual changes that arise because of transmission decline, such as loss of surgical skills.

中文翻译:

加纳采用的沙眼验证前监测策略的业务适应性:对成功和挑战的定性评估。

背景技术2009年,加纳根据世卫组织当前的建议开始设计沙眼验证前监测计划。该计划旨在通过主动和被动监视方法来识别主动沙眼复发,并识别和管理倒睫病例。本文概述并回顾了加纳在2011年至2016年之间所做的改编。该评估将为许多国家在实现消灭地位的进程中提供学习的机会。方法采用了混合方法,包括深度访谈和文档审查。在2016年1月至2016年4月期间,对卫生系统各个层面的沙眼监测系统投入运行的人员进行了20次深入访谈。使用主要归纳方法开发了三层主题编码框架,但也允许使用基于基础理论的更多迭代方法。结果在加纳监测计划的实施过程中,进行了许多调整(与WHO的建议相比),其中包括:(i)与仅对倒睫患者相比,在主动监测方法中包括了对主动沙眼的监测。案件查明,执行范围方面的挑战以及报告结构不明确等问题妨碍了有效性;(ii)随机选择并增加为主动监视组件选择的站点数量。这可能缺乏时空力量,无法及时发现复发。(iii)有针对性的倒睫病门到门病例搜索,由眼科护士领导。识别倒睫病例但资源密集的有效方法;(iv)眼科护士之间的伙伴系统,以在由于情况缺乏而难以获得诊断和手术技能的消除环境中支持技术技能。该策略没有考虑到经验丰富的人员的熟练程度的损失。结论加纳开发了一个全面的监测系统,该系统超出了世界卫生组织的建议,但敏感性和特异性问题可能导致资源利用效率低下。需要评估用于确定复发和反倒睫病例搜索的改进的有针对性的监测策略。策略必须解决因传播减少而引起的情境变化,例如手术技能的丧失。识别倒睫病例但资源密集的有效方法;(iv)眼科护士之间的伙伴系统,以在由于情况缺乏而难以获得诊断和手术技能的消除环境中支持技术技能。该策略没有考虑到经验丰富的人员的熟练程度的损失。结论加纳开发了一个全面的监测系统,该系统超出了世界卫生组织的建议,但敏感性和特异性问题可能导致资源利用效率低下。需要评估用于确定复发和反倒睫病例搜索的改进的有针对性的监测策略。策略必须解决因传播减少而引起的情境变化,例如手术技能的丧失。识别倒睫病例但资源密集的有效方法;(iv)眼科护士之间的伙伴系统,以在由于情况缺乏而难以获得诊断和手术技能的消除环境中支持技术技能。该策略没有考虑到经验丰富的人员的熟练程度的损失。结论加纳开发了一个全面的监测系统,该系统超出了世界卫生组织的建议,但敏感性和特异性问题可能导致资源利用效率低下。需要评估用于确定复发和反倒睫病例搜索的改进的有针对性的监测策略。策略必须解决因传播减少而引起的情境变化,例如手术技能的丧失。
更新日期:2019-08-27
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