CSM, THE SITUATION UP NORTH (PAGE 27, MARCH 11, 2010)

THE recent report of the outbreak of the deadly cerebrospinal meningitis (CSM) which killed 17 people and caused the hospitalisation of close to 100 others in the Upper West Region came as a surprise to most people in the region.
This is because the regional directorate of the Ghana Health Service (GHS) has over the years been educating the people on how to prevent the disease from attacking them. Meningitis is not a new disease in Ghana and for that matter the Upper West Region. Almost everybody knows it and calls it CSM. The only new thing about it this year, is the new type of bacteria causing the disease, W135.
It can occur any time of the year whether during the rainy season or the dry season but the attack is usually severe in the dry, hot and dusty season as such the weather being experienced currently is suitable for CSM.
The disease comes with many symptoms with the most common ones being headaches, fever, stiffness of neck, loss of appetite, vomiting and inability to tolerate light or loud noise, confusion or altered consciousness.
CSM is spread from person to person through coughing, sneezing and spitting especially in overcrowded and poorly ventilated places such as funerals, festivals, market squares, churches, mosques and schools. As the infected person coughs or sneezes the bacteria is released into the air. If the place is crowded without enough ventilation the bacteria circulates within that place and find their way into the nostrils or throat of the nearest person.
The disease can attack everybody but children are more vulnerable because they have the lower resistance.
“A person whose immunity is low is also at risk of getting the disease while people who live in overcrowded places like prisons and boarding schools are more likely to be affected,” said the Upper West regional director of Ghana Health Service (GHS), Dr Alexis Naa-beifubah.
He gave the breakdown of meningitis cases and deaths recorded since 2005 to 2009 as

YEAR – cases deaths fatality rate
2005 105 11 10.5
2006 98 25 25.5
2007 69 10 14.4
2008 114 9 9.6
2009 86 9 10.5
The prevention method, according to health authorities, was by taking in a lot of water and sleeping in well-ventilated rooms or if possible sleeping outside especially during the dry season when temperatures rise from about 40 to 45 degrees Celsius during the day and about 30 to 35 degrees Celsius in the night. One must report early to the nearest health facility when experiencing one or more of the symptoms as the health professional will help identify the cause of those symptoms and offer treatment. Others are people must cover their nose and mouth when sneezing and coughing and also support their village volunteers to report all hidden cases of any unusual condition to the health authorities. The body of a person who die of CSM must be buried immediately and at the approved cemetery.
“Accept isolation of your relative who has CSM as it is not a dishonour if your relative is isolated or quarantined. This is to stop the bacteria from getting you and the rest of your family members,” said Dr Naa-beifubah.
He said people should not panic and forcefully demand immunisation and that the CSM vaccine could protect people for three years, therefore, if people received the vaccine a year or two ago they were still protected.
With the various sensitisation programmes by the GHS, one would have thought that people would have heeded the advice of health personnel but to no avail. Some of the easiest causes of the disease are attributed to the lack of ventilation and crowding, yet the kind of building put up by people of northern Ghana does not give room for ventillation. This is because most of the buildings have very small openings (at times two) which serve as windows.
Even in some cases some of these openings have rubber sheets being used to cover them with the excuse that the sheet would prevent dust from entering the room.
This practice is very common in the villages and the Wa municipality, particularly, in the densely populated suburbs, like limaayiri, Zongo, Sokpoyiri, among others. A habit acquired over a period of time is very difficult to be dispensed with and it is in the light of this that the GHS should intensify its education immediately the rainy season ends around August every year.
The harmattan season starts around November till somewhere around January ending to mid-February. It is possible that the people might have certain beliefs which make them not to think that the disease was a medical one. Some villagers interviewed believed that the recent calamity was as a result of some wrongdoings in their society to which the gods must be pacified.
One old lady spoken to on a market day in Wa wondered why for almost 10 years there had not been any serious outbreak of the disease in the region and, therefore, appealed to those communities affected to offer sacrifices to appease their gods.
One would discount this claim but this is the belief of the people and it is very important that these beliefs are not wished away. It is in this regard that this writer would suggest that an integrated approach be adopted by factoring in the beliefs of the people during sensitisation programmes by health personnel. This could be done by involving them in the educational programmes; that is, it should be participatory with people deeply involved in the implementation of such activities.
This is because the people may have some indigenous knowledge of the disease and its prevention, which the health authorities may not be aware of.
This, when done, would go a long way to disabuse the minds of the people and also enable the people to have a broader knowledge of CSM.