Texila International Journal of Public Health ISSN: 2520-3134 DOI: 10.21522/TIJPH.2013.12.04.Art095 Received: 16.10.2024 Accepted: 08.11.2024 Published on: 10.12.2024 Corresponding Author: vcwutor@gmail.com Ghana Needs a Comprehensive Blueprint for Pandemic Management Victor Collins Wutor1,2* and Benoit Banga N’Guessan3,4,5 1Department of Biotechnology, Microbiology and Public Health, AEServe, Lethbridge, AB, Canada. 120 Couleesprings Way South. Lethbridge. Alberta T1K 5C5, Canada 2Pharmacy and Pharmaceutical Sciences. University of Alberta. 2-35 Medical Sciences Building. Edmonton, Alberta T6G 2H1, Canada 3Department of Pharmacology and Toxicology, School of Pharmacy, College of Health Sciences, University of Ghana, Legon, Accra, Ghana 4Department of Pharmacology and Toxicology, School of Pharmacy, University of Health and Allied Sciences, Ho, Volta Region, Ghana 5Institute of Traditional and Alternative Medicine, University of Health and Allied Sciences, Ho, Volta Region, Ghana Abstract This major study aimed to determine Ghanaian physicians, pharmacists, and nurses' knowledge, perception, and preparedness for a pandemic or another wave of COVID-19. The cross-sectional study, comprising 55 questions about COVID-19 knowledge, 29 about perception, and 21 about preparedness, was conducted between May and July 2023. The questionnaire was distributed through various social media platforms, ensuring a national reach. Participation from all 16 regions of Ghana was recorded for all three professionals. The inclusion criteria, a key aspect, are based on the healthcare professionals directly linked with hospitals and facilities who had direct contact with patients. Three thousand three hundred and twenty-three healthcare professionals responded to the survey, giving a 97% response rate. Seven hundred seventy-seven physicians, 1199 pharmacists, and 1347 nurses responded to the study, showcasing the extensive expertise of Ghanaian healthcare professionals. The findings reveal that Ghanaian physicians ranked high regarding their knowledge of COVID-19. Our study further shows that 98% of the pharmacist participants provided positive feedback about knowledge-related questions and an adequate understanding of attitudes toward coronavirus symptoms, transmission, disease severity, and preventive measures. The study also reveals that Ghanaian nurses were knowledgeable, had a good perception, and were prepared for a pandemic or another wave of COVID-19. However, the study also highlights a concerning trend where the level of preparedness for a pandemic or another wave of COVID- 19 was low in all instances. In conclusion, this study underscores the critical role of knowledge in shaping the actions of Ghanaian healthcare professionals in response to the COVID-19 pandemic threats. It also emphasizes the urgent need for a comprehensive blueprint for pandemic management in Ghana to address this gap. Keywords: COVID-19, Ghana, Knowledge, Nurses, Physicians, Pharmacist, Perception, Preparedness. Introduction The emergence of novel diseases during the 20th century led to a significant health crisis for the new generation (21). The coronavirus (COVID-19) pandemic has recently shaken the world globally. According to the report, by the 10th of August 2020, over 19.8 million people were affected, and more than 733,000 people worldwide died due to coronavirus [8]. Healthcare professionals have been impacted particularly by this pandemic, which accounts for approximately 10% or more of the infections as per the World Health Organization (WHO) [17]. By July 2020, affecting over 10,000 medical professionals (across 40 countries), COVID-19 has remained the continuous cause of death of people in Africa [17, 24]. Underlying the epidemic among these frontline workers are various factors that may be shaping healthcare workers risk of COVID-19, including preparedness indicators such as inadequate training, protocols, knowledge, personal protection equipment (PPE), as well as weak health systems, slow national responses, and poor political leadership [13]. However, the data indicated the inadequate preparedness of the medical workers during the pandemic [19]. Despite the challenges, frontline healthcare professionals in Ghana have shown commendable resilience and positive attitudes toward health and safety practices during the COVID-19 pandemic [12]. Ghana's preparedness for health crises, including COVID-19, has similarities in training healthcare workers, health infrastructure, public engagement, and political decisions, drawing lessons from past crises like Ebola [4]. The COVID-19 pandemic in Ghana has had significant indirect effects, impacting health-seeking behaviour, access to healthcare, and malaria prevention measures [4]. A study evaluating Ghanaian health workers' response to COVID-19 found high compliance with safety protocols, with factors like profession, years of experience, facility type, and region influencing the perceived risk of COVID-19 [21]. These findings suggest that Ghanaian healthcare professionals are prepared to face future pandemics by emphasizing adherence to safety protocols and addressing individual and systemic factors affecting risk perception. This study reveals the preparedness level of Ghanaian healthcare medical professionals and their positive perception of dealing with the upcoming future wave of the pandemic. This questionnaire-based survey is conducted at the national level in Ghana. Materials and Methods This cross-sectional questionnaire-based study was conducted to observe the preparedness level of healthcare professionals for a future pandemic or another wave of COVID-19 in Ghana. We used a convenient sampling technique to recruit professionals via social media platforms like Facebook, WhatsApp, and Email. The primary purpose of choosing this sampling technique is to obtain data across 16 different regions of Ghana at the national level. This design facilitates obtaining data at a single point without including observed variables. The standard eligibility criteria were identifying as health workers based in Ghana. The requirements include only those professionals still practising and affiliated with hospitals or health centres at the Government, public, or private levels. The instruments utilized in prior relevant studies were analyzed thoroughly to make the questionnaire more feasible and valid. The data was collected between May and July 2023. All the 260 districts comprising 16 total regions were targeted, and data was collected across the board to make this study more purposeful at the national level. The study participants were physicians, pharmacists, and nurses only. The sample size for the study was determined by using the online OpenEpi formula (https://www.openepi.com/SampleSize/SSPropo r.htm), targeting a 95% confidence level, a standard deviation of 0.5, and a confidence interval (margin of error) of ± 5%. The Statistical Package for the Social Sciences (SPSS Inc., version 22, IBM, Chicago, IL, United States) was used to analyze all study data with p < 0.05 as a level of statistical significance. Descriptive statistics will present frequency, percentages, mean, standard deviation, and median. A simple random sampling technique was opted for by every relevant member of this study. However, this study includes 3323 responses from all three groups collectively from different backgrounds and regions of Ghana. The SurveyMonkey application was employed to target the primary responders and ease data analysis. The University of Health and Allied Sciences (UHAS) Ho, Ghana, approved the study's ethical clearance (UHAS-REC A 5 [4] 22-23). Results A total of 3323 healthcare professionals completed the questionnaires, giving a final response rate of 97%, an adequate response rate. The detailed demographic characteristics of the surveyed participants are presented in Table 1. The sample of respondents comprised 777 (23.4) general physicians, 1199 (36.1) pharmacists, and 1347 (40.5) nurses. The workers were mainly females 1881 (56.6), working in the governmental sectors, private sectors, and solo practice. This sample is pretty much like the population of healthcare professionals in Ghana. The mean ± SD age of the respondents was 31.59±13.62 years for all the professions. There was a statistically significant difference (p>0.01) in age between male and female professionals in all three groups. Table 1. Demographic Characteristics of Healthcare Professionals Variables Total numbers (%) N = 3323 Gender Male 1442 (43.4) Female 1881 (56.6) Age Less than 30 354 (29.5) 31-40 529 (44.1) 41-50 219 (18.3) Above 50 97 (8.1) Profession Physicians 777 (23.4) Pharmacists 1199 (36.1) Nurse 1347 (40.5) Years of Practice Less than 5 873 (26.3) 5-9 1279 (38.5) 10-14 609 (18.3) 15-19 354 (10.7) Above 20 208 (6.3) Table 2. Region of Practice of the Professionals Region of practice Profession Total Pharmacist Physician Nurse Greater Accra 268 90 247 605 44.3% 14.9% 40.8% 100.0% Bono 90 30 66 186 48.4% 16.1% 35.5% 100.0% Savannah 18 21 60 99 18.2% 21.2% 60.6% 100.0% Western North 12 18 81 111 10.8% 16.2% 73.0% 100.0% Ashanti 37 117 87 241 15.4% 48.5% 36.1% 100.0% Central 102 18 166 286 35.7% 6.3% 58.0% 100.0% North East 6 39 111 156 3.8% 25.0% 71.2% 100.0% Northern 15 105 72 192 7.8% 54.7% 37.5% 100.0% Bono East 9 24 30 63 14.3% 38.1% 47.6% 100.0% Upper East 12 18 39 69 17.4% 26.1% 56.5% 100.0% Oti 6 30 39 75 8.0% 40.0% 52.0% 100.0% Upper West 177 21 39 237 74.7% 8.9% 16.5% 100.0% Volta 63 93 105 261 24.1% 35.6% 40.2% 100.0% Western 231 33 97 361 64.0% 9.1% 26.9% 100.0% Eastern Region 144 102 69 315 45.7% 32.4% 21.9% 100.0% Ahafo 9 18 39 66 13.6% 27.3% 59.1% 100.0% Total 1199 777 1347 3323 36.1% 23.4% 40.5% 100.0% Table 3: General Knowledge Symptoms of Covid-19 Symptoms Responses Profession Total P-value Pharmacist Physician Nurse Fever Yes 1178 750 1332 3260 < .001 No 21 27 15 63 I do not know 0 0 0 0 Runny Nose Yes 1095 711 1299 3105 < .001 No 104 63 45 212 I do not know 0 3 3 6 Sore throat Yes 1181 735 1258 3174 < .001 No 18 42 82 142 I do not know 0 0 7 7 Joint and muscle pain Yes 1145 682 1237 3064 < .001 No 49 87 95 231 I do not know 5 8 15 28 Shaking chills Yes 1130 682 1265 3077 < .001 No 53 89 76 218 I do not know 16 6 6 28 Shortness of breath Yes 1173 723 1293 3189 < .001 No 26 54 48 128 I do not know 0 0 6 6 Diarrhea Yes 1071 591 1185 2847 < .001 No 119 162 143 424 I do not know 9 24 19 52 Fatigue Yes 1163 704 1264 3131 < .001 No 36 72 71 179 I do not know 0 1 12 13 Dry cough Yes 1135 726 1283 3144 < .366 No 61 48 58 167 I do not know 3 3 6 12 Nasal congestion Yes 1075 683 1197 2955 < .403 No 117 91 138 346 I do not know 7 3 12 22 Weight loss Yes 1072 660 1117 2849 < .001 No 102 96 197 395 I do not know 25 21 33 79 Stomach discomfort Yes 1044 573 1186 2803 < .001 No 133 174 158 465 I do not know 22 30 3 55 Difficulty sleeping Yes 1081 695 1281 3057 < .001 No 95 79 57 231 I do not know 23 3 9 35 The incubation Yes 1187 741 1311 3239 < .001 No 6 27 30 63 period is 5– 14 days. I do not know 6 9 6 21 Which of the following situations are means of transmission/spread of coronavirus (COVID-19)? Symptoms Responses Profession Total P-value Pharmacist Physician Nurse Coughing or sneezing near people infected with the coronavirus (COVID-19) Yes 1181 699 1299 3179 < .001 No 15 78 48 141 I do not know 3 0 0 3 Go to areas/countri es affected by coronavirus (COVID-19) Yes 1136 678 1269 3083 < .001 No 60 93 78 231 I don’t know 3 6 0 9 Touching objects or surfaces that have been in contact with someone who has the virus Yes 1172 720 1314 3206 < .001 No 24 57 27 108 I don’t know 3 0 6 9 Shake hands with someone who has an active case of coronavirus (COVID-19) Yes 1154 708 1148 3010 < .001 No 42 63 199 304 I don’t know 3 6 0 9 Being on the same plane with someone with coronavirus (COVID-19) Yes 1160 708 1290 3158 < .001 No 36 66 57 159 I don’t know 3 3 0 6 Eating food prepared by someone infected or Yes 679 636 774 2089 < .001 No 492 126 537 1155 I don’t know 28 15 36 79 exposed to the coronavirus (COVID-19) Participate in blood transfusions Yes 136 162 620 918 < .001 No 1020 564 700 2284 I don’t know 43 51 27 121 By relating to people who were in a hospital or emergency room Yes 725 471 771 1967 < .163 No 456 300 552 1308 I don’t know 18 6 24 48 Relating to cases identified by doctors Yes 1136 672 837 2645 < .001 No 54 99 504 657 I don’t know 9 6 6 21 About cases identified during evaluations at entry points to my country Yes 1142 684 888 2714 < .001 No 45 81 459 585 I don’t know 12 12 0 24 Severity of the coronavirus (COVID-19). It can be cured Agree 349 354 576 1279 < .001 Disagree 787 348 173 1308 Not sure 63 75 598 736 It is highly contagious Agree 1166 696 1128 2990 < .001 Disagree 6 9 6 21 Not sure 27 72 213 312 The coronavirus mortality rate is worse than that of influenza or tuberculosis Agree 938 696 1254 2888 < .001 Disagree 216 30 15 261 Not sure 45 51 78 174 COVID-19 causes permanent physical damage to patients Agree 985 603 1134 2722 < .001 Disagree 111 90 54 255 Not sure 103 84 159 346 Agree 1148 720 1272 3140 < .001 You have symptoms similar to common flu and influenza Disagree 24 9 9 42 Not sure 27 48 66 141 My community/ country does not have a coronavirus vaccine Agree 258 261 561 1080 < .001 Disagree 743 288 705 1736 Not sure 198 228 81 507 My community/ country does not have adequate medicine or treatment for the disease Agree 261 324 579 1164 < .001 Disagree 716 270 693 1679 Not sure 222 183 75 480 Hospitals in my community/ country have not taken adequate infection control measures Agree 261 270 579 1110 < .001 Disagree 716 300 699 1715 Not sure 222 207 69 498 Coronavirus impact is worse compared to influenza or common cold Agree 842 669 1169 2680 < .001 Disagree 300 36 63 399 Not sure 57 72 115 244 The authorities of my country are prepared to face the disease Agree 896 543 1227 2666 < .001 Disagree 42 27 21 90 Not sure 261 207 99 567 The response of the health Agree 892 525 1236 2653 < .001 Disagree 39 30 27 96 Not sure 268 222 84 574 authorities of my country/com munity is effective Knowledge about contagion prevention/precaution measures Washing hands vigorously (soap/water) for 20 seconds helps prevent disease Agree 1094 732 1290 3116 < .001 Disagree 33 18 0 51 Not sure 72 27 57 156 Special care should be taken if a person has coronavirus (COVID-19) symptoms in my community Agree 1169 714 1287 3170 < .001 Disagree 0 0 0 01163 Not sure 30 63 60 153 Personal hygiene Agree 1163 723 1293 3179 < .001 Disagree 3 0 0 3 Not sure 33 54 54 141 Healthy lifestyle Agree 1163 705 1248 3116 < .001 Disagree 3 3 0 6 Not sure 33 69 99 201 Daily temperature monitoring Agree 1108 663 1296 3067 < .001 Disagree 19 33 0 52 Not sure 72 81 51 204 Avoid travelling abroad Agree 230 333 520 1083 < .001 Disagree 912 357 641 1910 Not sure 57 87 186 330 Use of mask Agree 1130 690 1311 3131 < .001 Disagree 0 6 3 9 Not sure 69 81 33 183 Clean environment Agree 1163 720 927 2810 < .001 Disagree 3 0 102 105 Not sure 33 57 318 408 Stay home if one is experiencing Agree 1166 693 1281 3140 < .001 Disagree 3 15 3 21 Not sure 30 69 63 162 symptoms of COVID-19. Seek medical attention if one is experiencing symptoms of COVID-19 Agree 1181 708 1296 3185 < .001 Disagree 3 0 0 3 Not sure 15 69 51 135 Avoid crowded places Agree 1166 705 1302 3173 < .001 Disagree 6 0 0 6 Not sure 27 72 45 144 Sending passengers with coronavirus symptoms (COVID-19) to a hospital or referral centre for examination Agree 1165 708 1278 3151 < .001 Disagree 7 6 3 16 Not sure 27 63 66 156 Use a disinfectant at home or work Agree 1148 717 1287 3152 < .001 Disagree 0 0 3 3 Not sure 51 60 57 168 Confirm symptoms on any website Agree 1075 636 880 2591 < .001 Disagree 67 42 62 171 Not sure 57 99 405 561 Wore something to clean objects that may have come in contact with someone with coronavirus (COVID-19) Agree 1111 684 1284 3079 < .001 Disagree 16 18 3 37 Not sure 72 75 60 207 Avoid Asian restaurants or shops Agree 87 162 396 645 < .001 Disagree 1024 510 738 2272 Not sure 88 105 213 406 Cancel appointment Agree 177 303 504 984 < .001 Disagree 950 399 735 2084 s in hospitals or doctor's offices. Not sure 72 75 108 255 Avoid public transportatio n Agree 1089 657 1128 2874 < .001 Disagree 59 18 69 146 Not sure 51 102 150 303 Antibiotics are the first- line treatment for the management of coronavirus (COVID-19) Agree 1098 654 1232 2984 < .001 Disagree 71 72 24 167 Not sure 30 51 91 172 Preparation of raw meats and other foods with different knives Agree 166 183 691 1040 < .001 Disagree 978 453 572 2003 Not sure 55 141 84 280 Table 2 shows that most professionals, 605, were from the Greater Accra region of Ghana. Among them, 268 (44.3%) are pharmacists, 90 (14.9%) are physicians, and 247(40.8%) are nurses. This is presented graphically (Figure 1). Most respondents (96.2%) worked in public health care centres and hospitals. The mean ± SD total years of experience of respondents was 9.56±7.43 overall. Figure 1. Graphical Representation of Respondents from the 16 Regions of Ghana Table 3 describes the general knowledge- related questions about the coronavirus. The responses to these questions were evaluated for each of the professionals collectively. The significant P>0.01 value indicates the respondents' sufficient knowledge about COVID-19. In the Central region, more nurses participated in the research (166, 58%), while more pharmacists participated in the Upper, Western and Eastern regions, 45.7%, 64% and 45.7 %, respectively. In the Ashanti and Northern regions, more physicians responded to the questionnaires. 48.5 %, 54.7 %, respectively. Most Physicians show higher knowledge levels than pharmacists and nurses. In response to the Dry cough and nasal congestion as a general symptom of Coronavirus was observed as not sure by the pharmacists and nurses. The data obtained was non-significant for the question “By relating to people who were in a hospital or emergency room” < .163. It is indicated by the “No” as a response by all the professionals. Table 4 describes the perception level of pharmacists, physicians, and nurses toward the COVID-19 pandemic. The questions were related to susceptibility perception to COVID-19. The survey results in an excellent perception (96%) among all the three groups. However, a strong perception was observed specifically among the nurses in response to the fear level. Table 4. Perceived Susceptibility to Covid-19 Questions Responses Profession Total P-value Pharmacist Physician Nurse Do you think there is a stigma related to the coronavirus (COVID-19) Yes 926 600 1119 2645 < .001 No 261 171 168 600 I don’t know 12 6 60 78 Thinking that I could become infected with coronavirus (COVID-19) makes me nervous/anxious Yes 536 423 775 1734 < .001 No 663 345 536 1544 I don’t know 0 9 36 45 Nothing I do can stop the risk of catching me Yes 471 390 595 1456 < .001 No 692 378 713 1783 I don’t know 36 9 39 84 If I contracted the coronavirus (COVID- 19), it will have serious consequences for me or my relatives Yes 478 399 600 1477 < .001 No 703 357 705 1765 I don’t know 18 21 42 81 I get upset when I think about the coronavirus (COVID-19) Yes 448 282 591 1321 < .001 No 733 474 729 1936 I do not know 18 21 27 66 Coronavirus (COVID- 19) problems will pass quickly Yes 516 420 729 1665 < .001 No 647 342 381 1370 I do not know 36 15 237 288 Are you afraid of: Fear of being in contact with people with flu symptoms (e.g., cough, Yes 932 621 750 2303 < .001 No 264 147 579 990 I do not know 3 9 18 30 runny nose, sneezing, fever) Fear of eating out (for example, street vendor centres, food courts) Yes 562 510 564 1636 < .001 No 628 264 723 1615 I do not know 9 3 60 72 Fear of being in contact with people who have just returned from abroad Yes 488 327 552 1367 < .001 No 699 450 729 1878 I do not know 12 0 66 78 Fear of visiting hospitals Yes 511 258 594 1363 < .001 No 673 519 735 1927 I do not know 15 0 18 33 Perceived susceptibility to coronavirus infection (COVID-19). Evaluation of the possibility of contracting the disease Oneself Very likely 646 513 240 1399 < .001 Probable 481 81 234 796 Unlikely 72 183 873 1128 My relatives Very likely 931 597 561 2089 < .001 Probable 214 120 321 655 Unlikely 54 60 465 579 People over 60years Very likely 1036 660 696 2392 < .001 Probable 163 102 648 913 Unlikely 0 15 3 18 Adults Very likely 992 621 741 2354 < .001 Probable 201 126 582 909 Unlikely 6 30 24 60 Children Very likely 307 276 231 814 < .001 Probable 435 225 354 1014 Unlikely 457 276 762 1495 Medical services personnel Very likely 1001 630 420 2051 < .001 Probable 174 126 909 1209 Unlikely 24 21 18 63 Food vendors Very likely 692 600 492 1784 < .001 Probable 453 156 834 1443 Unlikely 54 21 21 96 Food handlers Very likely 674 612 474 1760 < .001 Probable 468 153 843 1464 Unlikely 57 12 30 99 General public Very likely 994 657 1029 2680 < .001 Probable 205 117 318 640 Unlikely 0 3 0 3 Taxi drivers Very likely 1033 672 813 2518 < .001 Probable 163 84 534 781 Unlikely 3 21 0 24 Where are people likely to get coronavirus (COVID-19)? Home Very likely 201 156 148 505 < .001 Probable 624 180 604 1408 Unlikely 374 441 595 1410 Health institutions Very likely 1004 675 399 2078 < .001 Probable 159 90 927 1176 Unlikely 36 12 21 69 Public transport Very likely 1058 681 1092 2831 < .001 Probable 141 90 255 486 Unlikely 0 6 0 6 Markets or shops Very likely 1030 666 1068 2764 < .001 Probable 163 105 267 535 Unlikely 6 6 12 24 Countries affected by the coronavirus (COVID-19) Very likely 1052 681 876 2609 < .001 Probable 144 90 465 699 Unlikely 3 6 6 15 What do you think the percentage of? Efficacy of treatments for coronavirus (COVID-19) Very likely 309 366 645 1320 < .001 Probable 881 384 681 1946 Unlikely 9 27 21 57 Likelihood of having a major outbreak of coronavirus (COVID-19) from person to person in my community Very likely 777 606 254 1637 < .001 Probable 400 153 640 1193 Unlikely 22 18 453 493 Concern that you or your family members will get the virus Very likely 361 306 254 921 < .001 Probable 778 417 628 1823 Unlikely 60 54 465 579 Having effective medications or remedies available Very likely 370 294 695 1359 < .001 Probable 766 354 646 1766 Unlikely 63 129 6 198 Ghanaian frontline healthcare professionals have demonstrated commendable resilience and dedication in responding to the COVID-19 pandemic. The readiness and preparedness of all the healthcare workers illuminate their enthusiasm and strength to face the upcoming challenges of another wave of COVID-19. In Table 5, questions about preparedness level were asked and analyzed based on the responses obtained. Statistically significant data was obtained from all the professional groups. Despite the challenges due to proper vaccination and treatment, Ghana's health professionals are equipped to face the new pandemic. Table 5. Level of Preparedness Questions Responses Profession Total P-value Pharmacist Physician Nurse Education/training about COVID-19 Done 527 378 715 1620 < .001 In progress 549 384 563 1496 infection control and update policy as required? I do not know 123 15 69 207 Informational materials (e.g., brochures and posters) on COVID-19? Done 521 393 673 1587 < .001 In progress 573 369 620 1562 I do not know 105 15 54 174 Is alcohol-based hand sanitizer for hand hygiene available in every patient room? Done 775 447 685 1907 < .001 In progress 331 291 605 1227 I do not know 93 39 57 189 PPE available immediately outside of the patient room is provided Done 714 438 652 1804 < .001 In progress 368 294 641 1303 I do not know 117 45 54 216 Ensuring safety in working place Done 541 351 637 1529 < .001 In progress 526 402 647 1575 I do not know 132 24 63 219 Readiness to implement every standard precaution Done 433 354 628 1415 < .001 In progress 625 393 662 1680 I do not know 141 30 57 228 Activities to prevent COVID-19 transmission to family members Done 361 342 633 1336 < .001 In progress 652 375 644 1671 I do not know 186 60 70 316 Readiness for caring for febrile patients Done 373 342 624 1339 < .001 In progress 664 381 657 1702 I do not know 162 54 66 282 Readiness of self away from family members Done 376 342 640 1358 < .001 In progress 667 378 650 1695 I do not know 156 57 57 270 Readiness for caring for COVID-19- infected patients Done 372 360 640 1372 < .001 In progress 653 351 644 1648 I do not know 174 66 63 303 Readiness overwhelmed with the new COVID-19 Done 380 336 240 956 < .001 In progress 579 366 978 1923 I do not know 240 75 129 444 Readiness for telling family and friends if Done 367 375 648 1390 < .001 In progress 618 345 630 1593 infected with COVID- 19 I do not know 214 57 69 340 Readiness for caring for COVID-19- infected patients if their colleagues are infected with COVID- 19 Done 398 378 633 1409 < .001 In progress 606 345 653 1604 I do not know 195 54 61 310 The readiness of the institution to support healthcare providers Done 391 351 606 1348 < .001 In progress 622 363 684 1669 I do not know 186 63 57 306 Readiness for COVID- 19 crisis that increased workload Done 382 342 615 1339 < .001 In progress 643 363 666 1672 I do not know 174 72 66 312 Proper infection control training has been given Done 419 312 648 1379 < .001 In progress 618 420 645 1683 I do not know 162 45 54 261 Support from your team members Done 382 321 612 1315 < .001 In progress 643 393 669 1705 I do not know 174 63 66 303 Readiness that might eventually get COVID-19 at work Done 382 327 226 935 < .001 In progress 637 375 1013 2025 I do not know 180 75 108 363 Determine a contingency staffing plan. Done 367 324 615 1306 < .001 In progress 670 384 666 1720 I do not know 162 69 66 297 Designate a point of contact for the healthcare union. Done 400 333 663 1396 < .001 In progress 636 393 633 1662 I do not know 163 51 51 265 Designate a point of contact for the family members. Done 454 402 685 1541 < .001 In progress 594 333 620 1547 I do not know 151 42 42 235 Discussion This is the first-ever survey to be conducted in Ghana to measure the preparedness of healthcare professionals for the COVID-19 pandemic in Ghana. To date, many other studies have been conducted to investigate the attitudes and behaviour of all health workers. However, our study is the only one that compares the preparedness levels of physicians, pharmacists, and nurses. Other studies focus on the perception and behaviour of workers toward COVID-19. The present work assessed information resources that physicians, pharmacists, and nurses utilize. The respondents were also surveyed concerning their information-seeking behaviour and awareness of the coronavirus. They were also questioned regarding their expectations and future information needed. We tried to obtain a representative sampling of physicians, pharmacists, and nurses to obtain a reasonable response rate to assure the study's validity. All the respondents were working and in service regularly on their practice sites during the study. Our response rate was favourable and consistent with other surveys of health workers' perceptions, knowledge, and attitudes elsewhere. All regions of Ghana were represented in this survey, so it is fair to say that the study provides a sound foundation for at least some tentative conclusions about the preparedness level raised in this study. The knowledge behaviour related to the general symptoms of all three selected groups in Ghana was not significantly different from those of many developed countries such as the USA and the UK. [2, 5]. The results of our study show excellent knowledge of all the participants (97%), which is validated by the significant P- value. Physicians' knowledge was observed to be higher in response to the question of dry cough and stomach discomfort as general corona symptoms. Most of the responders marked it as “I do not know.” However, many studies support these symptoms as a significant source of virus transmission [11, 20] Interestingly, 119 pharmacists, 162 physicians, and 143 nurses do not consider diarrhoea a symptom of COVID-19. Three hundred ninety-five respondents said weight loss was not a side effect of COVID-19, while 79 indicated that they did not know. Also, 465 (133, 174, and 158 pharmacists, physicians, and nurses, respectively) did not consider stomach discomfort a symptom. While 1279 respondents agreed that COVID- 19 could be cured, 1308 disagreed, and 736 indicated they were unsure. A large number of the respondents (567) were not sure if the authorities in Ghana were prepared to face the disease, and 574 did not believe that the response by the health authorities at the national and community levels was effective. The spread and rapid transmission of COVID- 19, combined with inadequate preparedness, majorly contributes to many psychological issues, especially among frontline health professionals globally [15]. Since the declaration of COVID-19 as a global pandemic by WHO, there has been a constant increase in the number of studies conducted to examine the perception and attitude-behavior and psychological impact on frontline workers [10, 16]. However, this study results in the positive feedback perception of the health workers toward the coronavirus. The Ghana medical care heroes are not afraid and ready to face the new challenges of the pandemic in the future. The level of preparedness of healthcare professionals was troubling. When the survey was conducted, nearly 50 % of all respondents still indicated that educational/training about COVID-19 infection control and policy updates were in progress, and 207 did not know what was happening. The same trend was observed regarding the availability of information materials on COVID-19. Measures to ensure the safety of staff and patients at the workplace were not in place (1575 indicated that it was in progress, 1529 responded that it was done, and 219 did not know). More respondents showed their facilities were unprepared to care for infected patients (Table 5). In response to the question about the readiness of institutions to support healthcare providers, 1348 indicated that they were ready, while 1669 said measures were in progress, and 306 respondents stated that they did not know. Most healthcare professionals who responded to the survey did not receive proper infection control training. Preparedness has been linked to various factors among medical professionals before epidemic outbreaks. However, fewer studies have examined the inadequate level in the context of COVID-19. To our knowledge, no studies have been directly linked with that in Ghana and have specifically examined the perceived preparedness among HCWs to respond to COVID-19. The constrained and underfunded health conditions in Africa made the situation worse during the COVID-19 pandemic [9]. No empirical studies on this issue for health workers have been reported in the context of preparedness level. HCWs in African countries have been working under excessive workloads and psychologically charged environments due to a shortage of staff and limited resources, thus increasing the capacity demand [7]. Ghana has Africa's third-highest COVID-19 cases, with over 2,000 HCWs infected [6]. The country's preparedness for the upcoming pandemic is much less than other countries. In the history of the Ebola outbreak, especially in Ghana, previous studies also reported the same inadequate preparation issues (PPE, medical staff, treatment) [1, 2]. However, this study indicates the preparedness level of pharmacists, physicians, and nurses. It also addresses the issues and interventions related to the perception of adequate preparedness in response to COVID-19 and other factors in Ghana. Conclusions This finding is likely replicable in other low- resource settings, potentially globally, and highlights the need for interventions to increase providers’ preparedness. The government of Ghana has demonstrated a commitment to addressing the needs of healthcare professionals. However, more effort is needed. Government and other stakeholders must institute necessary training, protections, and incentives to improve HCWs’ psychological well-being and ability to respond to the pandemic. With the medical professional shortage in Africa, many cases among these frontline workers, inadequate PPE and preparedness, and growing work demands, such interventions are critically needed to retain them and maintain the quality of care in already strained health systems. Studies in different settings examining the impact of these factors on healthcare quality and outcomes in the context of the pandemic are also needed. From all indications, we believe Ghana needs a pandemic management blueprint covering prevention, education, containment, collaboration, research and development and immediate response. Data Availability: All information will be confidential and securely stored. However, information collected in this survey may be anonymized to allow reuse within the research team and other third parties for COVID-19 health service-related research only. Consent: Informed consent was obtained from all eligible study participants. Funding No external funding. 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