Primary Health Care

The information within this section is designed to bring primary health care awareness to teachers and other youth workers within the region. As best as possible, it is in alphabetical order.

General Information

These documents are in Microsoft Word format. For a free Word Viewer, if you don’t have this application installed, please click here.

Information Leaflets – Examples

Primary Health Care in Sierra Leone

We are now building simple resources that deal with the MAIN child killers in Sierra Leone. They follow later on this page.

In the coming weeks Dr Tom Samba, Director of Child Health, Sierra Leone and I will be writing primary health care materials that can be used by all who want to – there is no charge for using any of the materials. Whether you are a health professional or not please make use of the materials.

They will cover ALL the major diseases that can affect a childs life.

We hope you will find this facility useful.

An Introduction

Empowering the young

John Birchall

‘ No child in the world will go to bed hungry by the year 2000.’ This was one of the closing statements of the Food Security Conference in Rome in 1974. (1) According to the United Nations Development Programme, hunger now prevails among at least a quarter of the world’s inhabitants. Every day there are 30,000 – 40,000 child deaths in the world and most of these are from diseases related to poverty. (2) This means that there are 12 to 14 million-child deaths associated with hunger each year.

The well-known phrase ‘Health for all by the year 2000’ was first heard at the United Nations Alma Ata conference in 1978. Alas, its aims were never realised and so in the year 2000 it is now time to examine both why the target was not reached and what can be done to try and make some serious reductions in this tragic waste of human life. Such statements fall easily from the lips of politicians and planners but what is the reality against which they must be put in context?

According to the World Bank almost 65% of the inhabitants of Africa live in ‘absolute poverty’, a term used by the former World Bank President Robert MacNamara to describe a condition of total deprivation of the minimum living conditions essential for human dignity. (3)

We are familiar with such terms as the ‘Debt Trap’and other causes of morbidity and mortality amongst children and women – the most vulnerable groups. This ‘pathology of poverty’ in the Third World is associated with increased scarcity of resources, more hunger, and increasing death rates. The poverty gap has increased by 30% over the past decade. We are also aware of the problems caused by aids, the enforced reductions in public expenditure on health and welfare and the shrinking education budgets that many countries now battle with.

So, how can ordinary people attempt to do something positive to improve their quality of life and that of their families and communities? Well, let’s look at two simple statements.

  • there are more teachers than doctors
  • there are more pupils than patients

Simple statements yes but they offer a base from which to build programmes that allow those most at risk from serious and life threatening disease to begin to do something positive to help themselves. In modern political terms people need to be ‘empowered’ or offered the knowledge to ‘enable’ them to begin an active campaign to improve living condition for the most vulnerable members of society.

Let’s look again in more detail at the two statements.

Teachers meet with the young and build a trusting relationship through which knowledge and its application are passed. Why not incorporate in normal timetables/curriculum’s simple advice on the major diseases that cause so much of the poverty that is evident in Africa? This can be done in interesting ways that encourage participation and a desire to spread the information. Lessons can centre on outward signs of possible illness, ways of reducing the risk of catching such diseases and effective proposals for helping those who already have an illness. Greater awareness may also reduce prejudice and misunderstanding. (4) Access to life saving information need not be the privilege of those fortunate to live near to better-stocked medical centres.

The second statement noted that more pupils exist than patients. So, once again here is a perfect opportunity to allow the young to be pioneers within their own communities in the spreading of health messages that offer a positive input to communal life. None of this need be sophisticated. Indeed, the more basic the message the greater the chance of acceptance. Young people can be ‘peer educators’ to their own age group and ‘ information providers’ to their wider community. Such programmes do not require vast sums of money and individuals feel involved and valued.

Evidence of the impact on both individual and community health standards can be gathered from many different locations. An example is that of Nicaragua, where successive Structural Adjustment Programmes seriously reduced the fabric of the health and education facilities.  A more ‘upside down approach’, in which simple primary health information was given to young people has now been introduced in some regions and the levels of malnutrition and infant mortality are beginning to drop – though only by a little. (5) In India the ‘bottom upwards’ approach adopted in Vellore, South India has also paid visible dividends in increased child welfare and better treatment for women. (6)

In the coming weeks we will be concentrating on many of the diseases most prevalent in West Africa and producing simple, effective and free teaching materials. We will be including materials on each disease, community and individual reactions and possible life style changes that could help in the fight against the killer diseases. Each disease will be given adequate coverage to allow teachers and others who work with the young to offer positive, enabling instruction that will empower the next generation to make a significant contribution to the health of both themselves and their communities. We will also be offering other sources of information. If anyone would like to converse with John you can contact him on: john_birchall@bsc.biblio.net

Let’s begin the process of increasing awareness of the diseases mentioned in the above article

Hookworm

More details will follow

An excellent article on combating River Blindness in Burkina Fasso

http://news.bbc.co.uk/1/hi/world/africa/8105840.stm

Diseases which are basically confined to Africa

Sleeping Sickness

Human African Trypanosomiasis, also known as sleeping sickness, is a vector-borne parasitic disease. The parasites concerned are protozoa belonging to the Trypanosoma Genus. They are transmitted to humans by tsetse fly (Glossina Genus) bites which have acquired their infection from human beings or from animals harbouring the human pathogenic parasites.

Tsetse flies are found in Sub-Saharan Africa. Only certain species transmit the disease. Different species have different habitats. They are mainly found in vegetation by rivers and lakes, in gallery-forests and in vast stretches of wooded savannah.

  • Sleeping sickness occurs only in sub-Saharan Africa in regions where there are tsetse flies that can transmit the disease. For reasons that are so far unexplained, there are many regions where tsetse flies are found, but sleeping sickness is not.
  • The rural populations living in regions where transmission occurs and which depend on agriculture, fishing, animal husbandry or hunting are the most exposed to the bite of the tsetse fly and therefore to the disease.
  • Sleeping sickness generally occurs in remote rural areas where health systems are weak or non-existent. The disease spreads in poor settings. Displacement of populations, war and poverty are important factors leading to increased transmission.
  • The disease develops in areas whose size can range from a village to an entire region. Within a given area, the intensity of the disease can vary from one village to the next.
  • Human African Trypanosomiasis takes two forms, depending on the parasite involved:
    • Trypanosoma brucei gambiense (T.b.g.) is found in west and central Africa. This form represents more than 90% of reported cases of sleeping sickness and causes a chronic infection. A person can be infected for months or even years without major signs or symptoms of the disease. When symptoms do emerge, the patient is often already in an advanced disease stage when the central nervous system is affected.
    • Trypanosoma brucei rhodesiense (T.b.r.) is found in eastern and southern Africa. This form represents less than 10% of reported cases and causes an acute infection. First signs and symptoms are observed after a few months or weeks. The disease develops rapidly and invades the central nervous system.

Guinea Worm

Guinea worm disease is a debilitating and painful infection caused by a large nematode (roundworm), Dracunculus medinensis. It begins with a blister, usually on the leg. Around the time of its eruption, the person may experience itching, fever, swelling and burning sensations. Infected persons try to relieve the pain by immersing the infected part in water, usually open water sources such as ponds and shallow wells. This stimulates the worm to emerge and release thousands of larvae into the water. The larva is ingested by a water flea (cyclops), where it develops and becomes infective in two weeks. When a person drinks the water, the cyclops is dissolved by the acidity of the stomach, and the larva is activated and penetrates the gut wall. It develops and migrates through the subcutaneous tissue. After about one year, a blister forms and the mature worm, 1m long, tries to emerge, thus repeating the life cycle.

For persons living in remote areas with no access to medical care, healing of the ulcers can take several weeks. This can be further complicated by bacterial infection, stiff joints, arthritis and even permanent debilitating contractures of the limbs. People in endemic villages are incapacitated during peak agricultural activities. This can seriously affect their agricultural production and the availability of food in the household, and consequently the nutritional status of their family members, particularly young children.

Distribution of the disease

At the beginning of the 20th century, guinea-worm disease, was widespread in many countries in Africa and Asia. It is estimated that there were about 50 million cases in the 1950s. Due to concentrated efforts by the international community and the endemic countries, the number of cases of guinea-worm disease was reduced to about 96 000 by 1999. Guinea-worm disease is prevalent in only 13 countries in Africa including Sudan, Nigeria, Ghana, Burkina Faso, Niger, Togo and Côte d’Ivoire. A small number of cases have also been reported in Uganda, Benin, Mali, Mauritania, Ethiopia and Chad.

Some examples of information sheets – these can be used when working with teachers and pupils

Healthcare – a major cause for concern

Having a baby

Death during childbirth

Helping the young to grow

Feeding young people

Encouraging healthy eating

PHC Workshops

Tuberculosis Part 1

Tuberculosis – Part 2

Worms

Primary Health Care – Tanzania

The Cholera Process – simple diagrams can also help explain serious diseases

We can also use maps and simple data to improve awareness

Cholera in Africa

Aids

Charts of lifestyle changes are also useful

A possible short course

Click on the subject under the week title to get the information you want!

Week 1

(a) Basic introduction to:

·        PHC via education – use Power Point Presentation (already provided)

·        Peer and community education – health maps, body maps and calendars

.        Basic indications

(b) Introduction to major diseases to be covered

·        Water borne

·        Others

·        Reactions and life style improvements

Week 2

Water Borne diseases (A)

·        Malaria

·        Bilharzia

·        Clean safe water

·        Guinea Worm

Water borne (B)

·        River Blindness

·        Denge

·        Others

Week 3

Others

·        Vitamin A deficiency part 1 – part 2

·        HIV/Aids

·        Diabetes

·        Leprosy

·        Others

Week 4

Caring for the young of the community

·        Worms

·        Diarrhoea

·        Measles

·        Coughs, colds and pneumonia

·        Looking after your eyes

·        Looking after our teeth

Week 5

Helping those in community stay healthy or suffer less from a disease

·        Growing vegetables

·        Healthy food  how do we know if they are eating enough

·        Using resources e.g. school farms

·        Teenage girls have special food needs

.        Is there malnutrition in your community

.        Immunisation

Week 6

Concluding the content and discussing teaching styles

.         Lesson plans

.         Schemes of work

.         Involving colleagues

Some examples taken from the above course structure

Bilharzia an example of the style of materials we will be publishing.

What is Bilharzia?

Bilharzia is a human disease caused by parasitic worms called Schistosomes. Over one billion humans are at risk worldwide and approximately 300 millions are infected. Bilharzia is common in the tropics where ponds, streams and irrigation canals harbor bilharzia-transmitting snails. Parasite larvae develop in snails from which they infect humans, their definitive host, in which they mature and reproduce

Worms wriggling in your veins

Adult Schistosomes worms are about 1 cm long and hang out in mesenteric veins (the small veins that carry blood from the intestine to the liver). The worms feed on red blood cells and dissolved nutrients such as sugars and amino acids. This can cause anemia and decreased resistance to other diseases.

Schistosomes live in pairs, the male holding and protecting the female inside his ventral groove. Once paired, the two remain in constant copulation. The female lays hundreds of eggs each day, which find their way out of the human body through the urine or the faeces, depending on the species. The pathology is mostly caused by the large number of eggs becoming stuck in various body parts, in particular the liver (causing liver enlargement and malfunction) and the kidneys (causing kidney damage, detectable by blood in the urine).

Schistosomes eggs are evacuated from the human body via faeces or urine. When sanitation is poor, they can reach rivers or lakes. They hatch into tiny swimming larvae called miracidia. These swim about until they locate a snail and bore into its body. Over a period of 3 to 4 weeks, miracidia develop into hundreds of sporocysts, which each produce thousands of cercariae, the next infective stage. A single snail can shed thousands of cercariae each day

Can I catch Bilharzia from someone infected?

No – unless you are a snail !

Schistosomes must alternate between humans and snails to complete their life cycle. This means that Bilharzia can only caught from snails.

Under the tropics, any body of water containing vegetation could contain bilharzia-transmitting snails. Washing, swimming or paddling in that water therefore exposes you to infection by the parasite.

Is there a vaccine?

Not yet, although many medical scientists are working on it. The problems involved in vaccine development are threefold:

  • Adult worms are about one thousand times larger than the white blood cells responsible for the immune response.
  • Worms protect themselves with a tough tegument, protecting them from chemical attack.
  • Worms mimick their host by coating themselves with host molecules.

The good news is that there is a readily available treatment. A drug called praziquantel is injected into the bloodstream and disrupts the parasite’s tegument. The parasite is then destroyed.