Socio-demographic study of oncho-endemic communities in the basins of the lower balck Volta and southwest Ghana

.a f, SOCIO-DEMOGRAPHIC STUDY OF' ONCHO-ENDEMIC COMMT]NITIES N THE BASINS OF THE LOWER BLACK VOLTA AND SOUTHWEST GHANA STUDY DONE FOR OCP/WHO JUNE 1996 *hP 5. nu A K. AWEDOBA a { CONTENTS Acknowledgements Executive Summary Pre-Study Meeting .... Rationale Specific Objectives.... The Problem Introduction Methodology Data Gathering Instruments Findings Specific Findings Place Birth and Ethniciry Place of Birth .................. Location of Relatives Language, Education and Religion Education and Movement Patterns Religion and People's Movement Patterns Marrrage and Migration ........... Oncho Awareness The Affected .......... Some Inter-Site Comparisons: Braso and Tano Ano ... Ethnic Composrtion Conclusions Recommendations .......... Discussions and Future Study .................. Notes ........... Appendix Glossary...... References.. Study Area General Profi le of Communities ................ The Lower Black Volta Basin (Bui Area) ................ Current Eprdemiologrcal Situation of the Lower Black Volta Area ...... The South-West Ghana Area Basic Information on Respondents 3 4 5 5 5 5 6 6 6 7 '7 8 8 r6 l6 l8 l9 20 2t 22 22 23 25 27 21 Data Analysis ............... Sampling Eligibility for Interview Degree of Rapport ........ General Findings and Observations: Migratory Patterns Ethnic Character of Settlements Southwestern Communities ...... ll ll t2 t2 l3 t4 l4 t4 15 l5 30 32 34 36 38 39 40 SOCIO-DEIiIOGRAPHIC SflMY OF SOUTHWEST G}iANA RIVER BASINS AND LBV ACKNOWLEDGEMENTS The researcher is happy to acknowledge with sincere gratitude the assistance provided by the Director (Dr K. Y. Dadzie) of OCP/WHO, Ouagadougou and his staff, the funders of this project. I mention a few here: Dr Boakye Boatin (Chief of PET), Dr Azodoga Seketeli, APOC Programme Manager, Dr Alley Soumbey, Dr. Dembele, Mr. S. N'Gadjaga and others with whom I have worked and sought advice on the project. I wish to make a special acknowledgement for the assistance of Dr Boakye Boatin who from the outset worked closely with me to make the study a reality. If this has been a good study the credit is equally that of the staff of OCP. Inadequacies in the study are however entirely my responsibility. I benefitted from a team of experienced researchers pursuing M.Phil studies in the University of Ghana: Messrs: Faidoo, Assirifi, Johnson Narh, Enc Denutsui and the indefatigable support of Pierre Salbre of OCP, who not only introduced us, the rest of the study team to the study sites. Not only did not spare himself in the search for and interview of respondents in the homes and farms he was ever so helpful in getting such a multr-national team of researchers and supporting staffto socialise and ignore personal differences. The permission of the Vice-Chancellor of the University of Ghana, and that of the Director of the Institute of African Studies of the same University is hereby acknowledged with profound gratitude. I also record my profound gratitude to Prof G P Hagan of the lnstitute of African Studies who undertook to handle my teaching assignments in my absence from the classroom. Finally, but not the least, t thank the chiefs and leading men of the communities where we have worked and our respondents for their generous hospitality. I remember with gratitude the assistance of the Executive Director of the National Onchocerciasis Secretariat in Accra, Mr. Fosu, for the sundry ways in which he has personally been of assistance to me and the project. 3 SOCIO.DEMOGRAPHIC STUDY OF SOUTHWEST GHANA RIVER BASINS AND LBV EXECUTIVE SIIMMARY Migration within and without the Lower Black Volta Zone (also referred to as the Bui zone or area) and the river basin communities of the Ghanaian Southwest is considerable. However, we found no evidence to suggest that much movement existed between the two zones. Our conclusion is based on the following findings: . The indigenes of the Lower Black Volta are the Mo and Banda but less than ten of these were encountered in the southwest Ghanaian river basin communities. . The majority of migrants i.e peoples from other parts, at the Bui zone were either from the Upper-West Region of Ghana (ethnic Dagaba) or the Volta Region (ethnic Ewes). However, very few Dagabas were encountered and interviewed in the Southwestem river basin communities. We do not think this is due to sampling errors. The Ewes in the Lower Black Volta zone are primarily fishermen not farmers. Those in the Southwest are farmers and not fishermen. . Majority Northem groups encountered in the Southwest were the Kusasi, Bisa, Basare and Frafra. Few of these were encountered in the Lower Black Volta communities. . Akan people who dominate numerically in the Southwest were rarely encountered in the Lower Black Volta communities. . Very few of the affected in the Southwestern river basin communities had ever lived or worked in the vicinity of the Lower Black Volta. There are three categories of people encountered in the study communities Those born in the study community. Those whose roots are within the district or nearby communities. Those who come in from other regions of Ghana and sometimes from outside Ghana. There is however variation between communities in terms of the category that is numerically dominant and in their ethnic composition. tn the Bui zone the migrants outnumber those bom in the area. Those born in the community may or may not be from the indigenous (we use this term advisedly) ethnic groups. Where parents are not indigenous to the district in which the study site is located their children born in the host settlement may come to see that community as comparable to the hometown. This is true more for the Southwest where communities have more pernanency than for the Lower Black Volta zone, where the study communities seemed more fluid demographically. Respondents from another community within the district but presently living and working in the study village maintain their links with kin and family in the hometown through frequent visits. For migrants from other regions links with the hometown are hard to maintain through visits, though sporadic visits may be prolonged. In the latter case second generation migrants maintained fewer contacts with their parents' 4 a SOCIO-DEMOCUPHIC ST1JDY OP SOUTHWEST GhNA RIVER BASINS M LBV hometowns. I PRE-STUDY MEETING This was held at the offices of OCP in Apnl 1996. It afforded the researcher the opportunity of meeting the staff of OCP and to receive briefing on the objectives of the project to the undertaken, the problems to be addressed and briefing on the communities to be studied. It was on this occasion that the questionnaire schedule was devised. Previous questionnaires were made available for the purpose as well as other documents including a previous assessment of the communities in question. II RATIONALE: To conduct a socio-demographic study of the Bui area of the Lower Black Volta Basin and some Onchocerciasis-endemic communities of South-West Ghana mapping out population dl.namics and migration patterns. This is to enable us to answer the question of reintroduction of onchocerciasis into the Lower Black Volta Basin (Bui) from the South-West zone. III SPECIFIC OBJECTIVES: To determine the population dynamics between the Onchocerciasis-endemic areas in South-West Ghana and the Lower Black Volta Basin in Ghana (Bui area) To determine the migration patterns in the population in the lower Black Volta Basin in Ghana (Bui Area). IV TIIE PROBLEM: It is suspected that "contamination" of the Bui area derives from the South-West section of Ghana which has remained largely untreated until now. The apparent movement of peoples between the two areas, if any existed, might serve as the channel for this contamination. A socio-demographic study of population dynamics of the two areas, it is therefore expected, would shed considerable light on the problem. The wide differences in endemicity levels within the south-west itself is suspect, especially when some areas that lie close to the breeding places of the blackfly have low levels of endemicity. Is it possible that such communities are more fluid demographically, it might be asked? a. b 5 SOCIO-DEMOGRAPHIC ST1JDY OP SOUTHWEST GHANA RIVER BASINS AND LBV V INTRODUCTION i Study Area: The areas to be studred fall into two zones. They include the south-westem zone which lies wrthrn the basrns of several nvers that drarn South West Ghana namely the Tano, Bia, and Pra-Offin and their tnbutaries. The second zone centres on Bui and its surrounding villages in the basin of the Lower Black Volta. The communitres visited for the purpose of the study included the following, grouped by river basin Lower Black Volta: Bui Dam Site Yan-Mpenika Gblorkame Mpeasem Tain Aboi Southwest Ghana: Bia Basin: Biaso Brong Ahafo Region -do- -do- -do- Northem Region Brong Ahafo -do- -do- -do- Western Region -do- Central Region Central Region? Ashanti Region Tano Basrn Pra-Offin Tano-Ano/Asuadai Asuhyaie Anwiam Asawinso Betenase Adwumam Ampabena Bontomurso General Profiles of Communities The communities studied were relatively small-scale rural communities lying close to the banks of ma;or rivers such the Black Volta, the Bia, the Tano, and the Pra-Offin or their tributaries. The river was rarely more than a kilometre away from the settlement, although respondents' own estimations of distances from home to nearby rivers or sheams were sometimes vague and sometimes a little on the high side. Some communities like Asuhyiae are encircled by rivers: small and large, as the etymology of the Akan name of this settlement suggests. The main source of livelihood in these communities is farming and its related activities such as foodstuff processing and retailing. Both sexes were engaged in farming. Women also engaged in other farming related activities like gan-making and the preparation and retail of foodstuffs. Though there were salaried workers such as teachers even these engaged in farming. The farms were often located close to the banks of nvers. 6 SOCIO-DEMOGRAPHIC STUDY OF SOUTHWEST GHANA RIVER BASINS AND LBV Invariably, the Southwestem settlements included in the study lie at the hub of a network of satellite farming communities and cottages. It is in these that migrant farmers dwell so as to be within a short walking distance from their farms. Fishing is an important secondary source of employment in Lower Black Volta Communities; there it is a primary occupation for the Ewe communities. Taboos regarding the Tano mean, however, that fishing on the whole is of lesser importance in the Southwest basinsr. Some of the Southwest basin settlements appear to have been fairly old and long established as their lay-outs and structural features evidence. Lower Black Volta study villages on the other hand lack any form of perrnanency. In fact, with the exception of Gblorkame in the Bui Area the rest of the study communities in L B V resemble cottages more than villages. This is certainly the case for Yam-Penika, Bui Dam Site, Mpeasem and Tain Aboi. Communities lack basic modern infrastructural facilities but some communities were better endowed than certain others. Each could usually count on having a primary school in the village or nearby but for higher education, i.e access to secondary and technical education, villagers depend on nearby larger settlements or towns in the district and on the regional capitals. The quest for education leads inevitably to emigration. Similarly, the search for employment in the formal sector implied a willingness to emigrate and such employment goes with a willingness to accept tansfer from urban to urban, from urban to rural area and vice versa or from one rural area to another. This is certainly the case with the professional teachers we met in these villages. The Lower Black Volta Basin (Bui Area) This lies at the southern end of the area hitherto covered by the activities of the Onchocerciasis Control Programme (OCP). It has some of the largest breeding sites in the OCP control zones and indeed in West Africa. In I 987 it was one of the areas chosen to form part of the ivermectin tnals aimed at a determination of the extent to which transmission could be further reduced with the addition of ivermectin treatment of the population. Initially only first-line vrllages with a selected population of about 800 people were involved in the trial. Subsequently, treatment was extended to the entire population, estimated to be 4000, at risk of infection. Current Epidemiological Situation of the Black Volta Basin Area The preliminary results of the latest epidemiological evaluation carried out in January 1994 in l0 villages in the Bui area, showed that there had been a considerable reduction in Onchocerciasis prevalence over the pre-contol level in most of the villages to the north of the Black Volta. See map attached. These preliminary results were, however, not in conformity with what would have been expected i.e. zero or near zero prevalence levels after the 18 years or so of OCP vector control in the area. The view of WHO risk of recrudescence is as stated in Plaisier et al (1997) as follows: Taking into account uncertainty about the efficacy of ivermectin, our results indicate that, provided treafinent coverage is at least 65Yo and there is no importation of infection from elsewhere, l2 years of combined confrol will be sufficient to reduce the risk of recrudescence to below lolo in even the most afflicted areas. More importantly, infections were detected in some children below the age of 15 years in some of the 1 SOCIO-DEMOGRAPHIC STUDY OF SOUTHWEST CHANA RIVER BASINS A}ID LBV villages south of the Black Volta. All the rnfected chrldren were residents of the area and believed to have never travelled out ofthe area. In December 1994, another epidemiological evaluation was carried out in 5 villages further south of the Black Volta but still within the OCP area. The prevalence ranged from 2Yo-32.%o. Again among the infected were children. DNA tests indicated that most of the microfilaria collected from the infected people were of the savanna tlpe. These results are perhaps an indicatron that transmission might still be going on in the area. The entomological data however show that there has been no infected flies in the area for a long time. A possible "contamination" of this area from the untreated zone (neither by larvicrding nor under ivermectin distribution) further south rn Ghana therefore appears plausible. The South-West Ghana Area Unlike the Bui section, the South-West Area lying just south of the OCP zone was not covered by the activities of the OCP'?. It is now however the rntention of OCP to propose to the Ghana Government to institute distribution of ivermectin in this area. This, it is hoped, will stem the contamination problem for the already treated areas. Thus, in September 1995 OCP carried out an epidemiological evaluation of twenty first line villages in South West Ghana that lie in the river basins to assess the prevalence and intensity of infection prior to ivermectin distribution. Microfilaria collected from infected individuals were sent to the Bouak6 laboratories for DNA identification. The findings of the OCP investigation show a variegated picture of communities that range from high endemicity (i.e 60.4% as in Adwumam on the Pra-Offin basin) to low endemicity (i.e.2.2% at Mehame in the Tano basin). Basic Information on Respondents: As there is a need to place the findings in a social framework, we produce below some basic information on respondents. Ages ranged from l6 years to 98 years. There were a total of 1109 respondents distnbuted as follows: Lower Black Volta sites 230; and 879 for Southwest. The 25th, 50th and 75 percentiles fell respectively within 25 years, 33.5 years and 46 years for Bui and 28 years, 38 years and 50 years respectively in the case of Southwest Ghana. Male respondents were 57oh and 53%o respectively for L.B.V and Southwest while for females the scores stood at 43%, and 47%o rcspective thus indicating a slight preponderance of males. This was imbalance was not intended. Most people in the two zones in the study were farmers as the tables below show TABLE la: L B Volta Respondents by Main Occupation WORK I Freq Percent <N:229> B SOCIO-DEMOGRAPHIC ST1JDY OF SOUTIIWEST GTIANA RIVER BASINS ND LBV ------+---------- 140 6t.t% 38 t6.6% 2 09% 5 2.2% 6 2.6% 8 3.5% 30 13.lo/o FARMING FISHING CIVI S TEACHER TRADER UNEMPLOYED OTHERS Total | 22e 100.0% TABLE lb: SOUTHWEST BASIN RESPONDENTS BY MAIN OCCUPATION WORK I Freq Percent <N=868> Farming Civil Servant Teacher Trader Unemployed Others Student 695 80.1% 5 0.6% Total | 868 100.0% In the two zones the illiteracy rate is high as only a small percentage have had formal education to any appreciable standard. In the L.B.V.32% <N:228> have had some education only 4l or 54.7o/o of whom had completed Elementary school. In the Southwest, relatively more people i.e.62.50/o have had some schooling although not more than l0% had got beyond Middle School. Majority of respondents in both zones were mamed monogamously, with a fair number having at one time or the other divorced. For L.B.V. the married were 66.70/o of the sample and in the Southwest a comparable figure of 67.1% <N:870> was recorded. Those who had more than one wife at a time were few. 57/% of L.B.V. respondents considered themselves as Christians. The Muslim population was smaller, at 9%o.In the Southwest basins 75.2% were Christians and l2o/o were Muslims. A fair proportion of our respondents were neither Muslim nor Christians; they were either traditionalists (for whom the local gods and the ancestors were an important source of religious inspiration) or "free thinkers", people who did not mention any religious denomination. The degree of bilingualism was high in both zones as most people spoke other languages in addition to their mother tongues. In L.B.V. it is as high as 96.5% <N:230> and in the Southwest 69.40/o <N:870> were bilingual in one or more languages. When we consider the "Oncho status" of our respondents were find that the affected were in the minority in the L.B.V. while in the Southwest the scores nse due to the fact that a number of communities there were l0 36 20 l3 89 t.2% 4.t% 2.3% 1.5% 10.3% 9 SOCIO-DEMOGRAPHIC STUDY OF SOMWEST GHANA RIVER BASINS AND LBV ln fact hyper-endemrc for Oncho. But for the inclusion of low endemicity villages like Braso where none of those rnterviewed was an affected person, the scores for the Southwest could have been higher strll. In the tables below we present a breakdown of the sample in terms of age groupings and also by oncho status. Over 35%o of our respondents fall within the 30 to 45 years age group. The l5 to l6 years old age group is the least represented. This may be because many people within this age group are in school and there not available for rnterviews. It may also be that in seeking out respondents interviewers overlooked some individuals falling in thrs age group because of stunted growth. Table 2a: Gender and Age Groups: All Respondents of Southwest Basins AGEGROUP I F M lTotal Percent l5yr - 19 I 32 24 I 56 6.4% 20yr - 29 I 89 98 I 187 21.5%30yr-45 | l5l 161 | 318 36.6oh 46yr - 59 I 88 100 | 188 21.6% 60yr - 99 I 49 1t I 120 13.9% -----------+-------------+-- Total I 409 460 I 869 100.00% Table 2b: Gender and Age Groups: Respondents of L.B.V. Bastn AGEGROUP I F M lTotal Percent l5yr- I9 20yr - 29 30yr - 45 46yr - 59 60yr - 99 NO EVIDENCE AFFECTED NON-AFFECTED NOT EXAMTNED 67 30.0% 35 15.70 90 40.4o/o 3 r 13.9% u16 24 2l 38 43 16 22 922 11.8% 22.40/o 35.sYo 167% 13.6% 27 5l 8l 38 3l Table 3a Oncho Status of L b v Respondents ONCHO STATUS I Freq Percent Table 3b: Oncho Status of Southwest Basrn Respondents ONCHO STATUS I Freq Percent Cum. 10 SOCIO-DEMOGRAPHIC STUDY OF SOUTHWEST GHANA RIVER BASINS AND LBV NO EVIDENCE | 76 9.5% 9.5%AFFECTED | 218 27.3yo 36.8%NON-AFFECTED | 239 29.9% 6660/oNOTEXAMTNED | 267 33.4% 100.0% ----------+-- Total | 800 100.0% Note that in Tables 3a and 3b, the category "No Evidence" means a decision could not be taken on whether the respondent was an affected person or not. The category "Not Examined" is used to describe persons who said they were not present at the time of the preceding surveys conducted by the OCP teams records of which had been made available to this shrdy. New migrants would fall within this group. V[ METHODOLOGY The approach adopted was aimed at mapping out the pattems of intemal and external movement in a number of selected villages in both the Bui and the south-West zones. Data Gathering Instruments The questionnaire used was semi-structured combining open-ended questions on issues considered pertinent to the demographic profiles of village communities, and some probes. Specific questioning elicited the individual's town/village of birth, hometown or area of domicile of the respondent's corporate or "extended" family and where other relatives are to be found and if visits were exchanged and how often. Other questions asked about languages spoken by respondent and where leamt, about religion and place of conversion, and about marriages involving the respondent now and in the past and where spouses met. There were also questions about a person's education and occupation: places where respondent attended schools, the fype of job (main and secondary) and job place now and in the past and if these places were close to rivers. We wished to know where respondents live now and in the past and if place of habitation was close to a river now or in the past. In addition to these questions, the respondent was asked questions specifically about encounters with onchocercal diseases and their treatments. These assess respondents' awareness ofonchocerciasis as a drsease and whether they had obtained treatment in the past individually or collectrvely. These questions were motivated by the expectation that the stability of a community can be deduced from the frequency of movement by individuals for jobs, education, and social visits paid to relations living elsewhere, among other things. By asking a polyglot where he or she learnt languages we are able to determine past migratory patterns. If respondent X maintains that he or she had learnt a second language at place Y, we can conclude plausibly that respondent X must have lived at place Y for a considerable time, knowing that second language learning takes time for adequate exposure. Similar impressions can be obtained by asking a polygynist where he or she had met present or previous parlners, where a formally educated person had schooled or where a person had worked or acquired training in his or her profession or where a person had converted to his or her faith. We realise that the responses resulting from these probes do not carry the same weight. For example, conversion to a new faith may not take as long a period of residence at the place ofconversion as residence at the place ofacquisition ofa second language. 11 SOC]O DEMOGRAPHIC STUDY OF SOUTHWEST GHANA RIVER BASINS AND LBV The same semi-structured questionnaire were administered to all categones of respondents: affected and non- affected, as well as the potentially new arrivals i.e. the non-registered persons found tn the sites. Data Analysis The data collected was coded for the first round by the intervrewer who was also allowed some time to go over and check his coding. These codings were then checked and subsequently revised, where necessary by the researcher. Several rounds of re-codrng became necessary as new variables suggested themselves from the data viewed. The coding was specific and aimed at those variables that would shed light on the aims and objectives of the study. The coded data was subsequently entered into EPI INFO version 6 while the textual component which illustrates more specifically the issues tnvolved was typed into Textbase Alpha. Sampling Studies were conducted at l4 villages. Endemicity levels were taken into considered in the choice of villages. Consequently, hyper-endemic, mezo-endemic and hypo-endemic villages were represented in the sample of study communities. A total of 1108 respondents were administered semi-structured questionnaires. The number of persons interviewed depended on the size of the community and the willingness of individuals to be interviewed. In small villages everybody was invited. Where villagers were reluctant to come to us for intervtews we paid home visits to talk to them at their convenience. This was necessary at Biaso where there was least interest in the exercise. Although we did not usually target particular persons before hand, we did go after those affected who did not show up. Thrs was necessary since in a migration study interested in Onchocerciasis there is need to know which of the affected had left the community, when they left, where they had gone to and for how long they would be away or if they were likely to return at all. The approach was slightly different in the case of the villages of Mpeasem and Tain Aboi. We did not see many people to interview in these. So, we asked about each of those adults registered there previously. We noted the absentees. Many whom we were told were living in Bamboi and New Longoro we searched for at these places and interviewed. We did not always ltnd our query, nevertheless, a number of such interviews were conducted at Bamboi, New Longoro and a couple at Jugboi, some ktlometers north of Bamboi on the Bole road. It will be noted that neither Bamboi nor its twi community, New Longoro had been included in our sample of communities. Even then, for the LBV zone, only in the case of Mpeasem did we interview more than 70 (many of these were people living at New Longoro and Bamboi who either had farms at Mpeasem or had registered in one of the two places for the convenience of receiving the oncho treatment). In the larger communities of southwest Ghana we exceeded 80 respondents for most communities. As we have indicated above, data was collected using a semi-structured interview questionnaire admintstered by postgraduate students of the Institute of African Studies of the University of Ghana in the company of the investigator. Being present at the interviews and participating in the exercise also afforded the opportunity to observe these communities at close range. t2 SOCIO DEMOGR}PHIC STIJDY OF SOUTI{WEST GIIANA RIVER BASINS ND LBV The selection of village communities for assessment was based on the baseline survey conducted by OCP between 1994 and 1995. On those occasions entire village communities in the lower Black Volta and the Southern Ghanaian river basins were registered, examined for presence of onchocercal parasites in skin snips. The affected were treated by ivermectin dose. Communities chosen for this study included highly endemic ones like Adwumam (60.4%), Tano-Ano (58.0%) and Betenase (52.4%) as well as low endemic ones such as Biaso (0.5%). As the villages differ in size the sizes of samples chosen from each vrllage took this into account. Those who were interviewed were 16 years or above. Initially, it was decided to take 75-80 respondents from each village but we soon realised on the field that this was impossible due to the small sizes of some communities. This was particularly so for the Lower Black Volta communities. Certain communities were so small that even when the entire population was included in the sample the minimum sample size of 73 could still not be obtained. Eligibility for Interview The sampling as stated above included both affected and non-affected as well as others. Our objective was to ensure that equal chance was given to all categories in the first round of interviewing. This included affected, non-affected, non-examined and new migrants. Then, after a considerable number of intervrews had been conducted stock was taken to know if the affected, especially in the hypo-endemic communities had been covered. Where this proved not to be the case, the affected were then sought for individually or their whereabouts ascertained by asking those who knew them. This we considered a useful approach, one which if time and other considerations had allowed could have been extended to the entrre registered population. Nevertheless, where communities were small in size, as rn the case of the Lower Black Volta, we did attempt at the conclusion of the interviews at each village to ascertain the whereabouts of other registered persons that we were not able to see and interview. [n small communities people knew each other and the heads of community were usually helpful when asked about the whereabouts of absentees. Nevertheless, there were a few registered individuals whom we could not trace in these communities whom community leaders did not seem to know. We think these are non-members, people who had registered at the time of the previous surveys for the purpose of getting free treatment from the OCP teams. We must also point out that village communities visited saw us as another Oncho control team carrying out an exercise aimed at a further registration of individuals for future treatment rounds. It dawned on villagers that access to treatment depended on a previous registration. In this light some individuals who were not registered previously and could not now be interviewed because we had exceeded the village quota felt disappointed. To assuage this feeling those anxious for interviews were registered by taking their particulars such as name, place of birth, age etc. This too was a useful exercise as far as the objectives of this study were concerned. Degree of Rapport We should record that the reception the team received varied from place to place, often depending on the perception of onchocerciasis and the effect of previous treatment. It ranged from enthusiastic reception in places like Adwuman, a hyper-endemic area where everybody wanted ivermectin because it was considered as a very good drug, to indifference as in the case of Biaso which is very low on the scale of onchocerciasis. In Biaso the prospect of a skin snip was enough to keep many in the community away. Even the assurance 13 SOCIO.DEMOGRAPHIC STI]DY OF SOUTHWEST GHANA RIVER BASINS AND LBV that there would be no skin-snrpping was not persuasive enough. Biaso seemed from our observatron (confirmed by remarks from some members of the community) to have a leadership crisis compounded by its multi-ethnic character all of which made village mobilisation difficult. FINDINGS: General Findings and Observations: Migratory Patterns The potential for engagrng in cash cropping or subsistence farming seems to be the main impetus propelhng peoples from all over Ghana to the places and rural communities where these studies took place. In the Lower Black Volta zone, the migrants came from nearby communities and from the Upper West. The fisherfolk were usually from the Volta Region. This is not in anyway to suggest that the areas in questron were necessarily previously unoccupied. The evidence suggests that these areas have always have people living in them. However, the population profile of a number of the Southwestem River Basin communtttes had changed wtth the arrival of migrants in larger numbers in search of virgin land, as the old cocoa areas in Ashanti and other parts of the Brong Ahafo have declined in fertility. It is also becoming abundantly clear that as the agrrcultural potentials of these areas decline there would be an exodus to other areas of the country, such as the remote southwestem parts of the Westem Region like the Aowin-Suaman District. It is clear that villages hke Yan-Mpenika serve as farming cottages for neighbouring Banda, most of whom are from Banda Ahenkro, and for the other ethnic groups found the zone, including the Degha or Mo. It seemed that Bandas who went there maintained their kinship links with the hometown and when their farming did not seem to prosper they returned to the hometown. For example, the death of a migrant Banda man means his conjugal family beat a retreat to Banda Ahenlro. His wife might remarry if she was still young enough. This scenario was not peculiar to the Bandas but pertained to the Dagabas, Mos and others in these settlements. The Ewe communities around the Lower Black Volta were usually fisher folk. They tended to be people from Bator, Manfe, Adidome etc in the Volta Region. Smaller wards and settlements where they predominate can be found bearing as the name "Bator" as suffix or prefix, for example, Jama Bator, opposite Bui DamSite on the northern side of the Volta, or Bator Line in New Longoro etc. Akanyalaom is also called by the Ewe, Akanyakope. As remarked above, communities of the Lower Black Volta often lacked many modem amenities such as portable water, schools and even accessible market places. This is true for Bui Dam Site, Gblorkame, Yan- Mpenika, Mpeasem and Tain Aboi. The implication of this is that those who happened to be there were not encouraged to make the place a permanent home. Children of school going age are sent to nearby settlements to attend school. Lack of marriage opportunities means also that when daughters mature they have to sent to the home area in another adminishative district or region to seek marriage partners. Migrant workers themselves return to their hometowns and villages to marry or re-marry. Ethnic Characteristics of Settlements The indigenous people of the area usually constitute a sizable portion of the population of each settlement. The chief of the village was usually from the local ethnic group.One exception in the southwestern study sites is the case of Tano Ano where indigenous Bono are far outnumbered by peoples of Northern Ghanaian extraction such as the Kusasi, Bisa, Basare etc just as at Gblorkame in the Lower Black Volta basin the Ewes are predominant. t4 SOCIO DEMOGRAPHIC STUDY OF SOUTHWEST GHANA RIVER BASINS ND LBV In the L B Volta area the main migrant ethnic groups farmrng there include the Dagaabas, Bandas, Mos, Ewes, Frafras, Mossi, Bisa and others. The chief of Mpeasem is a Dagaba. The Konkomba who used to have a presence there and registered there during the 1994 survey by OCP staff have now withdrawn due to the ethnic riots and a feeling of insecurity. Movement within the Lower Black Volta basin area seemed to be widespread. Visiting kin accounted for this as well as the quest for opportunities such as more fertile land, fishing resources and others. Individuals living on the southern side of the Black Volta can easily relocate themselves on the Northern side or vice versa, as need be. Many of our Bui Damsite respondents lived on the opposite bank, northern banks of the Lower Black Volta at the time of the visit, a few of whom ferried themselves across to see us 3 There was also movement between the Lower Black Volta and the other parts of the Wenchi Diskict. Dagaba moved to and from the zone and their hometowns in the Dagaba motherland in the Upper West Region. A large number of Dagaba registered in 1994 or before were not around in Mpeasem when it was visited in April 1996. We did not however notice much movement by people in this area to the southwestem river basin communities. Bandas and Mos did not appear to mrgrate far into the southem frontiers of the Brong Ahafo Region. [n the same way, not many of the other southern Ghanaian peoples like the Ashantis, Ahafos and other Bono were found living in the Lower Black Volta area. This is perhaps not too surprising. The savannah ecology of the Lower Black Volta favoured root crops like yam which Northem people like the Dagaba, Banda, Mo and Konkomba specialised in. By contrast the Southwestern river basins supported cocoa and other tree cash crops which require caprtal outlay of the size that Northern subsistence farmers cannot afford. Southwestern Communities: These differed markedly from those of the Lower Black Volta in appearance. lndivrdual communities were larger in size and seemed more prosperous, better organised and better provisioned as far as facilities like schools, health centes and in some cases portable water were concerned. They attracted a variety of persons of various ethnicities and backgrounds willing and able to undertake cocoa farming or to facilitate the industry for a wage. It is not unusual to find retired civil servants who had gathered pensions farming here. The majority of people were of southern Ghanaian extraction and they came from nearly all regions of the country. The Ashantis predominate not only in the Ashanti settlements of Bontomurso and Asuhyiae (lying close to the Asonafo District) they also oufirumber the indigenes, as in the case of some of the Brong villages studied. Other groups include the Krobos, Ewes, Fante, and others. Peoples'of Northern Ghana extraction with sizable representation include Frafra, Kusasi, Bisa, Brmoba, and Dagaaba. They provide the labour for cash crop farming as they did in the past. Though the Southwest communities studied were multi-ethnic nevertheless many of immigrant origin had been bom in the villages where the interview took place. This is another point of difference between the two zones under study. For one thing it suggests a willingness on the part of the migrants to reside in these areas for a considerably longer spell than in the LBV zone. As far as intemal mobility was concerned, people in the Southwest are even more mobile than in the Lower Black Volta basin due to better communication facilities. Larger towns in the neighbourhood are visited frequently. Kumasi was a popular place to visit than say Accra, the nation's capital which is more distant. 15 SOCIO DEMOGRAPHIC STI-IDY OF SOUTH}JEST GHANA RIVER BASINS AND LBV Visits to distant kin were less frequent. Nearly everybody had a kin somewhere whom they visited at least once a year. Migrant southerners tended to visit home more frequently than Northemers found in these communities. Experience at the Aowin-Suaman area shows that the time to revisit home was immediately after the cocoa season'. We think the same obtains elsewhere in the cocoa growing areas of the southwest. SPECIFIC FINDINGS: This section indicates informants' responses on a number of questions relating more directly to population dynamics and movement pattems in the areas of study. The presentation will attempt inter and intra zonal comparisons. Place of Birth and Ethnicity: Ethnicity is an important variable in migration studies. Ethnicity suggests where a person is likely to have been born, where the home base is, where relations and kin are likely to be found and so on; but more importantly for this study, it sheds light on the respondents' potential movement pattems and whether the peoples of the LBV zone visited the areas of the southwest river basins and vice versa. The study shows the following That the majority of respondents in the southern zone were ethnically from the south of Ghana. There were some Northerners (i.e, peoples from the three northern regions of Ghana) and a few from outside Ghana living in the area. The Akans are by far the most dominant group and they comprised Ashantis, Bono, Denkyira, Sefivi, Fanti and other less frequently encountered Akan groups. The Bono, though from the Brong Ahafo were not people who had lived anywhere near the LBV, although LBV constitutes the northern parts of the Brong Ahafo. This is illustrated in the two tables, 4a. and 4b. below. Note that the Akans constitute in this sample 78.1%. The Ashanti, easily the largest of the Akan groups, accounts for over 4l%o of the sample in the southwestem river basin communities. Akans in table 4a refers to respondents who described themselves simply as Akan without reference to the specific group. Some of these are Ashanti too. TABLE 4a: ITIETOR ETHNIC GROUP SOUTHWEST BASIN COMMUNITIES AKANS AHAFO AKAN AKWAPIM ASHANTI DENKYIRA I Freq Percent <N:867> 0.6% 9.8% 0.7% 41.7% 12.7% 5 81 6 361 ll0 1.6 a a SOCIO.DEMOGRAPHIC STT'DY OF SOUII{WEST GHANA RIVER BASINS AND LBV FANTI BONO SEFWI wAssAw ASSIN ll 28 57 13 J t.3% 32% 6.6% t.5% 03% TOTAL I 681 '18.6% TABLE 4b: orspn ETHNTc GRoUPS SOUTHWEST BASIN COMMUNITIES OTHER GROUPS lFreq Percent <N:867> BASARE BUSANSI EWE FRAFRA GA-KROBO KUSASI MOSSI WANCARA BANDA KASENA DAGABA-WALA OTHERS t2 49 24 2l 16 l9 9 9 5 4 J l5 1.4% 5.7% 2.8% 2.4% 1.8% 2.2% t0% 1.0% 0.6% 0.5% 0.3% 1.7% TOTAL | 186 21.5% Just over 2l%o of the sample are people who do not belong to any of the Akan units in the strict sense of the term. We note the inclusion of 5 Banda, persons whose ethnic roots should be in the vicinity of the Bui area. The Busansi and the Kusasi would have their ethnic home bases in the basins of the White and Red Voltas. The Busasi, also called Bisa have communities in Burkina Faso and in the Bawku and Zebilla Districts of the Upper East. Under the label "Others" in Table 4b we have included vanous ethnic groups represented by less than three persons in the sample. The ethnic composition of L.B.V. respondents leads to the following conclusions That comparahvely few ethnic groups are represented there. The main ones are Banda, Dagaba, Ewe and Mo. The groups that are numerous in the Southwest river basins are almost all absent from the L.B.V zone TABLE 5: eruNrc GRoUpS: L.B.v.coMMUNrrrEs ETHNIC I Freq Percent Cum. Ashanti Banda Barrgo Dagaba 1 0.4% 35 l5.6Yo 1 0.4o/o 58 27.3010 0.4% t6.t% t6.5% 42.4% 71 SOCIO.DEMOGRAPHIC STUDY OF SOUTHWEST GTIANA RIVER BASINS AND LBV Ewe I Fon Ga Gonja Lobr Mo Nchumbum Sisala 69 30.8% 132% I 0.4% t 0.4% I 04% t 0.4% 53 23.7yo t 0.4% I 0.4% 13.lyo 74.lYo '75 0% 75.404 99.1% 99.6% 100.0% Total | 224 1000% There were a number of Konkomba ln the zone prior to 1995 but these, our enquiries revealed, had left due to the ethnic riots in the Ghanaian middle belt. Place of Birth The majority of respondents in the southem zone were either born rn the villages where the interviews took place or in a nearby place. At least 42.7% were born in the vrllage of interview. Tano Ano was one exception: only l8% or so were born there. Tano Ano seems to resemble the settlements of the L.B.V. in respect of the impermanence of the housing structures. Biaso and Betenase also had low scores of about260/o and28o/o respectively. In Tano Ano mrgrants from the North, particularly the Busansi and Kusasi dominate. By contrast in the L.B.V. zone fewer persons claimed to have been born at the village of interview, on average nine persons were born in the villages of interview. None of our respondents were born at Yan- Mpenika or Tain-Aboi while only one person claimed to have been born at Mpeasem, near New Longoro. In terms of region of birth the southem zone recorded comparatively higher figures for this variable. Ashanti, Brong Ahafo, Central regions, from where the majority of our study villages were drawn, accounted for 74.1%. Note that although only two, i.e. Asuhyiae and Bontomurso, out of the nine villages were considered as Ashanti, nevertheless more than 30% of respondents were from the Ashanti Region. Wrth only one representative village: Adwumam, nevertheless 18.6% of the sample said they had been born in the Central Region and this suggests the homogeneous character of Adwumam which is peopled by Denkyiras. Table 6a: Respondents' Birth Region: Southwests BREGION I Freq Percent Cum. ACCRA ASHANTI BRONG A. CENTRAL EASTERN NORTHERN U/EAST U/WEST 24 263 217 l6l 26 6 63 I 2.8% 30.4% 25.1% 18.6% 3.0% 0.7% 7.3% 0.1% 2.8% 33.2% s8.3% 7 6.9o/o 79 9% 80.6% 87.9% 88.0% 1B SOCIO DEMOGRAPHIC STI'DY OF SOUTIIWEST GHANA RIVER BASINS AND LBV Total | 865 r00.0% Table 6b: Respondents'Regron o[Birth: L.B V BREGION I Freq Percent Cum. --- --- - -+---- - - - - - VOLTA WESTERN FOREIGN ACCRA ASHANTI BRONG A. CENTRAL EASTERN NORTHERN U/EAST U/WEST VOLTA FOREIGN I 15 t.1yo I 7s 8.7% I 14 L6o/o 89.7% 98.4% 100.0% 5 2.2% 2.2% 7 3.1% 5.3% to4 45.6% 50.9%| 0.4% 51.3% 2 0.9o/o 52.2% 26 11.40/o 63.6% 4 t.8% 65.4% 40 t7.5yo 82.9% 36 15.8% 98.7% 3 1.3% r00.0% Total | 228 t00.0o/o We find in the case of the LBV that although few of the respondents were actually bom in the villages of interview, 45.6% of respondents were born in the Brong Ahafo where the villages of the L.B.V. belong. Note that nobody here was born at the Westem Region and only one and two persons were bom in the Cenhal and Eastem Regions respectively. It is also the case that most of our respondents bom in the Brong Ahafo Region saw the light of day in the Wenchi or Kintampo Disficts, two of the three regions (Bole is the other) which the L.B.V. communities straddle. Next to the Brong Ahafo, the other regions with significant births were the Upper West, the home region of the Dagaba, the Volta Region where the Ewe fisher folk come from and the Northem where some Mos live. Location of Relatives: The percentage of respondents with relatives in other parts of Ghana was high. 873% and 85%o for the L.B.V. and the Southwest respectively disclosed knowledge of such relations and their whereabouts. Relatives were distributed as follows for the southwest. TABLE 7a: LocerroN oF THE RELATToN SOUTHWEST RESPONDENTS LOCATION OF RELATIONS I Freq Percent Study Site Nearby Locality Elsewhere in The Region Another Region Outside Ghana 9 258 224 683 24 0.8v,1 21.5% 18.'7% 57.0% 2.0% Total I lr98 r00.0% 19 SOCIO-DEMOGRAPHIC STUDY OF SOUTT{WEST GHANA RIVER BASINS AND LBV Note that multiple entries were obtained from some respondents which accounts for the totals exceeding the sample populations. Table 7b: Location of Relatrves: L.B.V. Respondents LOCATION OF RELATIONS Freq Percent Study Srte Nearby Locality Elsewhere in The Regron Another Regron Outside Ghana 6 98 47 145 6 2.0% 32 5% t5.6% 48.0% 20% Total I 302 100.r% Note that'Another Region" here can mean the region on the other side of the Lower Black Volta since the communities studied were located along the banks of the river on either side. Certain stretches of the Lower Black Volta serve as the boundary between Northern and Brong Ahafo Regions nevertheless kinship and social ties knit together people living on opposite sides of the river. Language, Education and Religion: These three, language, education and religion, are useful variables in the study as we have observed above. Most people leam languages at places they have visited or lived in for some time. This could be the area where the bi-lingual was brought up or some other place visited later in life. Educational facilities in Ghana are woefully lacking in rural areas and therefore people with some amollnt of formal education have had per force to travel outside their area of domicile to obtain that education. This may be the district headquarters, the regional headquarters or even a city. This applies to a certain extent to religion. People are either bom into the faith or convert to it later on in life. Travel outside the home background entails many adjustments, including conversion to new religions in many cases and the leaming of new languages. In the Southwest,69.4yo of respondents were bi-lingual in one or more languages. This compares with 96.5% in the L.B.V . zone. The most popular languages leamt as second languages in the L.B.V. zone were Akan 54.4% (218 mentions) and English, a distant second with l2%o or (48 mentions). English (371 mentions or 39.7%) ranking as the most popular second language in the Southwest is certainly more important in the Southwest than it appears to be at the L.B.V.. Next to English in terms of frequency of mention by southwesterners were the Akan dialects of Ashanti, Denkyira, and Bono. Sefwi, a language spoken in the northem part of the Western Region had 64 mentions or 6.90/o, Hausa, a language spoken in the Zongos of Ghanaian cities had 4.5%o. Only one person had learnt Banda (Nafanra), spoken in and around the Bui area. For most respondents in the Southwest these second languages were learnt either in the village of study or in another region of the country. TABLE 8a: wHENE SOUTHWEST RESPONDENTS ACQUIRED SECOND LANGUAGES )i SOCIO-DEMOGRAPHIC STIJDY OF SOUTHWEST GTIANA RIVER BASINS AND LBV WHERE LEARNT6 I Freq Percent Study Village Village Nearby Another District Another Region Outside Ghana Study Village Village Nearby Another Distnct Another Region Outside Ghana | 3s3 17.5% 129 13.7o/o 78 8.3% 353 37.5% 29 3.t% | 8s 2t.4%| 184 45.8% I 33 8.2%| 90 22.4% I l0 2.4% Total | 942 t00.0% In the L.B.V. zone most respondents leamt a second language from a place within the zone. They did not have to go far to learn second languages. Most people learnt English in the school and this, in the case of the few literates in the LBV zone, was a place in the vicinity. TABLE 8b WHERE L.B.V. RESPONDENTS LEARNT SECOND LANGUAGES WHERE LEARNT 6 I Freq Percent Total | 402 100.2% Education and Movement Patterns The number of educated people was very low for the L.B.V. zone as compared to the Southem zones. Of the 32.9% who had been to school in the LBV zone, one out of thee of these did not go beyond primary school. This contrasts with the Southwest where of the 62.50/o who had had some form of education 29.7% of this number had failed to complete elementary school. The two zones differ further as to where people went for schooling. In the L.B.V. zone,59.5o/o of those who had ever been to school had elementary education in a nearby village whlle 23%o spent the first six or so years of education in another region. This compares with the 41.7o/o in the southem zone who had primary education in the village of study and 29.3%o who were educated in another district. The general pattem seems to be that the higher you go on the educational ladder the farther away from home you have to move to gain additional formal education. For example, in the southwest, 293% spent the first six years of basic education in another region; 30.2% completed elementary school in another region and 55.6%o were educated up to secondary level in another region. It can be concluded tentatively, drawing on our findings from the two river basin areas, that at least for educational purposes inter-basin mobility or movement of people from the Lower Black Volta zone to the Southwest River Basin areas or vice versa is not only uncommon but also unlikely since none of these zones is sufficiently endowed with educational facilities that support secondary education not to mention the tertiary levels. Religion and People's Movement Patterns 2t SOCIO.DEMOGRAPHIC STUDY OF SOUTHWEST GHANA RIVER BASINS AND LBV ---------+-------------- Most respondents in the study were either Christians or Muslim. In the Southwest those who espoused a specific religion did so either in the study village (55.6%) or in another village or town within the study district (15.6%)but22.6o/, converted in another region. This compares with 30.3% conversions in another region for the L.B.V. and66o/o within the site district or nearby. The tentatrve conclusion here again is that people rn the study villages do not espouse religious beliefs far from their home base. Those who do are likely to have converted at the place of birth where this is not the same as the place of interview. To recapitulate, place of birth or hometown locale for a southwestern river basis respondent is not likely to be anywhere close to the Lower Black Volta zone and vice versa. TABLE 9: Place of Religious Conversron Re: Southwest Respondents WHERE CONVERTED I Freq Percent Srudy Sire Study Drstrrct Study Regron Another Regron Outsrde Ghana HERE? THE DISTRICT THE REGION ANOTHER REGION ANOTHER COUNTRY 443 55 6% 124 ts.6% 44 5.5% 180 226% 6 08% Total | 797 t00.0% MARRIAGE AND MIGRATION: It rs assumed here that it takes time to know a person of the opposite sex well enough to make a marriage to or accept one from the proposer. This may not be so in all cases but common experience would ffiERELBVRESP*DE*SCG*RTED suggest that this is the norm. Therefore where a 'o couple have met is likely to be a place they have lived in for some time. t0t 9 T SM DSI SM StrE sm reG OI}I€R REG Fmm Table l0a: Where Southern Respondents Met Their Spouses WHERE MET I Freq Percent t!=- F 470 46.7% 158 t5.7% 80 1.9o/" 293 29 t% 6 0.6% a Total | 1007 100.0% Table 10b: Where L.b.v Respondents ZZ E 6 st SOCIO.DEHOGR.APHIC ST1JDY OF SOUTHWEST GHANA RIVER BASINS AND LBV Met Therr Spouses WHERE MET I Freq Percent J IN THIS VTLLAGE | 24 10.9o/o THrS DTSTRTCT | 130 58.8%THTSREGTON | 2 0.9% ANOTHER REGION | 6s 29 4% ------+------- Total | 221 100.0o/o For the majority of Southwestem respondents, spouses were sought from within the village. There seemed to have been a preference for spouses from the neighbouring villages over spouses or women from the other districts in the region. Nevertheless, marriages that took place in other regions were considerable: 29Yo or 3 out of ten. The implication of this finding is that movement between place of interview and other regions was of a higher order than that between the study sites and the other districts of the regions in which they are found. We should hasten to point out that we did not have evidence of southwestern respondents meeting present, past or deceased spouse in the LBV zone or vice versa. L.B.V respondents find their spouses not so much in the villages where they were interviewed as in neighbounng places such as Banda Ahenko and Bungase for Bandas, Akanyakrom for some Ewes, New Longoro and Bamboi for the Mos and others on the Kintampo side of the zone. It is important to observe that they rarely sought spouses from other parts of the Brong Ahafo or the Northem Region. This is perhaps because they did not have much to do with these places.T\e29.4o/o who sought spouses from other regions of Ghana were certainly Dagabas, one of the major ethnic groups represented here. These found these spouses at Jirapa or somewhere near Wa. ONCHO AWARENESS: The decision to enquire into general awareness of the disease, onchocerciasis, is motivated by the belief that disease burden and exposure to treatment options results in a higher awareness of a disease. However, such an enquiry was not always easy to conduct in the absence of local terms for onchocerciasis. Our approach was to adopt the term "Oncho" which, experience has shown, is the common term applied to the disease in other parts of Ghana where the conditron has received wide attention. [n the L.B.V zone there was no problem about this as most respondents were familiar with the term. Oncho knowledge differs markedly between the two zones. It was found to be much higher in the L.B.V. than in the Southwest. Whereas the term "Oncho" was generally known to respondents in the L.B.V. (98.3%), those in the southwest basins familiar with the term were 38.7%. Of those who claimed to know, 41.7% in the Southern zone did not really know what it is as compared to 18.9o/o in the L.B.V.. These findings should be examined against the context of a higher literacy and standard of education in the Southern zone. Table 1 1a: SouthwestRespondents Awareness of Onchocerciasis ONCHO KNOWLEDGE I Freq Percent 23 SOCIO DEMOGRAPHIC STIIDY OF SOUTHWEST GHANA RIVER BASINS AND LBV NONE I t60 41.7%ADEQUATE I t78 46.4%GOOD | 46 120%VERYGOOD | 0 00 __---_--__+___ Total I 384 100.0% Table I lb: I-.B.v Respondents Awareness of Onchocercrasis KNOWLEDGE I Freq Percent NONE I 4r t89%ADEQUATE I tt8 s4.4%GOOD | 47 2t.7% VERYGOOD I ll st% ----------+-- Total | 217 100.0% These findings reflect the lack of systematic or organised medical attention paid to the condition in the Southwest River Basin zones. Some highly affected communities in the southwest seemed to have a better understanding of the condrtion. This is explained by the resort to medical treatment by individuals who have been seriously burdened by the disease which manifests itself not only in blindness but also in skin rashes and troublesome itching. In conclusion, these findings show that the peoples of the two zones are mobile. They move about the study district in which they find themselves and they go to other parts of the country outside the region in which the study village is located. The big towns and the regional and district headquarters are favourite destinations. Southwest affected respondents were born in various places. We found that none was bom in a town in the L.B.V zone. The places of birth nearest are perhaps Wenchi and Tachiman in the Brong Ahafo and Daboya in the Gonja district of the Northern Region. [n all,4 individuals cited these. We have no evidence where these caught the disease. Is it possible they caught their condition in the place of birth?. This is doubtful since some of the affected in the southwestem sample were in fact born in places not known to have Onchocerciasis, such as Accra and Takoradi. TITE AFFECTED: We need to know more about the affected to answer the question of their involvement in the spread of onchocerciasis in the L.B.V. area. We now focus on this sample. The Sex and Age Profile of the Affected: TABLE lZa: ege and Sex Drstribution of the Affected: Re: L.B.V. AGEGROUPS I F M ITotal 24 SOCIO DEMOGRAPHIC STIIDY OF SOUTHWEST GIIANA RIVER BASINS AND LBV f l5- l9Yr 20-30Yr 31-45Yr 46-60Yr 61-l00Yr 4 3 t2 ll 5 I il 24 I35 t3 03 57 47 l4 TABLE 12b: Age and Sex Distributron of the Affected Southwest Basrn Zones AGE GROUPS F M lTotal Total l5-l9Yr 20-30Yr 31-45Yr 46-60Yr 6l-looYr Total ACCRA BRONG AHAFO. NORTHERN UPPER EAST UPPER WEST VOLTA I I I I I I 6 l5 42 l9 l3 1 2l 40 30 24 l3 36 82 49 37 I 95 t22 | 2t7 The majority of Affected persons in both zones are in the 3 I -60 age goups. These are age groupings with opportunity for travel and many of them could have lived in other regions of Ghana. In the case of the L.B.V. many of these people were born in and around the L.B.V. area in villages like Bamboi, Banda Ahenkro, New Longoro. One person was born at Nobeko, four kilometers from Anwiam, a study site on the Tano in the Southwest. He happened to be a teacher on transfer duties. TABLE 13: RecroN oF BrRTH oF AFFECTED (L.B.V. RESPONDENTS) BIRTH REGION I Freq Percent Cum. 1 2.9Yo 13 37.tyo 6 t7.l%| 2.9% 5 t4.3yo 9 25.7yo 2.9% 40.0% 57.1% 60.0% 743% 100.0% Total | 3s r00.0% If we take the Southwest, we notice that most of the affected were born in the three regions of Ashanti, Central and Brong Ahafo. 21.1% of the affected who were born in the Brong Ahafo were actually born in the several study basins of the Southwest rather than anywhere in the L.B.V. basin or near to it. The town 25 SOCIO DEMOGRAPHIC ST1JDY OF SOUTI{WEST GHANA RIVER BASINS AND LBV t4 27.5% 23 45.1% t3 25.5% I 2.0% of Bawku and its vrcinity in the Upper East, interestingly enough served as birth places for at least 7oh of the affected who were interviewed in the Southwest. None of the L.B.V. affected leamt any of their first two languages rn a district of the Brong Ahafo outside the Kintampo and Wenchi districts. The following table shows this. TABLE I4: PLACES wHERE L.B.v. RESPoNDENTS LEARNT MAIN SECOND LANGUAGES WHERE LEARNTI' I Freq Percent - - --------+---- --- - Study Village Study District Another Regron Outside Ghana Total I s l 100.0% If we take places near river basins where the Southwest affected have worked in the past we notice that rarely did they mention the Lower Black Volta. The table below shows that only one person had worked anywhere closed to the Lower Black Volta. TABLE I5: zuveR BASINS NEAR WHICH AFFECTED IN THE SOUTHWEST BASINS HAVE EVER WORKED RBASINI, I Freq Percent L.B.V BASIN I 1 TANO | 127 6t.t% oFFrN I 7s OTHERVOLTA I 5 0.s% 36.1% 2.4Yo Total | 208 100.0% The Lower Black Volta received only 9 references out of a total of 256 references made tn the Southwest: only about 3.5% mentions. This is clearly insignificant by comparison with the figures for Tano,basin (57.4%\ and the Offin basin (36.7%). The picture is no different when we consider the river basins in which affected respondents from the Southwest have lived or lived close to in the past. The L.B.V. scores 9 mentions, presumably by the same nine individuals who have mentioned it in connection with work location. It seems in order to conclude that the affected in the two zones have not had much contact. Why this is so can be explained perhaps by differences in ecology, perceived economic opportunities, differences in expectations and so on. The L.B.V. has been a sparsely populated savannah zone which lost economic opportunities when the Bui Dam project mooted by the Nlo:umah regime drd not materialise. SOME INTER-SITE COMPARISONS: BIASO AND TANO ANO 26 SOCIO.DEMOGRAPHIC STIJDY OF SOUGWEST GHANA RIVER BASINS AND LBV We now attempt a comparison of some study sites beginning with Biaso and Tano Ano in the Southwestem River Basins. These two vrllages are similar in some respects such as their ethnic compositions. They differ in endemicity levels, Biaso being a low endemic area with not more than a couple of certified cases while Tano Ano can be characterised as a hyperendemic site. Both lie within the same latitudes, Biaso being west of Tano Ano. As their names suggest, they lie near or on the banks of the Bia and Tano rivers respectively. Both are farming communities. Cocoa cultivation is still an important industry in Tano Ano which is thickly forested while Biaso which has what looks like degraded secondary forest seems not to support the cocoa industry any more. Ethnic Composition Biaso: Akan peoples predominate, accounting for about 63.50/o. 14 respondents or l4.l% described themselves as Bono. These generally live in the northern parts of the Brong Ahafo and are therefore nearer the LBV while their Ahafo neighbours (only 4 described themselves as such) are from further south and east of the Regionro. Northern peoples including migrants from Burkina Faso and beyond account for 26.3 %o of the random sample. Of the "northern groups" the Frafras, with 15 respondents or 15.2o/o of the sample, predominatedrr numerically. The majority groups in the LBV zoneviz. the Banda, Mo and Dagaba did not feature in our sample. The Ewe represented account for 8.1% of the sample and they were farmers rather than fishermen, unlike their colleagues found along the Black Volta. Table l6: Ethnic Composition of Biaso Respondents ETHNIC I Freq Percent Cum. ___-_______+___ Ahafol44.0%4.0% Akan I 13 l3.l% l1.l% Akwamu I I 1.0%18J%Ashanti | 27 21.3% 45.4%Assin I I1.0%46.4%Bimoba | 2 2.0%48.4%Bono I 14 l4.l% 62.5%Ewe | 8 8.1%70.6%Fante | 3 3.0%13.6%Frafra I 15 15.2% 88.2%Ga | 2 2.0%90.2%Kasena | 2 2.0%92.2%Mossi | 4 4.0%96.2%Wala I I 1.0%97.2% Zamrama | 2 2.0%99.2% Total 99 100.0% We know that our Bono respondents have had very little to do with the LBV zone because there were no mentions of places north of Wenchi in the responses solicited throughout the interviews which might have served as places of birth, home towns, places where old schools might be based etc . Table l6b: R Basins Where Biaso Respondent Ever Worked in the Past BASIN1 | Freq Percent Cum. 21 SOCIO DEMOGRAPHIC STUDY OF SOUTHWEST GHANA RIVER BASINS AND LBV Total 95 100.0% In the case of Tano Ano the largest single ethnic group mentioned was Busasi or Bisa (57.9% were in the sample) who have settlements in the Upper East near Bawku in the basins of the White and Red Voltas and in Burkina Faso. Few people described themselves as Ahafo or Bono (one of each was included in the sample) although those who said they were Ashanti were 22.4% of the sample. Again, as in the case of Biaso, the major ethnic groups found in the LBV zorre are absent. Only one Dagao (singular for Dagaba or Dagarti) was included in the sample. We did not come across Ewes or Bandas and Mos. Table l7: Ethnic Composrtion of Tano Ano Respondents ETHNIC I Freq Percent Cum. L Black Volta Bia Basin Tano Basin Offin Basin Other Voltas Others Akan Ahafo Ashanti Basare Busansis Dagarti Kusasi Osudoku Bono I r.t% 1.1% 83 87.4% 88.4% 2 2.1% 90.5% I 1.1% 91.6% I 1.1% 92.6% 1 7A% 100.0% | 1.3% 1 13% 17 22.4% 2 2.6% 45 57.90h 1.3% 9.2% 1.3% 13% 1.3% 2.6% 26.3% 28.9% 86.8% 88.1% 91.3% 98.1% 100.0% I 7 1 I Total 76 100.0o/o The only place mentioned which we could possibly describe as coming anywhere close to the LBV basin is Wenchi mentioned once as a respondent's place of birth and location of lineage. Techiman, south of Wenchi is mentioned once as a town in which one person learnt a second language, two people converted to their religious faith there. Of the river basins where respondents had lived or worked at the time of interview or in the past there was only one mention of the LBV while the Red and White Voltas received two mentions. Table l7b: Where Tano Ano Respondents Ever Worked m the Past PLACE OF WORK ---------------+ Study Site Place in the District Place in the Region I Freq Percent Cum. I l 2.7%| 4 10.8%| 6 16.2% 2.1% t35% 29.7% 2B SOCIO'DEMOGRAPHIC STTIDY OF SOI'THWEST GHA}.IA RIVER BASINS AND LBV Another Region Outside Ghana I 2t 56.80/o 86.5% I 5 13.5% lo0.o% Total | 37 100.0% Table l7b: River Basins Where Tano Ano Respondent Ever Worked in the Past RBASINI I Freq Percent Cum. --+------------ L. Black Volta I Tano Basin IOthers I 1 1.3% 1.3% 72 96.0% 97.3% 2 2.7% 100.0% Total The evidence available, which is reflected rn the tables above, seems not to suggest that there has been population movements between these sites and the LBV zones. We do not discount individual visits. This would be inevitable for populations within the same country where no physical or administrative bamers to inter or intra regional circulations of people exist now or have existed since the country's independence. The British policy to labour migration was very liberal as there was need for labour to make the cocoa industry and the mines viable. The presence of many non-Ghanaian peoples in the study sites illustrates the ease with which people circulate. CONCLUSIONS: We set out to find answers to two main questions:- firstly, why the recrudescence of onchocerciasis in the LBV, a zone where the disease has been being controlled for a number of years; and secondly, why some communities in the same ecological settings experience differences in endemicify levels. The problem of recrudescence is by no means a recent one, see Garms, Walsh and Davies (1979, p. 346) who report that by April 1975 S.damnosum females has reappeared in some parts of the programme area shortly after the aerial confol operations had started in February of that year. A partial answer to the first question lies in the replies of the respondents at the various sites about their movement patterns within the country. From the above information we can safely conclude that the re-introduction of onchocerciasis in the OCP control zone of the L.B.V. zone could not be due to contamination of this zoneby affected individuals from the river basins studied which lie in the rain forests to the south. There seems to have been very little contact between the two zones. This is not because the populations inhabiting these two zones are static. Migrations are endemic features of the two zones. However the two zones are different in terms of their potentialities as currently perceived by land users and their dependents. The savannah ecology supports cereals and root 29 | 7s 100.0% SOCIO DEMOGRAPHIC STUDY OF SOU'IHWEST GHANA RIVER BASINS AND LBV crops such as yam and cassava. Cashew nut farming is gaining some popularity as a cash crop in the Bui area but the acreage allocated to thrs crop is still too small. The evidence supports the view that big time agriculturalists have ventured into this zone yet. Yam and cereal which are significant here are however of interest to small scale agriculfuralists with not much money to invest in large acreage of land or in more important cash crops. Cocoa, a popular cash crop in Ghana, not only requires a larger capital out-lay, which is beyond the average farmer in the Bui or Lower Black Volta zone, but more importantly, it is unsuited to the savanna ecology, climate and vegetation. The Ghana govemment, like its successor, the colonial regime favoured cash crop farming, particularly cocoa which has been for many years the backbone of the country's economy. Cereals and root crops did not received the same levels of encouragement because they have been perceived as more or less subsistence products which might get to the urban areas to feed people but not to the international markets to eam foreign exchange. Producers of these crops which are penshables were not protected from pnce fluctuations or guaranteed any minimum prices for their products. Consequently, they were not attractive to wealthy farmers in the way that cocoa was for many years. The L.B.V. zone has been sparsely populated making it easy for poor migrants to settle there temporarily, land being relatively easy to acquire. This contrasts with the Southwestem river Basins. As the Southwestem nver Basin forests are degraded less and less land remains available for certarn forest cash crops like cocoa. This makes land acquisition expensive thus shutting out poor migrants who can only engage rn unsatisfactory and drsadvantageous arrangements with local landowners such as share cropping'2 or altematively, to provide wage labour to the cocoa farmers. Thus the two zones attract different categories of migrants. The fishing opportunities of the Lower Black Volta, furthermore attract the fishing communities of the Lower Volta, people as a matter of course. Though not all Ewe communities traditionally adopted fishing as a way of life, the Battors and others like them living in places close to the Lower Volta have traditionally led such a life. Ashantis, for example, who have expenence in cocoa cultivation and have the necessary resources now find themselves without access to fertile land near home due to forest degradation. One option for some of them is to go further afield to the southwest basins. While this explains the increasing presence of Ashantis here it does not explain the sizable presence of minor $oups like the Bisa, Kusasi, Basare and other Northem peoples in the southwest. It may be that a majority of these people who are driven mainly by economic difficulties in the sahel and northern savanahs which are home to them have to emigrate and they are attracted to the southwest because of the demand for labour in an industry which has been depended upon Northern labour since the colonial era. There appears also to be the question of tradition. Migration to the cocoa growing areas of southem Ghana has almost become institutionalised among some savannah peoples of Ghana and Burkina Faso since colonial days. We refer to various research accounts on migration such as Rouch (1954), Hart (1987) or to Hirschman (1970) thesis on Exit, Voice and Loyalty. These researchers admittedly, have exhibited more interest in urban-directed migrations from poor rural areas. It is clear however, that migration from homeland, whether to urban centres in another African country as the Mossi of Burkina Faso and the Malians migrants to Ghana have done since colonial times, see Rouch descriptions, or to rural areas where farming opportunities are perceived to exist, that migration is not been motivated solely by economic factors but also for social reasons as Elliot Skinner (1963) demonstrates. The social and economic objectives of the savannah migrants are met by targeting not only urban areas but also rural parts of the southwestern Ghanaian river basins. Where sahel and savannah migrants go depends to some extent on familiarity with and popularity of the target destination. This in tum may be influenced 30 SOCIO,DEMOGRAPHIC STI'DY OF SOUTHWEST GHANA RIVER BASINS AND LBV by the reports given by kin and other acquaintances of their positive experiences in these places. The concentrations of particular migrant ethnic goups in certain river basins, for example the Busasi in the Tano Ano area is thus accounted for. Immigrants like to work where they have the support of their kin. Dagaba are found in larger numbers in the L.B.V. zone because of the proximity of this area to the Upper West, the home region of the Dagaba. Secondly, the Dagaba are vigorous agriculturists adept at hoe cultivation. They are experienced cultivators of cereals and yam and the L.B.V. seems to suit them as short term migrants. Perhaps this explains their absence from the southwest communities that we have studied. The answer to the question of deferential endemicity in comparable ecological zones is not a straight forward one. The answer to the question seems obvious in some cases but not in others. Perhaps the answers are not purely sociological. We think Biaso, on the banks of the Bia river, has not much onchocerciasis because the river has been dammed. The river Bia at thrs point had ceased to be fast flowing, one of the conditions that favour the breeding of the vector fly. We are not sure how old that dam is but the clues provided by old abandoned Russian equipment once employed in the construction of the dam would suggest that the project commenced in the early 1960s. Biaso, it will be realised, is apparently closer to the LBV zone (about 138 km), if we measure distance by direct accessibility as the crow flies, than most of the other Southwestern River Basin sites, with exception perhaps of the Tano Ano site lying by the Tano (about I l0 km from the Black Volta) which seems nearer. Both sites bear another resemblance i.e. that they contain a good representation of northern Ghanaian peoples. We observe that Betenase, a hyper-endemic community lies in the same ecological zone as Asawinso. Both are close to the Tano and its tnbutaries. Both lie deep in the thick forest. Both are small communities with the same kind of ethnic mix. Betenase lies within the forest reserve, literally the last bus stop. The difference is that Asawinso lies on a second class road that links Sankore and the Asunafo District of the Brong Ahafo to Sefwi Wiawso in the Westem Region. It seems to have had a prosperous past. It is not too clear why Asawinso is hypo-endemic while Betenase is hyper-endemic. We know from interview comments that where the burden of onchocerciasis is great individuals have sought biomedical attention and other sources of coping with the condition. These individual acts cannot be said the explain the differences in endemicity levels. What is not so clear is the part that hospital workers might have played in the heatment of the two communities. It was clear from our interviews with some affected people that there has been a visit to the village of Betenase by health workers based at the Sefivi Wiawso hospital who treat some of the villager with what appeared from the descriptions to have been ivermectin. It was a one off event we are referring to herer3 . However, if remote Betenase was visted is it unreasonable to expect that Asawinso, which was near and more accessible to Sefwi Wiawso, could also have received similar visits, perhaps more frequently, hence the lower endemicity rates. Sight Savers is supporting the distribution of ivermectin in the Westem Region although not all communities were being treated as at the time of the research in May 1996. Finally, we note that pathogenesis of onchocerciasis is a complex issue with several dimensions not all of which have been studied comprehensively. There is the question of strain of Onchocerca volvulus: not only are there differences between forest and savannah strains, even within the savannah or forest varieties, it is believed that differences in antigens can occur, Guzman et al (1997: l6), Lobos and Weiss (1985). It has also been found, in a study based Uganda, that onchocerciasis prevalence can be affected by deforestation, see Fischer et al (1997). Mendoza et al (1997) came to the conclusion from the study of some Cameroonian affected communities that in addition to proximity to breeding sites, even altitude, a variable that at first sight we might be inclined to discount, also plays a role. They conclude as follows: 31 SOCIO-DEMOGRAPHIC STIJDY OF SOUTHWEST GHANA RIVER BASINS AND LBV .. Levels of infection and morbrdity due to oncchocerciasis in a given population depends on a complicated rnterplay of factors that rnclude location, altitude, duration of residence, human behaviour, the strains of parasites involved and other factors, some of which remain to be defined. [Mendoza et al (op cit. P.83)]. RECOMMENDATIONS: Though we cannot prove that there rs a Southwest factor in the re-invasion of the L.B.V. zone we should not rule out other neighbouring areas which may not have benefitted to the same extent from Onchocerciasis control measures. Many Ewe fishermen now at the L.B.V. have fished at several locations along the Volta down to Tefle and Sogakope and perhaps at other river tributaries long before the Volta was dammed. These fishermen are not stable but tend to move up and down the river. The diffrculty of guaranteeing regular treatment is not peculiar to the fishermen whose source of a livelihood is on the river; the same kinds of problems can be said to pertain to migrant farmers who have come from further afield, from other parts of Ghana, Burkina Faso, Togo and Cote D'Ivoire. We therefore suggest that the possibility of a re-introduction from other focal areas be not dismissed without a second look. We met a family of recent migrants to the Tain Aboi area who said they had come in from a village in the Kintampo area but had never been treated for oncho before. The question this rarses is whether there could still be some remote communities in the Lower Black Volta Basin that had not been treated for oncho on regular basis but which are nevertheless endemic. This may not seem as preposterous as it might appearro. Humans acting as hosts and reservoirs expediting the introduction of Onchocerciasis in a prevlously Onchocerciasis free zone may be only one of a number of possible explanations for the current recrudescence. There is also the indirect effect of human activities on the ecology which could possibly have a contribution here. We need to consider ecological and environmental changes, not necessary because NGOs can do anything to minimrse deletenous human activities on ecosystems. It has been known that the vector fly, in any case some species, feeds not exclusively on humans and that some livestock, wtld or domestic, could also serve as sources of blood meal for the fly. Not much domestic livestock is kept by the communities visited in the course of this survey but we note that there is a game and wild life sanctuary around the Bui Dam Site and a the large Mole Game Reserve at Bole, falls within the OCP programme area.. One wonders to what extent livestock can serve as an active or latent reservoir of onchocerca volvulus and the contnbution of this to the re-introduction of the disease. These are not questions that a socio-demographic study per se can unravel. More research would be necessary before we can make assertions in this area. We would suggest a number of measures including the following: . Treatment compliance needs to be reconsidered and reinforced. . The registration exercise should insist that people do not enter their names in households they do not really live in. We found that a few respondents in some sites have never actually met the treatment teams, although they claimed to be on treatment. The practice, were informed has been to leave drugs behind for the absentees. This practice is quite understandable in relatively inaccessible places like Tain Aboi or Mpeasem. However, JZ SOCIO,DEMOGRAPHIC STIJDY OF SOUTH}IEST GHANA RIVER BASINS AND LBV as we have explained above many have registered for convenience as belonging in households in these settlements there when the truth is that they actually reside in Bamboi, New Longoro, Jugboi or some other nearby settlements which may happen not to be eligible for masse treatment with ivermectin. Some of these opportunistic regishants furthermore are not known by household heads or else the latter did not recall that such a person had several years ago registered as a member of the household. We cannot be certain the opportunistic registrants are served regularly or if individuals who happen to be absent at the time of the treatment rounds take their drugs regularly and under the right circumstances. It is conceivable that some absentees might fail to take the drugs left for them with kin and associates. One only has to recall the inter-personal distrust that we know exists in families and which occasionally manifests itself in the form of witchcraft and sorcery accusations to realise that there could be reluctance on the part of some absentees to consume drugs which they could not be sure have not been tampered with. This problem could be minimised if the drugs are distributed in unbroken seals and local distributors are discouraged from opening these seals. It calls for the monitoring of the behaviours of the local drug distributors. The poor state of knowledge about what Onchocerciasis is, what it does to people etc needs to be corrected by education. In Adwumam, respondents'knowledge was reasonably good. They could tell the causes and symptoms of the disease accurately. This is due to radio programmes providing education to the villagers around, as some respondents admitted, or from other sources such as the education given by OCP teams or other health providers working in the area. Responses like the following were not unusual at the Adwumam site: Some people from this village went to Twifo Praso Health Centre. They mentioned it to my hearing for the first time. There <they were informed about onchocerciasis and > a certain insect by name Nkotia which when it bites you can create blindness in you. Yes, Onchocerciasis is caused by small flies which look like "Nkontia". This disease can cause blindness Yes, it is a disease of the skin which itches as a result and also affects the eyes By contrast we come across sites were knowledge of onchocerciasis can only be described at best as fair and at the worst, non-existent. Although most respondents seemed to know how many times in ayear they were entitled to treatment with Ivermectin some were not sure of this. Knowledge of why the drug has to be taken, how frequently, and in what dosage is very important. These is need to sustain the educational programmes of OCP and the local health workers in the affected areas. Local FM Radio offers a valuable tool in this regard. We cannot exhaust the question of the possible role of the Southwest River Basins in the return of onchocerciasiscerciasis to the LBV zone without taking into account the behaviour of the vector fly. The disease, according to WHO/OCP (1997:12) source, is rife only in rural areas and up to about ten kilometres on either side of water courses where the fly may happen to breed. The flies have been descnbed as follows: blackflies are excellent fliers and can travel several dozen kilometres, up to 80 km in 24 hours along 33 SOCIO DEMOGRAPHIC STIJDY OF SOUT1IWEST GHANA RIVER BASINS AND LBV watercourses. Wrth the aid of monsoon winds, they may even migrate for several hundred kilometres from one river basin to another during the hrst part ofthe rainy seasonr5. Many studies, including Hunter (1981,267)have remarked on the role of wind masses in the dispersal of vector flies. Garms, Walsh and Davies (1979,347) suspect S. Damnosum to be capable of distances up to l50km when assisted by air currents. The West Southwest monsoon winds in the West African zone do facilitate that movement. It strikes one that the two major basin areas are not all that far apart, given the ability of the vector fly to cover many kilometres in its flight. A cursory inspection of the relief maps and the physical geography of the Brong Ahafo indicates a narrow water shed in the neighbourhood of Sunyani separating the Tarn and its tnbutaries which flow into the LBV from the tributanes of Tano whrch unite and then flow southward down to Yamfo and the hyper-endemic zone at Tano Ano and Asudai. Thus not only is it possible for the savanna flies to colonise the forest the reverse would also be equally possible given the location and proximity of the two zones. DISCUSSION AND FUTURE STT]DY The question of a re-invasion of the Lower Black Volta area is by no means a simple one and it would deserve concerted and a multi-discipline effort in the quest for answers. A study of the dynamrcs of population movements in this and contiguous areas is certainly important and migration studies have a contribution. As Prothero (1987,83) has pointed out, movements are important in disease transmtsston patterns and impact on measures of control, eradication and the improvement of public health. It is however necessary to consider, as he advices, the nature, variety and impact of the diverse movement patterns in this study and we have attempted to do this. To illustrate the diversities of movement patterns he set up a typology of 24 patterns and in so doing he pointing out how the spread of diseases hke onchocerciasiscerciasis, schistosomiasis and others can be influenced by occupational pursuits stnce occupational demands might compel people to move from one area to another. I have indeed taken such concerns into account in designing a research protocol that would tease out relevant information. Respondents were made to recall movements they might have made in the recent or distant past. Any approach that requires respondents to recall events is however, confronted with the problem that most people may not always recall events clearly. However, by relating the recall to events and personalities that are of critical importance to individuals we hoped to minimise the recall difficulties to some extent. We have not asked respondents in the southwest basin specifically whether they had lived in the area of the Lower Black Volta or vice versa, nor have we suggested to respondents any place names that might juggle the memory. We felt there was a need not to prejudice the responses and we are satisfied that responses concerning place names in this study were spontaneous. We note that our records contain names of towns, crties and villages far and near. Though the size or importance of a town or its proximity to place of rnterview cannot be ruled out as factors determining responses we do not feel that this has worked in such a way as to prevent the mention of places in the Lower Black Volta area by south-western respondents or vice versa. While references to Accra abound and can be attnbuted to its importance as the nation's capital, nevertheless, it is also a fact that less known places near Kumasi are listed as places that some respondents have lived in or visited, when respondents could equally have named Kumasi, the next most important city of Ghana, after Accra. This same can be said for the minor villages in the Upper East, Upper-West and Northern Regions that respondents have mentioned, not to mention unknown places outside Ghana. 34 SOCIO DEMOGRAPHIC STUDY OF SOUTHHEST GHANA RIVER BASINS AND LBV There is the need to pay some attention to the economic underpinnings of migration. This study's scope did not extend into the realm of economic issues. Nevertheless as we have argued above, there seems to be an economic explanation to the differential patterns of migration. Some useful information might have been derived from observations of the market places. The rural market holds periodically and is frequented by people from other places near and far. For a potential surplus producer of stables like yams and maize, it can be expected that traders would visit from the larger commercial towns of Ghana to buy produce and retail elsewhere. Unfortunately, a rapid survey such as the kind we conducted does not capture this floating population whose role in the question of recrudescence cannot be dismissed outright. The southwestem river basin communities certainly would need to be further studied to assess their orientation to and their preparedness for new health initiatives like community directed treatment. Multi- country studies recently commissioned by WHO/TDR seem to suggest that community directed treatment is viable in some African communities (person information from a 1996 Accra workshop for the evaluation of instruments for conducting studies on community self treatment with Ivermectin)16. We can see that this novel approach to drug distribution can have its benefits and its draw backs for compliance and effective coverage of communities. 35 SOCIO DEMOGRAPHIC STUDY OF SOU:|HWEST GHANA RIVER BASINS AND LBV NOTES 2 J 4 5 The most powerful abosom or gods among the Ashanti are Tano, Bea (both rivers), Bosomtwe, a lake, and the sea, all of which are considered as the children of God, according to Busia (1954). Though the taboo on fishing in the Tano and the keeping of goats in communities through which the river and its tributaries flow is found in many Akan communities in Ghana, it is by no means universally upheld. Some Akan communities by the Tano ane known not to observe the taboo on fishing the Tano. Sight Savers, an NGO, are involved in the treatment of onchocerciasis in some of the nver basins inlne Western Region. It provides Ivermectin and logistic support to the Ministry of Health to enable the drug to be sent to the remote areas of the Region for distnbution' We were later informed that they had gathered at the opposite bank, on the Northern side in expectation of our crossing over to see them. As OCP rules forbid the crossing of larger rivers in unsafe dugouts we did not oblige. The main cocoa harvesting season lasts from about November to January. There is a minor season in July or August. ..Bregion" stands for the administrative region where respondent was born in. "Brong A" stands for Brong Ahafo (also B. A.) while U/East and UAVest stand for Upper East and Upper West regions respectively. These makeshift abbreviations are necessary here to allow the labels to fit in the table cells. In these tables, ,Another District' is a distrrct within the region in which the study village or community is found and 'Another Region' stands for any other Administrative Region of Ghana' Outside Ghana means any African or non-African country other than Ghana. This might be Burkina Faso where some groups iike the Bisa or Busasi and Moshie have status as nationals or Cote D'Ivoire where some of our Banda or Ligbi and Nafanra-speaking respondents claim to have visited' ,,Here,, means, in the study community or some village very close by. "The District" means somewhere in the District but not in the study community and "the Region" means somewhere in the region but not in the district to which the study community belongs. .,Study District" here refers to another village within the study district which and this excludes the study village. Note that in this case Bole District would include Bamboi, Jama Battor, Tain Aboi and Jugboi o, ih" northern side of the Lower Black volta while New Longoro and its satellite villages beiong to Kintampo District. Paradoxically, Bamboi and New Longoro, located in two different Administrative Regions, are twin settlements separated by a ferry and now a bridge over the Lower Black Volta. Bur Dam Site, Bui Camp, Yan-Penika, Gblorkame etc. belong in the Wenchi Drstrict' ,.Basinl,' is the code for the first river basin mentioned by respondent. Some of the respondents mentioned several river basins where they had worked in or had lived for a time. Subsequent mentions are coded under "Basin2" and "Basin3" respectively' 6 1 8 9 36 1 SOCIO.DEMOGRAPHIC STIJDY OF SOUTH}TEST GHA.IIA RIVER BASINS AND LBV l0 ll 12 l3 14. Most of the Ahafos are lrkely to describe themselves as either Ashanti or simply Akan to the interviewer unless care has been taken to get the respondent to specifu. There is a certain uneasiness between Ahafo and Bono peoples in the Brong Ahafo Region. This part of the region lies close to the Ahafo parts making it plausible to suppose that the Ahafo representation is higher than the numbers would indicate. On our rounds we met a number of recently amved Frafras who said they had come over for a short period of stay during which they would offer their labour for sale. Such temporary visits or seasonal migratory moves seem to be not uncommon with Frafra youth searching for employment. Share-cropping entails the shanng of the farm produce between the tenant farmer, who takes half or a third of the yield after harvest and provides the labour and the other inputs for agricultural production, and the landowner who has more perrnanent usufruct rights to the plot by reason of ethnic or lineage affiliation or because he had purchased the land from the chiefs. Allodial right to land often vests in the stool or the chief who acts on behalf of the ancestors, the "true owners" of the land. Arrangements may differ however from area to area. Those who received the dose had to pay for it, to off-set the fuel expenses incurred by the official in this case; so the community was told. This researcher discovered to hrs surprise in May 1996 that his wife's cousin, a girl of l5 years who had lived at a village near Kimtampo town since early childhood was posrtive for onchocerciasis. She had complained of itching which led eventually to a skin snip and an examination at the Legon Hospital. On receiving ivermectin she exhibited some of the standard side effects of the drug on affected persons. 15. WHO/OCP op cit page 14 16. This investigator is grateful Dr Hans Remme of WHO/TDR for the invitation to facilitate at the Accra workshop at which the instruments for the study of Community Self-Treatment with Ivermectin were revised. 31 SOCIO DEMOGRAPHIC STUDY OF SOUTHHEST GHANA RIVER BASINS AND LBV APPENDIX Recruitment and training of Research Assistants (Post-graduates) Study Period Bui Area and New Longoro Area Southwest Basin Sites Time Lines: April 1l- 15: April20- May 21: April2l -26: April26-Mry 20: li{ry 22 - NIay 26: Coding and Inspection of Completed Question, construction and revision of EPI 6 Rec Files June 16- June 29: Data entry, Analysis and preparation of report at OCP 1997 May 12th to July: Second Revision of the Original Draft 38 2. J 4 SOCIO-DEMOGRAPHIC STUDY OF SOT,THWEST GHANA RIVER BASINS AND LBV GLOSSARY OF'SOME TERMS AS USED IN TIIIS REPORT "Onchocerciasis Status" is defined by us rn terms of whether a person was examined and found to be Affected, Non-Affected or not examined. In the event of doubt a fourth category, "Evidence Lacking" was tncluded. There are thus four possibilities which were coded as follows: I : "Affected"; 2 : "Non-Affected"; 3 : "Non-Examined"; 0 : "No Evidence for determinatron of onchocerciasis disease status. L.B.V. stands for the Lower Black Volta Basin and its communities in this report. Occasionally it can also mean the stretch of river just north of Bui down to the stretch by Old Longoro. The area of operation of the Onchocerciasis Confol Programme is more extensive than this as it sfretches further south along the Volta and its tributaries. "The Southwest" stands in this report for the Southwest River Basin Communities. The main rivers here include the Tano, Bia, Ankobra, Offin and Pra. This includes portions of the three administrative regions of Brong Ahafo, Central and the Westem Regions. It is an area in which the Onchocerciasis Control Programme carried out surveys to assess the incidence and prevalence of onchocerciasis between 1994 and 1995. "Ahafo" refers to the other half of the Brong Ahafo Region to the south. Some of these people consider themselves to be Ashanti. "Bono" here is more or less the same as Brong, a sub-ethnic unit of the Akan of Ghana. Abbreviations such as the following are found in the text: Dist ....... District Regn....... Region Basinl ..... Code for first Basin mentioned Basin2 ..... Code for second Basin mentioned Bregion .... Code for Region where born Whlearnt ... Code for where a person learnt a second language. Whconvrt ... Code for where a person converted to his religious beliefs Std ........ Prefix to some codes. It stands for Study and in study site Cum......... Cumulativepercentage 5 6 39 SOCIO.DEMOGRAPHIC STUDY OF SOUII{WEST GHANA RIVER BASINS AND LBV References AlleyESetal 1994 "Onchocerciasis Control Programme in West Africa, Ouagadougou, Burkina Faso. The impact of five years of annual ivermectin treatment on skin microfilarial loads in the onchocerciasis focus of Asubende, Ghana". Transactions of the Royal Society of Tropical Medicine & Hygiene. 88(5):581-4,1994 Sep-Oct Busia K A 1954 "The Ashanti" in African Worlds, edited by D Forde, I.A.I pp 190-209 Fischer P et al 1997 "Reduced prevalence of onchocerciasis in Uganda following either deforestation or vector control with DDT" East African Medical Journal 74 (5) p.321-5 Garms R, Walsh J F and Davies J B 1979 "Studies on the Reinvasion of the Onchocerciasis Control Progarmme in the Volta River Basin by Simulium damnosum s.I. with Emphasis on the South-western Areas" Tropemed. Parasit, 30,345-362 GuzmanGEetal 1997 "Differential immune response to Onchocerca volvulus: IgG4 antibody responses differ in Onchocerciasis patrents from Guatemala and Ghana" Acta Tropica 63 no.1, p.15-3 I Hart, Keith 1 987 "Rural-urban migration in est Africa" in Migrations, Workers and the Social Order (ASA Monographs 26) ed Eades Jeromy Herbst Jeffrey 1990 "Migration, the politics of protest and state consolidation in Africa" African Affairs vol 89 p.1 83-203 Hirschman A 1970 Exit, Voice and Loyalty cited in Herbst 1990 Hunter J M 1981 "Progress and Concerns in the WHO Onchocerciasis Control Program in West Africa Lobos E and Weiss N 1985 "Immunological companson between worm extracts of Onchocerca volvulus from savanna and rain forest" Parasite immunol 7 ,333-347 Mendoza Aldana J, Piechulek H and Maguire J 1997 "Forest onchocerciasis in Cameroon: its distribution and implications for selection of communities for control programmes" Annals of Tropical Medicine and Parasitology vol 9l no. I p.79-86 40 ISOCIO-DEMOGRAPHIC ST1JDY OF SOUTHHEST G}IANA RIVER BASINS AND LBV Plaisier A P, et al 1997 "Required duration of combined annual ivermectin treatment and vector control in the Onchocerciasis Control Programme in west Afiica". Bulletin of the World Heatth Organization. 7 5(3):237 -45, 1997 . Prothero R M 1987 "Population Movement and Health Hazards in Tropical Africa" in Health and Disease in Tropical Africa ed by Rais Akhtar, Harwood Academic Publishers, Chur Rouch Jean 1954 Notes on Migrations into the Gold Coast, transl into English by P. E. O and J. B. Heigham Skinner E P 1963 "Strangers in West Afncan Societies" Africa 33 wHo T987 WHO Expert Committee on Onchocerciasis, Third Report, Technical Reports Series 752, Geneva WHO\OCP 1997 20 Years of Onchocerciasis Control: 1994 - 1994 47

.a f, SOCIO-DEMOGRAPHIC STUDY OF' ONCHO-ENDEMIC COMMT]NITIES N THE BASINS OF THE LOWER BLACK VOLTA AND SOUTHWEST GHANA STUDY DONE FOR OCP/WHO JUNE 1996 *hP 5. nu A K. AWEDOBA a { CONTENTS Acknowledgements Executive Summary Pre-Study Meeting .... Rationale Specific Objectives.... The Problem Introduction Methodology Data Gathering Instruments Findings Specific Findings Place Birth and Ethniciry Place of Birth .................. Location of Relatives Language, Education and Religion Education and Movement Patterns Religion and People's Movement Patterns Marrrage and Migration ........... Oncho Awareness The Affected .......... Some Inter-Site Comparisons: Braso and Tano Ano ... Ethnic Composrtion Conclusions Recommendations .......... Discussions and Future Study .................. Notes ........... Appendix Glossary...... References.. Study Area General Profi le of Communities ................ The Lower Black Volta Basin (Bui Area) ................ Current Eprdemiologrcal Situation of the Lower Black Volta Area ...... The South-West Ghana Area Basic Information on Respondents 3 4 5 5 5 5 6 6 6 7 '7 8 8 r6 l6 l8 l9 20 2t 22 22 23 25 27 21 Data Analysis ............... Sampling Eligibility for Interview Degree of Rapport ........ General Findings and Observations: Migratory Patterns Ethnic Character of Settlements Southwestern Communities ...... ll ll t2 t2 l3 t4 l4 t4 15 l5 30 32 34 36 38 39 40 SOCIO-DEIiIOGRAPHIC SflMY OF SOUTHWEST G}iANA RIVER BASINS AND LBV ACKNOWLEDGEMENTS The researcher is happy to acknowledge with sincere gratitude the assistance provided by the Director (Dr K. Y. Dadzie) of OCP/WHO, Ouagadougou and his staff, the funders of this project. I mention a few here: Dr Boakye Boatin (Chief of PET), Dr Azodoga Seketeli, APOC Programme Manager, Dr Alley Soumbey, Dr. Dembele, Mr. S. N'Gadjaga and others with whom I have worked and sought advice on the project. I wish to make a special acknowledgement for the assistance of Dr Boakye Boatin who from the outset worked closely with me to make the study a reality. If this has been a good study the credit is equally that of the staff of OCP. Inadequacies in the study are however entirely my responsibility. I benefitted from a team of experienced researchers pursuing M.Phil studies in the University of Ghana: Messrs: Faidoo, Assirifi, Johnson Narh, Enc Denutsui and the indefatigable support of Pierre Salbre of OCP, who not only introduced us, the rest of the study team to the study sites. Not only did not spare himself in the search for and interview of respondents in the homes and farms he was ever so helpful in getting such a multr-national team of researchers and supporting staffto socialise and ignore personal differences. The permission of the Vice-Chancellor of the University of Ghana, and that of the Director of the Institute of African Studies of the same University is hereby acknowledged with profound gratitude. I also record my profound gratitude to Prof G P Hagan of the lnstitute of African Studies who undertook to handle my teaching assignments in my absence from the classroom. Finally, but not the least, t thank the chiefs and leading men of the communities where we have worked and our respondents for their generous hospitality. I remember with gratitude the assistance of the Executive Director of the National Onchocerciasis Secretariat in Accra, Mr. Fosu, for the sundry ways in which he has personally been of assistance to me and the project. 3 SOCIO.DEMOGRAPHIC STUDY OF SOUTHWEST GHANA RIVER BASINS AND LBV EXECUTIVE SIIMMARY Migration within and without the Lower Black Volta Zone (also referred to as the Bui zone or area) and the river basin communities of the Ghanaian Southwest is considerable. However, we found no evidence to suggest that much movement existed between the two zones. Our conclusion is based on the following findings: . The indigenes of the Lower Black Volta are the Mo and Banda but less than ten of these were encountered in the southwest Ghanaian river basin communities. . The majority of migrants i.e peoples from other parts, at the Bui zone were either from the Upper-West Region of Ghana (ethnic Dagaba) or the Volta Region (ethnic Ewes). However, very few Dagabas were encountered and interviewed in the Southwestem river basin communities. We do not think this is due to sampling errors. The Ewes in the Lower Black Volta zone are primarily fishermen not farmers. Those in the Southwest are farmers and not fishermen. . Majority Northem groups encountered in the Southwest were the Kusasi, Bisa, Basare and Frafra. Few of these were encountered in the Lower Black Volta communities. . Akan people who dominate numerically in the Southwest were rarely encountered in the Lower Black Volta communities. . Very few of the affected in the Southwestern river basin communities had ever lived or worked in the vicinity of the Lower Black Volta. There are three categories of people encountered in the study communities Those born in the study community. Those whose roots are within the district or nearby communities. Those who come in from other regions of Ghana and sometimes from outside Ghana. There is however variation between communities in terms of the category that is numerically dominant and in their ethnic composition. tn the Bui zone the migrants outnumber those bom in the area. Those born in the community may or may not be from the indigenous (we use this term advisedly) ethnic groups. Where parents are not indigenous to the district in which the study site is located their children born in the host settlement may come to see that community as comparable to the hometown. This is true more for the Southwest where communities have more pernanency than for the Lower Black Volta zone, where the study communities seemed more fluid demographically. Respondents from another community within the district but presently living and working in the study village maintain their links with kin and family in the hometown through frequent visits. For migrants from other regions links with the hometown are hard to maintain through visits, though sporadic visits may be prolonged. In the latter case second generation migrants maintained fewer contacts with their parents' 4 a SOCIO-DEMOCUPHIC ST1JDY OP SOUTHWEST GhNA RIVER BASINS M LBV hometowns. I PRE-STUDY MEETING This was held at the offices of OCP in Apnl 1996. It afforded the researcher the opportunity of meeting the staff of OCP and to receive briefing on the objectives of the project to the undertaken, the problems to be addressed and briefing on the communities to be studied. It was on this occasion that the questionnaire schedule was devised. Previous questionnaires were made available for the purpose as well as other documents including a previous assessment of the communities in question. II RATIONALE: To conduct a socio-demographic study of the Bui area of the Lower Black Volta Basin and some Onchocerciasis-endemic communities of South-West Ghana mapping out population dl.namics and migration patterns. This is to enable us to answer the question of reintroduction of onchocerciasis into the Lower Black Volta Basin (Bui) from the South-West zone. III SPECIFIC OBJECTIVES: To determine the population dynamics between the Onchocerciasis-endemic areas in South-West Ghana and the Lower Black Volta Basin in Ghana (Bui area) To determine the migration patterns in the population in the lower Black Volta Basin in Ghana (Bui Area). IV TIIE PROBLEM: It is suspected that "contamination" of the Bui area derives from the South-West section of Ghana which has remained largely untreated until now. The apparent movement of peoples between the two areas, if any existed, might serve as the channel for this contamination. A socio-demographic study of population dynamics of the two areas, it is therefore expected, would shed considerable light on the problem. The wide differences in endemicity levels within the south-west itself is suspect, especially when some areas that lie close to the breeding places of the blackfly have low levels of endemicity. Is it possible that such communities are more fluid demographically, it might be asked? a. b 5 SOCIO-DEMOGRAPHIC ST1JDY OP SOUTHWEST GHANA RIVER BASINS AND LBV V INTRODUCTION i Study Area: The areas to be studred fall into two zones. They include the south-westem zone which lies wrthrn the basrns of several nvers that drarn South West Ghana namely the Tano, Bia, and Pra-Offin and their tnbutaries. The second zone centres on Bui and its surrounding villages in the basin of the Lower Black Volta. The communitres visited for the purpose of the study included the following, grouped by river basin Lower Black Volta: Bui Dam Site Yan-Mpenika Gblorkame Mpeasem Tain Aboi Southwest Ghana: Bia Basin: Biaso Brong Ahafo Region -do- -do- -do- Northem Region Brong Ahafo -do- -do- -do- Western Region -do- Central Region Central Region? Ashanti Region Tano Basrn Pra-Offin Tano-Ano/Asuadai Asuhyaie Anwiam Asawinso Betenase Adwumam Ampabena Bontomurso General Profiles of Communities The communities studied were relatively small-scale rural communities lying close to the banks of ma;or rivers such the Black Volta, the Bia, the Tano, and the Pra-Offin or their tributaries. The river was rarely more than a kilometre away from the settlement, although respondents' own estimations of distances from home to nearby rivers or sheams were sometimes vague and sometimes a little on the high side. Some communities like Asuhyiae are encircled by rivers: small and large, as the etymology of the Akan name of this settlement suggests. The main source of livelihood in these communities is farming and its related activities such as foodstuff processing and retailing. Both sexes were engaged in farming. Women also engaged in other farming related activities like gan-making and the preparation and retail of foodstuffs. Though there were salaried workers such as teachers even these engaged in farming. The farms were often located close to the banks of nvers. 6 SOCIO-DEMOGRAPHIC STUDY OF SOUTHWEST GHANA RIVER BASINS AND LBV Invariably, the Southwestem settlements included in the study lie at the hub of a network of satellite farming communities and cottages. It is in these that migrant farmers dwell so as to be within a short walking distance from their farms. Fishing is an important secondary source of employment in Lower Black Volta Communities; there it is a primary occupation for the Ewe communities. Taboos regarding the Tano mean, however, that fishing on the whole is of lesser importance in the Southwest basinsr. Some of the Southwest basin settlements appear to have been fairly old and long established as their lay-outs and structural features evidence. Lower Black Volta study villages on the other hand lack any form of perrnanency. In fact, with the exception of Gblorkame in the Bui Area the rest of the study communities in L B V resemble cottages more than villages. This is certainly the case for Yam-Penika, Bui Dam Site, Mpeasem and Tain Aboi. Communities lack basic modern infrastructural facilities but some communities were better endowed than certain others. Each could usually count on having a primary school in the village or nearby but for higher education, i.e access to secondary and technical education, villagers depend on nearby larger settlements or towns in the district and on the regional capitals. The quest for education leads inevitably to emigration. Similarly, the search for employment in the formal sector implied a willingness to emigrate and such employment goes with a willingness to accept tansfer from urban to urban, from urban to rural area and vice versa or from one rural area to another. This is certainly the case with the professional teachers we met in these villages. The Lower Black Volta Basin (Bui Area) This lies at the southern end of the area hitherto covered by the activities of the Onchocerciasis Control Programme (OCP). It has some of the largest breeding sites in the OCP control zones and indeed in West Africa. In I 987 it was one of the areas chosen to form part of the ivermectin tnals aimed at a determination of the extent to which transmission could be further reduced with the addition of ivermectin treatment of the population. Initially only first-line vrllages with a selected population of about 800 people were involved in the trial. Subsequently, treatment was extended to the entire population, estimated to be 4000, at risk of infection. Current Epidemiological Situation of the Black Volta Basin Area The preliminary results of the latest epidemiological evaluation carried out in January 1994 in l0 villages in the Bui area, showed that there had been a considerable reduction in Onchocerciasis prevalence over the pre-contol level in most of the villages to the north of the Black Volta. See map attached. These preliminary results were, however, not in conformity with what would have been expected i.e. zero or near zero prevalence levels after the 18 years or so of OCP vector control in the area. The view of WHO risk of recrudescence is as stated in Plaisier et al (1997) as follows: Taking into account uncertainty about the efficacy of ivermectin, our results indicate that, provided treafinent coverage is at least 65Yo and there is no importation of infection from elsewhere, l2 years of combined confrol will be sufficient to reduce the risk of recrudescence to below lolo in even the most afflicted areas. More importantly, infections were detected in some children below the age of 15 years in some of the 1 SOCIO-DEMOGRAPHIC STUDY OF SOUTHWEST CHANA RIVER BASINS A}ID LBV villages south of the Black Volta. All the rnfected chrldren were residents of the area and believed to have never travelled out ofthe area. In December 1994, another epidemiological evaluation was carried out in 5 villages further south of the Black Volta but still within the OCP area. The prevalence ranged from 2Yo-32.%o. Again among the infected were children. DNA tests indicated that most of the microfilaria collected from the infected people were of the savanna tlpe. These results are perhaps an indicatron that transmission might still be going on in the area. The entomological data however show that there has been no infected flies in the area for a long time. A possible "contamination" of this area from the untreated zone (neither by larvicrding nor under ivermectin distribution) further south rn Ghana therefore appears plausible. The South-West Ghana Area Unlike the Bui section, the South-West Area lying just south of the OCP zone was not covered by the activities of the OCP'?. It is now however the rntention of OCP to propose to the Ghana Government to institute distribution of ivermectin in this area. This, it is hoped, will stem the contamination problem for the already treated areas. Thus, in September 1995 OCP carried out an epidemiological evaluation of twenty first line villages in South West Ghana that lie in the river basins to assess the prevalence and intensity of infection prior to ivermectin distribution. Microfilaria collected from infected individuals were sent to the Bouak6 laboratories for DNA identification. The findings of the OCP investigation show a variegated picture of communities that range from high endemicity (i.e 60.4% as in Adwumam on the Pra-Offin basin) to low endemicity (i.e.2.2% at Mehame in the Tano basin). Basic Information on Respondents: As there is a need to place the findings in a social framework, we produce below some basic information on respondents. Ages ranged from l6 years to 98 years. There were a total of 1109 respondents distnbuted as follows: Lower Black Volta sites 230; and 879 for Southwest. The 25th, 50th and 75 percentiles fell respectively within 25 years, 33.5 years and 46 years for Bui and 28 years, 38 years and 50 years respectively in the case of Southwest Ghana. Male respondents were 57oh and 53%o respectively for L.B.V and Southwest while for females the scores stood at 43%, and 47%o rcspective thus indicating a slight preponderance of males. This was imbalance was not intended. Most people in the two zones in the study were farmers as the tables below show TABLE la: L B Volta Respondents by Main Occupation WORK I Freq Percent <N:229> B SOCIO-DEMOGRAPHIC ST1JDY OF SOUTIIWEST GTIANA RIVER BASINS ND LBV ------+---------- 140 6t.t% 38 t6.6% 2 09% 5 2.2% 6 2.6% 8 3.5% 30 13.lo/o FARMING FISHING CIVI S TEACHER TRADER UNEMPLOYED OTHERS Total | 22e 100.0% TABLE lb: SOUTHWEST BASIN RESPONDENTS BY MAIN OCCUPATION WORK I Freq Percent <N=868> Farming Civil Servant Teacher Trader Unemployed Others Student 695 80.1% 5 0.6% Total | 868 100.0% In the two zones the illiteracy rate is high as only a small percentage have had formal education to any appreciable standard. In the L.B.V.32% <N:228> have had some education only 4l or 54.7o/o of whom had completed Elementary school. In the Southwest, relatively more people i.e.62.50/o have had some schooling although not more than l0% had got beyond Middle School. Majority of respondents in both zones were mamed monogamously, with a fair number having at one time or the other divorced. For L.B.V. the married were 66.70/o of the sample and in the Southwest a comparable figure of 67.1% <N:870> was recorded. Those who had more than one wife at a time were few. 57/% of L.B.V. respondents considered themselves as Christians. The Muslim population was smaller, at 9%o.In the Southwest basins 75.2% were Christians and l2o/o were Muslims. A fair proportion of our respondents were neither Muslim nor Christians; they were either traditionalists (for whom the local gods and the ancestors were an important source of religious inspiration) or "free thinkers", people who did not mention any religious denomination. The degree of bilingualism was high in both zones as most people spoke other languages in addition to their mother tongues. In L.B.V. it is as high as 96.5% <N:230> and in the Southwest 69.40/o <N:870> were bilingual in one or more languages. When we consider the "Oncho status" of our respondents were find that the affected were in the minority in the L.B.V. while in the Southwest the scores nse due to the fact that a number of communities there were l0 36 20 l3 89 t.2% 4.t% 2.3% 1.5% 10.3% 9 SOCIO-DEMOGRAPHIC STUDY OF SOMWEST GHANA RIVER BASINS AND LBV ln fact hyper-endemrc for Oncho. But for the inclusion of low endemicity villages like Braso where none of those rnterviewed was an affected person, the scores for the Southwest could have been higher strll. In the tables below we present a breakdown of the sample in terms of age groupings and also by oncho status. Over 35%o of our respondents fall within the 30 to 45 years age group. The l5 to l6 years old age group is the least represented. This may be because many people within this age group are in school and there not available for rnterviews. It may also be that in seeking out respondents interviewers overlooked some individuals falling in thrs age group because of stunted growth. Table 2a: Gender and Age Groups: All Respondents of Southwest Basins AGEGROUP I F M lTotal Percent l5yr - 19 I 32 24 I 56 6.4% 20yr - 29 I 89 98 I 187 21.5%30yr-45 | l5l 161 | 318 36.6oh 46yr - 59 I 88 100 | 188 21.6% 60yr - 99 I 49 1t I 120 13.9% -----------+-------------+-- Total I 409 460 I 869 100.00% Table 2b: Gender and Age Groups: Respondents of L.B.V. Bastn AGEGROUP I F M lTotal Percent l5yr- I9 20yr - 29 30yr - 45 46yr - 59 60yr - 99 NO EVIDENCE AFFECTED NON-AFFECTED NOT EXAMTNED 67 30.0% 35 15.70 90 40.4o/o 3 r 13.9% u16 24 2l 38 43 16 22 922 11.8% 22.40/o 35.sYo 167% 13.6% 27 5l 8l 38 3l Table 3a Oncho Status of L b v Respondents ONCHO STATUS I Freq Percent Table 3b: Oncho Status of Southwest Basrn Respondents ONCHO STATUS I Freq Percent Cum. 10 SOCIO-DEMOGRAPHIC STUDY OF SOUTHWEST GHANA RIVER BASINS AND LBV NO EVIDENCE | 76 9.5% 9.5%AFFECTED | 218 27.3yo 36.8%NON-AFFECTED | 239 29.9% 6660/oNOTEXAMTNED | 267 33.4% 100.0% ----------+-- Total | 800 100.0% Note that in Tables 3a and 3b, the category "No Evidence" means a decision could not be taken on whether the respondent was an affected person or not. The category "Not Examined" is used to describe persons who said they were not present at the time of the preceding surveys conducted by the OCP teams records of which had been made available to this shrdy. New migrants would fall within this group. V[ METHODOLOGY The approach adopted was aimed at mapping out the pattems of intemal and external movement in a number of selected villages in both the Bui and the south-West zones. Data Gathering Instruments The questionnaire used was semi-structured combining open-ended questions on issues considered pertinent to the demographic profiles of village communities, and some probes. Specific questioning elicited the individual's town/village of birth, hometown or area of domicile of the respondent's corporate or "extended" family and where other relatives are to be found and if visits were exchanged and how often. Other questions asked about languages spoken by respondent and where leamt, about religion and place of conversion, and about marriages involving the respondent now and in the past and where spouses met. There were also questions about a person's education and occupation: places where respondent attended schools, the fype of job (main and secondary) and job place now and in the past and if these places were close to rivers. We wished to know where respondents live now and in the past and if place of habitation was close to a river now or in the past. In addition to these questions, the respondent was asked questions specifically about encounters with onchocercal diseases and their treatments. These assess respondents' awareness ofonchocerciasis as a drsease and whether they had obtained treatment in the past individually or collectrvely. These questions were motivated by the expectation that the stability of a community can be deduced from the frequency of movement by individuals for jobs, education, and social visits paid to relations living elsewhere, among other things. By asking a polyglot where he or she learnt languages we are able to determine past migratory patterns. If respondent X maintains that he or she had learnt a second language at place Y, we can conclude plausibly that respondent X must have lived at place Y for a considerable time, knowing that second language learning takes time for adequate exposure. Similar impressions can be obtained by asking a polygynist where he or she had met present or previous parlners, where a formally educated person had schooled or where a person had worked or acquired training in his or her profession or where a person had converted to his or her faith. We realise that the responses resulting from these probes do not carry the same weight. For example, conversion to a new faith may not take as long a period of residence at the place ofconversion as residence at the place ofacquisition ofa second language. 11 SOC]O DEMOGRAPHIC STUDY OF SOUTHWEST GHANA RIVER BASINS AND LBV The same semi-structured questionnaire were administered to all categones of respondents: affected and non- affected, as well as the potentially new arrivals i.e. the non-registered persons found tn the sites. Data Analysis The data collected was coded for the first round by the intervrewer who was also allowed some time to go over and check his coding. These codings were then checked and subsequently revised, where necessary by the researcher. Several rounds of re-codrng became necessary as new variables suggested themselves from the data viewed. The coding was specific and aimed at those variables that would shed light on the aims and objectives of the study. The coded data was subsequently entered into EPI INFO version 6 while the textual component which illustrates more specifically the issues tnvolved was typed into Textbase Alpha. Sampling Studies were conducted at l4 villages. Endemicity levels were taken into considered in the choice of villages. Consequently, hyper-endemic, mezo-endemic and hypo-endemic villages were represented in the sample of study communities. A total of 1108 respondents were administered semi-structured questionnaires. The number of persons interviewed depended on the size of the community and the willingness of individuals to be interviewed. In small villages everybody was invited. Where villagers were reluctant to come to us for intervtews we paid home visits to talk to them at their convenience. This was necessary at Biaso where there was least interest in the exercise. Although we did not usually target particular persons before hand, we did go after those affected who did not show up. Thrs was necessary since in a migration study interested in Onchocerciasis there is need to know which of the affected had left the community, when they left, where they had gone to and for how long they would be away or if they were likely to return at all. The approach was slightly different in the case of the villages of Mpeasem and Tain Aboi. We did not see many people to interview in these. So, we asked about each of those adults registered there previously. We noted the absentees. Many whom we were told were living in Bamboi and New Longoro we searched for at these places and interviewed. We did not always ltnd our query, nevertheless, a number of such interviews were conducted at Bamboi, New Longoro and a couple at Jugboi, some ktlometers north of Bamboi on the Bole road. It will be noted that neither Bamboi nor its twi community, New Longoro had been included in our sample of communities. Even then, for the LBV zone, only in the case of Mpeasem did we interview more than 70 (many of these were people living at New Longoro and Bamboi who either had farms at Mpeasem or had registered in one of the two places for the convenience of receiving the oncho treatment). In the larger communities of southwest Ghana we exceeded 80 respondents for most communities. As we have indicated above, data was collected using a semi-structured interview questionnaire admintstered by postgraduate students of the Institute of African Studies of the University of Ghana in the company of the investigator. Being present at the interviews and participating in the exercise also afforded the opportunity to observe these communities at close range. t2 SOCIO DEMOGR}PHIC STIJDY OF SOUTI{WEST GIIANA RIVER BASINS ND LBV The selection of village communities for assessment was based on the baseline survey conducted by OCP between 1994 and 1995. On those occasions entire village communities in the lower Black Volta and the Southern Ghanaian river basins were registered, examined for presence of onchocercal parasites in skin snips. The affected were treated by ivermectin dose. Communities chosen for this study included highly endemic ones like Adwumam (60.4%), Tano-Ano (58.0%) and Betenase (52.4%) as well as low endemic ones such as Biaso (0.5%). As the villages differ in size the sizes of samples chosen from each vrllage took this into account. Those who were interviewed were 16 years or above. Initially, it was decided to take 75-80 respondents from each village but we soon realised on the field that this was impossible due to the small sizes of some communities. This was particularly so for the Lower Black Volta communities. Certain communities were so small that even when the entire population was included in the sample the minimum sample size of 73 could still not be obtained. Eligibility for Interview The sampling as stated above included both affected and non-affected as well as others. Our objective was to ensure that equal chance was given to all categories in the first round of interviewing. This included affected, non-affected, non-examined and new migrants. Then, after a considerable number of intervrews had been conducted stock was taken to know if the affected, especially in the hypo-endemic communities had been covered. Where this proved not to be the case, the affected were then sought for individually or their whereabouts ascertained by asking those who knew them. This we considered a useful approach, one which if time and other considerations had allowed could have been extended to the entrre registered population. Nevertheless, where communities were small in size, as rn the case of the Lower Black Volta, we did attempt at the conclusion of the interviews at each village to ascertain the whereabouts of other registered persons that we were not able to see and interview. [n small communities people knew each other and the heads of community were usually helpful when asked about the whereabouts of absentees. Nevertheless, there were a few registered individuals whom we could not trace in these communities whom community leaders did not seem to know. We think these are non-members, people who had registered at the time of the previous surveys for the purpose of getting free treatment from the OCP teams. We must also point out that village communities visited saw us as another Oncho control team carrying out an exercise aimed at a further registration of individuals for future treatment rounds. It dawned on villagers that access to treatment depended on a previous registration. In this light some individuals who were not registered previously and could not now be interviewed because we had exceeded the village quota felt disappointed. To assuage this feeling those anxious for interviews were registered by taking their particulars such as name, place of birth, age etc. This too was a useful exercise as far as the objectives of this study were concerned. Degree of Rapport We should record that the reception the team received varied from place to place, often depending on the perception of onchocerciasis and the effect of previous treatment. It ranged from enthusiastic reception in places like Adwuman, a hyper-endemic area where everybody wanted ivermectin because it was considered as a very good drug, to indifference as in the case of Biaso which is very low on the scale of onchocerciasis. In Biaso the prospect of a skin snip was enough to keep many in the community away. Even the assurance 13 SOCIO.DEMOGRAPHIC STI]DY OF SOUTHWEST GHANA RIVER BASINS AND LBV that there would be no skin-snrpping was not persuasive enough. Biaso seemed from our observatron (confirmed by remarks from some members of the community) to have a leadership crisis compounded by its multi-ethnic character all of which made village mobilisation difficult. FINDINGS: General Findings and Observations: Migratory Patterns The potential for engagrng in cash cropping or subsistence farming seems to be the main impetus propelhng peoples from all over Ghana to the places and rural communities where these studies took place. In the Lower Black Volta zone, the migrants came from nearby communities and from the Upper West. The fisherfolk were usually from the Volta Region. This is not in anyway to suggest that the areas in questron were necessarily previously unoccupied. The evidence suggests that these areas have always have people living in them. However, the population profile of a number of the Southwestem River Basin communtttes had changed wtth the arrival of migrants in larger numbers in search of virgin land, as the old cocoa areas in Ashanti and other parts of the Brong Ahafo have declined in fertility. It is also becoming abundantly clear that as the agrrcultural potentials of these areas decline there would be an exodus to other areas of the country, such as the remote southwestem parts of the Westem Region like the Aowin-Suaman District. It is clear that villages hke Yan-Mpenika serve as farming cottages for neighbouring Banda, most of whom are from Banda Ahenkro, and for the other ethnic groups found the zone, including the Degha or Mo. It seemed that Bandas who went there maintained their kinship links with the hometown and when their farming did not seem to prosper they returned to the hometown. For example, the death of a migrant Banda man means his conjugal family beat a retreat to Banda Ahenlro. His wife might remarry if she was still young enough. This scenario was not peculiar to the Bandas but pertained to the Dagabas, Mos and others in these settlements. The Ewe communities around the Lower Black Volta were usually fisher folk. They tended to be people from Bator, Manfe, Adidome etc in the Volta Region. Smaller wards and settlements where they predominate can be found bearing as the name "Bator" as suffix or prefix, for example, Jama Bator, opposite Bui DamSite on the northern side of the Volta, or Bator Line in New Longoro etc. Akanyalaom is also called by the Ewe, Akanyakope. As remarked above, communities of the Lower Black Volta often lacked many modem amenities such as portable water, schools and even accessible market places. This is true for Bui Dam Site, Gblorkame, Yan- Mpenika, Mpeasem and Tain Aboi. The implication of this is that those who happened to be there were not encouraged to make the place a permanent home. Children of school going age are sent to nearby settlements to attend school. Lack of marriage opportunities means also that when daughters mature they have to sent to the home area in another adminishative district or region to seek marriage partners. Migrant workers themselves return to their hometowns and villages to marry or re-marry. Ethnic Characteristics of Settlements The indigenous people of the area usually constitute a sizable portion of the population of each settlement. The chief of the village was usually from the local ethnic group.One exception in the southwestern study sites is the case of Tano Ano where indigenous Bono are far outnumbered by peoples of Northern Ghanaian extraction such as the Kusasi, Bisa, Basare etc just as at Gblorkame in the Lower Black Volta basin the Ewes are predominant. t4 SOCIO DEMOGRAPHIC STUDY OF SOUTHWEST GHANA RIVER BASINS ND LBV In the L B Volta area the main migrant ethnic groups farmrng there include the Dagaabas, Bandas, Mos, Ewes, Frafras, Mossi, Bisa and others. The chief of Mpeasem is a Dagaba. The Konkomba who used to have a presence there and registered there during the 1994 survey by OCP staff have now withdrawn due to the ethnic riots and a feeling of insecurity. Movement within the Lower Black Volta basin area seemed to be widespread. Visiting kin accounted for this as well as the quest for opportunities such as more fertile land, fishing resources and others. Individuals living on the southern side of the Black Volta can easily relocate themselves on the Northern side or vice versa, as need be. Many of our Bui Damsite respondents lived on the opposite bank, northern banks of the Lower Black Volta at the time of the visit, a few of whom ferried themselves across to see us 3 There was also movement between the Lower Black Volta and the other parts of the Wenchi Diskict. Dagaba moved to and from the zone and their hometowns in the Dagaba motherland in the Upper West Region. A large number of Dagaba registered in 1994 or before were not around in Mpeasem when it was visited in April 1996. We did not however notice much movement by people in this area to the southwestem river basin communities. Bandas and Mos did not appear to mrgrate far into the southem frontiers of the Brong Ahafo Region. [n the same way, not many of the other southern Ghanaian peoples like the Ashantis, Ahafos and other Bono were found living in the Lower Black Volta area. This is perhaps not too surprising. The savannah ecology of the Lower Black Volta favoured root crops like yam which Northem people like the Dagaba, Banda, Mo and Konkomba specialised in. By contrast the Southwestern river basins supported cocoa and other tree cash crops which require caprtal outlay of the size that Northern subsistence farmers cannot afford. Southwestern Communities: These differed markedly from those of the Lower Black Volta in appearance. lndivrdual communities were larger in size and seemed more prosperous, better organised and better provisioned as far as facilities like schools, health centes and in some cases portable water were concerned. They attracted a variety of persons of various ethnicities and backgrounds willing and able to undertake cocoa farming or to facilitate the industry for a wage. It is not unusual to find retired civil servants who had gathered pensions farming here. The majority of people were of southern Ghanaian extraction and they came from nearly all regions of the country. The Ashantis predominate not only in the Ashanti settlements of Bontomurso and Asuhyiae (lying close to the Asonafo District) they also oufirumber the indigenes, as in the case of some of the Brong villages studied. Other groups include the Krobos, Ewes, Fante, and others. Peoples'of Northern Ghana extraction with sizable representation include Frafra, Kusasi, Bisa, Brmoba, and Dagaaba. They provide the labour for cash crop farming as they did in the past. Though the Southwest communities studied were multi-ethnic nevertheless many of immigrant origin had been bom in the villages where the interview took place. This is another point of difference between the two zones under study. For one thing it suggests a willingness on the part of the migrants to reside in these areas for a considerably longer spell than in the LBV zone. As far as intemal mobility was concerned, people in the Southwest are even more mobile than in the Lower Black Volta basin due to better communication facilities. Larger towns in the neighbourhood are visited frequently. Kumasi was a popular place to visit than say Accra, the nation's capital which is more distant. 15 SOCIO DEMOGRAPHIC STI-IDY OF SOUTH}JEST GHANA RIVER BASINS AND LBV Visits to distant kin were less frequent. Nearly everybody had a kin somewhere whom they visited at least once a year. Migrant southerners tended to visit home more frequently than Northemers found in these communities. Experience at the Aowin-Suaman area shows that the time to revisit home was immediately after the cocoa season'. We think the same obtains elsewhere in the cocoa growing areas of the southwest. SPECIFIC FINDINGS: This section indicates informants' responses on a number of questions relating more directly to population dynamics and movement pattems in the areas of study. The presentation will attempt inter and intra zonal comparisons. Place of Birth and Ethnicity: Ethnicity is an important variable in migration studies. Ethnicity suggests where a person is likely to have been born, where the home base is, where relations and kin are likely to be found and so on; but more importantly for this study, it sheds light on the respondents' potential movement pattems and whether the peoples of the LBV zone visited the areas of the southwest river basins and vice versa. The study shows the following That the majority of respondents in the southern zone were ethnically from the south of Ghana. There were some Northerners (i.e, peoples from the three northern regions of Ghana) and a few from outside Ghana living in the area. The Akans are by far the most dominant group and they comprised Ashantis, Bono, Denkyira, Sefivi, Fanti and other less frequently encountered Akan groups. The Bono, though from the Brong Ahafo were not people who had lived anywhere near the LBV, although LBV constitutes the northern parts of the Brong Ahafo. This is illustrated in the two tables, 4a. and 4b. below. Note that the Akans constitute in this sample 78.1%. The Ashanti, easily the largest of the Akan groups, accounts for over 4l%o of the sample in the southwestem river basin communities. Akans in table 4a refers to respondents who described themselves simply as Akan without reference to the specific group. Some of these are Ashanti too. TABLE 4a: ITIETOR ETHNIC GROUP SOUTHWEST BASIN COMMUNITIES AKANS AHAFO AKAN AKWAPIM ASHANTI DENKYIRA I Freq Percent <N:867> 0.6% 9.8% 0.7% 41.7% 12.7% 5 81 6 361 ll0 1.6 a a SOCIO.DEMOGRAPHIC STT'DY OF SOUII{WEST GHANA RIVER BASINS AND LBV FANTI BONO SEFWI wAssAw ASSIN ll 28 57 13 J t.3% 32% 6.6% t.5% 03% TOTAL I 681 '18.6% TABLE 4b: orspn ETHNTc GRoUPS SOUTHWEST BASIN COMMUNITIES OTHER GROUPS lFreq Percent <N:867> BASARE BUSANSI EWE FRAFRA GA-KROBO KUSASI MOSSI WANCARA BANDA KASENA DAGABA-WALA OTHERS t2 49 24 2l 16 l9 9 9 5 4 J l5 1.4% 5.7% 2.8% 2.4% 1.8% 2.2% t0% 1.0% 0.6% 0.5% 0.3% 1.7% TOTAL | 186 21.5% Just over 2l%o of the sample are people who do not belong to any of the Akan units in the strict sense of the term. We note the inclusion of 5 Banda, persons whose ethnic roots should be in the vicinity of the Bui area. The Busansi and the Kusasi would have their ethnic home bases in the basins of the White and Red Voltas. The Busasi, also called Bisa have communities in Burkina Faso and in the Bawku and Zebilla Districts of the Upper East. Under the label "Others" in Table 4b we have included vanous ethnic groups represented by less than three persons in the sample. The ethnic composition of L.B.V. respondents leads to the following conclusions That comparahvely few ethnic groups are represented there. The main ones are Banda, Dagaba, Ewe and Mo. The groups that are numerous in the Southwest river basins are almost all absent from the L.B.V zone TABLE 5: eruNrc GRoUpS: L.B.v.coMMUNrrrEs ETHNIC I Freq Percent Cum. Ashanti Banda Barrgo Dagaba 1 0.4% 35 l5.6Yo 1 0.4o/o 58 27.3010 0.4% t6.t% t6.5% 42.4% 71 SOCIO.DEMOGRAPHIC STUDY OF SOUTHWEST GTIANA RIVER BASINS AND LBV Ewe I Fon Ga Gonja Lobr Mo Nchumbum Sisala 69 30.8% 132% I 0.4% t 0.4% I 04% t 0.4% 53 23.7yo t 0.4% I 0.4% 13.lyo 74.lYo '75 0% 75.404 99.1% 99.6% 100.0% Total | 224 1000% There were a number of Konkomba ln the zone prior to 1995 but these, our enquiries revealed, had left due to the ethnic riots in the Ghanaian middle belt. Place of Birth The majority of respondents in the southem zone were either born rn the villages where the interviews took place or in a nearby place. At least 42.7% were born in the vrllage of interview. Tano Ano was one exception: only l8% or so were born there. Tano Ano seems to resemble the settlements of the L.B.V. in respect of the impermanence of the housing structures. Biaso and Betenase also had low scores of about260/o and28o/o respectively. In Tano Ano mrgrants from the North, particularly the Busansi and Kusasi dominate. By contrast in the L.B.V. zone fewer persons claimed to have been born at the village of interview, on average nine persons were born in the villages of interview. None of our respondents were born at Yan- Mpenika or Tain-Aboi while only one person claimed to have been born at Mpeasem, near New Longoro. In terms of region of birth the southem zone recorded comparatively higher figures for this variable. Ashanti, Brong Ahafo, Central regions, from where the majority of our study villages were drawn, accounted for 74.1%. Note that although only two, i.e. Asuhyiae and Bontomurso, out of the nine villages were considered as Ashanti, nevertheless more than 30% of respondents were from the Ashanti Region. Wrth only one representative village: Adwumam, nevertheless 18.6% of the sample said they had been born in the Central Region and this suggests the homogeneous character of Adwumam which is peopled by Denkyiras. Table 6a: Respondents' Birth Region: Southwests BREGION I Freq Percent Cum. ACCRA ASHANTI BRONG A. CENTRAL EASTERN NORTHERN U/EAST U/WEST 24 263 217 l6l 26 6 63 I 2.8% 30.4% 25.1% 18.6% 3.0% 0.7% 7.3% 0.1% 2.8% 33.2% s8.3% 7 6.9o/o 79 9% 80.6% 87.9% 88.0% 1B SOCIO DEMOGRAPHIC STI'DY OF SOUTIIWEST GHANA RIVER BASINS AND LBV Total | 865 r00.0% Table 6b: Respondents'Regron o[Birth: L.B V BREGION I Freq Percent Cum. --- --- - -+---- - - - - - VOLTA WESTERN FOREIGN ACCRA ASHANTI BRONG A. CENTRAL EASTERN NORTHERN U/EAST U/WEST VOLTA FOREIGN I 15 t.1yo I 7s 8.7% I 14 L6o/o 89.7% 98.4% 100.0% 5 2.2% 2.2% 7 3.1% 5.3% to4 45.6% 50.9%| 0.4% 51.3% 2 0.9o/o 52.2% 26 11.40/o 63.6% 4 t.8% 65.4% 40 t7.5yo 82.9% 36 15.8% 98.7% 3 1.3% r00.0% Total | 228 t00.0o/o We find in the case of the LBV that although few of the respondents were actually bom in the villages of interview, 45.6% of respondents were born in the Brong Ahafo where the villages of the L.B.V. belong. Note that nobody here was born at the Westem Region and only one and two persons were bom in the Cenhal and Eastem Regions respectively. It is also the case that most of our respondents bom in the Brong Ahafo Region saw the light of day in the Wenchi or Kintampo Disficts, two of the three regions (Bole is the other) which the L.B.V. communities straddle. Next to the Brong Ahafo, the other regions with significant births were the Upper West, the home region of the Dagaba, the Volta Region where the Ewe fisher folk come from and the Northem where some Mos live. Location of Relatives: The percentage of respondents with relatives in other parts of Ghana was high. 873% and 85%o for the L.B.V. and the Southwest respectively disclosed knowledge of such relations and their whereabouts. Relatives were distributed as follows for the southwest. TABLE 7a: LocerroN oF THE RELATToN SOUTHWEST RESPONDENTS LOCATION OF RELATIONS I Freq Percent Study Site Nearby Locality Elsewhere in The Region Another Region Outside Ghana 9 258 224 683 24 0.8v,1 21.5% 18.'7% 57.0% 2.0% Total I lr98 r00.0% 19 SOCIO-DEMOGRAPHIC STUDY OF SOUTT{WEST GHANA RIVER BASINS AND LBV Note that multiple entries were obtained from some respondents which accounts for the totals exceeding the sample populations. Table 7b: Location of Relatrves: L.B.V. Respondents LOCATION OF RELATIONS Freq Percent Study Srte Nearby Locality Elsewhere in The Regron Another Regron Outside Ghana 6 98 47 145 6 2.0% 32 5% t5.6% 48.0% 20% Total I 302 100.r% Note that'Another Region" here can mean the region on the other side of the Lower Black Volta since the communities studied were located along the banks of the river on either side. Certain stretches of the Lower Black Volta serve as the boundary between Northern and Brong Ahafo Regions nevertheless kinship and social ties knit together people living on opposite sides of the river. Language, Education and Religion: These three, language, education and religion, are useful variables in the study as we have observed above. Most people leam languages at places they have visited or lived in for some time. This could be the area where the bi-lingual was brought up or some other place visited later in life. Educational facilities in Ghana are woefully lacking in rural areas and therefore people with some amollnt of formal education have had per force to travel outside their area of domicile to obtain that education. This may be the district headquarters, the regional headquarters or even a city. This applies to a certain extent to religion. People are either bom into the faith or convert to it later on in life. Travel outside the home background entails many adjustments, including conversion to new religions in many cases and the leaming of new languages. In the Southwest,69.4yo of respondents were bi-lingual in one or more languages. This compares with 96.5% in the L.B.V . zone. The most popular languages leamt as second languages in the L.B.V. zone were Akan 54.4% (218 mentions) and English, a distant second with l2%o or (48 mentions). English (371 mentions or 39.7%) ranking as the most popular second language in the Southwest is certainly more important in the Southwest than it appears to be at the L.B.V.. Next to English in terms of frequency of mention by southwesterners were the Akan dialects of Ashanti, Denkyira, and Bono. Sefwi, a language spoken in the northem part of the Western Region had 64 mentions or 6.90/o, Hausa, a language spoken in the Zongos of Ghanaian cities had 4.5%o. Only one person had learnt Banda (Nafanra), spoken in and around the Bui area. For most respondents in the Southwest these second languages were learnt either in the village of study or in another region of the country. TABLE 8a: wHENE SOUTHWEST RESPONDENTS ACQUIRED SECOND LANGUAGES )i SOCIO-DEMOGRAPHIC STIJDY OF SOUTHWEST GTIANA RIVER BASINS AND LBV WHERE LEARNT6 I Freq Percent Study Village Village Nearby Another District Another Region Outside Ghana Study Village Village Nearby Another Distnct Another Region Outside Ghana | 3s3 17.5% 129 13.7o/o 78 8.3% 353 37.5% 29 3.t% | 8s 2t.4%| 184 45.8% I 33 8.2%| 90 22.4% I l0 2.4% Total | 942 t00.0% In the L.B.V. zone most respondents leamt a second language from a place within the zone. They did not have to go far to learn second languages. Most people learnt English in the school and this, in the case of the few literates in the LBV zone, was a place in the vicinity. TABLE 8b WHERE L.B.V. RESPONDENTS LEARNT SECOND LANGUAGES WHERE LEARNT 6 I Freq Percent Total | 402 100.2% Education and Movement Patterns The number of educated people was very low for the L.B.V. zone as compared to the Southem zones. Of the 32.9% who had been to school in the LBV zone, one out of thee of these did not go beyond primary school. This contrasts with the Southwest where of the 62.50/o who had had some form of education 29.7% of this number had failed to complete elementary school. The two zones differ further as to where people went for schooling. In the L.B.V. zone,59.5o/o of those who had ever been to school had elementary education in a nearby village whlle 23%o spent the first six or so years of education in another region. This compares with the 41.7o/o in the southem zone who had primary education in the village of study and 29.3%o who were educated in another district. The general pattem seems to be that the higher you go on the educational ladder the farther away from home you have to move to gain additional formal education. For example, in the southwest, 293% spent the first six years of basic education in another region; 30.2% completed elementary school in another region and 55.6%o were educated up to secondary level in another region. It can be concluded tentatively, drawing on our findings from the two river basin areas, that at least for educational purposes inter-basin mobility or movement of people from the Lower Black Volta zone to the Southwest River Basin areas or vice versa is not only uncommon but also unlikely since none of these zones is sufficiently endowed with educational facilities that support secondary education not to mention the tertiary levels. Religion and People's Movement Patterns 2t SOCIO.DEMOGRAPHIC STUDY OF SOUTHWEST GHANA RIVER BASINS AND LBV ---------+-------------- Most respondents in the study were either Christians or Muslim. In the Southwest those who espoused a specific religion did so either in the study village (55.6%) or in another village or town within the study district (15.6%)but22.6o/, converted in another region. This compares with 30.3% conversions in another region for the L.B.V. and66o/o within the site district or nearby. The tentatrve conclusion here again is that people rn the study villages do not espouse religious beliefs far from their home base. Those who do are likely to have converted at the place of birth where this is not the same as the place of interview. To recapitulate, place of birth or hometown locale for a southwestern river basis respondent is not likely to be anywhere close to the Lower Black Volta zone and vice versa. TABLE 9: Place of Religious Conversron Re: Southwest Respondents WHERE CONVERTED I Freq Percent Srudy Sire Study Drstrrct Study Regron Another Regron Outsrde Ghana HERE? THE DISTRICT THE REGION ANOTHER REGION ANOTHER COUNTRY 443 55 6% 124 ts.6% 44 5.5% 180 226% 6 08% Total | 797 t00.0% MARRIAGE AND MIGRATION: It rs assumed here that it takes time to know a person of the opposite sex well enough to make a marriage to or accept one from the proposer. This may not be so in all cases but common experience would ffiERELBVRESP*DE*SCG*RTED suggest that this is the norm. Therefore where a 'o couple have met is likely to be a place they have lived in for some time. t0t 9 T SM DSI SM StrE sm reG OI}I€R REG Fmm Table l0a: Where Southern Respondents Met Their Spouses WHERE MET I Freq Percent t!=- F 470 46.7% 158 t5.7% 80 1.9o/" 293 29 t% 6 0.6% a Total | 1007 100.0% Table 10b: Where L.b.v Respondents ZZ E 6 st SOCIO.DEHOGR.APHIC ST1JDY OF SOUTHWEST GHANA RIVER BASINS AND LBV Met Therr Spouses WHERE MET I Freq Percent J IN THIS VTLLAGE | 24 10.9o/o THrS DTSTRTCT | 130 58.8%THTSREGTON | 2 0.9% ANOTHER REGION | 6s 29 4% ------+------- Total | 221 100.0o/o For the majority of Southwestem respondents, spouses were sought from within the village. There seemed to have been a preference for spouses from the neighbouring villages over spouses or women from the other districts in the region. Nevertheless, marriages that took place in other regions were considerable: 29Yo or 3 out of ten. The implication of this finding is that movement between place of interview and other regions was of a higher order than that between the study sites and the other districts of the regions in which they are found. We should hasten to point out that we did not have evidence of southwestern respondents meeting present, past or deceased spouse in the LBV zone or vice versa. L.B.V respondents find their spouses not so much in the villages where they were interviewed as in neighbounng places such as Banda Ahenko and Bungase for Bandas, Akanyakrom for some Ewes, New Longoro and Bamboi for the Mos and others on the Kintampo side of the zone. It is important to observe that they rarely sought spouses from other parts of the Brong Ahafo or the Northem Region. This is perhaps because they did not have much to do with these places.T\e29.4o/o who sought spouses from other regions of Ghana were certainly Dagabas, one of the major ethnic groups represented here. These found these spouses at Jirapa or somewhere near Wa. ONCHO AWARENESS: The decision to enquire into general awareness of the disease, onchocerciasis, is motivated by the belief that disease burden and exposure to treatment options results in a higher awareness of a disease. However, such an enquiry was not always easy to conduct in the absence of local terms for onchocerciasis. Our approach was to adopt the term "Oncho" which, experience has shown, is the common term applied to the disease in other parts of Ghana where the conditron has received wide attention. [n the L.B.V zone there was no problem about this as most respondents were familiar with the term. Oncho knowledge differs markedly between the two zones. It was found to be much higher in the L.B.V. than in the Southwest. Whereas the term "Oncho" was generally known to respondents in the L.B.V. (98.3%), those in the southwest basins familiar with the term were 38.7%. Of those who claimed to know, 41.7% in the Southern zone did not really know what it is as compared to 18.9o/o in the L.B.V.. These findings should be examined against the context of a higher literacy and standard of education in the Southern zone. Table 1 1a: SouthwestRespondents Awareness of Onchocerciasis ONCHO KNOWLEDGE I Freq Percent 23 SOCIO DEMOGRAPHIC STIIDY OF SOUTHWEST GHANA RIVER BASINS AND LBV NONE I t60 41.7%ADEQUATE I t78 46.4%GOOD | 46 120%VERYGOOD | 0 00 __---_--__+___ Total I 384 100.0% Table I lb: I-.B.v Respondents Awareness of Onchocercrasis KNOWLEDGE I Freq Percent NONE I 4r t89%ADEQUATE I tt8 s4.4%GOOD | 47 2t.7% VERYGOOD I ll st% ----------+-- Total | 217 100.0% These findings reflect the lack of systematic or organised medical attention paid to the condition in the Southwest River Basin zones. Some highly affected communities in the southwest seemed to have a better understanding of the condrtion. This is explained by the resort to medical treatment by individuals who have been seriously burdened by the disease which manifests itself not only in blindness but also in skin rashes and troublesome itching. In conclusion, these findings show that the peoples of the two zones are mobile. They move about the study district in which they find themselves and they go to other parts of the country outside the region in which the study village is located. The big towns and the regional and district headquarters are favourite destinations. Southwest affected respondents were born in various places. We found that none was bom in a town in the L.B.V zone. The places of birth nearest are perhaps Wenchi and Tachiman in the Brong Ahafo and Daboya in the Gonja district of the Northern Region. [n all,4 individuals cited these. We have no evidence where these caught the disease. Is it possible they caught their condition in the place of birth?. This is doubtful since some of the affected in the southwestem sample were in fact born in places not known to have Onchocerciasis, such as Accra and Takoradi. TITE AFFECTED: We need to know more about the affected to answer the question of their involvement in the spread of onchocerciasis in the L.B.V. area. We now focus on this sample. The Sex and Age Profile of the Affected: TABLE lZa: ege and Sex Drstribution of the Affected: Re: L.B.V. AGEGROUPS I F M ITotal 24 SOCIO DEMOGRAPHIC STIIDY OF SOUTHWEST GIIANA RIVER BASINS AND LBV f l5- l9Yr 20-30Yr 31-45Yr 46-60Yr 61-l00Yr 4 3 t2 ll 5 I il 24 I35 t3 03 57 47 l4 TABLE 12b: Age and Sex Distributron of the Affected Southwest Basrn Zones AGE GROUPS F M lTotal Total l5-l9Yr 20-30Yr 31-45Yr 46-60Yr 6l-looYr Total ACCRA BRONG AHAFO. NORTHERN UPPER EAST UPPER WEST VOLTA I I I I I I 6 l5 42 l9 l3 1 2l 40 30 24 l3 36 82 49 37 I 95 t22 | 2t7 The majority of Affected persons in both zones are in the 3 I -60 age goups. These are age groupings with opportunity for travel and many of them could have lived in other regions of Ghana. In the case of the L.B.V. many of these people were born in and around the L.B.V. area in villages like Bamboi, Banda Ahenkro, New Longoro. One person was born at Nobeko, four kilometers from Anwiam, a study site on the Tano in the Southwest. He happened to be a teacher on transfer duties. TABLE 13: RecroN oF BrRTH oF AFFECTED (L.B.V. RESPONDENTS) BIRTH REGION I Freq Percent Cum. 1 2.9Yo 13 37.tyo 6 t7.l%| 2.9% 5 t4.3yo 9 25.7yo 2.9% 40.0% 57.1% 60.0% 743% 100.0% Total | 3s r00.0% If we take the Southwest, we notice that most of the affected were born in the three regions of Ashanti, Central and Brong Ahafo. 21.1% of the affected who were born in the Brong Ahafo were actually born in the several study basins of the Southwest rather than anywhere in the L.B.V. basin or near to it. The town 25 SOCIO DEMOGRAPHIC ST1JDY OF SOUTI{WEST GHANA RIVER BASINS AND LBV t4 27.5% 23 45.1% t3 25.5% I 2.0% of Bawku and its vrcinity in the Upper East, interestingly enough served as birth places for at least 7oh of the affected who were interviewed in the Southwest. None of the L.B.V. affected leamt any of their first two languages rn a district of the Brong Ahafo outside the Kintampo and Wenchi districts. The following table shows this. TABLE I4: PLACES wHERE L.B.v. RESPoNDENTS LEARNT MAIN SECOND LANGUAGES WHERE LEARNTI' I Freq Percent - - --------+---- --- - Study Village Study District Another Regron Outside Ghana Total I s l 100.0% If we take places near river basins where the Southwest affected have worked in the past we notice that rarely did they mention the Lower Black Volta. The table below shows that only one person had worked anywhere closed to the Lower Black Volta. TABLE I5: zuveR BASINS NEAR WHICH AFFECTED IN THE SOUTHWEST BASINS HAVE EVER WORKED RBASINI, I Freq Percent L.B.V BASIN I 1 TANO | 127 6t.t% oFFrN I 7s OTHERVOLTA I 5 0.s% 36.1% 2.4Yo Total | 208 100.0% The Lower Black Volta received only 9 references out of a total of 256 references made tn the Southwest: only about 3.5% mentions. This is clearly insignificant by comparison with the figures for Tano,basin (57.4%\ and the Offin basin (36.7%). The picture is no different when we consider the river basins in which affected respondents from the Southwest have lived or lived close to in the past. The L.B.V. scores 9 mentions, presumably by the same nine individuals who have mentioned it in connection with work location. It seems in order to conclude that the affected in the two zones have not had much contact. Why this is so can be explained perhaps by differences in ecology, perceived economic opportunities, differences in expectations and so on. The L.B.V. has been a sparsely populated savannah zone which lost economic opportunities when the Bui Dam project mooted by the Nlo:umah regime drd not materialise. SOME INTER-SITE COMPARISONS: BIASO AND TANO ANO 26 SOCIO.DEMOGRAPHIC STIJDY OF SOUGWEST GHANA RIVER BASINS AND LBV We now attempt a comparison of some study sites beginning with Biaso and Tano Ano in the Southwestem River Basins. These two vrllages are similar in some respects such as their ethnic compositions. They differ in endemicity levels, Biaso being a low endemic area with not more than a couple of certified cases while Tano Ano can be characterised as a hyperendemic site. Both lie within the same latitudes, Biaso being west of Tano Ano. As their names suggest, they lie near or on the banks of the Bia and Tano rivers respectively. Both are farming communities. Cocoa cultivation is still an important industry in Tano Ano which is thickly forested while Biaso which has what looks like degraded secondary forest seems not to support the cocoa industry any more. Ethnic Composition Biaso: Akan peoples predominate, accounting for about 63.50/o. 14 respondents or l4.l% described themselves as Bono. These generally live in the northern parts of the Brong Ahafo and are therefore nearer the LBV while their Ahafo neighbours (only 4 described themselves as such) are from further south and east of the Regionro. Northern peoples including migrants from Burkina Faso and beyond account for 26.3 %o of the random sample. Of the "northern groups" the Frafras, with 15 respondents or 15.2o/o of the sample, predominatedrr numerically. The majority groups in the LBV zoneviz. the Banda, Mo and Dagaba did not feature in our sample. The Ewe represented account for 8.1% of the sample and they were farmers rather than fishermen, unlike their colleagues found along the Black Volta. Table l6: Ethnic Composition of Biaso Respondents ETHNIC I Freq Percent Cum. ___-_______+___ Ahafol44.0%4.0% Akan I 13 l3.l% l1.l% Akwamu I I 1.0%18J%Ashanti | 27 21.3% 45.4%Assin I I1.0%46.4%Bimoba | 2 2.0%48.4%Bono I 14 l4.l% 62.5%Ewe | 8 8.1%70.6%Fante | 3 3.0%13.6%Frafra I 15 15.2% 88.2%Ga | 2 2.0%90.2%Kasena | 2 2.0%92.2%Mossi | 4 4.0%96.2%Wala I I 1.0%97.2% Zamrama | 2 2.0%99.2% Total 99 100.0% We know that our Bono respondents have had very little to do with the LBV zone because there were no mentions of places north of Wenchi in the responses solicited throughout the interviews which might have served as places of birth, home towns, places where old schools might be based etc . Table l6b: R Basins Where Biaso Respondent Ever Worked in the Past BASIN1 | Freq Percent Cum. 21 SOCIO DEMOGRAPHIC STUDY OF SOUTHWEST GHANA RIVER BASINS AND LBV Total 95 100.0% In the case of Tano Ano the largest single ethnic group mentioned was Busasi or Bisa (57.9% were in the sample) who have settlements in the Upper East near Bawku in the basins of the White and Red Voltas and in Burkina Faso. Few people described themselves as Ahafo or Bono (one of each was included in the sample) although those who said they were Ashanti were 22.4% of the sample. Again, as in the case of Biaso, the major ethnic groups found in the LBV zorre are absent. Only one Dagao (singular for Dagaba or Dagarti) was included in the sample. We did not come across Ewes or Bandas and Mos. Table l7: Ethnic Composrtion of Tano Ano Respondents ETHNIC I Freq Percent Cum. L Black Volta Bia Basin Tano Basin Offin Basin Other Voltas Others Akan Ahafo Ashanti Basare Busansis Dagarti Kusasi Osudoku Bono I r.t% 1.1% 83 87.4% 88.4% 2 2.1% 90.5% I 1.1% 91.6% I 1.1% 92.6% 1 7A% 100.0% | 1.3% 1 13% 17 22.4% 2 2.6% 45 57.90h 1.3% 9.2% 1.3% 13% 1.3% 2.6% 26.3% 28.9% 86.8% 88.1% 91.3% 98.1% 100.0% I 7 1 I Total 76 100.0o/o The only place mentioned which we could possibly describe as coming anywhere close to the LBV basin is Wenchi mentioned once as a respondent's place of birth and location of lineage. Techiman, south of Wenchi is mentioned once as a town in which one person learnt a second language, two people converted to their religious faith there. Of the river basins where respondents had lived or worked at the time of interview or in the past there was only one mention of the LBV while the Red and White Voltas received two mentions. Table l7b: Where Tano Ano Respondents Ever Worked m the Past PLACE OF WORK ---------------+ Study Site Place in the District Place in the Region I Freq Percent Cum. I l 2.7%| 4 10.8%| 6 16.2% 2.1% t35% 29.7% 2B SOCIO'DEMOGRAPHIC STTIDY OF SOI'THWEST GHA}.IA RIVER BASINS AND LBV Another Region Outside Ghana I 2t 56.80/o 86.5% I 5 13.5% lo0.o% Total | 37 100.0% Table l7b: River Basins Where Tano Ano Respondent Ever Worked in the Past RBASINI I Freq Percent Cum. --+------------ L. Black Volta I Tano Basin IOthers I 1 1.3% 1.3% 72 96.0% 97.3% 2 2.7% 100.0% Total The evidence available, which is reflected rn the tables above, seems not to suggest that there has been population movements between these sites and the LBV zones. We do not discount individual visits. This would be inevitable for populations within the same country where no physical or administrative bamers to inter or intra regional circulations of people exist now or have existed since the country's independence. The British policy to labour migration was very liberal as there was need for labour to make the cocoa industry and the mines viable. The presence of many non-Ghanaian peoples in the study sites illustrates the ease with which people circulate. CONCLUSIONS: We set out to find answers to two main questions:- firstly, why the recrudescence of onchocerciasis in the LBV, a zone where the disease has been being controlled for a number of years; and secondly, why some communities in the same ecological settings experience differences in endemicify levels. The problem of recrudescence is by no means a recent one, see Garms, Walsh and Davies (1979, p. 346) who report that by April 1975 S.damnosum females has reappeared in some parts of the programme area shortly after the aerial confol operations had started in February of that year. A partial answer to the first question lies in the replies of the respondents at the various sites about their movement patterns within the country. From the above information we can safely conclude that the re-introduction of onchocerciasis in the OCP control zone of the L.B.V. zone could not be due to contamination of this zoneby affected individuals from the river basins studied which lie in the rain forests to the south. There seems to have been very little contact between the two zones. This is not because the populations inhabiting these two zones are static. Migrations are endemic features of the two zones. However the two zones are different in terms of their potentialities as currently perceived by land users and their dependents. The savannah ecology supports cereals and root 29 | 7s 100.0% SOCIO DEMOGRAPHIC STUDY OF SOU'IHWEST GHANA RIVER BASINS AND LBV crops such as yam and cassava. Cashew nut farming is gaining some popularity as a cash crop in the Bui area but the acreage allocated to thrs crop is still too small. The evidence supports the view that big time agriculturalists have ventured into this zone yet. Yam and cereal which are significant here are however of interest to small scale agriculfuralists with not much money to invest in large acreage of land or in more important cash crops. Cocoa, a popular cash crop in Ghana, not only requires a larger capital out-lay, which is beyond the average farmer in the Bui or Lower Black Volta zone, but more importantly, it is unsuited to the savanna ecology, climate and vegetation. The Ghana govemment, like its successor, the colonial regime favoured cash crop farming, particularly cocoa which has been for many years the backbone of the country's economy. Cereals and root crops did not received the same levels of encouragement because they have been perceived as more or less subsistence products which might get to the urban areas to feed people but not to the international markets to eam foreign exchange. Producers of these crops which are penshables were not protected from pnce fluctuations or guaranteed any minimum prices for their products. Consequently, they were not attractive to wealthy farmers in the way that cocoa was for many years. The L.B.V. zone has been sparsely populated making it easy for poor migrants to settle there temporarily, land being relatively easy to acquire. This contrasts with the Southwestem river Basins. As the Southwestem nver Basin forests are degraded less and less land remains available for certarn forest cash crops like cocoa. This makes land acquisition expensive thus shutting out poor migrants who can only engage rn unsatisfactory and drsadvantageous arrangements with local landowners such as share cropping'2 or altematively, to provide wage labour to the cocoa farmers. Thus the two zones attract different categories of migrants. The fishing opportunities of the Lower Black Volta, furthermore attract the fishing communities of the Lower Volta, people as a matter of course. Though not all Ewe communities traditionally adopted fishing as a way of life, the Battors and others like them living in places close to the Lower Volta have traditionally led such a life. Ashantis, for example, who have expenence in cocoa cultivation and have the necessary resources now find themselves without access to fertile land near home due to forest degradation. One option for some of them is to go further afield to the southwest basins. While this explains the increasing presence of Ashantis here it does not explain the sizable presence of minor $oups like the Bisa, Kusasi, Basare and other Northem peoples in the southwest. It may be that a majority of these people who are driven mainly by economic difficulties in the sahel and northern savanahs which are home to them have to emigrate and they are attracted to the southwest because of the demand for labour in an industry which has been depended upon Northern labour since the colonial era. There appears also to be the question of tradition. Migration to the cocoa growing areas of southem Ghana has almost become institutionalised among some savannah peoples of Ghana and Burkina Faso since colonial days. We refer to various research accounts on migration such as Rouch (1954), Hart (1987) or to Hirschman (1970) thesis on Exit, Voice and Loyalty. These researchers admittedly, have exhibited more interest in urban-directed migrations from poor rural areas. It is clear however, that migration from homeland, whether to urban centres in another African country as the Mossi of Burkina Faso and the Malians migrants to Ghana have done since colonial times, see Rouch descriptions, or to rural areas where farming opportunities are perceived to exist, that migration is not been motivated solely by economic factors but also for social reasons as Elliot Skinner (1963) demonstrates. The social and economic objectives of the savannah migrants are met by targeting not only urban areas but also rural parts of the southwestern Ghanaian river basins. Where sahel and savannah migrants go depends to some extent on familiarity with and popularity of the target destination. This in tum may be influenced 30 SOCIO,DEMOGRAPHIC STI'DY OF SOUTHWEST GHANA RIVER BASINS AND LBV by the reports given by kin and other acquaintances of their positive experiences in these places. The concentrations of particular migrant ethnic goups in certain river basins, for example the Busasi in the Tano Ano area is thus accounted for. Immigrants like to work where they have the support of their kin. Dagaba are found in larger numbers in the L.B.V. zone because of the proximity of this area to the Upper West, the home region of the Dagaba. Secondly, the Dagaba are vigorous agriculturists adept at hoe cultivation. They are experienced cultivators of cereals and yam and the L.B.V. seems to suit them as short term migrants. Perhaps this explains their absence from the southwest communities that we have studied. The answer to the question of deferential endemicity in comparable ecological zones is not a straight forward one. The answer to the question seems obvious in some cases but not in others. Perhaps the answers are not purely sociological. We think Biaso, on the banks of the Bia river, has not much onchocerciasis because the river has been dammed. The river Bia at thrs point had ceased to be fast flowing, one of the conditions that favour the breeding of the vector fly. We are not sure how old that dam is but the clues provided by old abandoned Russian equipment once employed in the construction of the dam would suggest that the project commenced in the early 1960s. Biaso, it will be realised, is apparently closer to the LBV zone (about 138 km), if we measure distance by direct accessibility as the crow flies, than most of the other Southwestern River Basin sites, with exception perhaps of the Tano Ano site lying by the Tano (about I l0 km from the Black Volta) which seems nearer. Both sites bear another resemblance i.e. that they contain a good representation of northern Ghanaian peoples. We observe that Betenase, a hyper-endemic community lies in the same ecological zone as Asawinso. Both are close to the Tano and its tnbutaries. Both lie deep in the thick forest. Both are small communities with the same kind of ethnic mix. Betenase lies within the forest reserve, literally the last bus stop. The difference is that Asawinso lies on a second class road that links Sankore and the Asunafo District of the Brong Ahafo to Sefwi Wiawso in the Westem Region. It seems to have had a prosperous past. It is not too clear why Asawinso is hypo-endemic while Betenase is hyper-endemic. We know from interview comments that where the burden of onchocerciasis is great individuals have sought biomedical attention and other sources of coping with the condition. These individual acts cannot be said the explain the differences in endemicity levels. What is not so clear is the part that hospital workers might have played in the heatment of the two communities. It was clear from our interviews with some affected people that there has been a visit to the village of Betenase by health workers based at the Sefivi Wiawso hospital who treat some of the villager with what appeared from the descriptions to have been ivermectin. It was a one off event we are referring to herer3 . However, if remote Betenase was visted is it unreasonable to expect that Asawinso, which was near and more accessible to Sefwi Wiawso, could also have received similar visits, perhaps more frequently, hence the lower endemicity rates. Sight Savers is supporting the distribution of ivermectin in the Westem Region although not all communities were being treated as at the time of the research in May 1996. Finally, we note that pathogenesis of onchocerciasis is a complex issue with several dimensions not all of which have been studied comprehensively. There is the question of strain of Onchocerca volvulus: not only are there differences between forest and savannah strains, even within the savannah or forest varieties, it is believed that differences in antigens can occur, Guzman et al (1997: l6), Lobos and Weiss (1985). It has also been found, in a study based Uganda, that onchocerciasis prevalence can be affected by deforestation, see Fischer et al (1997). Mendoza et al (1997) came to the conclusion from the study of some Cameroonian affected communities that in addition to proximity to breeding sites, even altitude, a variable that at first sight we might be inclined to discount, also plays a role. They conclude as follows: 31 SOCIO-DEMOGRAPHIC STIJDY OF SOUTHWEST GHANA RIVER BASINS AND LBV .. Levels of infection and morbrdity due to oncchocerciasis in a given population depends on a complicated rnterplay of factors that rnclude location, altitude, duration of residence, human behaviour, the strains of parasites involved and other factors, some of which remain to be defined. [Mendoza et al (op cit. P.83)]. RECOMMENDATIONS: Though we cannot prove that there rs a Southwest factor in the re-invasion of the L.B.V. zone we should not rule out other neighbouring areas which may not have benefitted to the same extent from Onchocerciasis control measures. Many Ewe fishermen now at the L.B.V. have fished at several locations along the Volta down to Tefle and Sogakope and perhaps at other river tributaries long before the Volta was dammed. These fishermen are not stable but tend to move up and down the river. The diffrculty of guaranteeing regular treatment is not peculiar to the fishermen whose source of a livelihood is on the river; the same kinds of problems can be said to pertain to migrant farmers who have come from further afield, from other parts of Ghana, Burkina Faso, Togo and Cote D'Ivoire. We therefore suggest that the possibility of a re-introduction from other focal areas be not dismissed without a second look. We met a family of recent migrants to the Tain Aboi area who said they had come in from a village in the Kintampo area but had never been treated for oncho before. The question this rarses is whether there could still be some remote communities in the Lower Black Volta Basin that had not been treated for oncho on regular basis but which are nevertheless endemic. This may not seem as preposterous as it might appearro. Humans acting as hosts and reservoirs expediting the introduction of Onchocerciasis in a prevlously Onchocerciasis free zone may be only one of a number of possible explanations for the current recrudescence. There is also the indirect effect of human activities on the ecology which could possibly have a contribution here. We need to consider ecological and environmental changes, not necessary because NGOs can do anything to minimrse deletenous human activities on ecosystems. It has been known that the vector fly, in any case some species, feeds not exclusively on humans and that some livestock, wtld or domestic, could also serve as sources of blood meal for the fly. Not much domestic livestock is kept by the communities visited in the course of this survey but we note that there is a game and wild life sanctuary around the Bui Dam Site and a the large Mole Game Reserve at Bole, falls within the OCP programme area.. One wonders to what extent livestock can serve as an active or latent reservoir of onchocerca volvulus and the contnbution of this to the re-introduction of the disease. These are not questions that a socio-demographic study per se can unravel. More research would be necessary before we can make assertions in this area. We would suggest a number of measures including the following: . Treatment compliance needs to be reconsidered and reinforced. . The registration exercise should insist that people do not enter their names in households they do not really live in. We found that a few respondents in some sites have never actually met the treatment teams, although they claimed to be on treatment. The practice, were informed has been to leave drugs behind for the absentees. This practice is quite understandable in relatively inaccessible places like Tain Aboi or Mpeasem. However, JZ SOCIO,DEMOGRAPHIC STIJDY OF SOUTH}IEST GHANA RIVER BASINS AND LBV as we have explained above many have registered for convenience as belonging in households in these settlements there when the truth is that they actually reside in Bamboi, New Longoro, Jugboi or some other nearby settlements which may happen not to be eligible for masse treatment with ivermectin. Some of these opportunistic regishants furthermore are not known by household heads or else the latter did not recall that such a person had several years ago registered as a member of the household. We cannot be certain the opportunistic registrants are served regularly or if individuals who happen to be absent at the time of the treatment rounds take their drugs regularly and under the right circumstances. It is conceivable that some absentees might fail to take the drugs left for them with kin and associates. One only has to recall the inter-personal distrust that we know exists in families and which occasionally manifests itself in the form of witchcraft and sorcery accusations to realise that there could be reluctance on the part of some absentees to consume drugs which they could not be sure have not been tampered with. This problem could be minimised if the drugs are distributed in unbroken seals and local distributors are discouraged from opening these seals. It calls for the monitoring of the behaviours of the local drug distributors. The poor state of knowledge about what Onchocerciasis is, what it does to people etc needs to be corrected by education. In Adwumam, respondents'knowledge was reasonably good. They could tell the causes and symptoms of the disease accurately. This is due to radio programmes providing education to the villagers around, as some respondents admitted, or from other sources such as the education given by OCP teams or other health providers working in the area. Responses like the following were not unusual at the Adwumam site: Some people from this village went to Twifo Praso Health Centre. They mentioned it to my hearing for the first time. There <they were informed about onchocerciasis and > a certain insect by name Nkotia which when it bites you can create blindness in you. Yes, Onchocerciasis is caused by small flies which look like "Nkontia". This disease can cause blindness Yes, it is a disease of the skin which itches as a result and also affects the eyes By contrast we come across sites were knowledge of onchocerciasis can only be described at best as fair and at the worst, non-existent. Although most respondents seemed to know how many times in ayear they were entitled to treatment with Ivermectin some were not sure of this. Knowledge of why the drug has to be taken, how frequently, and in what dosage is very important. These is need to sustain the educational programmes of OCP and the local health workers in the affected areas. Local FM Radio offers a valuable tool in this regard. We cannot exhaust the question of the possible role of the Southwest River Basins in the return of onchocerciasiscerciasis to the LBV zone without taking into account the behaviour of the vector fly. The disease, according to WHO/OCP (1997:12) source, is rife only in rural areas and up to about ten kilometres on either side of water courses where the fly may happen to breed. The flies have been descnbed as follows: blackflies are excellent fliers and can travel several dozen kilometres, up to 80 km in 24 hours along 33 SOCIO DEMOGRAPHIC STIJDY OF SOUT1IWEST GHANA RIVER BASINS AND LBV watercourses. Wrth the aid of monsoon winds, they may even migrate for several hundred kilometres from one river basin to another during the hrst part ofthe rainy seasonr5. Many studies, including Hunter (1981,267)have remarked on the role of wind masses in the dispersal of vector flies. Garms, Walsh and Davies (1979,347) suspect S. Damnosum to be capable of distances up to l50km when assisted by air currents. The West Southwest monsoon winds in the West African zone do facilitate that movement. It strikes one that the two major basin areas are not all that far apart, given the ability of the vector fly to cover many kilometres in its flight. A cursory inspection of the relief maps and the physical geography of the Brong Ahafo indicates a narrow water shed in the neighbourhood of Sunyani separating the Tarn and its tnbutaries which flow into the LBV from the tributanes of Tano whrch unite and then flow southward down to Yamfo and the hyper-endemic zone at Tano Ano and Asudai. Thus not only is it possible for the savanna flies to colonise the forest the reverse would also be equally possible given the location and proximity of the two zones. DISCUSSION AND FUTURE STT]DY The question of a re-invasion of the Lower Black Volta area is by no means a simple one and it would deserve concerted and a multi-discipline effort in the quest for answers. A study of the dynamrcs of population movements in this and contiguous areas is certainly important and migration studies have a contribution. As Prothero (1987,83) has pointed out, movements are important in disease transmtsston patterns and impact on measures of control, eradication and the improvement of public health. It is however necessary to consider, as he advices, the nature, variety and impact of the diverse movement patterns in this study and we have attempted to do this. To illustrate the diversities of movement patterns he set up a typology of 24 patterns and in so doing he pointing out how the spread of diseases hke onchocerciasiscerciasis, schistosomiasis and others can be influenced by occupational pursuits stnce occupational demands might compel people to move from one area to another. I have indeed taken such concerns into account in designing a research protocol that would tease out relevant information. Respondents were made to recall movements they might have made in the recent or distant past. Any approach that requires respondents to recall events is however, confronted with the problem that most people may not always recall events clearly. However, by relating the recall to events and personalities that are of critical importance to individuals we hoped to minimise the recall difficulties to some extent. We have not asked respondents in the southwest basin specifically whether they had lived in the area of the Lower Black Volta or vice versa, nor have we suggested to respondents any place names that might juggle the memory. We felt there was a need not to prejudice the responses and we are satisfied that responses concerning place names in this study were spontaneous. We note that our records contain names of towns, crties and villages far and near. Though the size or importance of a town or its proximity to place of rnterview cannot be ruled out as factors determining responses we do not feel that this has worked in such a way as to prevent the mention of places in the Lower Black Volta area by south-western respondents or vice versa. While references to Accra abound and can be attnbuted to its importance as the nation's capital, nevertheless, it is also a fact that less known places near Kumasi are listed as places that some respondents have lived in or visited, when respondents could equally have named Kumasi, the next most important city of Ghana, after Accra. This same can be said for the minor villages in the Upper East, Upper-West and Northern Regions that respondents have mentioned, not to mention unknown places outside Ghana. 34 SOCIO DEMOGRAPHIC STUDY OF SOUTHHEST GHANA RIVER BASINS AND LBV There is the need to pay some attention to the economic underpinnings of migration. This study's scope did not extend into the realm of economic issues. Nevertheless as we have argued above, there seems to be an economic explanation to the differential patterns of migration. Some useful information might have been derived from observations of the market places. The rural market holds periodically and is frequented by people from other places near and far. For a potential surplus producer of stables like yams and maize, it can be expected that traders would visit from the larger commercial towns of Ghana to buy produce and retail elsewhere. Unfortunately, a rapid survey such as the kind we conducted does not capture this floating population whose role in the question of recrudescence cannot be dismissed outright. The southwestem river basin communities certainly would need to be further studied to assess their orientation to and their preparedness for new health initiatives like community directed treatment. Multi- country studies recently commissioned by WHO/TDR seem to suggest that community directed treatment is viable in some African communities (person information from a 1996 Accra workshop for the evaluation of instruments for conducting studies on community self treatment with Ivermectin)16. We can see that this novel approach to drug distribution can have its benefits and its draw backs for compliance and effective coverage of communities. 35 SOCIO DEMOGRAPHIC STUDY OF SOU:|HWEST GHANA RIVER BASINS AND LBV NOTES 2 J 4 5 The most powerful abosom or gods among the Ashanti are Tano, Bea (both rivers), Bosomtwe, a lake, and the sea, all of which are considered as the children of God, according to Busia (1954). Though the taboo on fishing in the Tano and the keeping of goats in communities through which the river and its tributaries flow is found in many Akan communities in Ghana, it is by no means universally upheld. Some Akan communities by the Tano ane known not to observe the taboo on fishing the Tano. Sight Savers, an NGO, are involved in the treatment of onchocerciasis in some of the nver basins inlne Western Region. It provides Ivermectin and logistic support to the Ministry of Health to enable the drug to be sent to the remote areas of the Region for distnbution' We were later informed that they had gathered at the opposite bank, on the Northern side in expectation of our crossing over to see them. As OCP rules forbid the crossing of larger rivers in unsafe dugouts we did not oblige. The main cocoa harvesting season lasts from about November to January. There is a minor season in July or August. ..Bregion" stands for the administrative region where respondent was born in. "Brong A" stands for Brong Ahafo (also B. A.) while U/East and UAVest stand for Upper East and Upper West regions respectively. These makeshift abbreviations are necessary here to allow the labels to fit in the table cells. In these tables, ,Another District' is a distrrct within the region in which the study village or community is found and 'Another Region' stands for any other Administrative Region of Ghana' Outside Ghana means any African or non-African country other than Ghana. This might be Burkina Faso where some groups iike the Bisa or Busasi and Moshie have status as nationals or Cote D'Ivoire where some of our Banda or Ligbi and Nafanra-speaking respondents claim to have visited' ,,Here,, means, in the study community or some village very close by. "The District" means somewhere in the District but not in the study community and "the Region" means somewhere in the region but not in the district to which the study community belongs. .,Study District" here refers to another village within the study district which and this excludes the study village. Note that in this case Bole District would include Bamboi, Jama Battor, Tain Aboi and Jugboi o, ih" northern side of the Lower Black volta while New Longoro and its satellite villages beiong to Kintampo District. Paradoxically, Bamboi and New Longoro, located in two different Administrative Regions, are twin settlements separated by a ferry and now a bridge over the Lower Black Volta. Bur Dam Site, Bui Camp, Yan-Penika, Gblorkame etc. belong in the Wenchi Drstrict' ,.Basinl,' is the code for the first river basin mentioned by respondent. Some of the respondents mentioned several river basins where they had worked in or had lived for a time. Subsequent mentions are coded under "Basin2" and "Basin3" respectively' 6 1 8 9 36 1 SOCIO.DEMOGRAPHIC STIJDY OF SOUTH}TEST GHA.IIA RIVER BASINS AND LBV l0 ll 12 l3 14. Most of the Ahafos are lrkely to describe themselves as either Ashanti or simply Akan to the interviewer unless care has been taken to get the respondent to specifu. There is a certain uneasiness between Ahafo and Bono peoples in the Brong Ahafo Region. This part of the region lies close to the Ahafo parts making it plausible to suppose that the Ahafo representation is higher than the numbers would indicate. On our rounds we met a number of recently amved Frafras who said they had come over for a short period of stay during which they would offer their labour for sale. Such temporary visits or seasonal migratory moves seem to be not uncommon with Frafra youth searching for employment. Share-cropping entails the shanng of the farm produce between the tenant farmer, who takes half or a third of the yield after harvest and provides the labour and the other inputs for agricultural production, and the landowner who has more perrnanent usufruct rights to the plot by reason of ethnic or lineage affiliation or because he had purchased the land from the chiefs. Allodial right to land often vests in the stool or the chief who acts on behalf of the ancestors, the "true owners" of the land. Arrangements may differ however from area to area. Those who received the dose had to pay for it, to off-set the fuel expenses incurred by the official in this case; so the community was told. This researcher discovered to hrs surprise in May 1996 that his wife's cousin, a girl of l5 years who had lived at a village near Kimtampo town since early childhood was posrtive for onchocerciasis. She had complained of itching which led eventually to a skin snip and an examination at the Legon Hospital. On receiving ivermectin she exhibited some of the standard side effects of the drug on affected persons. 15. WHO/OCP op cit page 14 16. This investigator is grateful Dr Hans Remme of WHO/TDR for the invitation to facilitate at the Accra workshop at which the instruments for the study of Community Self-Treatment with Ivermectin were revised. 31 SOCIO DEMOGRAPHIC STUDY OF SOUTHHEST GHANA RIVER BASINS AND LBV APPENDIX Recruitment and training of Research Assistants (Post-graduates) Study Period Bui Area and New Longoro Area Southwest Basin Sites Time Lines: April 1l- 15: April20- May 21: April2l -26: April26-Mry 20: li{ry 22 - NIay 26: Coding and Inspection of Completed Question, construction and revision of EPI 6 Rec Files June 16- June 29: Data entry, Analysis and preparation of report at OCP 1997 May 12th to July: Second Revision of the Original Draft 38 2. J 4 SOCIO-DEMOGRAPHIC STUDY OF SOT,THWEST GHANA RIVER BASINS AND LBV GLOSSARY OF'SOME TERMS AS USED IN TIIIS REPORT "Onchocerciasis Status" is defined by us rn terms of whether a person was examined and found to be Affected, Non-Affected or not examined. In the event of doubt a fourth category, "Evidence Lacking" was tncluded. There are thus four possibilities which were coded as follows: I : "Affected"; 2 : "Non-Affected"; 3 : "Non-Examined"; 0 : "No Evidence for determinatron of onchocerciasis disease status. L.B.V. stands for the Lower Black Volta Basin and its communities in this report. Occasionally it can also mean the stretch of river just north of Bui down to the stretch by Old Longoro. The area of operation of the Onchocerciasis Confol Programme is more extensive than this as it sfretches further south along the Volta and its tributaries. "The Southwest" stands in this report for the Southwest River Basin Communities. The main rivers here include the Tano, Bia, Ankobra, Offin and Pra. This includes portions of the three administrative regions of Brong Ahafo, Central and the Westem Regions. It is an area in which the Onchocerciasis Control Programme carried out surveys to assess the incidence and prevalence of onchocerciasis between 1994 and 1995. "Ahafo" refers to the other half of the Brong Ahafo Region to the south. Some of these people consider themselves to be Ashanti. "Bono" here is more or less the same as Brong, a sub-ethnic unit of the Akan of Ghana. Abbreviations such as the following are found in the text: Dist ....... District Regn....... Region Basinl ..... Code for first Basin mentioned Basin2 ..... Code for second Basin mentioned Bregion .... Code for Region where born Whlearnt ... Code for where a person learnt a second language. Whconvrt ... Code for where a person converted to his religious beliefs Std ........ Prefix to some codes. It stands for Study and in study site Cum......... 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