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April 18 2001 by Marko Kokic, in Ouagadougou If you find yourself travelling through Boulsa province in Burkina-Faso you might easily come across a group of men and woman, young and old, on bicycles sporting the Red Cross emblem. It is hard to miss them as the Red Cross stands out in the predominantly yellow sun-parched landscaped draped by a bright blue sky. This fetching scene belies a more tragic reality. Inquiries will reveal that they are Red Cross volunteers participating in a meningitis awareness campaign. Since January, a meningitis epidemic has ravaged Burkina-Faso affecting 26 of the country's 53 districts, afflicting about ten thousand individuals and killing close to fourteen hundred people. Meningococcal meningitis (Neisseria meningitidis) is a contagious bacterial disease that is both endemic and epidemic. N. meningitidis is a common bacteria usually found in the mucosal membranes of the nose and throat. About 5-10% of people are asymptomatic carriers who inadvertently spread the disease. It is spread person to person via respiratory droplets from those infected. A small minority of those infected will develop an acute inflammation of the meninges, the membranes which cover the brain and spinal cord. Even if the disease is diagnosed early and adequate medical intervention administered the mortality rate is still between 5-10%. In the absence of treatment this figure may exceed 50%. 15-20% of those who survive suffer from persistent neurological defects, particularly deafness. Other consequences of this illness are loss of limbs, mental retardation and paralysis. The most affected tend to be young children, teenagers and young adults (WHO). The highest number of cases of meningococcal disease occur in sub-Saharan Africa in the area referred to the "meningitis belt" stretching between Senegal and Ethiopia. Meningococcal epidemics occur during the dry season between the end of November and the end of June for two to three consecutive years. Heavy concentrations of dust particles in the air are thought to be a vehicle for spreading the bacteria. This area has experienced epidemic cycles every 8-12 years in the past . Alarmingly, the intervals between major epidemics has become shorter and increasingly irregular in the past two decades. Once the disease reaches epidemic proportions a mass immunisation campaign covering 80% of the population is necessary to effectively halt its spread. The vaccine of choice immunises against the two serogroups A and C meningococci responsible for epidemic meningococcal disease in this region. A large widespread epidemic can follow from localised outbreaks the previous year. Unless stemmed by mass immunisation incident rates will remain high for up to two years. The socio-economic implications of epidemic meningitis are immense. To prevent and curb the disease requires massive amounts of vaccine, medicines and logistical support from national health authorities. An epidemic places great strains on an already burdened health system. The result is less resources available to treat individuals suffering from other ailments. Burkina-Faso figures as one of the five poorest countries on the planet. Simply put, Burkina health authorities can not cope with an epidemic of this magnitude. For this reason, the International Co-ordinating Group on Vaccine Provision and Epidemic Meningitis Control (ICG) exists to assist during such crisis situations. Spearheaded by the WHO, it was established when epidemics in sub-Saharan Africa depleted world stocks of meningococcal vaccine during severe epidemics in 1996 and 1997. The role of the ICG is to co-ordinate the best use of limited amounts of available vaccine. One of the members of the ICG is the International Federation of Red Cross and Red Crescent Societies. Via the ICG, National Red Cross Societies and the Federation support national health authorities during mass meningitis vaccination campaigns. With Federation support National Red Cross Societies assist health authorities in administering vaccines as well as providing the social mobilisation necessary to ensure widespread vaccination coverage. To date, the Burkina-Faso Red Cross has heklped vaccinate approximately 20,000 people. However, their efforts at administering vaccines have been limited due to a global deficit in meningitis vaccine stocks. Health authorities initially requested over seven million doses and have since had access to only about 2.5 million, due to the global shortage. "We have the ability to vaccinate up to 10,000 people per day. It's rather frustrating because the lack of vaccines prevents us from reaching our full capacity. We are relegated to waiting for more vaccines to arrive," says Mr. Sidi Ouedragaogo, National Youth and Training Coordinator. Vaccination is but one step in curtailing this epidemic. Providing beneficiaries with awareness of the benefits of vaccination is equally important. The public must be taught to detect the symptoms and risks associated with meningitis as well as what measures to take to shield themselves from exposure. To this end, the Burkina-Faso Red Cross supported by the Federation has been distributing posters and leaflets in the country's predominant languages: French, Moré, Fulfuldé, and Djula. Volunteers have been distributing this information in both the capital and provinces. As many beneficiaries are illiterate volunteers take the time to explain all the material they distribute. Back in Boulsa province the local branch has no motor vehicle at their disposal but that does not prevent volunteers from accomplishing their work. When asked how large an area they cover the volunteers laughingly responded, "As far as our bicycle pedals can take us". Considering that midday temperatures can reach 40o Celsius in the shade, their efforts are nothing short of remarkable. In neighbouring Kourittenga province the Red Cross Chapter in the town Koupéla is a model example of what a local chapter with limited resources - but great aspirations - can accomplish. They have a training centre teaching women to read and write in the local Moré language. To raise funds necessary to cover branch operating costs volunteers help run two micro enterprises, a piggery and a soap making facility fabricating over a hundred bars a day. Koupéla has no less than 60 volunteers. They too were actively combating the meningitis epidemic in their community and province. Loaded into an old Peugeot 404 pickup draped with the Red Cross flag and on loan from the local health department, volunteers were ready for deployment. Their destination, the town of Pouytenga where about 70% of the province's commerce takes place. Large concentrations of people in the town's three markets make it a high risk area for epidemics and a prime location to provide mass awareness. Pouytenga's livestock market is the largest of the town's three markets. It is a high risk area for meningitis. The reason, a lack of sanitary conditions, a large transient population and excessive dust produced by herds of cattle, mules and goats. In the town's second market volunteers focused their attention on food vendors and their clients. People and vendors in the general market were also provided with information on meningitis. Romain Guigma, Secretary General of the Red Cross branch in Koupéla, explains some of the goals of the vaccination campaign, "Volunteers take the opportunity to not only inform beneficiaries about meningitis but also try to dispel some mistaken ideas they have about the disease and vaccination itself. First off, beneficiaries must be informed of the symptoms of meningitis and the need to get medical attention, secondly they need to know the vaccine is safe and the location of vaccination points in their community. "Beneficiaries tend to see traditional healers before seeking professional medical assistance. With an unforgiving disease like meningitis any delay in seeking medical attention often proves deadly. Finally, some people mistakenly think that once they are vaccinated they can no longer become ill . When they do become ill from other diseases they proclaim the vaccine as ineffective. All this misunderstanding needs to be clarified if we are to make an impact". |
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A
food vendor in Pouytenga,one of the focus groups Red Cross volunteers
provided with meningitis awareness. (p6392).
