WORLD HEALTH ORGANIZATION ORGANISATION MONDIALE DE LA SANTE ONCHOCERCIASIS CONTROL PROGRAMME IN WEST AFRICA PROGRAMME DE LUTTE CONTRE L'ONCHOCERCOSE EN AFzuQUE DE L'OUEST EXPERT ADVISORY COMMITTEE Ad hoc Session Ouasadousou 1l - 15 March 2002 EAC.AD.7 Original: English December 2001 SOCIO-DEMOGRAPHIC STUDY IN THE PRU BASIN 1 TABLE OF CONTENTS LIST OF TABLES J LIST OF FIGURES J ACKNOWLEDGEMENTS 4 ACRONYMS 5 EXECUTIVE SUMMARY 6 CHAPTER ONE: INTRODUCTION 9 1.0 The Study Background 9 1.1 Programme Achievements 9 1,.2 The Problem Statement 10 1.3 Objectives of the Study 10 . Major Objective 10 . Specific Objectives 10 1.4 Method of Data Collection l0 1.5 Field Problems 11 CHAPTER TWO: SOCIAL STRUCTURE OF THE COMMUNITIES t2 2.0 Introduction t2 2.1 Location t2 2.2' Geographical Features t2 2.3 The Population t2 2.4 Economic Activities 13 2.5 Social Infrastructure 13 2.6 Conclusion t4 2 CHAPTER THREE: FINDINGS 15 3.0 Introduction l5 3.1 Socio-demographic Characteristics of Respondents l5 3.1.0 Sex t5 3.1.1 Age 15 3.t.2 Educational Background l6 3. 1.3 Economic Activities l7 3.t.4 Religion 17 3.1.5 Duration of Residence t7 3.2 SettlementPatterns 17 3.3 Patterns of Population Movement 18 3.4 Organization of Treatment 19 3.4.0 Coverage 2t 3.4.1 The Community Distributors 27 3.5 Other Issues 27 3.5.0 Causes and Treatment of Oncho 28 3.5.1 Ivemectine 29 3.5.2 General Concerns 29 CHAPTER FOUR: CONCLUSION AND RECOMMENDATION 30 4.0 Findings 30 4.1 Recommendations 3l J LIST OF TABLES Table I Data Collection Techniques and Respective Respondents 11 Table 2 Age Distribution of Respondents t6 Table 3 Educational Background of Respondents r6 Table 4 Distribution of Ivermectine in Pru Basin (2000) 22 Table 5 Distribution of Ivermectine in Pru Basin (2001) 23 Table 6 Distribution of Ivermectine in Pru Basin (2000 - 2001) 24 Table 7 Perceived Health Problems of the Communities 28 LIST OF FIGURES Figure I The Distribution Process 20 Figure 2 Treatment Rates for 2000 & 200L 25 Figure 3 Treatment Rates for 2000 & 2001 26 4 ACKNOWLEDGEMENTS The production of this report would not have been possible without the support of many people and organisations. lt is in this regard that I want to cxpress my hr:art-fclt thanks to all who have assistcd in this task. My thanks go to Dr. Boakye A. Boatin, the Director of OCP and to Dr. K. Siamevi of OCP Responsible Technical Officer, for their patience and for the confidence reposed in me. If it has taken too long to flrnally seal the deal, this was mainly due to my desire to produce a good report. I also wish to thank Dr. Kofi Ahmed, the Director of the National Ochocerciasis Secretariat for not only showing me the study site but also for providing me with useful background information. Within the Secretariat, I wish to thank Mr. Richard Odoi for transmitting my many messages to Ouagodougou and personally bringing to me their responses. I wish to thank my 'foot soldiers' Ms. Harriet Takyi and Mr. Kodjovi Akpabli-Honu (both of the Department of Sociology, University of Ghana) for their readiness to forgo their other equally important commitments in order to be part of this study. Their sense of commitment shown from the beginning to the end of this study is highly remarkable. Without his sense of humour and punctuality and his good knowledge of the study site work would have been very difficult. This is why my team express its gratitude to Mr. Abudulai Adam Mogli, our pilot. Finally, my thanks go to Dr. Asemanyi Mensah (District Director of Health Services, Atebubu), Mr. Zakaryya Abubakar and Mr. Gabriel Addah both Senior Technical Officers of MOH, Atebubu, and to all the community distributors and inhabitants of the Pru Basin who accorded us so much hospitality and to Ms. Ophelia Abedi who provided the needed secretarial support. K.A.S 5 ACRONYMS CD Community Distributors ( of ivernectine) DDHS. District Director of Health Services DHMT- District Health Management Team DOC District Oncho Coordinator FAO Food and Agriculture Organization FGD Focus Group Discussion GWEP- Guinea Worm Eradication Programme MOH Ministry of Health NOS National Onchocerciasis Secretariat OCP Onchocerciasis Control Programme RDHS- Regional Director of Health Services RMS Regional Medical Stores UNDP - United Nations Development Programme VRA Volta River Authority wHo - World Health Organisation 6 EXEC UTIVE SUM RY After several years combined of vector control and ivermectin treatment of the populations in the pru Basin against onchocerciasis, the Onchocerciasis Control Programme has recorded unsatisfactory entomo-epidemiological lObf; profile of the disease, especially in the Subene area. As part of the measures to enhance its understanding of the current state of affairs and to institute appropriate intervention measures before the end of the Programme, OCP commissioned this study. In more specific terms, the study sought to do the following: o Investigate the spatial distribution of and accessibility to the villages and hamlets in the pru Basin; Study th^e^ movement ' (migratory) patterns of the people and the impact of such movements on the effectiveness of oncho control activities; o Examine the mode of organisation of community directed treatment with ivermectine; and o Investigate the knowledge, attitudes, beliefs and practices of health workers and members of the community with respect to oncho control activities. and qualitative Quantitative data were collected from Ministry of Health,s programme officers, inhabitants and opinion leaders of the various communities in the basin, and some community distributors of ivermectin. The entire study was carried out in 24 days fr;; 1^tt 1ri;;.;;;;; 5/, December 2001. - Main Findings. o It has been found that villages along the banks of the river are essentially settler communities inhabited by various ethnic groups. These are close to each other but vary in terms of distance from the river' Subene is the closest to the river. These villages are surrounded by an unknown number of hamlets which are not easily accessible. The villagers o do not migrate but movement is fairly rapid especially during the off-farming season' Visits are made to home villages while others engage in commercial activities. On the other hand, during the farming season there is an inflow of riigrant labourers o It has been found that such movements cause absenteeism and high default rate while the inclusion of migrant labourers often cause shortages of ivermectine driring distribution. r The mode of procurement and distribution of the drug is quite cumbersome and involve long bureacratic procedures' Thus, in times of shortage, immediaie re-stocking is almost impossible. o In the communities, ivermectine is distributed at central locations often for about a week. Thereafter people collect their medicines in the homes of CDs or the latter follow them to their homes. Some medicines are reserved for absentees and the very sick. Distribution period is often between August and November. o There were instances when non-eligibles were treated with the drug. o The communities are very satisfied with these arrangements. 1 t The CDs do others things apart from oncho activities. However, they are constrained by lack of means of transportation. i Ivermectine is loved by the people but there are a few misconceptions about it: people are not clear about how many times in a year the drug must be taken and how the drug works. t There are a number of health concerns in the village which need urgent attention. Perhaps the most urgent ones are the opthalmic problems and frequent epileptic seizures. Recommendations Against the background of these findings the following recorrunendations are made 0 There is the need for the DHMT rvith assistance from the district assembly, local leaders and members of the community to undertake a reliable mapping of all villages and hamlets in the basin. This rvill provide a reliable census figure rvith rvhich to plan future ivermectine distribution in the basin. i Because population movement is heavy during the off-farming season, the distribution of ivermectine must be done before this period to ensure higher coverage of the population. The DHMT and the Regional Health Directorate must work out a plan to reduce the long process involved in the procurement of the drug. For instance, the medicine can be kept at the district medical store to enable a quicker access to it in case shortages occur during distribution. Given the low educational background of CDs, it is necessary to organise refresher courses for them periodically. Subjects to be treated must include good record-keeping, treatment procures and community education. 0 The mode of delivery of ivermectine to the communities must be reviewed. In this regard it is suggested that the communities be put under two zones - Abease and Prang health centres. Communities near to these health centres will be made to collect their portion of ivermectine from here. a The DHMT must use the World Day Against Blindness to conscientize inhabitants of the basin on onchocerciasis and eye care. This should be in addition to frequent community education which must be carried on. i Given the large number of opthtalmic cases in the basin, there is the need for the DHMT to run eye clinic in Prang and Abease health centres on monthly basis. This will relieve people of the trouble in travelling to Atebubu or Agogo Hospital for eye care. a Although CDs are community volunteers, and indeed love their job, it is nonetheless suggested that their job be made lighter through motivating them rvith gifts such as T- shirts, bicycles and free health care.