Time Zone: is local time. No daylight saving time in 2008
Tel. Country Code: 233
USADirect Tel.: 191
Electrical Standards: Electrical current is 220/50 (volts/hz). United Kingdom Style Adaptor Plug and European Style Adaptor Plug. Grounding Adaptor Plugs C, D.
Travel Advisory - Ghana
Sub-Saharan Africa has the highest incidence of insect-transmitted diseases, such as malaria, and all travelers need products to prevent mosquito and tick bites. I recommend all travelers use a combination of DEET or Picaridin repellent on their skin and Permethrin fabric insecticide on their clothing for greater than 99% protection against mosquito and tick bites.
Dr. Rose Recommends for Travel to Ghana
HIV Test: Not required.
Required Vaccinations: A yellow fever vaccination certificate is required from all travelers arriving from all countries.
Passport/Visa: Ghana is a developing country on the West Coast of Africa. The capital is Accra. Facilities for tourism are available in the population centers of the greater Accra region, Kumasi in the Ashanti region, and in the Cape Coast area of the Central region, but they are limited in the more remote areas of the country.
ENTRY/EXIT REQUIREMENTS: A passport and visa are required, as is evidence of a yellow fever vaccination. Travelers should obtain the latest information and details from the Embassy of Ghana, 3512 International Drive, NW, Washington, DC 20008; telephone (202) 686-4520. Consular services are also available at the Ghana Permanent Mission to the UN at 19 East 47th Street, New York, NY 10017, telephone (212) 832-1300, and the Honorary Consulate of Ghana, 3434 Locke Lane, Houston, TX, telephone (713) 960-8806. Overseas, inquiries should be made at the nearest Ghanaian Embassy or Consulate. Visit the Embassy of Ghana website at www.ghanaembassy.org for the most current visa information.
Vaccinations: Recommended and Routine
Hepatitis A: Recommended for all travelers >1 year of age not previously immunized against hepatitis A.
Hepatitis B: Recommended for all non-immune travelers at potential risk for acquiring this infection. Hepatitis B is transmitted via infected blood or bodily fluids. Travelers may be exposed by needle sharing and unprotected sex; from acupuncture, tattooing or body piercing; when receiving non-sterile medical or dental injections, or unscreened blood transfusions; by direct contact with open skin sores on an infected person. Recommended for long-term travelers, expatriates, and any traveler requesting protection against hepatitis B infection.
Influenza: Vaccination recommended for all travelers >6 months of age who have not received a flu shot in the previous 12 months.
Meningococcal (Meningitis): Quadrivalent conjugate meningitis vaccine is recommended for those travelers anticipating living or working closely with local people. The risk is greatest in the dry season, from November to May/June. Vaccination should be considered for all travelers venturing into epidemic regions at any time of year.
Polio: A one-time dose of IPV vaccine is recommended for any traveler >age 18 who completed the primary childhood series but never received an additional dose of polio vaccine as an adult. Available data do not indicate the need for more than a single lifetime booster dose with IPV (Inactivated Polio Vaccine).
Rabies: Rabies vaccine is recommended for: persons anticipating an extended stay; for those whose work or activities may bring them into contact with animals; for people going to rural or remote locations where medical care is not readily available; for travelers desiring extra protection.
Routine Immunizations: Immunizations against tetanus-diphtheria, measles, mumps, rubella (MMR vaccine) and varicella (chickenpox) should be updated, if necessary, before departure. MMR protection is especially important for any female of childbearing age who may become pregnant.
• In addition to tetanus, all travelers, including adults, should be fully immunized against diphtheria. A booster dose of a diphtheria-containing vaccine (Td or Tdap vaccine) should be given to those who have not received a dose within the previous 10 years.
Note: ADACEL is a new tetanus-diphtheria-pertussis (Tdap) vaccine that not only boosts immunity against diphtheria and tetanus, but has the advantage of also protecting against pertussis (whooping cough), a serious disease in adults as well as children. The Tdap vaccine can be administered in place of the Td vaccine when a booster is indicated.
Typhoid: Recommended for all travelers with the exception of short-term visitors who restrict their meals to major hotels.
Yellow Fever: All travelers >1 year of age entering the country from all countries are required to present a certificate of immunization against yellow fever.
Hospitals / Doctors
Medical facilities and communications are poor outside urban areas. Emergency facilities are extremely limited.
All travelers should be up-to-date on their immunizations and are advised to carry a medical kit as well as antibiotics to treat travelers diarrhea or other infections; they should bring drugs for malaria prophylaxis, if needed according to their itinerary. Travelers who are taking regular medications should carry them properly labeled and in sufficient quantity to last for the duration of their trip; they should not expect to obtain prescription or over-the-counter drugs in local stores or pharmacies in this country - the equivalent drugs may not be available; may be of dubious origin; may be counterfeit; or of unreliable quality.
• Travelers are advised to obtain comprehensive travel insurance with specific overseas coverage, including air ambulance medevac. In the event of a serious illness or injury that can't be treated locally, every effort should be made to arrange medical evacuation to Europe.
Medical facilities include:
• Hobats Clinic
Opposite Tesano GNTC
Tel:  21 220 833
• Korle-Bu Teaching Hospital
University of Accra
Tel:  21 665 401
General medical/surgical facility and cardiothoracic center.
• North Ridge Clinic
near KLM office
Tel:  21 227 328
• Nyaho Medical Centre
Airport Residential Area
Tel:  21 775 341
• Komfo Anokye Teaching Hospital
Tel:  51 22 300/301/302
Destination Health Info for Travelers
AIDS/HIV: Heterosexual contact is the predominate mode of transmission of HIV in sub-Saharan Africa. People in sub-Saharan Africa do not have many more lifetime partners than people in other parts of the world. However, researchers have found that in some areas it is not uncommon for people to have two or more regular sex partners at the same time. Someone is most likely to transmit HIV during the period shortly after they are infected, when they have very high levels of virus in their body. Therefore someone who has two or more concurrent partners is more likely to transfer HIV between their partners than someone who has a series of monogamous relationships. This too may help to explain why HIV is more widespread in Africa.
Both HIV prevalence rates and the numbers of people dying from AIDS vary greatly between African countries. In Somalia and Senegal the HIV prevalence is under 1% of the adult population, whereas in South Africa and Zambia around 15-20% of adults are infected with HIV. In four southern African countries, the national adult HIV prevalence rate has risen higher than was thought possible and now exceeds 20%. These countries are Botswana (24.1%), Lesotho (23.2%), Swaziland (33.4%) and Zimbabwe (20.1%).
West Africa has been less affected by AIDS, but the HIV prevalence rates in some countries are creeping up. HIV prevalence is estimated to exceed 5% in Cameroon (5.4%), Cote dIvoire (7.1%) and Gabon (7.9%). Until recently the national HIV prevalence rate has remained relatively low in Nigeria, the most populous country in sub-Saharan Africa. The rate has grown slowly from below 2% in 1993 to 3.9% in 2006. (Source: Avert.org)
• Adult HIV prevalence in Ghana is relatively low compared to other countries. The adult (15-49) prevalence rate is 2.3%.
More statistics are available at: http://www.avert.org/subaadults.htm
• Transmission of HIV can be prevented by avoiding: sexual contact with a high-risk partner; injecting drug use with shared needles; non-sterile medical injections; unscreened blood transfusions.
• The threat of HIV/AIDS should not be a primary concern for the traveler. However, there may be a concern for a subset of travelers who may be exposed to HIV, the virus that causes AIDS, through contact with the body fluids of another person or their blood. Although travel has contributed in a general way to the global spread of AIDS, fear of traveling because of this disease is not warranted.
Accidents & Medical Insurance: Accidents and injuries are the leading cause of death among travelers under the age of 55 and are most often caused by motor vehicle and motorcycle crashes; drownings, aircraft crashes, homicides, and burns are lesser causes.
• Heart attacks cause most fatalities in older travelers.
• Infections cause only 1% of fatalities in overseas travelers, but, overall, infections are the most common cause of travel-related illness.
• MEDICAL INSURANCE: Travelers are advised to obtain, prior to departure, supplemental travel health insurance with specific overseas coverage. The policy should provide for direct payment to the overseas hospital and/or physician at the time of service and include a medical evacuation benefit. The policy should also provide 24-hour hotline access to a multilingual assistance center that can help arrange and monitor delivery of medical care and determine if medevac or air ambulance services are required.
African Sleeping Sickness (Trypanosomiasis): Low apparent risk, but cases were reported in Ghana in the early 1980s. Sleeping sickness is currently reported in Ivory Coast, a neighboring country. Travelers at most risk are those on safari and game-viewing holiday. Travelers to urban areas are at very low risk. The tsetse fly comes out in the early morning and the late afternoon. Insect repellent applied to the skin does not prevent tsetse fly bites, so travelers should wear protective clothing and sleep under a bed net.
Initial symptoms: The bite of tsetse fly can be painful and may develop into a raised red sore, called a chancre. The initial sore may subside or develop into an expanding red, tender, swollen area, followed by a generalized illness with fever, myalgia, abdominal discomfort, diarrhea, vomiting, headache, rigors, and sweats.
Read more: hthttp://www.phac-aspc.gc.ca/tmp-pmv/info/af_trypan-eng.php
Avian Influenza A (Bird Flu): The World Animal Health Organisation (OIE) has confirmed that there have been five cases of Avian Influenza (Bird Flu) in different parts of the country. The last case reported was in June 2007 in the Volta Region. No human infections or deaths have been reported.
• Avian influenza A (H5N1) is predominantly a disease of birds. The virus does not pass easily from birds to people and does not to pass from person to person (except in very rare cases of close contact with an infected blood relative).
• The risk to humans from avian influenza is believed to be very low and no travel restrictions are advised, except travelers should avoid visiting animal markets, poultry farms and other places where they may come into close contact with live or dead poultry, or domestic, caged or wild birds and their excretions. In addition, travelers are advised to:
1. Cook poultry and egg dishes thoroughly. (Well-cooked poultry is safe to eat.)
2. Wash hands frequently with soap and water if around poultry.
• The World Health Organization (WHO) does not recommend travel restrictions to countries experiencing outbreaks of influenza A (H5N1) in birds, including those countries which have reported associated cases of human infection. To date, no cases of avian influenza A (H5N1) illness have been identified among short-term travelers visiting countries affected by outbreaks among poultry or wild birds.
The usual vaccines against influenza are not protective against bird flu. Oseltamivir (Tamiflu) is somewhat effective in the treatment of avian influenza A (H5N1). It seems to be effective in some cases, but may fail in others. Recently, resistant strains have been reported. In addition, the dosage and duration of treatment appear to be different in severe cases.
Cholera: Outbreaks of cholera continue to occur across the country, mainly in rural areas of Ghana but also in parts of Accra and Kumasi. Although this disease is reported active, the threat to tourists is very low. Cholera vaccine is recommended only for relief workers or health care personnel who are working in a high-risk endemic area under less than adequate sanitary conditions, or travelers who work or live in remote, endemic or epidemic areas and who do not have ready access to medical care. Canada, Australia, and countries in the European Union license an oral cholera vaccine. The cholera vaccine is not available in the United States.
• The main symptom of more severe cholera is copious watery diarrhea.
• Antibiotic therapy is a useful adjunct to fluid replacement in the treatment of cholera by substantially reducing the duration and volume of diarrhea and thereby lessening fluid requirements and shortening the duration of hospitalization.
• A single 1-gm oral dose of azithromycin is effective treatment for severe cholera in adults. This drug is also effective for treating cholera in children. (NEJM:http://content.nejm.org/cgi/content/short/354/23/2452)
Filariasis: Bancroftian filariasis is reported in northeastern areas. Infection rates of 20% have been reported from the Vea and Tono rice irrigation project areas. Travelers should take measures to prevent mosquito bites.
Hepatitis: All travelers not previously immunized against hepatitis A should be vaccinated against this disease. Hepatitis A is transmitted through contaminated food and water. Travelers who will have access to safe food and water are at lower risk. Those at higher risk include travelers visiting friends and relatives, long-term travelers, and those visiting areas of poor sanitation.
• Hepatitis E is endemic with a seroprevalence of 4% to 8% in ages under 16. Transmission of the hepatitis E virus (HEV) occurs primarily through drinking water contaminated by sewage and also through raw or uncooked shellfish. Farm animals, such as swine, and also deer and wild boar, may serve as a viral reservoirs. (HEV is one of the few viruses which has been shown to be transmitted directly from animals through food.) In developing countries, prevention of hepatitis E relies primarily on the provision of clean water supplies and overall improved sanitation and hygiene. There is no vaccine.
• The overall hepatitis B (HBsAg) carrier rate in the general population is estimated at >10%. Hepatitis B is transmitted via infected blood or bodily fluids. Travelers may be exposed by needle sharing and unprotected sex; from non-sterile medical or dental injections, and acupuncture; from unscreened blood transfusions; by direct contact with open skin lesions of an infected person. The average traveler is at low risk for acquiring this infection. Vaccination against hepatitis B is recommended for: persons having casual/unprotected sex with new partners; sexual tourists; injecting drug users; long-term visitors; expatriates, and anybody wanting increased protection against the hepatitis B virus.
• Hepatitis C is endemic with a prevalence of 2.8% in the general population. Most hepatitis C virus (HCV) is spread either through intravenous drug use or, in lesser-developed countries, through blood contamination during medical procedures. Over 200 million people around the world are infected with hepatitis C — an overall incidence of around 3.3% of the population of the world. Statistically, as many people are infected with HCV as are with HIV, the virus that causes AIDS.
Influenza: Influenza is transmitted year-round in the tropics. The flu vaccine is recommended for all travelers over age 6 months.
Insects: All travelers should take measures to prevent both daytime and nighttime insect bites. Insect-bite prevention measures include a DEET-containing repellent applied to exposed skin, insecticide (permethrin) spray applied to clothing and gear, and use of a permthrin-treated bednet at night while sleeping.
Leishmaniasis: Low risk. Cases of cutaneous and visceral leishmaniasis have been reported from neighboring countries. Travelers should take precautions against insect (sandfly) bites.
Malaria: Risk is present throughout this country year-round, including urban areas. Risk may be elevated during and immediately following the rainy seasons, March through June and October through November in the south; March through October in the north. P. falciparum accounts for >85% of cases, followed by P. malariae and P. ovale.
• Prophylaxis with atovaquone/proguanil (Malarone), mefloquine (Lariam), doxycycline or primaquine is recommended.
A malaria map is located on the Fit for Travel website, which is compiled and maintained by experts from the Travel Health division at Health Protection Scotland (HPS). Go to www.fitfortravel.nhs.uk and select Malaria Map from the Ghana page on the Destinations menu or A-Z Index.
Malaria is transmitted via the bite of an infected female Anopheles mosquito. Anopheles mosquitoes feed predominantly during the hours from dusk to dawn. All travelers should take measures to prevent evening and nighttime mosquito bites. Insect-bite prevention measures include applying a DEET-containing repellent to exposed skin, applying permethrin spray or solution to clothing and gear, and sleeping under a permethrin-treated bednet. DEET-based repellents have been the gold standard of protection under circumstances in which it is crucial to be protected against insect bites that may transmit disease. Nearly 100% protection can be achieved when DEET repellents are used in combination with permethrin-treated clothing.
NOTE: Picardin repellents (20% formulation, such as Sawyer GoReady or Natrapel 8-hour) are now recommended by the CDC and the World Health Organization as acceptable non-DEET alternatives to protect against malaria-transmitting mosquito bites. Picaridin is also effective and ticks and biting flies.
• You should consider the diagnosis of malaria if you develop an unexplained fever during or after being in this country.
• Long-term travelers who may not have access to medical care should bring along medications for emergency self-treatment should they develop symptoms suggestive of malaria, such as fever, chills, headaches, and muscle aches, and cannot obtain medical care within 24 hours.
Meningitis: As of February 2008, >1,000 cases of meningococcal meningitis, including 324 deaths, were recorded in the African meningitis belt. Burkina Faso was seriously hit by the disease with >1400 cases cases reported. Outbreaks were also reported in Democratic Republic of the Congo, Central African Republic and Uganda. Other countries reporting meningitis activity included Benin, Cote d’Ivoire, Ethiopia, Ghana, Mali, Niger and Togo.
• Quadrivalent conjugate meningitis vaccine is recommended for those travelers anticipating living or working closely with local people. The risk is greatest in the dry season, from November to May/June. Vaccination should be considered for all travelers venturing into epidemic regions at any time of year.
• Areas in sub-Saharan Africa with frequent epidemics of meningococcal meningitis are found at: http://wwwn.cdc.gov/travel/yellowBookCh4-Menin.aspx#651
Onchocerciasis: Widely distributed along fast-flowing rivers, but incidence has declined due to blackfly control programs. Moderate risk remains in central mountainous areas along the Pru River. Travelers should take precautions against insect (blackfly) bites.
Other Diseases/Hazards: African tick typhus (transmitted by dog ticks, often in urban areas, and bush ticks)
• Anthrax (cutaneous; usually from contact with freshly slaughtered, infected animals)
• Brucellosis (from consumption of raw dairy products)
• Dengue fever (risk in both urban and rural areas; daytime mosquito bite protection recommended)
• Lassa fever (sporadic, rare Lassa fever activity occurs; transmission via contact with infected rodents)
• Leptospirosis (39% of agricultural workers have been exposed)
Rabies: There has been a surge of human rabies (transmitted by dogs) in the north-east Bongo region, which continues in 2010. (http://allafrica.com/stories/200910271144.html November 2009).
Rabies is considered a public health problem in many rural and periurban areas. There is a high incidence of dog rabies, with frequent human cases reported. All animal bites or scratches, especially from a dog, should be taken seriously, and immediate medical attention sought. Rabies vaccine may be required. Although rabies is rare among travelers—there is risk. No one should pet or pick up any stray animals. All children should be warned to avoid contact with unknown animals.
Rabies vaccine is recommended for: persons anticipating an extended stay; for those whose work or activities may bring them into contact with animals; for people going to rural or remote locations where medical care is not readily available; for travelers desiring extra protection. Children are considered at higher risk because they tend to play with animals and may not report bites.
• Pre-exposure vaccination eliminates the need for rabies immune globulin, but does not eliminate the need for two additional booster doses of vaccine. Prompt medical evaluation and treatment of any animal bite is essential, regardless of vaccination status. Note: If adequate rabies treatment is not available locally, medical evacuation is advised to a facility that can provide treatment.
Schistosomiasis: Swimming or bathing is unsafe in any of Ghana’s bodies of freshwater. Urinary schistosomiasis is widely distributed. Many cases occur in the southeast (southern shore of Lake Volta, the area below the Akosombo Dam along the lower Volta River, and the Accra vicinity) and in the northeast. Limited foci of intestinal schistosomiasis are distributed sporadically, occurring predominantly in the extreme north, the southwest (Tarkwa), and the southeast (along the lower Volta River). Acute infection (Katayama fever) has resulted from swimming in the estuary of the Volta.
• Schistosomiasis is transmitted through exposure to contaminated water while wading, swimming, and bathing. Schistosoma larvae, released from infected freshwater snails, penetrate intact skin to establish infection. All travelers should avoid swimming, wading, or bathing in freshwater lakes, ponds, streams, cisterns, aqueducts, or irrigated areas. There is no risk in chlorinated swimming pools or in seawater.
Travelers' Diarrhea: Large urban areas have treated, piped water which is subject to recontamination during distribution. All water sources should be considered potentially contaminated. Outside of hotels and resorts, we recommend that you boil, filter or purify all drinking water or drink only bottled water or other bottled beverages and do not use ice cubes. Avoid unpasteurized dairy products. Do not eat raw or undercooked food, especially meat, fish, raw vegetables. Peel all fruits.
• Good hand hygiene reduces the incidence of travelers’ diarrhea by 30%.
• A quinolone antibiotic, or azithromycin, combined with loperamide (Imodium), is recommended for the treatment of diarrhea. Diarrhea not responding to antibiotic treatment may be due to a parasitic disease such as giardiasis, amebiasis, or cryptosporidiosis.
• Seek qualified medical care if you have bloody diarrhea and fever, severe abdominal pain, uncontrolled vomiting, or dehydration.
Tuberculosis: Tuberculosis is highly endemic in Ghana with an annual occurrence was greater than or equal to 40 cases per 100,000 population. Tuberculosis (TB) is transmitted following inhalation of infectious respiratory droplets. Most travelers are at low risk. Travelers at higher risk include those who are visiting friends and relatives (particularly young children), long-term travelers, and those who have close contact, prolonged contact with the local population. There is no prophylactic drug to prevent TB. Travelers with significant exposure should have PPD skin testing done to evaluate their risk of infection.
Typhoid Fever: Typhoid vaccine is recommended by the CDC for all people traveling to or working in sub-Saharan Africa, especially if visiting smaller cities, villages, or rural areas and staying with friends or relatives where exposure might occur through food or water. Current vaccines against Salmonella typhi are only 50-80% protective and do not protect against Salmonella paratyphi, the cause of paratyphoid fever. (Paratyphoid fever bears similarities with typhoid fever, but the course is generally more benign.) Travelers should continue to practice strict food, water and personal hygiene precautions, even if vaccinated.
Yellow Fever: This disease is currently active in the Upper West Region. An outbreak of yellow fever previously occurred along Lake Volta in the Eastern Region during late 1987. One death has been reported so far in 2008. A vaccination certificate is required for entry to this country. Ghana is in the Yellow Fever Endemic Zone. A valid yellow fever vaccination certificate may be required for travel to other countries in South America, Africa, the Middle East, or Asia.