Factors Influencing the Incidence of Measles in Ho District

Abstract

Ho District has the second largest land area and the largest population among the twelve Districts of the Volta Region. Ho doubles as the capital of both the district and the region. Over the past five years the incidence of measles has been increasing and has come to be among the top ten diseases in the district. This research was organized to study the characteristics of measles cases and their families in order to find out who were affected, where within the district they are coming from, what their family backgrounds are and what can be done to stop the increasing trend. A total of 76 cases from the Ho District Hospital admitted from January 1998 to June 1999 were studied. Their records were reviewed and their mothers were interviewed to ascertain their children’s immunization status, their social background and beliefs and practices with regard to measles. Twenty-nine CHNs were also interviewed with regard to their knowledge and practice of the cold chain and their workload. The cases studied were equally distributed between rural and urban areas. However irrespective of the place they came from the background characteristics of their mothers were strikingly similar: mostly married, Christian, educated up to JSS (average of 9 years of education), either farming or trading and earning less than ₵100,000 each month. They are characteristically the rural and urban poor. The mean age of cases was 26.7 months but about 17% had measles before the recommended age for vaccination of 9 months; 21% of cases had been fully immunized. Many mothers did not know the mode of transmission for measles; almost all mothers accepted that immunization is the best way to prevent measles; 35% of mothers of children who were not immunized claimed to be too busy or had traveled at the time the child was due for immunization. From the CHNs it was learnt that almost half do not reach their target communities regularly because of transport difficulties. Three sub-districts do not have cold storage facilities and therefore those from far away communities collect their vaccines, keep then overnight in vaccine carriers and use then the next day for immunization sessions. This can possibly result in a break in the cold chain at the very last level. It was recommended that: ♦ The DHA make all possible efforts to provide the needed logistics especially transport and cold storage facilities to support the immunization program. ♦ CHNs should organize occasional mini mass immunization for isolated communities in order to catch up with those who miss opportunities. ♦ An incentive system should be developed to motivate the field staff and ♦ Use should be made of the new local government system to improve community participation in Child Welfare Clinics.