Friday, November 2, 2012
Show more commitment to malaria control — Mrs Binka
By Rebecca Kwei
The Executive Secretary of the African Media and Malaria Research Network (AMMREN), Mrs Charity Binka, has called on African leaders to show more commitment to and support for the control of malaria, despite the achievements made so far.
She said donor fatigue was now a reality and African governments must respond to the situation and commit more funds to help maintain the gains made against malaria and other tropical diseases.
Mrs Binka made the call at a forum organised by AMMREN with support from the INDEPTH Network Effectiveness and Safety Studies (INESS) as part of activities to mark this year’s World Malaria Day which fell on April 25.
This year's World Malaria Day was held on the theme "Sustain Gains, Save Lives: Invest in Malaria”.
Malaria caused an estimated 655,000 deaths worldwide and about 560,000 of the victims were children under five in 2010. In Ghana on the average, about 3,000,000 cases of malaria are reported in public health facilities annually.
Mrs Binka said about 12 years ago, 40 African Heads of State made a declaration in Abuja, Nigeria to reduce the malaria burden on the continent by setting targets.
However, she noted, many countries have missed the 2005 and 2010 targets and it was unlikely that the 2015 targets would be met unless conscious efforts were made to achieve universal coverage of essential malaria interventions.
“Reduction of malaria deaths by a third over the last decade in Africa shows that investing in malaria does bring results. It has also shown that these gains are fragile and will be reversed unless malaria continues to be a priority for decision-makers and donors,” she said.
For Ghana, she appealed to the government for more funds to scale up interventions like the Affordable Medicines Facility for malaria (AMFm) to make artemisinin-based combination therapy (ACTs) as well as rapid diagnostic test (RDTs) accessible and affordable.
Mrs Binka also appealed to the private sector and corporate organisations to support malaria by implementing life-saving interventions at their workplaces and communities; health workers should adhere to known interventions by making sure all malaria suspected cases are confirmed before treatment and for individuals to seek appropriate treatment, stop using monotherapies and sleep under insecticide-treated nets (ITNs).
She further called on the media to promote discussions and debate on the malaria menace in national and international fora with the aim of influencing policies on malaria.
The Head of Pharmacovigilance Unit, University of Ghana Medical School, Professor Alex Dodoo, said the World Health Organisation’s (WHO) new initiative known as T3 — Test, Treat and Track, which urges all malaria-endemic countries and donors to move towards universal access to diagnostic testing and antimalarial treatment, and to build robust malaria surveillance systems was a laudable strategy.
Prof. Dodoo said INESS, which provides a platform to examine the real life safety and effectiveness of antimalarials in several African countries, was in the best position to give a reliable plan for understanding and expanding the rollout of the T3.
For his part, the Technical Coordinator of the African Leaders Malaria Alliance (ALMA), Mr Kwame Robert Agyarko, said out of the 45 African nations that have the malaria burden, 28 have removed tariffs on anti-malarial medicines; 23 have removed tariffs on Rapid Diagnostic Test (RDTs) kits; and 19 have removed tariffs on Long Lasting Insecticide Treated Nets (LLINs).
Sixteen have also removed tariffs on In-door Residual Spray (IRS) pumps while 12 have removed tariffs on insecticides for IRS.
To avert the threat of drug resistance, the Malaria Focal Person at the Police Hospital, Ms Ellen Sam, called for concerted efforts to stop the sale of fake and substandard malaria drugs and use of single drug treatments.
The Communications and External Relations Manager of INDEPTH, Jeannette Quarcoopome, who chaired the function, expressed the hope that when the Broadcast Bill was passed it would make provision for media houses to allocate a certain percentage of space and airtime to health and social issues.
At the forum, eight journalists who had consistently written stories on malaria for their media houses and the AMMREN magazine, Eyes on malaria, were rewarded.
NetsforLife, Vodafone promote ITNs
By Rebecca Kwei
AS part of the World Malaria Day celebrations which comes off on April 25, NetsforLife in partnership with Vodafone Ghana, has promoted the use of insecticide treated bednets (ITNs) in Old and New Saasabi and Oyibi near Dodowa in the Greater Accra Region to help fight malaria.
ITNs, which has been approved by the World Health Organisation (WHO), give double protection by preventing the mosquito from landing on a person and the insecticide in it repels or kills the mosquito when they land on the net.
ITNs have been known to reduce mortality in children under five by about 20 per cent and malaria illnesses among children under five and pregnant women by up to 50 per cent.
A survey showed that almost every household in Ghana had an ITN but “sleeping in the ITN” was the problem.
NetsforLife is thus championing ‘Hang Up’ which is a paradigm shift in the strategy for deploying ITNs in communities. Under this, volunteers go to the homes of beneficiaries and hang up the ITNs over the sleeping areas of the households. In times past, ITNs were distributed to people to hang themselves but they were not used for the purpose for which they were intended.
Thus, at the ceremony to promote ITNs at Saasabi, volunteers from Netsforlife and Vodafone staff hanged about one thousand ITNs in the community and its environs.
The Business Development Manager of NetsforLife, Ms Delia Awusi, said the organisation under the Episcopal Relief and Development, had since 2006 distributed 7.2 million ITNs in 17 sub-saharan African countries and 45,000 volunteers had been trained in malaria education.
She explained that after a ‘hang up’ project in any community, the organisation went back after a few months to evaluate the success of the project and added that so far, the surveys had shown a decrease in morbidity and mortality in those communities.
For her part, the Sustainability Manager of Vodafone, Ms Mamle Asare, said the partnership to promote the use of ITNs formed part of Vodafone’s global task to support the Millennium Development Goals.
She said Vodafone Ghana had chosen to support malaria, water and sanitation.
The Chief of Saasabi, Nii Saasabi, expressed his appreciation to the two organisations for the project since malaria was a major cause of morbidity and mortality in the community.
He appealed to Vodafone to assist the community to construct a KVIP and a clinic.
Reproductive Health Centre now operational at Korle Bu
By Rebecca Kwei
As part of efforts to improve its reproductive health services to the public, the Korle Bu Teaching Hospital has opened a new unit known as the Reproductive Health Centre.
The centre, which is close to the Maternity Block of the hospital, offers counselling, education, information on contraception and family planning services — oral contraceptives, injectables, intra-uterine devices (IUD), implants, pap smear and adolescent health.
In an interview, an Obstetrics and Gynaecology Specialist of the centre, Dr Feller Adoboe, said the facility which was opened in June 2010, also has a wing that deals with comprehensive abortion care.
This involves the management of abortion-related problems, effective use of contraceptives and linking up clients to other facilities, where necessary.
Furthermore, Dr Adoboe said the centre was opened to provide a conducive environment and confidentiality for clients since most people do not feel comfortable talking about their reproductive health problems.
He added that contraceptive awareness in Ghana was very high but there was a very low contraceptive prevalence rate of 17 per cent of women.
The reasons for the low contraceptive prevalence rate, he said, was varied and ranged from negative attitudes, religious beliefs and misconceptions to myths.
"Some people think that when they use contraceptives they may not be able to give birth in future and it is our aim to correct the misconceptions about contraceptions as well as encourage people to take their reproductive health seriously", he said.
Dr Adoboe also said the centre would soon offer tubal ligation and vasectomy services that it was open from Monday through Friday and encouraged women to patronise the centre’s services for screening and counselling to ensure their well-being.
Giving figures on new clients who had visited the facility for 2010 and 2011, the Principal Nursing Officer in charge, Madam Christina A. Addo, said there were 869 clients for Family Planning (short and long term) in 2010 and 1532 in 2011.
Three hundred and thirty-eight clients opted for permanent family planning method in 2011, compared to 271 in 2010.
A total of 1,854 women received care under the Comprehensive and Abortion Care (CAC) and Post Abortion Care (PAC) services in 2010, while the figure dropped slightly to 1,852 in 2011.
For adolescent health services, there were 436 clients in 2011 and 400 in 2010.
In 2011, 88 women had their implants removed while 92 also had their IUD taken out. For 2010, there were 103 implants and 126 IUD removals.
The centre also has a unit for screening cancers of the cervix, uterus, ovary and vulva.
According to Dr Kofi Effah, the screening enables the detection of pre-cancerous cells that could be treated since the late presentation of the cancer may be fatal.
He encouraged women from the age of 21 to report to the centre early to undergo screening for cervical cancer.
Dr Effah also said cervical cancer had been found to be the commonest cause of death among women and that there was evidence to show that more that 99 per cent of cervical cancer was caused by the Human papillomavirus (HPV) which is sexually transmitted.
Epilepsy — Keep patients out of the shadows
By Rebecca Kwei
Preliminary results of a study conducted by the Department of Psychiatry, the Neurology Unit, all of the University of Ghana Medical School, and the Kintampo Health Research Centre show that there are increasing numbers of people living with epilepsy in the three northern regions and parts of Accra.
However, similar studies have not been conducted in the other regions. According to a Neurologist at the Korle Bu Teaching Hospital, Dr Albert K. Akpalu said epilepsy formed 30 per cent of all cases seen at the neurology clinic.
The World Health Organisation estimates that of the 10 million people in Africa who live with epilepsy, eight million are not treated with readily available modern drugs. Other statistic shows that the number of new cases of epilepsy detected among 100 000 people during one year were: 83 in Burkina Faso, 64 in Ethiopia, 73 in Tanzania, 119 in Togo, and 156 in Uganda. These incidence rates are higher than those reported from the developed world, which usually range from 40 to 70 per 100 000 people.
What is epilepsy?
Epilepsy is a disorder that disrupts the transmission of electrical signals inside the brain. While it is more common in childhood and after 65 years, epilepsy can develop in any age. Normally, all functions of the brain are enabled by electrical impulses that travel between nerve cells. Epileptic seizure occurs when the nerve cells in the brain generate sudden, uncontrolled bursts of electrical activity. Normal communication between nerve cells become confused. Our thoughts, feelings or movements become uncontrolled for a short period of time. Dr Akpalu says if one has two or more seizures in a year, then that person is said to be living with epilepsy.
Is it a curse or spiritual disease?
Dr Akpalu was very emphatic that epilepsy was not a spiritual disease; neither was it caused by a demonic attack, curse or witchcraft but purely a manifestation of abnormal electrical activities in the brain, which is non-communicable and treatable.
Causes
Dr Akpalu says the causes of epilepsy has been put in three categories by the International League Against Epilepsy — the structural problem which has to do with abnormalities in the developing brain; the metabolic or functional and the idiopathic which is the unknown causes. Additionally, epilepsy can also be caused by infections such as meningitis, post cerebral malaria, peri-natal (around birth) factors, poor maternal health and delayed labour. Again, lack of oxygen to the brain after a stroke, head injuries causing scar tissue in the brain, tumours, degenerative conditions such as Alzheimer’s disease and dementia, family history of seizures, use of certain illicit drugs and intake of excessive alcohol can also cause epilepsy.
Stigma and discrimination
The biggest concern for Dr Akpalu and other health practitioners who treat people living with epilepsy is stigmatisation and discrimination. “Because epilepsy is plagued by myths and superstition in Ghana and in Africa, people living with epilepsy are highly stigmatised and discriminated against. Our traditional and belief systems influence the expression of stigmatisation and this has taken a toll on people living with epilepsy causing impaired physical, psychological and social functioning of those affected,” Dr Akpalu said. For instance in Ghana, if a family has someone living with epilepsy, then people are strongly advised not to marry from that family. This practice, Dr Akpalu said should be discouraged.
Reports from Sub-Saharan African generally indicate that people believe seizures to be contagious, spread by saliva, urine, faeces or flatus expelled during a convulsion. The fear of epilepsy being contagious results in stigmatisation.
However, Dr Akpalu says epilepsy is not contagious and is not spread by saliva, urine, faeces or flatus. Supernatural beliefs, such as witchcraft, are frequently cited as causing seizures or a person versed in magical arts may ‘‘put a curse’’ on someone, thereby draining the family`s precious financial resources.
“When patients and or their families hold supernatural beliefs regarding seizures, care seeking will be directed toward traditional healers or churches rather than hospital or clinic, resulting in delayed medical treatment” Dr Akpalu noted.
People taken to such traditional healers and churches are chained, flogged and given concoctions but Dr Akpalu advised that although it was good to pray, it was also very important to seek medical care immediately one experiences any form of seizure to be diagnosed.
Discrimination on the grounds of epilepsy manifests itself in all spheres of life, including health care, educational systems, employment, social and family life. For example in Côte d’Ivoire, people with epilepsy have to wash their clothes separately and ladies are not allowed to cook meals. Workers must also use their own tools and should not mix them with the group’s. In Burkina Faso’s Nankara ethnic group, people with epilepsy are not allowed to make speeches during traditional assemblies. When they die, they are not buried, but are thrown into the mountains or the sacred bush. Most people in the Gambia attribute the immediate cause of epilepsy to malevolent spirits. Behaviours such as bathing late at night or fetching water late at night by pregnant women are also believed in the Gambia to predispose to epilepsy. In northern Ghana and Zambia, epilepsy is thought to be caused by the projection of the shadow of a bird flying over one’s head. People living with epilepsy who fall into open fire during an attack are believed in northern Ghana to be untreatable thereafter.
In many African ethnic groups, people with epilepsy cannot marry, although this is not specific to the African continent. They may also not be permitted to participate in traditional ceremonies celebrating the passage to adulthood.
But Dr Akpalu said people living with epilepsy can marry and lead normal lives once the seizures are controlled. “I see patients who are politicians, pastors, nurses, lawyers, doctors, etc,” he said.
A survey by Agbohoui (1994) conducted in schools revealed a high rate of social withdrawal among children living with epilepsy. The study revealed that in certain instances children are denied access to education out of shame on the part of the family or the school’s refusal to accommodate them for fear of “contaminating” other pupils.
“Ignorance about epilepsy and the effects of some antiepileptic drugs often leads to misinterpretation of certain behaviours, such as drowsiness, memory impairment and attention deficits which are mistaken for laziness and lack of interest among teachers,” Dr Akpalu noted. However, Dr Akpalu said children living with epilepsy do not have to be withdrawn from school and that those he treats are very intelligent and through proper care can be helped to live healthy, normal lives.
Due to the seizures, people living with epilepsy are advised not take jobs as heavy duty drivers or crane operators but regulations regarding epilepsy and driving are not uniform across the region and this according to Dr Akpalu must be addressed. The consequences of stigmatisation and discrimination of people living with epilepsy are low self esteem often complicated by scars from injuries, shame and rejection by families and society.
Realities
Mrs Francisca Aba Larbie has been living with epilepsy for the past 33 years. She started having seizures at the age of six. According to her, she used to be very worried about living with the disease because she thought she would not get anyone to marry her till she met her husband.
“I have a very supportive husband and I am not worried anymore,” she says. Talking about her seizures, she said she feels it when she is about to have an attack but does not remember anything after that. After the seizure, she only feels tired. Mrs Larbi said living with epilepsy did not mean one could not lead a normal life and it was important for people not to look down on epilepsy patients.
Mr Thomas Larbie, a banker who has been married to Francisca for the past five years, says being married to someone with epilepsy has not been easy and can be very challenging but he was a “proud husband.” He said knowing his wife’s health challenge did not deter him from marrying her because he was not concerned about what others thought and the stigma attached to the disease. “People had a perception that she will not be able to get pregnant and all sorts of things were said but my mind was made up,” he recalled. He said there had been a vast improvement in his wife’s condition since they got married and her situation had given him the opportunity to learn so many things such as how to handle people with similar conditions.
Mr Larbie was grateful to Dr Akpalu for his support as well as his family who had been very encouraging. The couple have two daughters — Pearl who is three years and Albertina (name after Dr Albert Akpalu), one year, three months old.
Treatment
Dr Akpalu said epilepsy can be managed with antiepileptic drugs. However, the challenge had to do with the treatment gap which is the difference between the need for effective treatment and the receipt of such treatment. There are specific drugs for the different types of seizures. Most patients in Ghana are not accessing care due to several factors paramount of which is stigma and traditional belief that seizures are spiritual in nature. Several interventions are being rolled out to reduce this gap. The NHIS and the new Mental Health bill are both important in this regard. The Korle Bu Teaching Hospital has started an Epilepsy Clinic which runs on Monday afternoon. It is run by Dr Akpalu, Dr Patrick Adjei and other residents. Dr E. Badoe runs the paediatric epilepsy clinic.
Legislation
Fortunately, the Mental Health Bill which has just been passed by Parliament will ensures that standards, conditions and rights are relevant for all facilities in order to prevent the abuse of people with mental disorder including physical and sexual abuse.
• Driving laws - none exist on when and what someone living with epilepsy can drive.
• Protection at workplace — there is no workplace policy for now.
Disclosure
This is a thorny issue that may lead to dismissal. We need human resource managers who understand the issues and problems and are supportive. Livelihoods Under the European Union/Basic Needs Livelihoods Project, 1200 poor people with mental illness and epilepsy engage in occupational therapy to enhance recovery and build their skills for improved well-being and livelihoods “I dropped out of school because of epilepsy, but this training will prepare me to earn a decent income in future,” said one of the beneficiaries.
Way forward
For Dr Akpalu, it is important to demystify epilepsy and empower communities through education and awareness programmes. This is actively being done by the Epilepsy Society of Ghana (ESG) of which he is the Secretary. “The way we refer to people suffering from epilepsy has changed from ‘epileptic’ to “people living with epilepsy. There is also the need to increase and improve pre-natal consultation and medically assisted delivery as well as improve maternal and infant immunisations.
Dr Akpalu said measures such as wearing of helmets and other personal protective clothing at work, prevention of road accidents, avoidance of excessive alcohol intake and environmental pollution could prevent the incidence of epilepsy. He also stressed the need to highlight, manage and prevent infectious diseases that affect the brain and also the training of more community health nurses.
“People living with epilepsy often suffer unwarranted exclusion or are prevented from taking part in certain activities for no good reason. We have to eliminate discrimination in all spheres of life. It is important for all to know that most patients can live a normal life with just minor restrictions. We must keep them out of the shadows,” Dr Akpalu said.
Fight Against Epilepsy to the rescue
An initiative known as Fight Against Epilepsy is in the offing to help improve access to care and services for people living with epilepsy. The Coordinator for the initiative, Dr Cynthia Sottie, said the treatment gap in Ghana was very wide — about 80 per cent meaning that out of the total number of people with the disease only 20 per cent receive treatment.
She said the project is to help bridge the gap and for people to know that epilepsy is not a mental illness but a neurological disease which is treatable.
Dr Sottie said the Initiative which has been implemented in China, Uganda and other African countries will promote training of all health care providers to be competent in diagnosing and treating epilepsy, and integrate provision of care and services for epilepsy into the primary health care system.
She also said awareness of community groups will be promoted and improved to decrease stigma and increase demand for epilepsy care as well as training of community volunteers to help identify people living with epilepsy who because of stigmatisation do not seek appropriate care.
Additionally, she said most children drop out of school because of the stigma associated with the disease so the initiative will also target teachers and train them on what to do when a child gets seizure at school. “Above all we want to increase awareness that epilepsy is not infectious; you won’t get it by touching the saliva or urine of anyone with the disease. Having epilepsy does not mean one cannot function. It is treatable and you can live a normal life” she stressed.
The initiative which is a World Health Organisation (WHO) and Ministry of Health (MOH) collaboration was launched in the Tolon-Kumbungu district in the Northern Region on September 26, 2012.
First aid
• Do not panic, stay calm
• Clear the area, let patient lie down without harming you or himself
• Check Airway, Breathing and Circulation (ABC)
• Avoid forcing things into the mouth e.g. spoons, mobile phones, etc.
• Keep comfortable till seizure is over • If seizures intractable > 5 minutes - hospital
Preliminary results of a study conducted by the Department of Psychiatry, the Neurology Unit, all of the University of Ghana Medical School, and the Kintampo Health Research Centre show that there are increasing numbers of people living with epilepsy in the three northern regions and parts of Accra.
However, similar studies have not been conducted in the other regions. According to a Neurologist at the Korle Bu Teaching Hospital, Dr Albert K. Akpalu said epilepsy formed 30 per cent of all cases seen at the neurology clinic.
The World Health Organisation estimates that of the 10 million people in Africa who live with epilepsy, eight million are not treated with readily available modern drugs. Other statistic shows that the number of new cases of epilepsy detected among 100 000 people during one year were: 83 in Burkina Faso, 64 in Ethiopia, 73 in Tanzania, 119 in Togo, and 156 in Uganda. These incidence rates are higher than those reported from the developed world, which usually range from 40 to 70 per 100 000 people.
What is epilepsy?
Epilepsy is a disorder that disrupts the transmission of electrical signals inside the brain. While it is more common in childhood and after 65 years, epilepsy can develop in any age. Normally, all functions of the brain are enabled by electrical impulses that travel between nerve cells. Epileptic seizure occurs when the nerve cells in the brain generate sudden, uncontrolled bursts of electrical activity. Normal communication between nerve cells become confused. Our thoughts, feelings or movements become uncontrolled for a short period of time. Dr Akpalu says if one has two or more seizures in a year, then that person is said to be living with epilepsy.
Is it a curse or spiritual disease?
Dr Akpalu was very emphatic that epilepsy was not a spiritual disease; neither was it caused by a demonic attack, curse or witchcraft but purely a manifestation of abnormal electrical activities in the brain, which is non-communicable and treatable.
Causes
Dr Akpalu says the causes of epilepsy has been put in three categories by the International League Against Epilepsy — the structural problem which has to do with abnormalities in the developing brain; the metabolic or functional and the idiopathic which is the unknown causes. Additionally, epilepsy can also be caused by infections such as meningitis, post cerebral malaria, peri-natal (around birth) factors, poor maternal health and delayed labour. Again, lack of oxygen to the brain after a stroke, head injuries causing scar tissue in the brain, tumours, degenerative conditions such as Alzheimer’s disease and dementia, family history of seizures, use of certain illicit drugs and intake of excessive alcohol can also cause epilepsy.
Stigma and discrimination
The biggest concern for Dr Akpalu and other health practitioners who treat people living with epilepsy is stigmatisation and discrimination. “Because epilepsy is plagued by myths and superstition in Ghana and in Africa, people living with epilepsy are highly stigmatised and discriminated against. Our traditional and belief systems influence the expression of stigmatisation and this has taken a toll on people living with epilepsy causing impaired physical, psychological and social functioning of those affected,” Dr Akpalu said. For instance in Ghana, if a family has someone living with epilepsy, then people are strongly advised not to marry from that family. This practice, Dr Akpalu said should be discouraged.
Reports from Sub-Saharan African generally indicate that people believe seizures to be contagious, spread by saliva, urine, faeces or flatus expelled during a convulsion. The fear of epilepsy being contagious results in stigmatisation.
However, Dr Akpalu says epilepsy is not contagious and is not spread by saliva, urine, faeces or flatus. Supernatural beliefs, such as witchcraft, are frequently cited as causing seizures or a person versed in magical arts may ‘‘put a curse’’ on someone, thereby draining the family`s precious financial resources.
“When patients and or their families hold supernatural beliefs regarding seizures, care seeking will be directed toward traditional healers or churches rather than hospital or clinic, resulting in delayed medical treatment” Dr Akpalu noted.
People taken to such traditional healers and churches are chained, flogged and given concoctions but Dr Akpalu advised that although it was good to pray, it was also very important to seek medical care immediately one experiences any form of seizure to be diagnosed.
Discrimination on the grounds of epilepsy manifests itself in all spheres of life, including health care, educational systems, employment, social and family life. For example in Côte d’Ivoire, people with epilepsy have to wash their clothes separately and ladies are not allowed to cook meals. Workers must also use their own tools and should not mix them with the group’s. In Burkina Faso’s Nankara ethnic group, people with epilepsy are not allowed to make speeches during traditional assemblies. When they die, they are not buried, but are thrown into the mountains or the sacred bush. Most people in the Gambia attribute the immediate cause of epilepsy to malevolent spirits. Behaviours such as bathing late at night or fetching water late at night by pregnant women are also believed in the Gambia to predispose to epilepsy. In northern Ghana and Zambia, epilepsy is thought to be caused by the projection of the shadow of a bird flying over one’s head. People living with epilepsy who fall into open fire during an attack are believed in northern Ghana to be untreatable thereafter.
In many African ethnic groups, people with epilepsy cannot marry, although this is not specific to the African continent. They may also not be permitted to participate in traditional ceremonies celebrating the passage to adulthood.
But Dr Akpalu said people living with epilepsy can marry and lead normal lives once the seizures are controlled. “I see patients who are politicians, pastors, nurses, lawyers, doctors, etc,” he said.
A survey by Agbohoui (1994) conducted in schools revealed a high rate of social withdrawal among children living with epilepsy. The study revealed that in certain instances children are denied access to education out of shame on the part of the family or the school’s refusal to accommodate them for fear of “contaminating” other pupils.
“Ignorance about epilepsy and the effects of some antiepileptic drugs often leads to misinterpretation of certain behaviours, such as drowsiness, memory impairment and attention deficits which are mistaken for laziness and lack of interest among teachers,” Dr Akpalu noted. However, Dr Akpalu said children living with epilepsy do not have to be withdrawn from school and that those he treats are very intelligent and through proper care can be helped to live healthy, normal lives.
Due to the seizures, people living with epilepsy are advised not take jobs as heavy duty drivers or crane operators but regulations regarding epilepsy and driving are not uniform across the region and this according to Dr Akpalu must be addressed. The consequences of stigmatisation and discrimination of people living with epilepsy are low self esteem often complicated by scars from injuries, shame and rejection by families and society.
Realities
Mrs Francisca Aba Larbie has been living with epilepsy for the past 33 years. She started having seizures at the age of six. According to her, she used to be very worried about living with the disease because she thought she would not get anyone to marry her till she met her husband.
“I have a very supportive husband and I am not worried anymore,” she says. Talking about her seizures, she said she feels it when she is about to have an attack but does not remember anything after that. After the seizure, she only feels tired. Mrs Larbi said living with epilepsy did not mean one could not lead a normal life and it was important for people not to look down on epilepsy patients.
Mr Thomas Larbie, a banker who has been married to Francisca for the past five years, says being married to someone with epilepsy has not been easy and can be very challenging but he was a “proud husband.” He said knowing his wife’s health challenge did not deter him from marrying her because he was not concerned about what others thought and the stigma attached to the disease. “People had a perception that she will not be able to get pregnant and all sorts of things were said but my mind was made up,” he recalled. He said there had been a vast improvement in his wife’s condition since they got married and her situation had given him the opportunity to learn so many things such as how to handle people with similar conditions.
Mr Larbie was grateful to Dr Akpalu for his support as well as his family who had been very encouraging. The couple have two daughters — Pearl who is three years and Albertina (name after Dr Albert Akpalu), one year, three months old.
Treatment
Dr Akpalu said epilepsy can be managed with antiepileptic drugs. However, the challenge had to do with the treatment gap which is the difference between the need for effective treatment and the receipt of such treatment. There are specific drugs for the different types of seizures. Most patients in Ghana are not accessing care due to several factors paramount of which is stigma and traditional belief that seizures are spiritual in nature. Several interventions are being rolled out to reduce this gap. The NHIS and the new Mental Health bill are both important in this regard. The Korle Bu Teaching Hospital has started an Epilepsy Clinic which runs on Monday afternoon. It is run by Dr Akpalu, Dr Patrick Adjei and other residents. Dr E. Badoe runs the paediatric epilepsy clinic.
Legislation
Fortunately, the Mental Health Bill which has just been passed by Parliament will ensures that standards, conditions and rights are relevant for all facilities in order to prevent the abuse of people with mental disorder including physical and sexual abuse.
• Driving laws - none exist on when and what someone living with epilepsy can drive.
• Protection at workplace — there is no workplace policy for now.
Disclosure
This is a thorny issue that may lead to dismissal. We need human resource managers who understand the issues and problems and are supportive. Livelihoods Under the European Union/Basic Needs Livelihoods Project, 1200 poor people with mental illness and epilepsy engage in occupational therapy to enhance recovery and build their skills for improved well-being and livelihoods “I dropped out of school because of epilepsy, but this training will prepare me to earn a decent income in future,” said one of the beneficiaries.
Way forward
For Dr Akpalu, it is important to demystify epilepsy and empower communities through education and awareness programmes. This is actively being done by the Epilepsy Society of Ghana (ESG) of which he is the Secretary. “The way we refer to people suffering from epilepsy has changed from ‘epileptic’ to “people living with epilepsy. There is also the need to increase and improve pre-natal consultation and medically assisted delivery as well as improve maternal and infant immunisations.
Dr Akpalu said measures such as wearing of helmets and other personal protective clothing at work, prevention of road accidents, avoidance of excessive alcohol intake and environmental pollution could prevent the incidence of epilepsy. He also stressed the need to highlight, manage and prevent infectious diseases that affect the brain and also the training of more community health nurses.
“People living with epilepsy often suffer unwarranted exclusion or are prevented from taking part in certain activities for no good reason. We have to eliminate discrimination in all spheres of life. It is important for all to know that most patients can live a normal life with just minor restrictions. We must keep them out of the shadows,” Dr Akpalu said.
Fight Against Epilepsy to the rescue
An initiative known as Fight Against Epilepsy is in the offing to help improve access to care and services for people living with epilepsy. The Coordinator for the initiative, Dr Cynthia Sottie, said the treatment gap in Ghana was very wide — about 80 per cent meaning that out of the total number of people with the disease only 20 per cent receive treatment.
She said the project is to help bridge the gap and for people to know that epilepsy is not a mental illness but a neurological disease which is treatable.
Dr Sottie said the Initiative which has been implemented in China, Uganda and other African countries will promote training of all health care providers to be competent in diagnosing and treating epilepsy, and integrate provision of care and services for epilepsy into the primary health care system.
She also said awareness of community groups will be promoted and improved to decrease stigma and increase demand for epilepsy care as well as training of community volunteers to help identify people living with epilepsy who because of stigmatisation do not seek appropriate care.
Additionally, she said most children drop out of school because of the stigma associated with the disease so the initiative will also target teachers and train them on what to do when a child gets seizure at school. “Above all we want to increase awareness that epilepsy is not infectious; you won’t get it by touching the saliva or urine of anyone with the disease. Having epilepsy does not mean one cannot function. It is treatable and you can live a normal life” she stressed.
The initiative which is a World Health Organisation (WHO) and Ministry of Health (MOH) collaboration was launched in the Tolon-Kumbungu district in the Northern Region on September 26, 2012.
First aid
• Do not panic, stay calm
• Clear the area, let patient lie down without harming you or himself
• Check Airway, Breathing and Circulation (ABC)
• Avoid forcing things into the mouth e.g. spoons, mobile phones, etc.
• Keep comfortable till seizure is over • If seizures intractable > 5 minutes - hospital
Two vaccines to save children’s lives
By Rebecca Kwei
Two vaccines that will save thousands of children in Ghana from dying as a result of diarrhoea caused by the rotavirus diarrhoea and pneumonia will be introduced in the country next month.
The vaccine for rotavirus diarrhoea, known as the rotavirus vaccine, has proven to reduce severe diarrhoea in children in countries where it has been introduced while that for pneumonia is the pneumococcal vaccine (Prevenar 13).
In Ghana, next to malaria, diarrhoea and pneumonia are the second cause of mortality for children under five. Rotavirus is the most common cause of severe diarrhoea. Worldwide rotavirus kills nearly half a million children each year and more than 85 per cent of these deaths occur in developing countries. In Ghana rotavirus infection is responsible for 39 to 58.9 per cent of diarrhoeal cases in children.
The World Health Organisation (WHO) has since 2010 recommended that rotavirus vaccines be introduced into every country’s national immunisation programme.
In an interview with Prof George E. Armah of the Noguchi Memorial Institute for Medical Research, he said the combined effect of the two vaccines would save thousands of Ghanaian children from dying needlessly.
On rotavirus he said it was a common infection in Ghana with most children being infected with at least one infection by the age of 12 months and 60 per cent of hospitalised children with severe diarrhoea excreted rotaviruses.
Rotavirus infection which is associated with vomiting, severe watery (non-bloody diarrhoea) and severe dehydration, is seasonal with the peak infection occurring during the months of November to February in Ghana.
According to Prof Armah, without access to treatment for the severe dehydration rotavirus can cause, it can be a death sentence since the dehydration caused by the virus can kill babies who do not receive treatment within a few hours.
He explained that rotavirus was extremely contagious and although hand washing and improved sanitation had helped reduce the incidence of diarrhoea, the proportion of diarrhoea due to viruses had not been reduced hence the need to introduce the rotavirus vaccine.
“Improvement in hygiene, sanitation and drinking water which prevent other forms of diarrhoea do not prevent rotavirus infection. The only intervention available is by vaccination and it offers the best protection” Prof Armah emphasised.
The pneumococcal vaccine is to protect against severe forms of pneumococcal disease such as meningitis, pneumonia and bacteraemia. The risk of serious pneumococcal disease is highest in the first year of life but remains throughout the first 24 months of life.
Health experts say vaccinating against pneumococcal disease is a cost-effective way of preventing the disease and can reduce substantial mortality and morbidity in under served populations in developing countries.
Stroke strikes more young people
By Rebecca Kwei
Many more young people are suffering from stroke, an illness that occurs when blood supply to a part of the brain is interrupted or severely reduced, depriving the brain tissue of oxygen and nutrients.
According to a neurologist at the Korle-Bu Teaching Hospital (KBTH), Dr Albert K. Akpalu, stroke is becoming more common in young people between 25 and 45, a situation he described as alarming.
He attributed the situation to unhealthy lifestyles, including excessive alcohol intake and poor control of blood pressure.
Additionally, he said stroke formed 30 per cent of all admissions at the Department of Medicine of Korle-Bu and was the biggest cause of death in the department, accounting for more than 25 per cent of mortality there.
Stroke has also been identified as a leading cause of adult disability in Ghana.
Interestingly, a BBC report on October 11, 2012 indicated that strokes are becoming more common at a younger age, with about one in five victims now below the age of 55, according to a research in the American Academy of Neurology Journal.
The report said the study followed 1.3 million people in a US region and found that 19 per cent of those experiencing a stroke in 2005 were in that age group, up from 13 per cent in 1993.
This is despite a trend of overall falling rates of the condition.
The Stroke Association said the findings were alarming.
Report author Dr Brett Kissela said: "The reasons for this trend could be a rise in risk factors such as diabetes, obesity and high cholesterol."
The study looked at all people over the age of 20 in greater Cincinnati and North Kentucky over three periods in 1993, 1999 and 2005.
Looking at the UK parallels, the study said as well as a rise in the occurrence of stroke in the under-55s over this time from 109 per 100,000 people in 1993 to 176 per 100,000 in 2005, the study also found the average age of those experiencing the condition fell from 71 years in 1993 to 69 years in 2005.
Dr David Werring, a neurologist from the University College, London, said: "Stroke is usually considered a disease of older people, but this study reminds us that young people are also affected.”
Dr Akpalu said many factors can increase one’s risk of a stroke.
These include one’s family history, explaining that “your risk of stroke is slightly greater if one of your parents or a brother or sister has had a stroke or a temporary interruption of blood flow to a part of the brain known as transient ischemic attack (TIA)”.
Age is also another factor, as the risk of stroke increases as you get older.
He said stroke affects men and women about equally but women are more likely to die of stroke than men, and in the case of race blacks are at greater risk of stroke than people of other races. This is partly due to a higher prevalence of high blood pressure and diabetes.
Other risk factors are high blood pressure (hypertension), undesirable levels of blood cholesterol, high levels of low-density lipoprotein (LDL) cholesterol, cigarette smoking, diabetes, obesity and cardiovascular disease.
In order to improve the care of people suffering from the illness, a Stroke Unit has been established at the KBTH and work has commenced on the building of the unit, although a multi-disciplinary team is already in place.
The aim of the project, among others, is to work in partnership with the multi-disciplinary stroke team at the hospital and scale up training of staff at all entry points involved in stroke admissions.
Dr Akpalu said stroke survivors who could go home to a spouse or other companion were more likely to become independent and productive again and that encouragement and early treatment were important.
He said recovery and rehabilitation depended on the area of the brain involved and the amount of tissue damaged.
“Harm to the right side of the brain may impair movement and sensation on the left side of the body. Damage to brain tissue on the left side may affect movement on the right side. This damage may also cause speech and language disorders. In addition, people who've had a stroke may have problems with breathing, swallowing, balancing and hearing, and loss of vision and bladder or bowel function,” he said.
In view of this, rehabilitation, which is facilitated by a diverse team, focuses on giving education on four areas: swallowing, where patient may choke because he/she is unable to swallow; positioning, frequent turning to prevent bed sores and improve mobility, information on stroke to patients and carers and continence management which has to do with bladder and bowel care.
Kwame Asare Boadu reports from Kumasi that stroke has consistently remained the leading cause of mortality at the Komfo Anokye Teaching Hospital (KATH) for the past 10 years.
At KATH, it has been established that 43 per cent of patients with stroke die on admission, while up to 60 per cent has severe functional limitation, making them heavily dependent on relatives.
A study conducted by Dr Fred Stephen Sarfo, a clinic neurologist at KATH, revealed that the most important risk factor for stroke in Ghana was high blood pressure (or hypertension).
“The most affected age group are patients in their mid-50s, with a slight female predilection,” the study said.
A good number of younger persons in their 30s are also being affected these days as a result of factors including lifestyles.
According to Dr Sarfo, 85 per cent of all stroke patients had hypertension.
“By far, the most important risk factor for stroke among Ghanaians is high blood pressure (or hypertension),” he said.
He said nearly 70 per cent of the patients with hypertension were not aware they had hypertension.
“That is why hypertension is seen as a silent killer because it is often without any striking symptoms,” he said.
Giving further details on the situation at KATH, the clinical neurologist indicated in his study, “Among those who were known hypertensives, only 20 per cent reported taking their pressure medications (anti-hypertensives) consistently.
“In the same study, 73 per cent were physically inactive, 65 per cent were obese or overweight, 50 per cent had high blood cholesterol (fat in the blood) and 38 per cent were diabetics (high blood sugar).”
Dr Sarfo emphasised that that was an indication that the control of stroke in Ghana could be tackled head-on through intensive public education on lifestyle modification.
He described stroke as a growing public threat in the country and, indeed, most developing countries. This is against the fact that the incidence of stroke is gradually declining in the developed world,
Dr Sarfo pointed out that stroke is a preventable disease because the risk factors for its predisposition are largely remediable.
He disclosed that in Ghana, there were no community-based studies conducted to date to assess the prevalence of stroke in Ghana.
It has been estimated that one-third of patients die after their first stroke, one-third will have severe functional limitation (or incapacitation) and one-third will recover fully.
Additionally, Dr Sarfo noted, “there is a paucity of trained personnel, namely, neurologists, neurosurgeons, neurophysiologists, specialist nurses, physiotherapists and speech and occupational therapists to manage patients who present to our health institutions with stroke”.
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