{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,14]],"date-time":"2025-05-14T04:13:10Z","timestamp":1747195990382,"version":"3.40.5"},"reference-count":31,"publisher":"Public Library of Science (PLoS)","issue":"1","license":[{"start":{"date-parts":[[2021,1,5]],"date-time":"2021-01-05T00:00:00Z","timestamp":1609804800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/publicdomain\/zero\/1.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>The 2013\u20132016 Ebola Virus Disease (EVD) outbreak remains the largest on record, resulting in the highest mortality and widest geographic spread experienced in Africa. Ghana, like many other African nations, began screening travelers at all entry points into the country to enhance disease surveillance and response. This study aimed to assess the challenges of screening travelers for EVD at border entry in northern Ghana.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Design and methods<\/jats:title>\n<jats:p>This was an observational study using epidemiological weekly reports (Oct 2014-Mar 2015) of travelers entering Ghana in the Upper East Region (UER) and qualitative interviews with 12 key informants (7 port health officers and 5 district directors of health) in the UER. We recorded the number of travelers screened, their country of origin, and the number of suspected EVD cases from paper-based weekly epidemiological reports at the border entry. We collected qualitative data using an interview guide with a particular focus on the core and support functions (e.g. detection, reporting, feedback, etc.) of the World Health Organization\u2019s Integrated Disease Surveillance and Response system. Quantitative data was analyzed based on travelers screened and disaggregated by the three most affected countries. We used inductive approach to analyze the qualitative data and produced themes on knowledge and challenges of EVD screening.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>A total of 41,633 travelers were screened, and only 1 was detained as a suspected case of EVD. This potential case was eventually ruled out via blood test. All but 52 of the screened travelers were from Ghana and its contiguous neighbors, Burkina Faso and Togo. The remaining 52 were from the four countries most affected by EVD (Guinea, Liberia, Sierra Leone, and Mali). Challenges to effective border screening included: inadequate personal protective equipment and supplies, insufficient space or isolation rooms and delays at the border crossings, and too few trained staff. Respondents also cited lack of capacity to confirm cases locally, lack of cooperation by some travelers, language barriers, and multiple entry points along porous borders. Nonetheless, no potential Ebola case identified through border screening was confirmed in Ghana.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Screening for Ebola remains sub-optimal at the entry points in northern Ghana due to several systemic and structural factors. Given the likelihood of future infectious disease outbreaks, additional attention and support are required if Ghana is to minimize the risk of travel-related spread of illness.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0245039","type":"journal-article","created":{"date-parts":[[2021,1,5]],"date-time":"2021-01-05T20:39:53Z","timestamp":1609879193000},"page":"e0245039","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":2,"title":["Self-reported challenges to border screening of travelers for Ebola by district health workers in northern Ghana: An observational study"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1094-8212","authenticated-orcid":true,"given":"John Koku","family":"Awoonor-Williams","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cheryl A.","family":"Moyer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0167-5512","authenticated-orcid":true,"given":"Martin Nyaaba","family":"Adokiya","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2021,1,5]]},"reference":[{"key":"pone.0245039.ref001","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12913-017-2225-0","article-title":"Health workers perceptions and attitude about Ghana\u2019s preparedness towards preventing, containing, and managing Ebola Virus Disease","volume":"17","author":"PB Adongo","year":"2017","journal-title":"BMC Health Serv Res"},{"key":"pone.0245039.ref002","doi-asserted-by":"crossref","DOI":"10.3390\/ijerph16234638","article-title":"Exit and entry screening practices for infectious diseases among travelers at points of entry: Looking for evidence on public health impact","volume":"16","author":"VA Mouchtouri","year":"2019","journal-title":"Int J Environ Res Public Health"},{"key":"pone.0245039.ref003","first-page":"1","author":"MFC Gomes","year":"2014","journal-title":"Assessing the International Spreading Risk Associated with the 2014 West African Ebola Outbreak"},{"key":"pone.0245039.ref004","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1016\/S0140-6736(14)61828-6","article-title":"Assessment of the potential for international dissemination of Ebola virus via commercial air travel during the 2014 west African outbreak","volume":"385","author":"II Bogoch","year":"2015","journal-title":"Lancet"},{"key":"pone.0245039.ref005","first-page":"2014","volume":"385","author":"BJ Cowling","year":"2015","journal-title":"Ebola: worldwide dissemination risk and response priorities"},{"key":"pone.0245039.ref006","first-page":"1","author":"KA Alexander","year":"2015","journal-title":"What Factors Might Have Led to the Emergence of Ebola in West Africa?"},{"key":"pone.0245039.ref007","first-page":"1","author":"N Gray","year":"2018","journal-title":"When Ebola enters a home, a family, a community \u2018: A qualitative study of population perspectives on Ebola control measures in rural and urban areas of Sierra Leone"},{"key":"pone.0245039.ref008","doi-asserted-by":"crossref","first-page":"637","DOI":"10.1016\/S0140-6736(14)61377-5","article-title":"Ebola: a failure of international collective action","volume":"384","author":"T. Lancet","year":"2013","journal-title":"Lancet"},{"key":"pone.0245039.ref009","first-page":"1","author":"L Rossi","year":"2018","journal-title":"Assessing the International Spreading Risk Associated with the 2014 West African Ebola Outbreak"},{"key":"pone.0245039.ref010","first-page":"197","volume":"21","author":"LA Selvey","year":"2015","journal-title":"Entry Screening for Infectious Diseases in Humans"},{"key":"pone.0245039.ref011","unstructured":"WHO. WHO Interim Guidance for Ebola Virus Disease Exit Screening at Airports, Ports and Land Crossings. 2014."},{"key":"pone.0245039.ref012","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1146\/annurev-anthro-102116-041616","article-title":"Epidemics (Especially Ebola)","volume":"46","author":"S Abramowitz","year":"2017","journal-title":"Annu Rev Anthropol"},{"key":"pone.0245039.ref013","unstructured":"ECDC. Infection prevention and control measures for Ebola virus disease: Entry and exit screening measures. 2014."},{"key":"pone.0245039.ref014","doi-asserted-by":"crossref","first-page":"577","DOI":"10.1007\/s10995-007-0289-x","article-title":"Maternal Mortality Decline in the Kassena-Nankana District of Northern Ghana","volume":"12","author":"S Mills","year":"2008","journal-title":"Matern Child Health J"},{"key":"pone.0245039.ref015","unstructured":"Ghana Health Service. Ghana Health Service 2012 Annual Report. 2013."},{"key":"pone.0245039.ref016","first-page":"968","author":"AR Oduro","year":"2012","journal-title":"Profile of the Navrongo Health and Demographic Surveillance System"},{"key":"pone.0245039.ref017","unstructured":"Ghana Statistical Service. 2010 Population & Housing Census: Regional Analytical Report\u2014Upper East Region. Accra; 2013. Available: https:\/\/www.ndpc.gov.gh\/downloads\/53\/"},{"key":"pone.0245039.ref018","doi-asserted-by":"crossref","DOI":"10.1596\/978-0-8213-9589-9","volume-title":"Decentralization and Governance in the Ghana Health Sector","author":"BF Couttolenc","year":"2012"},{"key":"pone.0245039.ref019","doi-asserted-by":"crossref","first-page":"1481","DOI":"10.1056\/NEJMoa1411100","article-title":"Ebola virus disease in West Africa\u2014The first 9 months of the epidemic and forward projections","volume":"371","author":"B Aylward","year":"2014","journal-title":"N Engl J Med"},{"key":"pone.0245039.ref020","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1177\/1098214005283748","article-title":"A General Inductive Approach for Analyzing Qualitative Evaluation Data","volume":"27","author":"DR Thomas","year":"2006","journal-title":"Am J Eval"},{"key":"pone.0245039.ref021","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1177\/1609406917733847","article-title":"Thematic Analysis: Striving to Meet the Trustworthiness Criteria","volume":"16","author":"LS Nowell","year":"2017","journal-title":"Int J Qual Methods"},{"key":"pone.0245039.ref022","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1177\/146879410100100307","article-title":"Thematic networks: an analytic tool for qualitative research","volume":"1","author":"J. Attride-Stirling","year":"2001","journal-title":"Qual Res"},{"key":"pone.0245039.ref023","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1371\/journal.pone.0166797","article-title":"Development and implementation of the Ebola traveler monitoring program and clinical outcomes of monitored travelers during October\u2014May 2015, Minnesota","volume":"11","author":"A DeVries","year":"2016","journal-title":"PLoS One"},{"key":"pone.0245039.ref024","doi-asserted-by":"crossref","first-page":"1","DOI":"10.2807\/1560-7917.ES2014.19.42.20936","article-title":"Assessing the impact of travel restrictions on international spread of the 2014 west African Ebola epidemic","volume":"19","author":"Poletto","year":"2014","journal-title":"Eurosurveillance"},{"key":"pone.0245039.ref025","doi-asserted-by":"crossref","first-page":"1012","DOI":"10.3201\/eid2106.150013","article-title":"Ebola risk perception in Germany, 2014","volume":"21","author":"N R\u00fcbsamen","year":"2015","journal-title":"Emerg Infect Dis"},{"key":"pone.0245039.ref026","article-title":"Dynamics and control of Ebola virus transmission in Montserrado, Liberia: A mathematical modelling analysis","author":"JA Lewnard","year":"2014","journal-title":"Lancet Infect Dis"},{"key":"pone.0245039.ref027","first-page":"1","author":"MN Adokiya","year":"2015","journal-title":"The integrated disease surveillance and response system in northern Ghana: challenges to the core and support functions"},{"key":"pone.0245039.ref028","first-page":"1","article-title":"Challenges to Ebola preparedness during an ongoing outbreak: An analysis of borderland livelihoods and trust in Uganda","volume":"15","author":"MM Schmidt-Sane","year":"2020","journal-title":"PLoS One"},{"journal-title":"Assessment of the core and support functions of the Integrated Disease Surveillance system in Maharashtra, India","year":"2013","author":"RK Phalkey","key":"pone.0245039.ref029"},{"key":"pone.0245039.ref030","first-page":"196","article-title":"Structure and performance of infectious disease surveillance and response, United Republic of Tanzania, 1998","volume":"80","author":"P Nsubuga","year":"2002","journal-title":"Bull World Health Organ"},{"key":"pone.0245039.ref031","first-page":"1","volume":"14","author":"VM Kiberu","year":"2014","journal-title":"Strengthening district-based health reporting through the district health management information software system: the Ugandan experience"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0245039","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,1,5]],"date-time":"2021-01-05T20:40:12Z","timestamp":1609879212000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0245039"}},"subtitle":[],"editor":[{"given":"Ka Chun","family":"Chong","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2021,1,5]]},"references-count":31,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2021,1,5]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0245039","relation":{},"ISSN":["1932-6203"],"issn-type":[{"type":"electronic","value":"1932-6203"}],"subject":[],"published":{"date-parts":[[2021,1,5]]}}}