The Fascinating Case of Ghana’s fight against TB

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 2016, Delft Imaging was awarded the ‘Accelerating TB Case Detection’ project, a project financed by the Dutch Enterprise Agency (RVO, now part of Invest International). 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 man 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 1.2 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.

Making a difference

Over the years, Delft Imaging has provided many additional EasyDR multi-functional X-ray systems, mobile MAC X-ray systems and CAD4TB software to many institutions across the country, both public and private.

In 2022, Delft Imaging delivered another 20 Delft Light portable backpack X-ray systems to the Ministry of Health, procured with COVID-19 funding.

At the start of the ‘Accelerating TB 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.

In total, the installed base of Delft Imaging solutions in Ghana covers close to 60 stationary EasyDR X-ray systems, 2 mobile X-ray systems, 20 Delft Light portable backpack X-ray systems and over 85 sites using CAD4TB.