The Fascinating Case of Ghana’s fight against TB
About
The 2015 WHO report claimed that about 67% of all new TB cases remain undetected. Yet, interestingly, Ghana also has a substantial 85% of curing known cases. In 2020, Ghana had a total population of 31 million people. In that year, there were an estimated 44,000 people who developed TB. Among them 6,600 were children. Moreover, there were 31,326 missing people with TB (of which 5,988 were children).
Delft Imaging has been active in Ghana for a very long time. In 2014, we delivered the first X-ray container fitted with an EasyDR multi-functional X-ray system and CAD4TB as a pilot for the upcoming TB prevalence survey. In 2015, 4 portable X-ray systems (Atomed) were added. These 5 systems made it possible to conclude the national TB prevalence survey in a stunningly short period of 6 months. During this time, almost 60,000 people were screened for TB.
Furthermore, in 2016, we were awarded the ‘Accelerating TB Case Detection’ project, financed by the Dutch Enterprise Agency (RVO, now part of Invest International). It was a bilateral government project where both the Dutch and the Ghanaian governments actively worked together to eradicate TB in Ghana. The project would involve the installation of 52 EasyDR multi-functional stationary X-ray systems across the country. It entailed a two-year installation and training, two-year initial warranty and five year of additional maintenance – a total of nine years in which the project would run.
The 52 EasyDR X-ray systems were installed across Ghana and all systems were provided with the CAD4TB artificial intelligence software, which enabled the sites to rapidly detect TB-related abnormalities on chest X-rays. Out of the 52 EasyDR X-ray systems, 30 were installed in containerized clinics (also supplied by Delft Imaging), 20 were installed in existing hospitals and clinics, and two were installed in OneStopTB mobile screening clinics (also provided by Delft Imaging). The project included all of the necessary onsite training and installation services, and even included a comprehensive radiographer training program to build capacity across the country to operate the systems.
Over the years, the project has shown tremendous success. The initial roll-out started building up in 2018 and 2019, and up to 2022 over 1.4 million X-rays have been taken. The EasyDR X-ray system is easy to install, to maintain and to use and this has been reflected in the numbers. As part of the project, each year Delft Imaging implements a Planned Preventive Maintenance round (PPM) where each site is visited and checked to ensure it’s performing optimally. Looking at the data of 2020, 2021 and 2022, each system has had – on average – less than 0.59 calls per year for technical issues (less than 1 issue per system per year). Moreover, there were only 1.22 calls per year on IT/application issues, looking at the three year average. Furthermore, IT/application issues were resolved on average in less than <1 and technical issues in less than 2 days (again considering a three year average). If we look at data spanning 2019, 2020, 2021 and 2022, on average the satisfaction with the EasyDR was rated by the different users at 95%, on a four-year average. Moreover, 96% of the users found the Planned Preventive Maintenance rounds helpful and relevant. All data has been collected during the PPM rounds every year and reported to Ghana Health Services, as part of Ghana’s Ministry of Health.
When the COVID-19 pandemic hit, each of the 52 sites included in the ‘Accelerating TB Case Detection’ project was updated; the CAD4TB software, used normally to support TB screening in the country, was retrained to CAD4COVID (using COVID-19 data) and remotely upgraded to facilitate the detection of COVID-19 related abnormalities. Post-pandemic, all sites were switched back to CAD4TB, aiming to further support TB screening within the country further.
Over the years, Delft Imaging has provided many additional EasyDR multi-functional X-ray systems, mobile MAC systems and CAD4TB software to many institutions across the country, both public and private.
In 2022, we delivered another 20 Delft Light portable backpack X-ray system to the Ministry of Health, procured with COVID-19 funding. At the start of the ‘Accelerating TV Case Detection’ project, Delft Imaging founded Delft Imaging Ghana, a subsidiary of Delft Imaging. To date, Delft Imaging Ghana has engineers, IT- and application specialists and radiographers to support projects of Delft Imaging not only in Ghana but across the entire African continent, in close collaboration with our service partners in all individual countries. The installed based of Delft Imaging solutions in Ghana covers nearly 60 stationary EasyDR X-ray systems, two mobile X-ray systems, 20 Delft light portable backpack X-ray systems and over 85 sites using CAD4TB.
Making a Difference
For more information about the roll-out of the 52 EasyDR stationary X-ray systems across Ghana, please view the story of ‘Accelerating Case Detection of Tuberculosis in Ghana: A Health System Strengthening Project with a Focus on TB,’ presented by Dr. Nicholas Adjabu, Deputy Director of the Clinical Engineering Department at Ghana Health Service. The story was presented during the 2022 Q4 Delft webinar. The same project was also covered by the news station BBC World News, and the coverage of the of the project can be viewed here. The story was also covered on the news website Ghana Web.
The Global Fund also wrote about utilisation of the CAD4TB software, using Ghana as an example, in their article ‘Tools to Turbocharge the Fight Against Tuberculosis.’ They wrote: Artificial Intelligence (AI) has the potential to revolutionise the way X-rays are read. Many computer-aided detection tools rely on AI to rapidly and accurately read X-rays to find TB. In addition to screening for TB, a recent study found that AI could save on costs by rapidly reading X-rays to determine if further and costly testing was needed. AI has the potential to be a game-changer in the fight against TB.
The Minister of Foreign Affairs and Regional Integration, Shirley Ayorkor Botchwey, thanked the Dutch government for its strong support of Ghana’s health sector, mentioning the ORIO project, where we installed 52 portable X-ray systems, equipped with CAD4TB, across Ghana. Read about it here.
Case Study
In Ghana’s rural mining communities, an integrated mobile clinic approach was used to screen and diagnose TB, HIV, and COVID-19, reaching thousands and identifying numerous cases. Discover how this efficient strategy helps tackle these diseases by providing critical diagnostics and care in high-risk areas through this case study “Integrated Case-finding approach for TB, HIV & COVID-19 in Mining Communities with OneStopTB Mobile Clinic.”
