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Paragraph: One therefore wonders how well prepared HCWs within Ghana are to responding not only to EVD but other epidemic prone diseases (EPDs) requiring a concerted approach to preparedness and management. Even though some resources have been invested in response to the EVD scare in Ghana, there has not been any assessment on the preparedness of health workers in the face of any possible emergency scenarios. Simply providing the tools such as medications, personnel protective equipment (PPE) and other logistics is no panacea for adequately and appropriately responding to EPDs. Consequently, if healthcare staff lack the basic knowledge, practical and organizational skills to plan and respond to such emergency situations, it would not only spell doom for themselves but also for the general population as was the case of the recent epidemic in West Africa. It is important for example to understand the dynamics of what will propel a HCW to be willing to put his or her life in the line of duty for a case of EVD. It is therefore critical to understand current preparedness of the healthcare worker in Ghana in order to make recommendations for future training and planning for any epidemics situation. The need for Ghana to therefore have empirical data on general emergency preparedness to determine and understand knowledge gaps, and to assess knowledge versus practice in a bid to provide direction for policy cannot be overemphasized. In view of this, we therefore assessed the level of preparedness, readiness and knowledge of EVD emergency response among a population of healthcare workers (HCWs) in the Kumasi Metropolis of Ashanti Region, Ghana. We conducted a hospital based cross-sectional study among healthcare workers at the Kumasi South and Suntreso Government Hospitals designated as "advanced Ebola holding unit" and "Ebola standing team" respectively, in the Kumasi Metropolis. The Kumasi South and Suntreso hospitals have an average monthly Out Patient Department (OPD) attendance of about 20,603 and 11,712 patients respectively and health staff of approximately 450 each. Similar to most facilities, there are more females nurses than males. We organized a day's training for our research assistants on how to use Personal Digital Assistant device (PDAs) Samsung Galaxy note 8 GT-N5100 (Samsung Electronics Co. Ltd., Seoul, Korea) in capturing data. The original version of the questionnaire was pretested, with five healthcare workers who were similar in their characteristics to the members of the study population but outside the area of jurisdiction and study to ensure validity and measurement bias. The questionnaire was revised based on the suggestions and comments (mainly on how the questions had been constructed) obtained from the pilot. This was the final and validated data capturing tool used during the study. At both facilities, we contacted the Medical Superintendents to obtain permission to attend their morning meetings to explain the aims and objectives of the work to HCWs. During this time, HCWs were given the opportunity to ask questions. Two field assistants were stationed at each of the study sites for data capture. Some of the questions asked included the organism responsible for EVD, the mode of transmission of the disease, HCW preparedness to handle any EVD case and among other things early clinical features of the infection. In estimating the sample size for this study, previous data from the hospital indicates that there are approximately 900 HCWs at the two facilities. Assuming a 95% confidence interval and if 70% of these HCWs would come into contact with an EVD suspected case, allowing an error rate of 10%, approximately 87 HCWs would provide a default study power of 80% and an alpha of 5%. With approximately a non-response rate of 15% allowing us to sample 101 HCWs from the two facilities providing emergency services within the Ashanti Region of Ghana. Any healthcare worker attending directly to patients in emergency situation was therefore eligible for inclusion in the study. Our sampling frame consisted of a list of a total of 200. From this list, we then took a systematic random sample of all eligible health workers to represent the sample size. After obtaining written informed consent indicated by signature and or thumbprint of participants, we then administered the questionnaires within the two facilities. We used the WHO (2015) and CDC (2014) Checklist for Ebola Preparedness that provides practical and specific suggestions to ensure that health facilities are able to help their personnel detect possible Ebola cases, protect personnel, and respond appropriately [9, 10] . This checklist included facility evaluation, knowledge and preparedness of HCWs. Based on these checklists we developed a questionnaire to ascertain the overall knowledge and preparedness of Ghanaian HCWs on EVD outbreak. Our questionnaire was administered from a PDA and recorded each participant's demographics, preparedness, form of compensation HCWs think would be appropriate when taking care of EVD case, and knowledge of EVD during the period October to December 2015. Answers to these questions were needed from HCWs to determine information access on EVD among HCWs, their knowledge about EVD and the form of compensation HCWs think would be appropriate when taking care of EVD case among others. Data were collected electronically using tablets for cloud storage through CommCare ODK version 2.27.2, aggregated into Microsoft Excel file, exported into STATA version 14 and analyzed. Descriptive statistics was used to summarize the distribution of various variables into tables and figures. Categorical variables were analyzed using chisquare tests and logistic regression for associations. Background of the study participants Table 1 shows the background characteristics of the study participants. A total of 101 study participants were interviewed, of which 85 (84.16%) were females. Respondents were categorized into three main groups by occupation: Nurses (76.24%), Medical Doctors (19.80%) and Physician Assistants (PA) (3.96%). Majority (54.46%) of the respondents were married. A total 52.48% (53) had been practicing their profession for less than 5 years (SD = 9.22 ± 10.52 years). At both facilities, 75.25% (76) of the respondents had been working in the facility for less than 5 years (SD = 4.04 ± 4.07 years). Table 2 shows the participants knowledge and awareness of EVD. Of the 101 HCWs interviewed, 83.17% (n = 84) correctly identified the cause of EVD, 13.86% (n = 14) did not know the cause, while 2.97% (n = 3) incorrectly labeled the cause to be a bacterium. Even though one (0.99%) Doctor and 16 (15.84%) Nurses were unable to correctly identify the cause; no group was significantly likely to incorrectly label the cause of EVD (χ 2 = 5.41, p = 0.247). A total of 72 (71.29%) HCWs indicated media especially radio as the main source of information when asked where they first heard of EVD. This was significantly more than other sources (χ 2 = 45.44, p < 0.05). When asked which biosafety level laboratory (BSL) is required to test sample from suspected patient with EVD, a total 19 (18.81%) indicated BSL-3 of which 11 (10.89%) were Medical Doctors, while 8 (7.92) and 1 (0.99%) were Nurses and Physician Assistants, respectively. A further 76 (75.25%), of which 9 (8.91%) were doctors, 62 (61.39%) Nurses When asked which disinfectant to use after attending to and caring for a suspected patient with EVD, only 8.91% (n = 9) could correctly identify bleach (0.5% Sodium Hypochlorite) which disinfectant to use (χ 2 = 28.52, p = 0.001). Preparedness for an EVD outbreak by HCW category Table 3 shows the levels of preparedness of HCWs to handle and manage EVD outbreak. When HCWs were asked if they considered their facilities sufficiently equipped to handle and manage EVD patients, 25.74% (n = 26) responded in the affirmative, while 54.46% (55) indicated otherwise. Of this, 14 (13.86%) were Medical Doctors, 39 (38.61%) Nurses and 2 (1.98%) were PA (χ 2 = 2.66, p = 0.62). If they became accidentally infected with EVD after attending to a patient with EVD, 98 (97.03%) of those surveyed indicated they would accept to be isolated (χ 2 = 4.69, p = 0.321). Meanwhile, 44.55% (n = 45) of HCWs would willingly attend to an EVD suspected patient (χ 2 = 8.03, p = 0.09). A total of 92 (91.09%) HCWs surveyed indicated they were not adequately trained to handle an EVD suspected case. When asked to rate their competence in handling an EVD suspected patient, 18.81% (n = 19) indicated they had little confidence and competence, while 6.93% (n = 7) indicated they were extremely confident to handle a suspected case of EVD (χ 2 = 13.09, p = 0.11). Beyond EVD, we asked our survey population to name other epidemic prone diseases. Of the total number of HCWs interviewed, 56.43% (57/101) mentioned epidemic diseases of bacteria origin such as tuberculosis and cholera. A further 33.70% (34/101) named diseases of viral origin such as SARS, Flu, HIV, Lassa fever and dengue, while 9.90% (10) mentioned others referring to malaria. When asked the form of compensation HCWs thought would be appropriate when taking care of an Ebola suspected patient, responses given included personal insurance (32/101), family compensation in case of death (31/101), money (30/101) and awards (8/101) while others also suggested job promotion (7/101), and others (18/101). Our survey population recommended the provision of logistics and training as two key issues in the way forward in adequately preparing HCWs towards any epidemic prone diseases. Many issues surrounding the preparedness of HCWs have been extensively discussed globally especially in the aftermath of the Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV) and the Middle East Respiratory Syndrome (MERS)-CoV epidemic. While it is on record that the recent EVD outbreak recorded very high mortality among HCWs, to the best of our knowledge, only few studies have addressed these issues in anticipation of an EVD outbreak particularly in countries not hit by the EVD epidemic and especially in sub Saharan Africa, such a study is almost non-existent. Our study therefore assessed how prepared HCWs are in the face of a possible EVD epidemic. The results of this survey showed that more than half (54.46%) HCWs indicated that their facilities were not ready to handle EVD cases. Nearly 92% indicated they were not adequately trained to handle an EVD suspected case and it is not surprising that less than 50%  indicated they would willingly attend to a suspected patient. Moreover, nearly a third of HCWs would also want insurance for themselves and their families in case they were infected with EVD. These results are clearly indicative of how ill-prepared the HCWs surveyed are in the face a potentially life threatening epidemic prone diseases, such as EVD in Ghana. In this study, only 25.7% of HCWs said their facility was sufficiently equipped to handle an EVD outbreak. Such low ratings of the hospitals by majority of HCWs is a mark of lack of confidence in their facilities preparedness and this may actually indicate a real lack of preparedness and readiness of the hospitals to handle not only EVD cases but potentially other epidemic prone diseases. Alternatively, it could also mean that HCWs were probably unaware of preparatory work and retooling of their facilities to handle EVD outbreak situation. Willingness to work during outbreaks and emergencies is deemed a sense of duty even in the face of risk. In this study,   of HCWs indicated their willingness to work in the event of an EVD outbreak. Additionally, over one third indicated various forms of compensation for themselves or families in case of death or while taking care of an EVD case. This implies that if HCWs are assured or guaranteed that they and or their families would be taken care of in case of death or while taking care of an EVD case, they will willingly work in the face of any emergency scenario. The assumption is that HCWs would willingly work in the face of an infectious diseases emergency and respond appropriately; however, there are evidences of HCWs avoiding this "sacred duty" in caring for patients and would leave patients vulnerable in times of crisis [11] . In order to prevent HCWs from being infected while obliged to work even in the face of personal risk as required by their codes of ethics and professionalism, it is imperative to ensure that appropriate conventional standards, guarantees and effective public health practices are met to enable HCWs respond to such outbreaks so that they are not infected and or affected despite the risks they might face and continue to face [12] . Thus, appropriate training of HCWs as indicated by those surveyed during the study, coupled with retooling of some health facilities preparation is very critical in ensuring that they are equipped with the needed knowledge and tools needed to work with in the face of any epidemic. General knowledge of EVD is crucial to adequately respond to and care for patients. Nearly 17% of our study population could not identify that EVD as caused by a virus. Arguably, infection control measures would be difficult and problematic for such HCWs. Less than 10% could correctly identify 0.5% Sodium Hypochlorite as the best disinfectant out of the many options provided. This strongly contradicts a similar study in Conakry conducted during the peak of the epidemic where 68% of HCWs knew the correct concentration of disinfectant [5] . While not trying to compare these two scenarios, this information may be vital in the realization that knowledge of HCWs in infection prevention and control measures is critical in their line of duty. This study showed that most HCWs first heard of EVD through the media especially radio. This establishes the crucial role media plays in informing the general populace in such disease outbreaks. In Ghana, there are over 350 media outlets (radio and television put together) and majority of households either own a radio, television or have access to internet. Notwithstanding the media pluralism, it is still incumbent upon health institutions and facilities to organize special training on any emerging infectious disease that occurs globally to update the knowledge of HCWs. Isolation is a key public health measure to prevent the spread of infectious diseases. In this study, over 97% of HCW indicated their willingness to comply and accept to be isolated in case they became infected after attending to suspected EVD patient. However, a small proportion of HCWs surveyed stated that they would be very unhappy, and this could ultimately affect compliance. Isolation is one of the oldest methods of controlling communicable disease outbreaks for patients [13] .

Question: How many healthcare workers would be willing to continue working during the Ebola virus outbreak?
less than 50%