David D. Nicholas

Is poliomyelitis a serious problem in developing countries?--lameness in Ghanaian schools.

A postal survey of lameness in schools throughout Ghana showed an estimated prevalence of lameness attributable to poliomyetitis of 5-8 per 1000 school-aged children and an estimated mean annual incidence of paralytic poliomyelitis of 23 per 100 000 population. Official reported incidence rates range from 0-1 to 2-1 per 100 000 population, indicating that at least 90% of cases are not reported. No evidence of epidemics was found to account for these high rates. These suggest that mean annual incidence rates in tropical endemic countries have always been as great, if not greater, than those experienced by temperate countries during epidemic periods in the twentieth century and that the total number of cases of paralytic poliomyelitis occurring in the world each year has been reduced by only 25% since the advent of polio vaccine. Immunisation against poliomyelitis must have a high priority in Ghana and other tropical countries where the disease is endemic.

An evaluation of male contraceptive acceptance in rural Ghana.

To evaluate the effect of male contraceptive acceptance on fertility, the Danfa Family Planning Project in rural Ghana studied a sample of its male family planning acceptors. The findings show that half of the survey respondents accepted foam for use by their partners and half accepted the condom. The continuation rate (69 percent at 12 months) and use-effectiveness rate (80 percent at 12 months) reported by men were higher than those reported by women program acceptors. It is felt that men can play a significant role in affecting fertility through their influence on a couples choosing to use contraception and as a result of their motivation to obtain contraception and see that it is used. It is urged that increasing emphasis be placed on providing family planning services for men in African programs.

Outside Europe. Is poliomyelitis a serious problem in developing countries?--the Danfa experience.

Children were examined for lameness in the Danfa Project district of rural Ghana to assess the impact of endemic poliomyelitis and to test a widely held hypothesis that paralytic poliomyelitis is relatively rare in such districts (less than 1 per 1000 children affected). The observed prevalence of lameness attributable to poliomyelitis was 7 per 1000 school-aged children, and the annual incidence is estimated to be at least 28 per 100 000 population. Although no evidence for an epidemic was found, these rates are comparable with those in the USA and Europe during the years of severe epidemics and indicate that a high price is being paid in the Danfa district for the natural acquisition of immunity. As a result, immunisation against poliomyelitis has been given high priority. A teacher questionnaire was also tested for use in postal surveys as a rapid means of estimating the prevalence of lamenes attributable to poliomyelitis in countries with a reasonable network of primary schools.

The Danfa family planning program in rural Ghana.

The objectives of the Danfa Family Planning Program in rural Ghana are to provide family planning services to the people in the region and to conduct research into ways of making these services as effective and accessible as possible within given resource limitations. The effort is made to describe the planning and operating experience of the program during its 1st 2 1/2 years. In order to test the hypotheses and satisfy service, research, and teaching objectives, the region in which the project operates was divided into 4 areas with each area receiving different service inputs. This division was related to the following arguments with the 4th area used as a control area to learn how much family planning occurs in the absence of special health, education, and family planning programs: 1) couples will want to limit the number of their children only if they perceive that they need no longer fear that several of them will die before reaching adulthood; 2) the most cost-effective approach is to provide family planning services in conjunction with an intensive educational program promoting good health practices and family planning but without comprehensive health services; and 3) by amking family planning services available without concern for comprehensive health services or a special education program, adequate acceptance of family planning and a favorable fertility change at minimum cost will be achieved. The 4 research areas covering about 200 square miles are located in a rural region 8-50 miles north of Accra, the capital of Ghana, and have a population of 60,000. It was learned that it is easier to operate a family planning program in this region of rural Ghana than had originally been anticipated and that education about the benefits of family planning and the methods available along with accessibility to services are 2 elements that are crucial to the success of a family planning program in this setting.

Attitudes towards family size and family planning in rural Ghana-Danfa Project: 1972 survey findings.

A KAP survey of 2000 households in the Danfa Project in Ghana was conducted April-October 1972. Follow-up surveys were taken in 1975 and 1977 to evaluate changes related to health education and family planning programs. 2745 females aged 15-44 and 1973 males aged 15-64 were interviewed. More older men were included because of their remarriage practices. 47.5% were under 15; average age 17. The population is primarily agricultural; 2/3 adults are uneducated. The birth rate is 47/1000; the death rate 17/1000. With a growth rate of 3% the population will double in twenty years. Five questionnaires were used to obtain information on fertility maternal and child health practices illness within the preceding 2 weeks and family planning KAP. 70% approved family planning but most preferred large families. Ideal family size for males was 9.8 children for females 6.6. Women with 10 children are honored in their villages. Ghanans marry early: men in mid-20s women 18-19 and start families immediately. The desire for large families eliminates motivation to use birth control. Improved health conditions increased size of reproductive age population and early marital age will increase the 3% growth rate. Women will be more important than men in deciding family planning practice. Most villagers hear about family planning by word of mouth. Village-based health educators work with birth attendants community leaders teachers and church groups to encourage family planning.

Factors influencing utilization of a malaria prophylaxis programme in Ghana

Abstract In 1973 an interview survey was done in rural Ghana to learn about factors affecting participation in a malaria prophylaxis programme and whether volunteer workers could effectively serve as medication distributors. Several maternal characteristics were associated with higher participation and continuation rates. Education was not a factor, but women over age 30 and those with larger families had better programme attendance. This was attributed to a greater sense of need in larger families and greater previous use of and satisfaction with health programmes by older mothers. In addition, mothers who knew about modern preventive actions to avoid fever had significantly higher entry and continuation rates in the programme. Village volunteers were more successful than trained health workers in creating initial awareness of the programme and in motivating mothers to start and remain in the programme. Special efforts will be made in this years (1974) malaria programme to motivate younger mothers to participate and to maintain improved information flow.

Integration of family planning and maternal and child health in rural West Africa.

The Danfa Comprehensive Rural Health and Family Planning Project in Ghana is a service teaching research and demonstration project in the rural part of the country. Instituted in 1970 for an 8-year period the project was designed to investigate the feasibility and advantages of an integrated delivery system for family planning and maternal and child health services. The advantages of integrated health care are cited. It was postulated before the project started that integrated health care would be most effective in per acceptor costs and acceptance rates. Within the project area different areas provide different programs of health care. The various types of care are described. Functional and cost analysis show that for every family planning acceptor in the area providing only family planning services 2 acceptors are gained by the family planning plus health education program and 5 for the comprehensive health care/family planning program.

The evolution of a primary health care programme: the Danfa experience 1970-1977.

The Danfa Comprehensive Rural Health and Family Planning Project was established in Ghana as a demonstration service teaching and research program. Originally population coverage was poor. To improve coverage of preventive and curative services a number of village-based programs were developed that progressively increased community participation. 60% of the children attend school; 60% of the men and 32% of the women in the 15-44 year age group are literate. 1/2 the population is Christian. The rest hold traditional religious beliefs. 18% of the population are children under 5; 49% are children under 15 18% are women age 15-44; only 3% are over age 65. At the beginning of the project the infant mortality rate was estimated to be 100/1000 live births; the maternal mortality was approximately 5/1000 live births; and expectation of life at birth was 55 years. The birth rate was 47/1000 population; the crude death rate was 15/1000/year. Health service priorities are the major causes of mortality. In children these are malaria measles respiratory infections poliomyelitis intestinal parasites whooping cough diarrhea and malnutrition. Treatment of acute illness and maternal and child welfare programs were carried out at the beginning of the project. The progressive involvement of the community can be divided into 3 phases. Phase I included: 1) health education; 2) sanitation; and 3) training of traditional birth attendants. Phase II introduced 3 new programs: 1) malaria chemoprophylaxis; 2) family planning; and 3) immunization. Phase III is the village health worker program which seeks to improve and co-ordinate village-based health programs to increase health care coverage and to reduce costs. It is estimated that less than 30% of the countrys population of 10 million has access to modern health care.