Epidemiology of Buruli ulcer in Amansie West district, Ghana.

This paper describes 90 cases of Buruli ulcer in Amansie West district, Ghana. 49% were below 15 years of age while 20% were over 50 years. There was a significant difference in the age and sex composition, with more males among the younger age groups than females but the converse among adults. Seasonal variation is described, with peak incidence in September and October. Cases who had received bacillus Calmette-Guérin (BCG) vaccination had a shorter duration of the ulcer than those who were not vaccinated. No such association was found between BCG vaccination and the age of onset of the disease. There was no significant difference between cases and controls regarding their BCG vaccination status. There is an urgent need to regard Buruli ulcer in Ghana more seriously.

An outreach education and treatment project in Ghana for the early stage of Mycobacterium ulcerans disease.

Mycobacterium ulcerans disease starts as a painless, subcutaneous nodule, excision of which prevents the development of large Buruli ulcers. An outreach programme was set up in Ghana to promote nodule recognition and excision. The programme was cost-effective and shifted the pattern of disease presentation. This could from a model for other countries.

Global warming and health: a review.

The paper looks at the phenomenon of global warming and its potential health effects and outlines a number of plausible response by the health sector in developing countries to its threat. It suggests that the health sector should facilitate an international effort at addressing this challenge, mainly through advocacy, epidemiological surveillance and awareness creation.

PIP: There is reasonable evidence that the world's concentration of greenhouse gases is increasing and global warming is occurring. However, the relation between the increasing concentration of greenhouse gases and global warming, the magnitude of the change, and the likely health effects in the future remain unclear. Measures must nonetheless be taken to check any potential future adverse effects of global warming. Global warming and its potential health effects are discussed along with some plausible responses by the health sector in developing countries to its threat. A collective international effort is needed to avert a global catastrophe. The health sector should facilitate such a collaboration mainly through advocacy, epidemiological surveillance, and awareness creation of the potential health effects of global warming.

Intended response of caretakers of pre-school children to acute respiratory infection in a rural district in Ghana.

Caretakers of pre-school children were interviewed in Afigya Sekyere district, Ghana. Over 46% (n = 400) will buy drugs and 33% will use various herbs for mild ARI at home. Food is withheld during ARI episodes and few will attempt to treat perceived severe ARI at home. No association was found between knowledge of signs or causation of ARI and intended practice for mild and severe ARI. Finance and poor attitude of health workers were major concerns expressed by caretakers in seeking help from the orthodox health system.

Ghana. Selective versus comprehensive primary health care.

PIP: The choice between selective vs. comprehensive primary health care (PHC) affects program planning, implementation, financing, and the achievement of health policy goals in Ghana. Comprehensive PHC unites health with the total development of the community. It promotes community participation, intersectoral collaboration, and use of appropriate technology. It stresses the development of horizontal institutional structures. This type of institutional development allows for management of emerging new health problems without establishing new and extra structures. Major problems with comprehensive PHC are that results are not readily detectable in the short term and costs are too high for developing countries, due to its extensive coverage and the number of trained personnel needed to sustain it. Selective PHC focuses on prevention or treatment of the few diseases that cause the most mortality and morbidity and for which there are effective interventions. Decision makers should consider prevalence, morbidity, mortality, and feasibility of control when selecting targeted diseases. The advantages of selective PHC include: a rational, cost-effective way to prioritize disease problems; narrow scope, making it affordable for developing countries; and readily detectable results in the short term. For Ghana, however, selective PHC poses major problems. Since it is disease oriented, it encourages the ingrained misconception that only the Ministry of Health is responsible for health. Reduction in the mortality of a few diseases does not necessarily mean reduction of overall mortality. Often unreliable and inconsistent mortality data do not form a basis for determining health priorities. Economic rationality is not always justifiable on ethical grounds. Ghana is working to dismantle the vertical system and towards integration and decentralization. This restructured system should accommodate both strategies.^ieng

Effectiveness of excision of pre-ulcerative Buruli lesions in field situations in a rural district in Ghana.

The effectiveness of excision of pre-ulcerative Buruli lesions in field situations was assessed in a prospective study in an endemic focus in rural Ghana. All 50 patients, clinically diagnosed as having pre-ulcerative Buruli lesions, had their lesions excised followed by primary suturing. The patients were then followed up until the wound healed and thereafter for a year or until recurrence. The median duration for complete healing after excision was 31.5 days while the 1-year recurrence rate was 16%. None of the patients had any form of deformity after healing in contrast with the usual consequences of other forms of treatment. Our findings suggest that excision of pre-ulcerative Buruli lesions is effective in preventing deformities but less so for preventing recurrence of lesion.

Perceptions of caretakers of pre-school children on acute respiratory infection (ARI) in a rural district in Ghana.

Focus group discussions, key informant interviews and structured community interviews were used to describe the perceptions of caretakers of pre-school children in a predominantly rural district in Ghana. Over 75% considered ARI important in the community and there are a variety of local terms of describe various ARI illness entities. The perception of signs of severe ARI in children above two months of age was reasonably high; over 88% could mention at least one of two cardinal signs for severe ARI (difficulty in breathing, rapid breathing). The same cannot be said of their perception of signs for children less than two months of age. There was also a favourable perception of cause; a few misconceptions were however identified. There was no significant difference in perception between locality, age groups and educational levels. A high correlation between perception of cause and prevention of ARI was found. Health education programmes should re-enforce positive perceptions and address misconceptions. The difference in presentation of signs of severe ARI between older children and younger ones should also be stressed.

Efficacy of the combination rifampin-streptomycin in preventing growth of Mycobacterium ulcerans in early lesions of Buruli ulcer in humans.

Mycobacterium ulcerans disease is common in some humid tropical areas, particularly in parts of West Africa, and current management is by surgical excision of skin lesions ranging from early nodules to extensive ulcers (Buruli ulcer). Antibiotic therapy would be more accessible to patients in areas of Buruli ulcer endemicity. We report a study of the efficacy of antibiotics in converting early lesions (nodules and plaques) from culture positive to culture negative. Lesions were excised either immediately or after treatment with rifampin orally at 10 mg/kg of body weight and streptomycin intramuscularly at 15 mg/kg of body weight daily for 2, 4, 8, or 12 weeks and examined by quantitative bacterial culture, PCR, and histopathology for M. ulcerans. Lesions were measured during treatment. Five lesions excised without antibiotic treatment and five lesions treated with antibiotics for 2 weeks were culture positive, whereas three lesions treated for 4 weeks, five treated for 8 weeks, and three treated for 12 weeks were culture negative. No lesions became enlarged during antibiotic treatment, and most became smaller. Treatment with rifampin and streptomycin for 4 weeks or more inhibited growth of M. ulcerans in human tissue, and it provides a basis for proceeding to a trial of antibiotic therapy as an alternative to surgery for early M. ulcerans disease.

AIDS in Ghana: profile, strategies and challenges.

PIP: More and more Ghanians no longer deny or are indifferent to the AIDS epidemic as they witness the increase in AIDS cases. The 1st reported AIDS case in Ghana was in March 1986 and by the end of 1986 the number of AIDS cases had already increased to 26. Between 1986 and 1987, the increase was 35%, but in 1988, the increase was 600%. There was a fall in AIDS cases between 1990 and 1991 (1011-903) but health officials believe that the 1991 number is low due to underdiagnosis and underreporting. The total number of AIDS cases is 3140. Almost 75% of the cases acquired HIV from outside Ghana. Most of them were female prostitutes. The female to male ratio is 4:1 compared with 1:1 in other African countries. HIV prevalence rate among prostitutes in Accra is 2.5%, 4.6% among patients of a sexually transmitted disease clinic, and 0.5-1.5% among blood donors. The Ghanian AIDS Advisory Committee, created in 1985, counsels the government on how to prevent HIV transmission. The 1989 Medium Term Plan supports creation of HIV surveillance systems; information, education, and communication (IEC) efforts; testing of the blood supply; psychosocial support programs for HIV-infected people; and adequate clinical management of HIV/AIDS cases. Regional and District AIDS Committees are in charge of implementing the plan. The National Advisory Counsel on AIDS guides AIDS policy development. HIV/AIDS control activities are integrated into the existing primary health care system. Some obstacles to HIV/AIDS control efforts are inadequate funding including donor agencies not honoring their pledges and inappropriate allocation of funds by the unstable government, insufficient supply of reagents to screen blood, and some hospitals still using unscreened blood. The greatest obstacle is long-held sociocultural beliefs, attitudes, and practices in Ghana. For example, even though 80% of the people know how HIV is transmitted, most people still practice risky sex behavior. Many people equate the condom with infidelity so condom use is low.^ieng