Background

The 2013–2016 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.

Design and methods

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’s 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.

Results

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.

Conclusion

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.

中文翻译：

---

加纳北部地区卫生工作者自我报告对埃博拉旅行者进行边境筛查的挑战：一项观察性研究

背景

2013-2016 年埃博拉病毒病 (EVD) 疫情仍然是有记录以来最大规模的一次，导致非洲死亡率最高、地理传播范围最广。加纳与许多其他非洲国家一样，开始在该国所有入境点对旅行者进行筛查，以加强疾病监测和应对。本研究旨在评估在加纳北部边境入境时筛查旅行者埃博拉病毒病的挑战。

设计与方法

这是一项观察性研究，使用了上东部地区 (UER) 进入加纳的旅行者的流行病学每周报告（2014 年 10 月至 2015 年 3 月），并对 UER 的 12 名主要信息提供者（7 名港口卫生官员和 5 名地区卫生主管）进行定性访谈。我们通过边境入境处的纸质每周流行病学报告记录了接受筛查的旅客人数、原籍国以及疑似埃博拉病毒病病例数。我们使用访谈指南收集定性数据，特别关注世界卫生组织综合疾病监测和应对系统的核心和支持功能（例如检测、报告、反馈等）。定量数据是根据受影响最严重的三个国家筛选和分类的旅行者进行分析的。我们使用归纳法来分析定性数据，并提出了有关埃博拉病毒病筛查知识和挑战的主题。

结果

共有 41,633 名旅客接受了筛查，只有 1 人因埃博拉病毒病疑似病例而被拘留。最终通过验血排除了这一潜在病例。除 52 名接受筛查的旅客外，其余所有旅客均来自加纳及其邻国布基纳法索和多哥。其余 52 人来自受埃博拉病毒病影响最严重的四个国家（几内亚、利比里亚、塞拉利昂和马里）。有效边境筛查面临的挑战包括：个人防护设备和用品不足、空间或隔离室不足、过境点延误以及训练有素的工作人员太少。受访者还指出，当地缺乏确认病例的能力、一些旅行者缺乏合作、语言障碍以及边境线上多个入境点。尽管如此，加纳并未确认通过边境筛查发现的潜在埃博拉病例。

结论

由于多种系统性和结构性因素，加纳北部入境点的埃博拉筛查工作仍不理想。考虑到未来传染病爆发的可能性，如果加纳要尽量减少与旅行相关的疾病传播的风险，就需要额外的关注和支持。