The 'Forgotten Killers'

Have a guess at the world’s biggest infant killer? Something scary, something unpredictable, something out of our scope to help with???

Pneumonia.

Closely followed by Diarrhoea.

In Ghana the problem is the same. Diseases that don’t really scare you at the thought, or make you think of death. But they are killing children in Ghana and the rest of the world, yet have such simple solutions.

You can  prevent pneumonia by washing your hands before eating. It’s not expensive, out of reach or ‘innovative’. To cure pneumonia you take some antibiotics. In Ghana they can cost as little as AUD$1.00 or if you can’t afford that, it’s free.

Diarrhoea can similarly be prevented and easily treated, again, hygiene and sanitation is key. But these diseases reflect more than just the diagnosis, it shows the living conditions, poverty, and healthcare accessibility of those severely affected. When you think about #1 cause of death in Ghana (or Africa in general), the cliché is to blame HIV/AIDS, maybe conflict, or some obscure disease like Nodding Disease. These are all difficult things to tackle, with big social impacts, or costs involved. But HIV rates in Ghana are 1.8%. The percent of children with suspected pneumonia receiving antibiotics is just 24%. The percent of children with suspected pneumonia taken to an appropriate health care provider is 51%. It is clear where the biggest impact can be made in health.

Ghana has just introduced 2 new vaccines to help prevent both diarrhoea and pneumonia. There has been much media coverage, and here is a great video about it.

Other things that are being done are;

1.  Promoting exclusive breastfeeding – by giving nothing but breast milk for the first 6 months in life it prevents infection, contamination and malnutrition. A simple, but effective way to ensure good health for your under 6month old. The problem lies in the following years where food is introduced, and it is often inadequate or insufficient.

2. Sanitation and hygiene. Ensuring all households have access to safe drinking water.

3. Community-based treatment of childhood illnesses. A program where volunteers in the community bring diagnosis and treatment to hard to reach places.

4. Promoting handwashing with soap. Massive campaigns and strategies are in place to improve handwashing. A study I worked on recently found that just 6% of people use soap. And then it mostly was for washing clothes rather than hands.

Wash those hands!

And for the final say, here is a news story on the current situation.

Neighbourhood Watch

Defining a Household:

“People who slept here last night and ate from the same cooking pot”

Does this mean that the Jenkins’ who often have three cooking pots (1 “normal”, 1 vegetarian, and 1 gluten free) is not one household? Three households under the same roof?

Defining a household is important in the nutrition surveillance system I am helping implement in the three Northern Regions of Ghana. It always brings such controversy because the living situations are so diverse here. It is not uncommon for many households to be living under the same roof (house). Hence the addition of the statement ‘eating from the same pot’. This will generally distinguish the different households, as commonly, food for only the immediate ‘family’ can only be afforded.

The average household size in the Northern Region is 6, yet the number of people living in a house can vary greatly. In one community I went to, the chief’s house contained hundreds of people, however many “households”. So it is an interesting question, and reflection of the living situation in Northern Ghana. I have been fortunate enough to go to the communities and help train the health staff on how to take height, weight, MUAC (mid upper arm circumference) measurements for malnutrition screening, as well as mortality and household data. It gives you an insight into the living conditions and cultural traditions as well.

The Dagomba tribe (Tamale area) generally give away their first girl child to a sister or brother, to help in the house. Once they are in their 20’s or so, they can go back to their family, but it seems there is always a disconnect between them.

The Upper West has the greatest gender inequality. Women may have some of their own land, however must farm the man’s land first, therefore never quite meeting the needs of their own land. I don’t think they ever can receive land through the death of their husband either, they must go to be a second (or third) wife in the husband’s brother’s household, or must marry again (which is hard when you are older).

Also the ‘community entry’ routine is interesting. You must greet the chief which means entering his home without your shoes, making sure you are lower than them, say hello (in the local language to really ‘integrate’) and clap your hands slowly. Then you ask permission, discuss, thank, and ‘dash’ or ‘give kola’ which used to mean a present or offering of kola nuts, but now it means give some cedi (money). Exiting the community is equally important and a visit to the chief must be made.

So back to the definition. According to Ghana’s standards, the Jenkins family home (when Kat and I still lived there) had three separate households living under the same roof. It's all relative, and a great lesson to learn living abroad. Never generalise but learn from your situation.... enjoy.

MUAC measurements being taken

Weighing child - with mother 'tared'

Taking household data. Under the tree in the village.

Height measurements mostly make the children cry... This one was lucky!

Community exit. Thanking the chief. and photo op!

All crammed into a 'tro tro' - a local minibus. was the way to travel!