Limiting spread of COVID-19 in Ghana: Compliance audit of selected transportation stations in the Greater Accra region of Ghana

PLoS One. 2020 Sep 11;15(9):e0238971. doi: 10.1371/journal.pone.0238971. eCollection 2020.


Globally, little evidence exists on transmission patterns of COVID-19. Recommendations to prevent infection include appropriate and frequent handwashing plus physical and social distancing. We conducted an exploratory observational study to assess compliance with these recommendations in selected transportation stations in Ghana. A one-hour audit of 45 public transport stations in the Greater Accra region was carried out between 27th and 29th March 2020. Using an adapted World Health Organization (WHO) hand hygiene assessment scale, the availability and use of handwashing facilities, social distancing, and ongoing public education on COVID-19 prevention measures were assessed, weighted and scored to determine the level of compliance of stations. Compliance with recommendations was categorized as "inadequate" "basic", "intermediate" and "advanced", based on the overall score. Majority (80%) of stations in Accra have at least one Veronica Bucket with flowing water and soap, but the number of washing places at each station is not adequate. Only a small minority (18%) of stations were communicating the need to wash hands frequently and appropriately, and to practice social/physical distancing while at the station. In most stations (95%), hand washing practice was either not observed, or only infrequently. Almost all stations (93%) did not have alcohol-based hand sanitizers available for public use, while social distancing was rarely practiced (only 2%). In over 90% of the stations, face masks were either not worn or only worn by a few passengers. Compliance with COVID-19 prevention measures was inadequate in 13 stations, basic in 16 stations, intermediate in 7 stations, and advanced in 9 stations. Compliance with COVID-19 prevention measures in public transportation stations in the Greater Accra region remains a challenge. Awareness creation should aim to elevate COVID-19 risk perception of transportation operators and clients. Transport operators and stations need support and guidance to enforce hand washing and social distancing.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • COVID-19
  • Communicable Disease Control / methods
  • Communicable Disease Control / standards*
  • Coronavirus Infections / epidemiology
  • Coronavirus Infections / prevention & control*
  • Coronavirus Infections / transmission
  • Ghana
  • Guideline Adherence / statistics & numerical data*
  • Humans
  • Masks / statistics & numerical data
  • Pandemics / prevention & control*
  • Pneumonia, Viral / epidemiology
  • Pneumonia, Viral / prevention & control*
  • Pneumonia, Viral / transmission
  • Transportation / statistics & numerical data*
  • World Health Organization

Grant support

Funding for the study was obtained from the University of Ghana Office of Research, Innovation, and Development. The Initial of recipient is RA. The URL of the funder site is The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.