Photo: David Swanson/IRIN

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JAKARTA, 18 January 2010 (IRIN) – Indonesia reported fewer deaths from bird flu in 2009, but health specialists warn that the risk to humans remains high.

Indonesia’s Health Ministry said 20 people were infected with the H5N1 avian influenza virus last year and 19 cases were fatal. The country recorded 24 cases in 2008, 20 fatal.

Since 2005, Indonesia has had 161 bird flu cases, with 134 deaths, making the country’s death toll from the virus the highest in the world.

“There has been a lull recently. We have not had positive cases since November,” Health Minister Endang Rahayu Sedyaningsih told reporters on 15 January.

“The trend is similar across the world. Some diseases are seasonal, and we have to continue to be vigilant,” he said.

Sedyaningsih said effective surveillance and measures to control the disease in poultry had contributed to the decrease.

However, Gregory Härtl, a WHO spokesman in Geneva, told IRIN: “Our risk assessment has not changed,” with the number of deaths in 2009 very similar to 2008.

According to WHO data, globally, 32 people died of bird flu last year, against 33 in 2008.

Härtl noted that “governments are very aware of the challenge and threat posed by H5N1 and are reacting well”.

Monitoring

Agus Wiyono, director of animal health at Indonesia’s Agriculture Ministry, said there had been no major outbreaks of bird flu in fowl over the past three years.

Participatory Disease Searching and Response (PDSR) teams were working to monitor and report cases of bird flu in 70,000 villages, with real-time data available in 10,000 villages, Wiyono said.

“If there are new cases, they will be reported to PDSR. No reports mean there are no new cases of avian influenza,” he said.

Only two of the country’s 33 provinces – North Maluku and Gorontalo – are free from bird flu, while West Kalimantan will soon be declared bird-flu free, he said.

The UN Food and Agriculture Organization (FAO) reported that 134 villages under surveillance were positive for H5N1 in poultry in October 2009, and the virus was endemic on Java, Sumatra and Sulawesi islands, according to WHO.

However, Chairil Anwar Nidom, a microbiologist at Universitas Airlangga in Surabaya, the provincial capital of East Java Province, cast doubt on the effectiveness of the reporting system.

“It’s likely that cases in several regions have gone unreported. The reporting system isn’t very good,” he said.

“If we look at the method of transmission, from birds to humans, the situation may have not improved. The risk for humans has not decreased,” he said.

Poultry ban

In 2007, backyard chickens were banned in the capital Jakarta and authorities announced plans to relocate poultry farms and slaughterhouses from the city by April this year.

“So far it has not been carried out seriously. I think the Jakarta plan can be used as a yardstick to measure how successful our efforts are to curb bird flu,” Nidom said. “If Jakarta succeeded, other regions would follow suit.”

Indonesia needed to set up a new body after the National Commission on Avian Influenza and Pandemic Preparedness is disbanded in March this year, when its mandate expires, Nidom said.

“The commission has been at the forefront of public education on bird flu. Unless there’s a replacement, the public awareness campaign is likely to take a backseat,” he said.

Indonesia stopped announcing individual cases of bird flu last year and the country has been criticized for refusing to share virus specimens, arguing that the current global virus-sharing system under WHO was unfair because poor countries benefited little from vaccine produced by foreign companies.

Health Minister Sedyaningsih said: “We still insist that the responsibility to share viruses should be on an equal footing with the benefits we receive,” adding that developing nations insisted that use of specimens shared under the WHO system by third parties, including vaccine manufacturers, required permission from originating countries.

atp/ds/mw source.irinnews

Photo: Indostef/Photobucket

JAKARTA, – Serious overcrowding, a shortage of medical staff and a lack of funding are thwarting Indonesia’s efforts to tackle tuberculosis (TB) in prisons, experts say.

Indonesia’s 422 prisons hold more than 140,000 inmates, even though they were designed for 80,000, according to the Justice Ministry.

The government started a programme to control TB in prisons in 2004 by adopting the so-called Directly Observed Treatment, Short-course or DOTS, a treatment strategy for detection and cure recommended by the World Health Organization (WHO).

But so far only 122 prisons in 17 of the country’s 33 provinces have benefited from the DOTS programme, which receives support from the Global Fund, said Daniel Rasjid, head of the TB control strategy at the director general of the prison system.

“The main problem is overcrowding,” Rasjid told IRIN. “Overcrowding makes it easy for diseases to spread and TB spreads much more easily compared to HIV because it doesn’t require physical contact.” A crackdown on drugs had contributed to the overcrowding, with most inmates, particularly in major cities, convicted of drug offences, he said.

Overcrowding makes it easy for diseases to spread and TB spreads much more easily compared to HIV because it doesn’t require physical contact.

Left untreated, each person with active TB can infect on average 10 to 15 people a year.

According to Justice Ministry data, 90 prisoners across the country died of TB in 2009, after 150 the previous year.

Indonesia, the world’s fourth most populous nation of 230 million people, has the third-highest tuberculosis burden in the world, according to WHO. An estimated 140,000 Indonesians die from TB each year, according to Stop TB Partnership Indonesia, with TB the second leading cause of death after heart disease for all ages in the country, according to the Health Ministry.

And while little is known about the current prevalence of TB in Indonesian prisons, a Health Ministry study in 2005 showed that 1.7 percent of prisoners had TB, said Tjandra Yoga Aditama, the Health Ministry’s director-general for disease control and environmental health.

That figure was 16 times as high as the prevalence of the disease among the general population, he said.

Aditama said in addition to overcrowding, a shortage of health specialists, poor sanitation, poor monitoring of prisoner transfers, and lack of awareness among prison officials and inmates contributed to the spread of TB.

“TB control and prevention measures cannot be carried out fully because of the poor conditions of prison buildings and infrastructure,” Aditama said.

“But efforts are being made to [separate] inmates with TB from others, especially those who are vulnerable, such as people with HIV/AIDS,” he said.

A prison TB surveillance system is still being developed applying the same standards used in the national TB control programme, he said.

Photo: Contributor/IRIN

Left untreated, each person with active TB can infect on average 10 to 15 people a year (file photo)

Shortage of doctors

Rasjid said prisons in provinces such as Aceh and Papua had no permanent doctors while in places such as Maluku, East Nusa Tenggara and West Nusa Tenggara, one doctor was solely responsible for all the prisons.

Doctors working for the local health department made irregular visits to these prisons, sometimes once in two weeks, Rasjid said.

“Doctors and nurses are at the forefront of the fight against TB. But most of more than 300 doctors we have serve in Jakarta and other prisons on Java island,” he said.

Ideally a major prison should be served by two doctors, one dentist, two nurses and one lab technician, he said.

Funds allocated by the government were also insufficient to allow prisons to provide decent healthcare and meals, Rasjid said. “Let’s say that the capacity of a prison is 700 people. Even if there are 2,500 inmates there, the food budget will cover only 700 people.”

Muhammad Hatta, a consultant for the government’s TB control programme, said there had been cases of multiple drug resistance (MDR) among prisoners.

About 2 percent of newly diagnosed TB cases in Indonesia are estimated to have developed MDR, WHO said.

Hatta said Indonesia’s TB fight was “failing” because it had been unable to maintain the continuity of medical supplies, with money mostly coming from foreign donors.

“Our TB programme depends heavily on foreign funds, including the provision of drugs,” Hatta said. “There’s been a lack of support on the part of the government as well as NGOs for TB programmes in prisons. There are hundreds of NGOs working on HIV/AIDS but very few are dealing with TB,” he said.

He said the problem of overcrowding was so bad that in one instance, 50 people were cramped in a 25 sqm cell. “Inmates had to take turns lying down because there wasn’t enough space for them all to lie down at the same time,” he said.

atp/ds/mw source.irinnews

Photo: ReliefWeb

CAIRO,  – Days after flash floods killed several people and forced hundreds of families out of their damaged homes in the Sinai Peninsula, government assistance is yet to arrive, survivors say.

“Our conditions are so desperate,” Nuweiga Gemeiaa, a local resident whose home was destroyed in the 18 January floods, told IRIN. “We sleep in the open, but the government hasn’t done anything effectual so far to give us either shelter or money to compensate [us] for what we’ve lost.”

Gemeiaa was one of hundreds of people who clashed with Egyptian police on 20 January after accusing the government of neglecting them in the aftermath of the floods.

The government has promised to give 25,000 Egyptian pounds (US$4,545) to each household badly affected by the floods in al-Arish in northern Sinai and in Ras Sidr in the south.

South Sinai Governor Mohamed Abdel Fadil Shousha said on 23 January that he had formed five committees to assess the flood damage. Speaking on Egyptian TV, Shousha said his staff would go from home to home to assess damage and give proper compensation for victims.

Officials from several NGOs met politicians in Cairo on 23 January to discuss how they could offer help to the Sinai floods victims. They promised to send aid convoys with food and money. They also agreed to open telephone hotlines to receive donations from the public.

So far, only minimal rescue work has been carried out by the Egyptian army and small amounts of aid from the vicinity have been delivered.

Until further assistance materializes, Gemeiaa and more than 350 families will have to wait in the open. They say conditions are so bad that some of them have broken into undamaged homes to take food and money.

“No money to buy food”

Gemeiaa and his wife and four children have been spending their nights in an olive farm a few hundred metres away from their damaged house.

“What happens here now amounts to starvation,” said Hussein Salem, a local resident. “Some shops started to open, but we’ve no money to buy food. Everything went away with the water.”

Starting on 18 January, three days of heavy rain in disparate locations in Egypt – south Sinai, Aswan in southern Egypt and the eastern coastal town of Hurghada – killed more than six people, injured hundreds and made thousands homeless.

President Hosni Mubarak met flood victims in Aswan and gave assurances they would be compensated, but Sinai residents complain they have been forgotten.

ae/ed/cb source.irinnews

By Antony Gitonga and Peter Opiyo

International Criminal Court prosecutor, Luis Moreno-Ocampo has expressed concern at reports that key witnesses of the post-election violence are being threatened.

Consequently, he has written to the Government seeking to know what steps it had taken to protect the witnesses.

In the letter, Moreno-Ocampo asked the Government to protect the witnesses.

“I wish to draw your attention to the fact that my office is aware of a growing number of reports suggesting that individuals who previously contributed to the enquiries by Kenya National Human Rights Commission and Waki Commission are perceived as the potential ICC witnesses and had been threatened and intimidated,” reads part of the letter dated January 22.

It adds: “As we discussed before our meeting of 3rd of July 2009 in The Hague, following which the Kenyan authority transmitted to my office a report on the operalisation of the witness protection programme, the primary responsibility to protect persons at risk lies first and foremost with Kenyan authority.”

He called on the Government to share with his office the information on the threats.

On the expected trial, Ocampo exuded confidence the pre-trial chamber would render a decision soon.

“In the meantime, in accordance article 15(2) of the Statute (Roman), my office keeps collecting supporting information,” it continued.

Work continues

He announced that the pre-trial chamber had ordered for the collection of views from the witnesses through the newly formed ‘victims participation and preparation section’.

Justice Minister Mutula Kilonzo on Monday confirmed to The Standard that he had received Ocampo’s letter and would respond accordingly.

“Yes, I have received the letter and I would download it from the Internet to look at it keenly,” Mutula told us on the sidelines of the constitutional talks in Naivasha.

Even as he wrote to the Government on the protection of witnesses, Moreno-Ocampo is collecting information from the ICC’s seat in The Hague, Netherlands.

“I can take statements here in the seat of the court. I am inviting witnesses to take testimony here. We are continuing the collection of evidence from here in The Hague,” he told The Standard last week.

Mutula said the Government had proposed amendments to the Witness Protection Act to make it effective in protecting witnesses and would present them in Parliament as soon as it reconvenes.

source.standard.ke