ZIMBABWE: Growing risk of waterborne diseases in rural areas

Photo: Médecins Sans Frontières (MSF)

An aid worker treats a cholera patient in Beitbridge, Zimbabwe, on the border with South Africa during the 2008/2009 outbreak of the waterborne disease

MHONDORO,  – Barbra Phiri, 20, a single mother living on a farm settlement in rural Mhondoro, about 45km southwest of the Zimbabwean capital Harare, does not think twice about letting her two-year-old twins splash about in a pool of greenish water close to her hut.

Since the rains began several weeks ago, dirty water has been accumulating on the settlement, now home to hundreds of former farmworkers and others displaced during Operation Murambatsvina in 2005 which razed illegal structures and left thousands without shelter.

Phiri remembers the 2008-2009 outbreak of cholera which killed more than 4,000 people and infected nearly 100,000 others, but sees it as a thing of the past and is still ignorant of how waterborne diseases are spread.

Her twins have a skin infection and frequent bouts of diarrhoea but, like most residents, she attributes such ailments to witchcraft, consulting a traditional healer for a cure.

Phiri told IRIN her first child died two years ago from diarrhoea. “We don’t use dirty water for drinking or cooking. We get clean water from the dam or the wells, so how can our children die from waterborne diseases?” she asked.

A few metres from Phiri’s hut is an overflowing pit latrine. Many inhabitants have resorted to relieving themselves in the open since most of their pit latrines are overflowing and unusable.

The 2009 Multiple Indicator Monitoring Survey (MIMS), compiled by the government and UN Children’s Fund (UNICEF), listed diarrhoea as one of the major causes of infant mortality resulting in around 4, 000 deaths in Zimbabwe annually.

The MIMS survey showed a 20 percent increase in under-five mortality since 1990.

With the advent of the rainy season and poor sanitary and hygienic facilities, people living in rural and peri-urban settlements like Phiri’s are vulnerable to waterborne diseases.

The survey said: “Recent assessments show a significant decline in rural sanitation sector performance,” adding: “The inability of vulnerable populations to access safe water and basic sanitation… has resulted in frequent diarrhoeal and cholera outbreaks.”

The Consolidated Appeals Process (CAP) for Zimbabwe, launched in early December 2011, said “a third of rural Zimbabweans still drink from unprotected water sources and are thus exposed to waterborne diseases,” and noted reports of cholera cases in rural Chipinge, in the eastern province of Manicaland, and Chiredzi in the southeast of the country. 

More people seek treatment

A senior nurse at a clinic in rural Seke District, about 50km south of Harare, who preferred anonymity, told IRIN the number of people seeking treatment for diarrhoea and dysentery had increased since the onset of the rains.

“Typical of this time of the year when the rains fall, we treat a high number of people suffering from waterborne diseases… We have not received any cases of cholera but there is need to be on the alert all the time, because the surrounding villages are characterized by poor hygiene and sanitation. Many villagers tend to relieve themselves in the open because they cannot rehabilitate the Blair pit toilets that were built long ago,” she said.

Blair pit toilets were constructed in large numbers to improve rural sanitation in the 1980s. A fine wire mesh allowed gases produced by decomposition to escape, but prevented flies around the faecal matter from exiting the septic tank and so prevented the spread of diseases.

The boreholes that were drilled in the 1980s have broken down and only a few that were sunk in recent years still function

According a 2011 report by the UN Children’s Fund (UNICEF) and the government entitled A Situational Analysis on the Status of Women’s and Children’s Rights in Zimbabwe, 2005-2010 42 percent of people in rural communities practised open defecation, while cholera, which used to see significant outbreaks every 10 years or so in the 1980s and 1990s, has now become an annual event.

Poor household income, the senior nurse said, prevented some villagers from seeking treatment, “meaning that the number of people suffering from waterborne diseases could be higher as some of the cases go unreported [as people cannot afford to travel to clinics].”

David Shoniwa, 65, from Dema village in Seke District, said people in his community tended to relieve themselves along river beds during the dry season.

“The boreholes that were drilled in the 1980s have broken down and only a few that were sunk in recent years still function while, due to poor rains, it is difficult to sink new wells. When the rains fall, people turn to the rivers for water to drink and use for cooking, thereby exposing themselves to the diseases carried by the human waste,” Shoniwa told IRIN.

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source www.irinnews

MIDDLE EAST: The year that was

Photo: Syriana2011/Flickr

The year 2011 saw huge changes in the Arab world

DUBAI,  – When hundreds of thousands of people across the Arab world poured into the streets in 2011 to demand freedom from dictatorship, they set in motion a series of events which not only created humanitarian needs in countries that were otherwise relatively stable, but also exacerbated existing humanitarian and developmental challenges.

“Despite the fact that the Arab Spring may have brought hopes for freedom, democracy and better living conditions, it has not been without cost,” said Abdul Haq Amiri, head of the UN Office for Coordination of Humanitarian Affairs in the Middle East.

Here are the top 10 humanitarian consequences of a momentous year in the region, focusing on Egypt, Libya, Syria and Yemen.

Lives lost

2011 began with an 18-day uprising against former Egyptian President Hosni Mubarak which left more than 800 people dead and over 6,000 injured. By year end, sporadic clashes between protesters, security forces and “thugs” had killed at least another 81 people and injured hundreds more.

In Syria, a crackdown against demonstrators demanding President Bashar el-Assad step down led to more than 5,000 dead – though the number is constantly changing.

In Yemen, at least 2,700 protesters, tribal supporters, defected soldiers and government-aligned army members and policemen have been killed in what began as peaceful protests against President Ali Abdullah Saleh but increasingly involved an armed opposition. Some 24,000 others were injured since the protest movement broke out in the first week of February, according to the NGO Dar al-Salam.

Former rebels in Libya estimate the war there killed 50,000 people.

Displacement

Thousands fled Syria for Turkey, Lebanon and Jordan due to fighting between government forces and protesters, supported by army defectors. The economic situation of many host families in Lebanon was strained, and Syrians were attacked along and across the border, leaving them vulnerable not only in their home country but also when seeking refuge.

So-called sectarian clashes in Egypt, as well as a series of attacks on Coptic Christian churches, led as many as 100,000 Christians to flee the country in the months that followed the revolution, according to a local NGO.

In Libya, many people were unable to return to their homes because of the heavy damage and sensitive politics.

Iraq prepared for an influx of returnees from places affected by instability.

Migration

The Arab Spring both affected the millions of migrants already in the Middle East and North Africa when uprisings erupted across the region; and also created new migration flows.

In Libya, sub-Saharan African migrants were accused of fighting alongside former leader Muammar Gaddafi and targeted by rebel forces. Hundreds of thousands of migrants left Libya during the war, in many cases returning to communities that did not have the capacity to support them.

In Egypt, migrants returning from Libya came home to a difficult reality and heightened nationalism led to violence and discrimination against foreigners, including migrants and refugees.

Despite a host of problems in Yemen, Somali and Ethiopian refugees and migrants continued streaming into the country in unprecedented numbers, often accused of being a party to the conflict between Saleh and the protesters trying to oust him.

Meanwhile, tens of thousands of Yemenis illegally entered neighbouring Saudi Arabia in search of work. Saudi authorities say they detained 239,000 illegal immigrants in 2011, up 37 percent on the year before.

Access to health care

The often-violent crackdown on protests in Egypt’s Tahrir Square led to a shortage of vital medicines in pharmacies and a sharp drop in blood donors. Amid the security vacuum that followed Mubarak’s departure, hospitals became dangerous places.

In certain parts of Yemen, vaccination rates decreased by 20-40 percent as a result of the country’s political and economic challenges. Hospitals struggled to cope with increased demand among protesters. Health care facilities were barely functioning and access remained limited due to a lack of security, leading some health workers to flee their hospitals and clinics. Military presence in and around hospitals in Yemen led some wounded to seek treatment in private clinics.

Similarly in Syria, activists said they were afraid to take wounded protesters to hospitals, for fear they would be arrested by security forces there.

In Libya, the severely wounded had a hard time reaching hospitals and the government struggled to secure medical treatment for the war-wounded abroad.

Access to education

The unrest in the region set back the likelihood that many countries would achieve the Millennium Development Goals for education by 2015.

In Egypt, nationwide demonstrations and repeated confrontations between demonstrators and military policemen forced several schools and educational institutions to close, while parents complained that their children were attacked by thugs on their way to school. Some rights groups said criminals used arms to take money from schoolchildren.

In Yemen, hundreds of thousands of children stayed at home because their schools were either housing displaced people or being used as army barracks.

In the Syrian city of Homs a school came under attack.

On the positive side, the children of displaced Syrians in Lebanon were able to enrol in public schools in northern Lebanon.

Access to basic services

Yemen faced acute water and power outages. By year end, the price of water-trucking had risen to US$8 per cubic metre in some places, 2-3 times more than in March 2011. The power went out for more than 20 hours a day in most of the country’s main cities, including the capital Sana’a, due to repeated attacks on the national grid.

Some areas of Libya went without water and electricity for months due to severe damage to infrastructure; and activists in Syria said water and electricity were cut from certain cities for days at a time before and during military operations.

Economy

Across the region, the Arab Spring led to higher food and fuel prices, less availability of certain products on the market, people losing their jobs, enterprises going out of business, and investors being wary. The economies of Egypt, Syria and Yemen  were particularly hard hit. Libya’s oil production dropped significantly and it had trouble accessing funds frozen under sanctions against Gaddafi.

Food security

The devastated economies forced families to make difficult choices. In Yemen, where one third of people did not have enough to eat before the crisis, aid workers warned of shocking malnutrition figures.

The price of basic food commodities in Yemen increased by 43 percent on average over the course of 2011, in a country where families spend 30-35 percent of their daily income on bread.

The Studies and Economic Media Center, a local think tank, warned that the number of food-insecure people increased from seven million to nine million in 2011 because of the unrest.

In Syria, the government made cash payments to thousands of vulnerable families to stem food insecurity.

The Egyptian government was incapable of maintaining the bread subsidy that many poor Egyptians rely on,  and there were signs of increasing malnutrition in Upper Egypt.

Proliferation of weapons

Weapons proliferation increased in the region, especially in Libya, where an estimated 120,000 fighters needed to be demobilized; and surprisingly, in places like Egypt, where citizens purchased small arms to defend their families. An increasing number of army defectors led to a more violent Arab Spring in Yemen and in Syria, where the UN resident coordinator in September warned of the risk of civil war.

In Yemen, less government control has led tribesmen to break into military camps, looting small, medium and heavy arms.

Aid delivery

Insecurity and the spread of conflict in several areas of Yemen hindered access of humanitarian actors and made aid delivery even more complex.

Syria has been virtually off-limits for aid workers and certain areas of Libya remained inaccessible for months due to fighting during the war.

According to one UN official, the unrest in the region caused some Gulf countries to cut some of their foreign spending and refocus funds internally, to appease the local population and avoid uprisings in their own countries. The Palestinian Authority, for example, complained of decreased donor funding.

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source www.irinnews.org

ETHIOPIA: New PMTCT plan needs men

Photo: Dogs and music/flickr

Male partner involvement in PMTCT has been shown to reduce the risk of mother-to-child HIV transmission

ADDIS ABABA, 4 January 2012 (PlusNews) – Ethiopia’s new plan to eliminate mother-to-child HIV transmission by 2015 cannot be attained unless men are more meaningfully involved in reproductive health, experts say.

“Among the pregnant women who come to our hospital, less than 10 percent of them come with their partners,” said Etalem Gebrehiwot, head nurse at the prevention of mother-to-child transmission (PMTCT) wing of Gandhi Memorial Hospital. “Those who find out that they are living with the virus usually face a problem while taking medicines, given that most prefer to take it without the knowledge of their partners.”

Studies show that low male partner involvement is one of the challenges to the success of the country’s PMTCT programme.

According to experts, men’s involvement in PMTCT can have a positive impact on PMTCT by encouraging their partners to visit antenatal clinics and have skilled health workers attend the birth of their children. In a 2010 Kenyan study, male partner involvement in PMTCT reduced the risks of vertical transmission and infant mortality by more than 40 percent compared to no involvement.

“The biggest challenge we are currently facing is to convince mothers to get tested in order to determine that they are eligible for PMTCT services… the major reason for their resistance is lack of consent from their husbands or partners, who are more influential in family matters including this,” said Aster Shewa, who supervises Zewditu Hospital antiretroviral service centre in Addis Ababa.

“Besides, after they know their status, most HIV-positive mothers refrain from disclosing it, which usually impacts the way they use PMTCT services and their effectiveness,” she added.

Many men do not see the advantages of an HIV test; one father, whose wife gave birth to a daughter in November 2011, told IRIN/PlusNews: “We are married – what is there to test about?”

“At the moment, hospitals with PMTCT services are increasing, and we have to work hard in convincing pregnant women, along with their partners, to use health facilities with the service in order to reach zero new infections,” said Aster.

New national plan

The biggest challenge we are currently facing is to convince mothers to get tested to determine whether they are eligible for PMTCT services… the major reason for their resistance is lack of consent from their husbands or partners

The national accelerated emergency PMTCT plan – launched in December 2011 – has three objectives: reaching 90 percent of pregnant women with access to antenatal care services; ensuring universal access by pregnant women to a skilled attendant during delivery; and providing ARVs to at least 80 percent of HIV-positive pregnant women.

An estimated 1.2 million Ethiopians are living with HIV, including about 90,000 pregnant women; just 9.3 percent of pregnant women who are eligible for HIV services are currently receiving them. The number of Ethiopian women who visit antenatal clinics is growing – from 616,763 in 2008-2009 to 796,099 in 2009-2010 – and the number of mothers receiving HIV testing as part of PMTCT services has grown to over 70 percent, but just 6 percent of births are attended by a skilled health worker, according to the UN World Health Organization.

“The new plan will focus on increasing the quality of services that expectant mothers get in the health services and also retain those who are using it. We intend to work on both in the demand and supply side of the service,” said Tadesse Ketema, a maternal health adviser at the Ministry of Health.

“Through the health extension programme, the country manages to create easy access for family planning services for many families and that has worked so far. We are now planning to copy that in the PMTCT programme to reach out [to] each pregnant woman and give the service at their convenience,” he added.

Ethiopia’s “health extension programme” employs more than 30,000 lower cadre health workers to provide basic health care at village level. The government also intends to use “health development armies” – community groups mobilized to further government health programmes – to create demand and convince the community, including male partners, to benefit from nearby PMTCT services.

bt/kr/cb source www.irinnews.org