Conference Abstract | Volume 9, Abstract 0014 (ConfProc7) | Published: 20 Apr 2026
Ebenezer Tagoe1,2,3,&, Rita Agyekumwah Asante2, Estella Abazesi3
¹Ghana Health Service, Bongo District, Upper East Region, Ghana, ²Ghana Field Epidemiology and Laboratory Training Program – Frontline Training, School of Public Health, University of Ghana, Accra, Ghana, ³Bongo District Health Directorate, Ghana Health Service, Bongo, Ghana
&Corresponding author: Ebenezer Tagoe, Ghana Health Service, Bongo District, Ghana, Email: ebentozua1983@gmail.com, ORCID: https://orcid.org/0009-0005-5605-4483
Received: 29 Aug 2025, Accepted: 28 Oct 2025, Published: 20 Apr 2026
Domain: Infectious Disease Epidemiology
Keywords: Disease surveillance, Case reporting, Fishbone analysis, IDSR, Ghana
©Ebenezer Tagoe et al. Journal of Interventional Epidemiology and Public Health (ISSN: 2664-2824). This is an Open Access article distributed under the terms of the Creative Commons Attribution International 4.0 License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Cite this article: Ebenezer Tagoe et al. Silent signals in Bongo: Root cause analysis of case reporting gaps in disease surveillance, 2025. Journal of Interventional Epidemiology and Public Health. 2026;9(ConfProc7):014. https://doi.org/10.37432/JIEPH-CONFPRO7-0014
Accurate case reporting is essential for effective disease surveillance, yet significant reporting gaps persist in resource-limited settings. A prior Data Quality Audit in Bongo District revealed weaknesses in the Integrated Disease Surveillance and Response (IDSR) system, including incomplete reporting and inconsistent application of case definitions. This study aimed to conduct a systematic problem analysis to identify the root causes of inadequate case reporting in the district.
A cross-sectional study was conducted in August 2025 using a participatory fishbone (Ishikawa) analysis. Two structured brainstorming sessions were held with health workers from different cadres, including disease control officers, nurses, midwives, and district management staff. Identified root causes were categorized into human resource, material, process, technological, and environmental factors. These were further classified using the TPN (Totally, Partially, Not controllable) framework to determine the level of local control over each factor. Findings were summarized and presented using a fishbone diagram.
A total of 26 health workers participated, of whom 61.5% (16/26) were female. Fifteen distinct root causes were identified. Totally controllable factors included poor understanding of IDSR case definitions, lack of orientation for newly posted staff, inadequate ICT training, and poor staff attitudes toward reporting. Partially controllable factors included delayed feedback from higher administrative levels, lack of laptops for data entry, and limited reporting tools. Non-controllable factors included poor internet connectivity and inadequate funding for supervisory activities. Poor understanding of IDSR case definitions emerged as the most critical barrier to accurate case detection and reporting.
The analysis showed that many barriers to effective case reporting in Bongo District are locally controllable, particularly those related to staff knowledge and training. Strengthening staff capacity through regular orientation on case definitions and ICT skills could significantly improve IDSR implementation and disease surveillance performance.
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