It was a hot afternoon on February 7, this year, when Adam Fuseina, a resident of Charikpong in the Nadowli-Kaleo District in the Upper West Region, noticed that her 10-year-old son had developed fever.
At first, she thought it was just the usual afternoon warm temperature. But within hours, little Salifu Mashud’s (not real name) fever worsened and he complained of a severe headache and stiffness in his neck.
By nightfall, he was unresponsive. She rushed the child to hospital but the doctors said it was too late. He succumbed to the illness.
Mrs Fuseina said doctors diagnosed the child with cerebrospinal meningitis (CSM) at the hospital but all efforts by the health workers to resuscitate him yielded no result.
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"When he started feeling feverish, I didn’t take it seriously, so I was treating him with some local herbs.”
“When we rushed him to the hospital, they told me it was CSM but they couldn’t manage it because it was too late, I have never heard of that illness before" she narrated.
In Lawra, a 35-year-old man, Yussif Alhassan, barely survived CSM last year.
"I was fine in the morning, then I started feeling headache and feverish. By the evening, I couldn’t even stand on my feet”.
“When I was rushed to hospital, the doctor said if we had delayed a few more hours, I would have lost my life” he recounted to the Daily Graphic.
Mr Alhassan said although he was lucky to be alive, the disease had left him with partial hearing loss, a common complication of CSM.
He and little Yussif are part of many people in the Upper West Region who have fallen prey to the CSM disease.
CSM, also known as Meningococcal meningitis, is a bacterial infection that inflames the membranes surrounding the brain and spinal cord.
It is often caused by viral, fungal or bacterial infection.
Bacterial meningitis is caused by several bacterial pathogens but Neisseria meningitidis (Nm), Streptococcus pneumoniae and Haemophilus influenzae type B represent the triad causing over 80 per cent of all cases of bacterial meningitis.
It spreads through respiratory droplets, making it highly contagious in crowded and poorly ventilated spaces.
Symptoms include headache, fever, stiff neck and back, vomiting, joint and muscle pain, drowsiness, light sensitivity and seizures.
The disease is endemic in Northern Ghana, particularly in the Upper West Region, during the hottest months of every year, fuelled by extreme heat and dry Harmattan winds.
The recurrent meningitis outbreaks in Ghana, particularly in the regions of the north, led to the conduct of a mass preventive immunisation campaign in the country in 2012 to address the burden of Group A meningococcus, which was accounting for an estimated 80–85 per cent of all cases in the meningitis belt in the country.
The successful immunisation programme led to a dramatic decline and the occurrence of meningitis outbreaks due to other Nm serogroups as well as other bacteria which are rather a new concern, a new strain.
Current scourge
As of Sunday, February 16, this year, 129 cases had been recorded in the Upper West Region, the Minister of Health, Kwabena Mintah Akandoh, told Parliament last week.
Dr Demain Punguyeri (right), Upper West Regional Director of Health Services, touring some health facilities to assess the situation
Out of that, 16 deaths have been recorded while 29 individuals are currently receiving treatment at various health facilities, according to the Ghana Health Service (GHS).
Similarly, the United States’ National Institute of Health Centre for Biotechnology Information indicates that between 2018 and 2020, about 1,176 cases of CSM were recorded in the Upper West Region, with 118 deaths and 1,058 survivors.
Situation
The Upper West Regional Director of Health Services, Dr Demain Punguyeri, identified the most affected districts as Nadowli-Kaleo, Wa Municipal, Wa West, Jirapa and Nandom.
He attributed the increasing cases of mortalities to late reporting to health facilities, as most patients often arrived at hospitals in critical conditions, making it difficult for medical staff to provide effective treatment.
“Another major challenge is that we have been dealing with a disease that does not transmit easily but it is very deadly, it is not like the previous one that can transmit to many people so you have to vaccinate,” Dr Punguyeri said.
“Unfortunately, there is no vaccine for this strain of disease so all that we have to do is to educate the public on preventive measures and ensure that cases are managed well to ensure the wellbeing of patients”.
Dr Punguyeri indicated that “we are in the early days yet because the period that we are likely to have higher numbers is March, that is when the heat is very high and we expect the transmission to be very high”.
Heat, CSM
The GHS estimates that CSM cases spike between November and April, when temperatures in Northern Ghana regularly exceed 40°C (104°F).
Dr Demain Punguyeri (middle), Upper West Regional Director of Health Services, and a team touring some health facilities to assess the situation
Studies show that extreme heat itself does not directly cause CSM. However, the heat and the dry weather conditions can create environmental and social conditions that facilitate the spread of the pathogens responsible for CSM, particularly within the African meningitis belt.
According to health experts, when the air is dry, it damages the natural mucus lining in the throat which normally acts as a barrier against infections and once the defence is weakened, the meningitis bacteria can easily enter the bloodstream and attack the brain membranes.
For instance, a study by Benjamin Sultan, Khaled Labadi, Jean-François Guégan and Serge Janicot in 2005 on “Climate Drives the Meningitis Epidemics Onset in West Africa” found that low humidity and high dust concentrations during the dry season are key drivers of meningitis epidemics in Africa.
Also, a study conducted by the World Health Organisation (WHO) in 2023 revealed that countries in the "meningitis belt" of Africa, including Ghana, are experiencing longer and more severe outbreaks due to extreme heat.
Globally, extreme heat has emerged as the deadliest weather-related killer. The United Nations (UN) reports that the condition has killed about 489,000 people each year, since 2000.
The Director of the United Nations University Institute for Natural Resources in Africa, Fatima Denton, speaking at a recent training workshop on extreme heat reporting in Accra, pointed out that extreme heat was a major consequence of climate change which was taking a toll on humans globally.
She said in spite of the impact of extreme heat it had often received less attention in Africa.
Ms Denton, however, called for deliberate efforts to help mitigate the growing impact of extreme heat and climate change in general.
CSM prevention
On measures taken to contain the CSM, the Upper West Regional Director of Health Services indicated that the service had intensified surveillance to track all suspected cases for management.
Dr Punguyeri advised the public to sleep in the open and avoid overcrowding to minimise the risk of contracting the disease.
Also, he advised the public to report immediately to the nearest health facility when they notice a sudden onset of fever, severe headache, general body pains, stiffness of the neck and altered consciousness.
Visit/donation
Following the outbreak of the CSM, the Minister of Health and the acting Director-General of the Ghana Health Service (GHS), Professor Samuel Kaba Akoriyea, visited the Upper West Region on February 12, this year, to assess the situation and offer support to mitigate it.
The officials engaged with key stakeholders to discuss strategies to manage the outbreak and better prepare for future health challenges.
Mr Akandoh emphasised the importance of early detection and treatment in tackling the disease.
He advised the public to avoid crowded areas and seek medical care as soon as symptoms appear.
Also, the Speaker of Parliament, Alban Sumana Kingsford Bagbin, presented medical consumables worth GH¢300,000 to the Upper West Regional Health Directorate to fight the outbreak of meningitis in the region.
The donation is to supplement the efforts of the government to provide the needed care to the people of the region during this trying moment.
While presenting the items to health authorities in Wa, Mr Bagbin indicated that Parliament was working with the government to combat the menace and assured the health workers in the region of Parliament’s support.
Heat impact
As climate change intensifies, extreme heat has wide-ranging impacts on human health, affecting both physical and mental well-being.
For Director of Health Services of the La Dadekotopon in the Greater Accra Region, Dr Caryn Agyemang Prempeh, the frequency, intensity and duration of heat waves were increasing, exacerbating health risks.
Beyond CSM, she explained that it was also causing other illnesses such as heat rashes and heat stroke.
Way forward
Currently, Ghana is increasingly bearing the brunt of extreme heat and its impacts on health, livelihoods and the economy.
However, the country does not have a standalone policy specifically targeting extreme heat reduction.
As a signatory to the 1.5 degree Celsius global warming limit commitment under the Paris Agreement adopted by the United Nations Framework Convention on Climate Change (UNFCCC) in 2015, there is a need to intensify efforts to limit temperature rise to 1.5°C.
This would go a long way to reduce the frequency and intensity of heat waves.
The tragic story of Salifu Mashud, Yussif Alhassan and many others highlight the devastating impact of this disease on individuals and families in the Upper West Region.
It is, therefore, imperative for health authorities to enhance public awareness, ensure timely access to medical care and develop targeted prevention strategies. The time to act is now.
Writer’s email: mohammed.fugu@graphic.com.gh
