Member states of the World Health Organization (WHO), Ghana 
included, have accepted the Primary Health Care (PHC) concept as 
the logical strategy for achieving the social goal of health for all by 
the year 2000. The countries are thus committed to ensuring that 
the mass of their people become aware of and use better means of 
preventing diseases and healthier ways of growing up. This brings 
into sharp focus the importance of public education. 
The link between PHC and communication thus becomes 
obvious. Health information - about improved nutrition, clean 
water supplies, personal hygiene, family planning, vaccination 
services and treatment of common ailments and injuries - has to be 
communicated to the entire citizenry. 
The majority of Africa's peoples reside in rural areas and the 
purpose of this study is to find out about the communication 
sources that rural dwellers - who are expected to be the major 
beneficiaries of the PHC system - use to obtain information about 
health issues. The study also looks at what the people know about 
diseases like cholera, and acquired immune deficiency syndrome 
(AIDS) and health related issues like oral rehydration therapy, 
treatment of water and mass immunization services. 
A major benefit of this study is that it would help unearth the 
communication channels that would be most effective in carrying 
the PHC concept's preventive health message across to Ghana's 
ruralites. A number of studies have been done on rural health 
practices in Ghana but none of these has focused on how the 
indigenous or modern media systems can be used to transmit 
health information to the ruralites [1]. Thus this study would 
contribute to the bridging of this gap in the literature to which we 
now turn our attention. 
Related Studies 
Reviewing different studies on drug information, Lilja observed 
that studies of media preferences appeared to indicate that 
physicians were often the source of information about prescribed 
drugs, whereas pharmacists were the source most sought after for 
information about orally taken drugs [2]. 
Concerning general health education studies Lilja found that 
choice of communication channels was greatly influenced by the 
level of education with the better educated using impersonal (i.e. 
mass media) sources and the less educated relying more on 
Interpersonal sources [31. 
121
In a 1971 study. Fejer etaL concluded that the news media were 
the most popular sources of drug information for a general 
population of students [4]. They noted however, that the students's 
inclination to use drugs was an important factor affecting the 
effectiveness or influence of the information source: those 
students who did not use drugs relied on the mass media but drug 
users relied on their own experience or on friends [5]. 
A closely related study is that of Sinnet etaL which looked at the 
credibility of sources of drug information among students of high 
(secondary) school age 16]. They found significant differences 
among users and non-users in the sources they considered 
credible. For the drug abusers, law enforcement sources were the 
least credible (Policeman - 10.5%; Sheriff - 13.0%) while health 
authorities were the most trusted source of information for the 
non-users (Physician - 78.2%; Bureau of Narcotics and Dangerous 
Drugs - 75%). But by far the most credible source for the users was 
the users own experience (86%). Sinnetet aL felt that the user's 
pleasure and lack of suffering may lead him to believe other drug 
education information. 
Probably one study that is very closely related to our present 
study is the one undertaken by the School of Communication 
Studies, University of Ghana in 1975 on sources of information 
about selected national affairs topics in Ghana [71. It was found 
that radio was the most popular source of information. This was 
followed by Government agents (Ministry of Information officials) 
newspapers and local authorities, in that order. 
Concerning respondents' awareness of the selected topics. 
Operation Feed Yourself (89.2%) and Family Planning (73.9%) were 
by far the most familiar. Awareness rates for these topics were very 
high because they were the subjects of extensive information 
campaigns involving both the mass media and a number of 
governmental agencies. Whilst the campaigns could be said to have 
been successful in creating topic awareness, their success in 
communicating the officially correct concepts, however, were 
widely different. 
The next most familiar topics were "General Gowon" (48.9%), 
OAU (38.8%), Low-Cost Housing (37.2%) and Dawhenya Irrigation 
Project (33.9%). The weakest topics, were the "Charter of 
Redemption' (24.4%) and 'Inflation', campaigns on which were just 
beginning in both the mass and interpersonal media at the time of 
the survey. Although 72.2% of respondents were aware of inflation, 
the authors contended that the high degree of awareness of the rise 
in the price of foreign foods was simply due to the practical nature 
of the topic. Information on inflation could be obtained directly 
without mediation. 
However, its weakness lay in the proportion of respondents who 
122
could correctly explain the meaning of inflation (8.3%). Figures for 
the other topics were Charter (9.6%), Dawhenya (11.5%), Housing 
(13.5%). OAU (20.4%), Family Planning (15.8%) and OFY (50.8%). 
The respondent's level of education influenced both topic 
awareness and the percentage of officially correct responses on the 
eight topics studied but it has a much smaller effect on the 
correctness of information about OFV and Family Planning than 
on other topics. 
On credibility of information sources, radio was trusted by far 
more Ghanaians than any other medium. The next most trusted 
source was Government agents. Conversation was least trusted. 
Probably we should point out here that as acknowledged by the 
authors, the questionnaires were administered by some 
Government agents (officials from the Ministry of Information) 
and this could have introduced some element of bias in the 
responses. 
Let us now look at our methodology. 
Methodology 
We were particularly interested in how respondents obtained 
information about cholera, a nationwide mass immunization 
campaign launched in 1986, AIDS, oral rehydration therapy and 
treatment of water. 
The communication channels that we looked at included 
conversation, the town crier, the market place, church, school, 
meetings of committees for the defence of the revolution (CDR), 
vans of the Ministry of Information, health officers, newspapers 
and radio. 
The survey was carried out in two villages in the Tongu District of 
the Volta Region of Ghana. The population of the villages, Vume 
and Fiave - Kpotame, were 831 and 463 respectively [8]. Both 
villages are located along the Accra - Lome - Highway and have 
primary and middle schools. Vume has a primary health care 
centre whilst Kpotame has a government clinic. The people of 
Vume use water from the Volta River which is less than 200 metres 
away but at Kpotame the inhabitants rely on well water. 
We took 10% samples of the two villages and interviewed 84 
people in Vume and 46 in Kpotame. In both villages, we entered 
every other house and interviewed thejlrst male and female 
adults that we saw. Where we did not meet both sexes, we talked to 
any two adults who were available. Out of the 130 questionnaires 
125 werejound to be usable, 80 from Vume and 45 from Kpotame. 
The researcher was ably assisted by a research assistant who 
hailed from the area and spoke the local Ewe language fluently. 
123
In this study, by sources of information we shall be referring to 
channels of communication through which messages concerning 
health issues flow to the inhabitants of the two villages. 
We asked a number of knowledge-testing questions on the health 
issue that we studied and for each issue a respondent was marked 
"correct", when he or she was able to identify at least one of the 
constituent elements. 
Let us look at these in turns. 
Cholera - This was recognised by the frequent pale, waterly and 
phlegmy stools and vomiting. In addition, the patient becomes 
weak and prostrate, his tongue becomes blue and he passes little or 
no urine. Cholera can be prevented by living in clean, hygienic 
sorroundings, drinking clean water and eating wholesome food. 
Mass Immunization - Children from 0-5 years and pregnant 
women were being immunized. The diseases that they were being 
innoculated against were diphtheria, poliomeyelitis, whooping 
cough, tuberculosis, tetanus and measles. 
Treatment of Water - Straining, boiling, filtration and the use of 
disinfectants and alum were marked 'correct'. 
Aids - This is contracted through sexual contact with an AIDS 
patient or transfusion with an infected donor's blood. 
Oral Rehydration Therapy - This refers to the treatment of 
dehydration due to diarrhoea or cholera. A respondent who 
mentioned the use of coconut juice, salt and sugar solution or oral 
rehydration salts was marked 'correct'. 
We used simple frequencies and percentages to analyse our 
data and did some cross-tabulations to find out whether certain 
demographic factors could influence our knowledge variables. 
Findings 
We begin this section by talking briefly about our sample 
characteristics. 
Women constituted 56% of our combined sample. Again for the 
combined sample, 49.6% of the respondents had some formal 
education ranging from primary school to diploma awarding 
colleges while the rest had had no formal education. Overall our 
respondents' ages fell between 15 and 70 years with 51.2% aged 
between 15 and 35 years and 48.8% between 36 and 70 years. 
Most of our respondents were farmers (48%), teachers (15.2%), 
artisans (10.4%) and traders (8.8%). 
We turn our attention now to respondents' sources of 
information. 
124
Sources of Information 
We had an opening question on sources of information about 
national affairs in general and the respondents showed the 
prominence of conversation (60.8%) and radio (60%). Two other 
sources, newspapers (24.8%) and the town crier (7.2%) were of 
minor importance. 
Like information on national affairs, conversation was the most 
popular source of information on the health issues studied. 
A look at Table 1 below shows that conversation was the major 
source through which information about cholera and treatment of 
water was received. It was the second most quoted source of 
information about AIDS and O.RT., and the fourth in the 1986 
mass immunization campaign. Conversation thus, recorded the 
highest mean percentage of 33.73 followed by radio (23.20%), 
health officers (20.23%) and the town crier (10.95%). 
Percentage use of sources in hearing about the health issues 
41.32 
2.48 
0.83 
0.83 
Conversation 
Town crier 
Newspapers 
Information Van 
Radio 36.36 
Market 
Church 
0.00 
0.00 
0.00 
0.00 
6.61 
School 
CDR Meetings 
Health Officers 
Posters 
E.WA 
Others 
11.57 
0.00 
Cholera 
0.00 
1.83 
0.00 
0.00 
60.00 
1.83 
0.00 
0.00 
0.00 
0.00 
Mean 
2.3 
0.3 
TOTAL:- 100 
(112) 
100 
(109) 
100 
(33) 
100 
(76) 
100 
(90) 
100 
(429) 
E.WA means Eye Witness Account: 
Water 
AIDS 
125 
Table 1 
c Ic 
10.10 57.58 
52.29 0.00 
0.00 0.00 
0.00 
11.93 
0.00 
6.06 
0.00 
0.00 
0.00 
0.00 
0.92 
0.00 
24.24 
0.00 
12.12 21.10 
0.00 
33.7 
3.95 
0.00 
10.9 
1.2 
0.1 
60.53 
1.31 
23.2 
1.5 
3.95 
2.63 
6 
26.32 33.33 
0.00 0.00 
1.11 
0.00 
1.11 
4.45 
0.00 
0.00 
0.00 
0.8 
5.5 
0.0 
20.2 
0.00 
1.31
Radio was the most popular source of information on AIDS and 
health officers were the most quoted source of information on 
O.RT. 
The town crier was also the major source of information on the 
mass immunization campaign. 
It was easily noticeable that each of the health issues had a major 
channel through which information was received. This is because 
emphasis was placed on different channels for the various health 
issues. For example, in the mass immunization campaign in the 
Volta Region, emphasis was on the traditional rulers in 
disseminating information about the vaccination in the villages. 
Thus, the town crier was the most important source of 
information. And with O.RT., community health nurses played the 
major role in educating people and selling the therapy at child 
welfare centres. 
Secondly, conversation's popularity as the source of information 
on all the health issues stemmed from the possibility that opinion 
leaders who have heard about health issues on the radio, from 
health officers or in school informed others through conversation. 
This dominance of conversation is not surprising given the paucity of the modern 
media and the preponderance of traditional interpersonal channels in Africa. 
This also explained why radio and conversation were the two 
most quoted sources on AIDS and Cholera, the two dreadful 
diseases in the study. The Government relied very much on the 
radio to inform and educate the people on the outbreak of such 
diseases. 
Table n 
Least credible source of health information 
Vume Kpotame 
82.06 
2.56 
1.28 
2.56 
6.41 
5.13 
85.00 
12.50 
0.00 
2.50 
0.00 
0.00 
Conversation 
Town Crier 
Newspapers 
Radio 
Market 
Church 
TOTAL:- 100 
(78) 
100 
(40) 
Despite the popularity of conversation as the most used source 
for the health issues, it was the least credible source in both 
126
villages. And its levels of credibility in both villages were similar. 
(See Table II.) 
That conversation was the least trusted source was a clear Indication of the 
villagers' awareness of Its use as a channel for idle gossip and rumour. Nobody 
believed its content. 
From Table II, we notice that respondents in Kpotame considered the town crier 
as the second least credible source and in Table II they did not even mention it as 
worth believing. However, Vume respondents saw It as the third most credible 
source. (Table III) 
Table m 
Most credible source of health information 
Kpotame% Vume% 
Town Crier 
Newspapers 
Information Van 
Radio 
Health Officers 
0.00 
2.27 
4.55 
36.36 
56.82 
7.50 
2.50 
1.25 
13.75 
75.00 
100.00 
(40) 
100.00 
(78) 
Both villages, as in the case of the least credible source, 
mentioned health officers as the most trusted source of health 
information and radio as the second most trusted source, but they 
varied in their percentages of trust. While health officers were 
trusted more at Vume (75%) than at Kpotame (56.82%), radio was 
less trusted at Vume (13.75%) than at Kpotame (36.36%). (Table III) 
The position of conversation as the least credible but the most 
popular source of information revealed the absence of very credible 
sources through which rural dwellers could hear health 
information. 
Thus they had to content themselves with the distorted information through 
conversation as the only guide to health information education. 
Knowledge of health issues: 
We started by finding out the percentage of respondents who had 
heard about each of the health issues. 
Our percentage tables on the knowledge questions, therefore, 
excluded those who did not hear about each of the health issues. 
Cholera and the 1986 mass immunization campaign were by far, 
the most familiar health issues heard by the respondents followed 
by oral rehydration therapy and AIDS in that order (See Table IV 
below): 
127
Table IV 
Percentage qj respondents who heard about the health issues 
Vume Kpotame Have you heard 
about ? Yes No No Yes 
97.77 
82.22 
64.44 
3.75 
10.00 
41.25 
2.23 
17.78 
35.56 
96.25 
90.00 
58.75 
71.11 
Cholera 
Immunization 
AIDS 
O.RT. 27.70 28.89 72.50 
We may explain the very high percentage of hearing about 
cholera to be the result of its outbreak in the area in the 1970s. And 
11.57 per cent of the respondents were eye witnesses. (See Table I). 
We may also attribute the popularity of the immunization 
campaign to, probably, the most important advantage of the town 
crier. That is, information was disseminated when most people 
were at home. 
On the other hand, AIDS scored the lowest probably because 
campaigns were started only a few months before the survey. 
However, there was no marked difference between it and ORT. This 
could be because of its incurable and sexual characteristics. 
According to AUport and Postman (1946), "Sex, as a proposition for 
tropical Interest, is a never falling target for rumour" [9], 
Table V 
Knowledge of cholera symptoms 
What are two 
symptoms of Cholera? 
Kpotame 
% 
Vume 
% 
5.20 
0 
94.80 
Don't know 
Wrong 
Correct 
4.55 
0 
95.45 
Total 100 
(77) 
100 
(44) 
Responses to the knowledge questions on symptoms of cholera 
indicated in Table IV above showed very high levels of awareness 
and both villages did not differ much in their percentages of 
'correctness'. However, performance on the prevention of cholera 
was low. Whereas Vume had 62.34 per cent, Kpotame scored 31.82 
per cent. 
128
There was a cholera outbreak in both villages about a decade ago, and this could 
explain the high levels of awareness. The low levels of knowledge about prevention of 
cholera Is a rather sad commentary on the health ministry's efforts at public 
education on health matters. 
Table VI 
Knowledge of diseases for the immunization 
Kpotame % Average % Vume% What diseases are they 
vaccinating people against? 
61.47 
11.01 
27.52 
70.27 
5.41 
24.32 
56.94 
13.89 
29.17 
Don't know 
Wrong 
Correct 
TOTAL:- 
100 
(109) 
100 
(37) 
100 
(72) 
On the mass immunization campaign, 90.28 per cent of the 
respondents in Vume were aware of the age group of people 
vaccinated while at Kpotame it was 81.08%. Reference to Table VI 
above reveals that despite the high level of awareness of the age 
group, very few respondents knew of the diseases people were 
immunized against. In the combined sample, out of 27.52% 
'correctness', only 4.58% mentioned between three and five of the 
six diseases; the remaining 22.94% had one or two diseases correct. 
One may attribute the low knowledge about the diseases to the 
50.4% illiteracy rate of the combined sample. On the contrary, this 
had no influence on the knowledge of the diseases. 
It is likely that the failure of the town crier to give details of its 
messages may be the cause. 
Or could we attribute it to the town crier's inability to interpret technical health 
information to a largely illiterate audience? 
Table VII 
Knowledge about O.RTs. use 
•What is O.RT. used for? Vume 
% 
Kpotame 
% 
43.75 Don't know 
Wrong 
Correct 
TOTAL:- 
24.14 
0 
75.86 
100 
(58) 
56.25 
100 
(32) 
129
With the awareness level of the use of O.RT. in both villages, we 
expected to find a higher percentage of 'correctness' at Kpotame 
than Vume because of the former's clinic and child welfare 
advantages over Vume but this was not the case (Table VII). 
However, they had similar percentages in using O.RT. to cure 
diarrhoea (See Table VIII). 
As shown in Table VIII below, the majority of the respondents 
treated their children who had diarrhoea with terramycine 
capsules, M and B tables, codeine and herbs. It was also found out 
that the majority of those who were aware of the use of O.RT. 
surprisingly used these tablets and herbs. 
Prom Tables VII and VIII although 75.86% and 56.25% in both villages knew about 
ORTs use, only 41.54% and 41.03% respectively, actually used it to treat diarrhoea. 
Table VUI 
Treatment of diarrhoea 
Vume 
% 
With what do you 
treat diarrhoea? 
41.54 
41.54 
6.15 
9.23 
1.54 
O.RT. 
Terramycine Capsule 
MSCB Tablets 
Herbs 
Codeine 
10 
65
0 
NB: Data was collected irrespective of whether the respondent 
heard or did not hear about O.RT. 
It is worth mentioning at this point that education, sex, age and 
other demographic variables did not influence the correctness' or 
the practice of the health issues analysed above, Nevertheless, sex, 
age, and education had effects on hearing about AIDS. 
Aids had the strongest influence (See Table IX below). Hearing 
about AIDS appeared to fall with increase in age. Put another way, 
young men and women were more likely to have heard about AIDS 
than old men and women probably because sexual immorality is 
more common with the youth than the aged. (The influence of sex 
and education on the hearing about AIDS is referred to in Table IX.) 
130 
Kpotame 
% 
41.03 
23.03 
12.82 
20.51 
2.56 
10 
39
0
Table IX 
Relating age to hearing about AIDS 
Above 56 
% 
46-55 
% 
15-25 yrs 
% 
36-45 
% 
26-35 
% 
Have you 
heard about 
AIDS? 
25.00 
75.00 
30.00 
70.00 
55.00 
45.00 
80.95 
19.05 
Yes 
No 
TOTAL:- 
99.91 
9.09 
100 
(22) 
100 
(20) 
100 
(20) 
100 
(20) 
100 
(42) 
X2 = 13.42 4 degrees of freedom P < .05 
Though only 58.75 and 64.44 per cent of the respondents in 
Vume and Kaptome heard about AIDS, their awareness level was 
encouraging. Between the two villages, Vume was more aware 
(89.36%) than Kaptome (75.86%). It was assumed that the greater 
the population in a settlement the more likely would be their 
awareness of AIDS. This is because immorality tends to be higher 
in bigger than in smaller settlements. 
Results about the treatment of water had been very poor 
considering the most serious health problem in the area. Bilharzia 
was the most serious health problem at Vume, while at Kaptome it 
was the second. (See Appendix D). Surprisingly, at Kaptome more 
people treated their water before its use (60%) than at Vume 
whereby only 7.59 % of the respondents treated their water. 
Summary and Conclusion 
This paper set out to find out about the communication sources 
that inhabitants of two Ghanaian villages relied on to obtain 
information about health ma tiers. It also looked at what the people 
knew about cholera, AIDS, oral rehydration therapy, treatment of 
water and a mass immunization campaign launched by Ghana's 
health ministry. The knowledge measures were cross-tabulated 
with demographic variables like education, age and sex. 
We found that conversation was the most popular but the least 
trusted source of health information. This appeared to underline 
the absence of very credible sources within the villages' 
communication set ups through which the inhabitants could 
gather information on health issues. 
Radio was the second both in terms of its popularity as a source 
of health information and also its credibility. The health officer was 
the most trusted source and the third most popular. Sources like 
131
the church, market place and newspapers played very insignificant 
roles. 
Furthermore, our study revealed that the awareness level of the 
respondents was generally low. There was equally a low practical 
use of knowledge gained. 
In broad terms, our findings appear to cast some doubts on the 
professed ubiquitousness of such traditional channels as the town 
crier, the market place and the folk media/theatre in the rural 
communication system. 
In an indigenous communication system such as obtained in 
our rural areas, one would expect at least the town crier or gong 
man to be one of most frequently cited sources of information on 
most issues not excluding health. 
We admit that when respondents mentioned conversation as a 
source of information we did not probe to find out where exactly 
this conversation took place and with whom. In fact another study 
which we will undertake shortly, will address this particular 
shortcoming. 
In the mean time, given the high credibility rating accorded 
radio, and our rural dwellers often quoted dependence on the 
traditional media, it appears there is no other option than to call for 
a careful blend of the traditional and modern media systems for the 
dissemination of messages in such vital areas as matters relating 
to health. That way we stand to reap the best from both systems. 
REFERENCES 
Examples include (a) Health Care, Health Services and the Rural 
Community. A report to the Government of Ghana, Vol. 1 IDS Health Group, 
Institute of Development Studies, University of Sussex, Brighton, Sussex, in 
collaboration with, ISSER University of Ghana, Legon, Ministry of Health and 
Department of Community Health. Korle Bu, Ghana, (b) Newman Alfred K., 
Wurapa Frederick K., Lourie Irvln M. and Ammah Samuel Ofosu. "Strategies 
for strengthening health services infrastructure: A case study in Ghana." 
Social Sciences and Medicine. 13C, 1979. (c) A number of published and 
unpublished works on the Danfa Project administered by the Ghana Medical 
School and the School Public Health, University of California, Los Angeles. 
Lilja, John. "The Evaluations of Drug Information Programs." Social Science 
and Medicine, Vol. 21. No. 4 1985. pp. 407-415. 
Ibid. 
132
4. Fejer, D. Smart R.G., Whl tehead P.C. and Laforest L., "Sources of Information 
About Drugs Among High School Students," Public Opinion Quarterly Vol. 
35 No. 2 1971 pp. 235-241. 
5. Ibid. p. 240 
6. Sinnet. E.R.. Press A.. Bates R and Harvey. W. "Credibility of Sources of 
Informatatlon about Drugs." Psychology Report 36, 1975, pp. 299-309. 
7. School of Communication Studies, University of Ghana, Legon. "Sources of 
Information on National Affairs Topics." Unpublished. 
8. 1984 Enumeration Area Population. Volta Region. Population Census Office, 
Accra. 1984. 
9. Allport. Gordon and Leo Postman; "An analysis of Rumour. "Public Opinion 
Quarterly Vol. 10 1946 p. 509. 
133