African Press International (API)

"Daily Online News Channel".

Archive for April 22nd, 2012

Hani Issa wants to pack up and leave for good: with the wild leaves she feeds her family

Posted by African Press International on April 22, 2012

Hani Issa wants to pack up and leave for good: with the wild leaves she feeds her family

TILLABERI/NIAMEY,  – Small farmers in Oullam District in Niger’s western region of Tillaberi, faced with their third drought in seven years, are being forced to consider bundling up their few possessions and leaving for good the villages they have lived in all their lives.

To better understand what is happening, IRIN visited two villages in Oullam District which has the highest proportion of its population classified as severely food-insecure, according to a multi-agency survey in December 2011.

In Talkadabey, (“poor person’s home” in the local D’jerma language), the Oullam local authorities say 75 percent of residents do not have enough to eat; and in Banemate (“health or prosperity must come”) the figure is 90 percent.

Grandmother Hani Issa was born and brought up in Talkadabey, where the residents are mainly D’jerma and small farmers. Poor rains followed by an attack by caterpillars in September 2011 had snuffed out any hope of a decent harvest. The men in Issa’s home left the village four months ago in search of work, leaving Issa to look after seven grandchildren.

“I have to find food for the children for another four months [until the next rains]… I don’t think I can go on like this. I will have to pack up, take the children and leave,” she told IRIN.

Ousseini Idrissa, an official in charge of Oullam town and nearby villages, said: “There are hundreds of people leaving,” adding that everyone had been aware that villages in Oullam would run out of food soon.

''In 50 years since independence, Niger has been in a food deficit situation for half of them''

Yacouba Mainassara, the village chief, said they had fared better during the last drought in 2010, when the government had provided wages for short-term environmental services jobs.

Dabey reckoned agriculture in Niger missed military ruler Seyni Kountché who died in 1987. Kountché had invested heavily in agriculture and health services thanks to the discovery of uranium at a time when global prices were high. But when the uranium boom ended in the early 1980s, Niger’s ability to fund development slumped.

“We need an irrigation system, good seeds and cheap fertilizer and then we can have enough to feed ourselves,” said Dabey. Most of the residents get by on remittances from family members who have migrated to neighbouring countries. According to the World Bank, in 2010, 2.4 percent of Niger’s population had migrated and sent US$70 million home that year.

When IRIN visited Banemate village in Dinghazi Commune, the children seemed reserved; some were exhibiting signs of malnutrition – bloated bellies, listless eyes and discoloured hair.

There was plenty of millet and sorghum available in the local market in Dinghazi, but affordable only for those who had remittances to fall back on.

Locals explained that some people migrate seasonally – between planting and harvests. Droughts and a rapidly growing population have forced many to leave their homes for neighbouring countries to support their families. “It is part of our way of life now,” explained the local official. But this year there have been families who have left seemingly for good, he added.

Underfunded appeal

Despite early signs in 2011 that Niger – and particularly people in Tillaberi, Diffa and Agadez regions – were going to need help, as of 15 April only 41 percent of the more than US$229 million appeal for assistance had been covered. Aid insiders say the appeal is now being revised upwards to more than $400 million.

Donors and aid agencies have yet to figure out how to respond between the time an early warning is sounded and when a crisis requires an emergency response, explained Peter Gubbels, who authored the multi-agency 2010 study Escaping the Hunger Cycle: Pathways to Resilience in the Sahel

Early response, such as cash transfers or fodder for livestock, can help to stop people’s livelihoods from collapsing and prevent people from fleeing.

Nigeriens nourish Nigeriens (3N)


Photo: Jaspreet Kindra/IRIN
Children in Banemate were reserved

People in Niger, the world’s second least developed country, have been hit by a series of shocks: regular droughts; four coups since independence in 1958; Tuareg rebellions; the Libyan crisis which affected remittances; and fluctuations in the price of the main export, uranium.

In 50 years since independence, Niger has been in a food deficit situation for half of them, says the 3N programme (Nigeriens nourish Nigeriens), the new government framework to make Nigeriens food secure for good. At the moment, 60 percent of households can only cover their food needs for three months, says the government.

“Our vision is to help ourselves become food secure. We were inspired by the previous military government’s initiative [which set up the Higher Authority of Food Security in 2010 to develop a food strategy for the country],” said Barkire Gabdokoye, the government’s technical adviser on 3N.

The five cornerstones of the plan, he said, were: develop production (land, fisheries and livestock); build infrastructure; improve drought preparedness; focus on nutrition; and create an enabling environment including legislation to make it all possible. Details of the framework are still being worked out. But Gabdokoye shared some of its features.

3N has all the ingredients of a respectable sustainable food security strategy in a land under immense climatic and population pressure.

Eighty percent of the population lives on agriculture and only about 12 percent of the land is arable. Most famers depend on rain. 3N has highlighted the need to develop irrigation based on the Kandadji Dam (under construction) on the River Niger, which provides the country’s only reliable source of water.

The dam is expected not only to help reduce Niger’s dependence on energy imports from Nigeria but provide irrigation to 45,000 hectares by 2035. In the next five years, Gabdokoye said they hoped the dam would be able to irrigate 10,000 hectares of land.

3N focuses on sustainable agriculture practices such as harvesting water; use of conservation techniques to grow drought-resilient millet, sorghum and vegetables; and the provision of subsidized fertilizer, seeds and fodder for livestock.

A big impetus will be on getting pastoralists to diversify (“but we don’t want them to give up on pastoralism”). 

“We want to build roads, improve infrastructure in the rural areas, make it mandatory for all villages to keep aside a communal reserve of cereals; have kitchen gardens,” said Gabdokoye. “We do not want people migrating to urban areas, which cannot sustain them. We are looking at value-added businesses such as cheese-making, handicrafts in the rural areas.”

Lack of funds

But 3N needs US$2 billion over five years. The government has put in $200 million. Niger’s main sources of revenue are foreign aid (which finances 40 percent of its budget), uranium exports and remittances.

In light of the European debt crisis the World Bank says it does not expect any substantial increase in funding for development in Niger. The reality on the ground is that it is hard to raise funds for long-term projects, said Oxfam’s Gaelle Bausson. “More funds are allocated to emergency response/relief programmes which are more visible, more in the media.”

Revenue from uranium is not adequate to fund 3N, said Gabdokoye. The outlook for uranium prices is uncertain in the wake of the nuclear accident in Japan in March 2011, with uranium prices down $20 a pound since 2011, said the World Bank, which also estimates the shortfall in remittances d ue to the Libya crisis to run at about $42 million.

In 2011 Niger also had to cancel a deal to sell a stake in the state-owned telecommunications company, Sonitel, to Libya, which has left a $60 million gap in its budget.

Climate change

Meanwhile, scientists’ climate warnings are getting louder. Since 1970, West Africa has experienced one of the most abrupt changes in climate since weather data began being recorded in 1896, say scientists Gil Mahe and Jean-Emmanuel Paturel in the 2009 peer-reviewed journal Comptes Rendus Geoscience.

Mahe and Paturel, who studied rainfall patterns in the Sahel 1896-2006, concluded that drought was still continuing in the region even if annual rainfall had increased since the very dry period in the 1970s and 1980s.

jk/cb source www.irinnews.org

About these ads

Posted in AA > News and News analysis | Leave a Comment »

PAKISTAN: More work needed on breastfeeding awareness

Posted by African Press International on April 22, 2012

Photo: IRIN
Only 37 percent of infants in Pakistan are exclusively breastfed till six months, according to a survey (file photo)

LAHORE,  – Low awareness of the benefits of breastfeeding in Pakistan poses a significant health risk to infants, say experts.

The tin of infant formula milk in Nargis Bibi’s kitchen stands on a high shelf, along with two feeding bottles. As she offers a bottle to her firstborn, a son aged nearly four months, Nargis, educated to grade five and the wife of a corner shop owner, tells IRIN: “I know all about boiling water to mix the formula, and I also wash the bottles in hot water.”

She says she is feeding her child mostly formula rather than breast milk because she believes “it will make him bigger and stronger. My milk was no longer enough.” Nargis has not heard about the World Health Organization (WHO) recommendation that infants be exclusively breastfed till they are six months old, or of the benefits of this. “All my sisters fed their babies formula. They are older than me and they strongly advised me to do the same,” she added.

“The indicators we have show Pakistan has fallen behind its neighbours as far as good breastfeeding practices go, and this plays a major role in the high child and infant mortality rate in the country,” said Baseer Achakzai, director of the Nutrition Wing at the National Institute of Health, Islamabad.

Pakistan’s under-five mortality rate stands at 87 per every 1,000 live births, according to the UN Development Programme’s Human Development Report for 2011, making it one of the highest in the region.

According to the Pakistan Demographic and Health Survey 2006-7, only 37 percent of infants are exclusively breastfed till six months. “This proportion is very low when compared with the recommended 100 percent exclusive breastfeeding for children under six months,” the survey said. “The propensity to feed infants under two months with plain water (13 percent) and other milk (28 percent) is high. At 2-3 months, the propensity to feed plain water and other milk increases further.”

“Even now there are so many mothers who are simply not aware of the need to exclusively breastfeed infants. This is something health workers in communities and paediatricians everywhere need to promote far more aggressively and actively,” said Anees Fatima, a paediatrician at a government hospital.

A major cause of diarrhoea among infants, she told IRIN, was improper sterilization or the making up of formula with unboiled water. “Such gastrointestinal infections are a major cause of childhood death, especially among younger children who get dehydrated quickly.” She also pointed out recent studies conducted around the world had shown that breastfeeding “protected against a variety of infections”.

Unconvinced

But many mothers remain unconvinced. “Look at me, I am weak and often sick. What good can my milk do my newest baby?” asked Fakhra Bibi, 35, a mother of five in a semi-rural area on the outskirts of Lahore. Rather than breast milk, she feeds her daughter, aged two months, a mixture of honey with water and a formula. “I sometimes add less powder to the water than the amount written down because we are poor, and cannot afford to buy too many tins,” she said. Fakhra’s husband works as a farm labourer, earning some 6,000 rupees (US$67) a month.

“We try to encourage all women to breastfeed, but it is not easy to change ideas. We also try to promote better nutrition for mothers, many of whom are anaemic,” Asma Akhtar, a Lady Health Worker who works in the area under a government scheme, told IRIN.

While Pakistan passed a specific law in 2002 to promote breastfeeding, this has had little impact on the ground. “I have heard only very vaguely about the law. The mothers I work with have heard nothing of it,” Akhtar said.

“Besides, more than laws, what we need to do is to persuade mothers that breastfeeding exclusively till six months is beneficial to their baby’s health. Too many feed formula, in addition to their own milk, because they have been told it is `better’,” she said.

“We need to catch up with other nations and make sure people are aware about breastfeeding benefits,” the National Institute of Health’s Achakzai said.

But the task for now seems to be a challenging one, with Nargis Bibi saying: “I have been told, and also read, formula has many vitamins. Surely these are good for my baby.”

kh/eo/cb
source www.irinnews.org

Posted in AA > News and News analysis | Leave a Comment »

A ledger tracking patient ART adherence in Kathmandu

Posted by African Press International on April 22, 2012

A ledger tracking patient ART adherence in Kathmandu

KATHMANDU, – Poor understanding of antiretroviral therapy (ART) amongst health officials, clinicians and patients in Nepal could undermine gains in the country’s HIV/AIDS prevention efforts and threaten future progress in lowering the number of new infections.
 
“Treatment illiteracy is occurring at all levels, from patients who have to keep up with their own treatment, to clinicians who administer treatment, to government officials crafting policies,” said Gokaran Bhatt, coordinator of Nepal’s Country Coordinating Mechanism, the independent body tasked with coordinating all money granted to Nepal by the Global Fund to Fight AIDS, Tuberculosis (TB) and Malaria.
 
Government figures for 2012 put HIV prevalence in the adult population at below 0.3 percent, down from 0.45 percent in 2005.
 
According to Nepal’s first National AIDS Response Progress report, an estimated 50,000 people are living with HIV, and four out of every five new infections are attributed to sexual transmission. ART was introduced in Nepal in 2004 and 6,483 people are currently receiving antiretroviral (ARV) drugs.
 
“Given the poverty and geographical challenges in Nepal, we are doing extremely well here,” Sashi Sharma, head of the Internal Medicine Unit at the Teaching Hospital in the capital, Kathmandu, told IRIN.
 
But many now argue those gains could evaporate if proper adherence to treatment policies and regimens is not exercised.
 
Patient adherence
 
It is extremely important that patients always follow their ART regimen. “In a resource-poor country like Nepal, adherence is our only option to survive, and the baseline of adherence is treatment literacy,” said Rajhiv Khafle, founder of the National Association of People Living with HIV Nepal (NAP+N).
 
Health workers stress that patients need a combination of counselling and monitoring to help them understand that they must always take their medicines at the same time each day, and that a dose should never be skipped. “Before ART can start, patients have to go through a full two-day counselling session,” noted Madhab Raj Pant, an HIV technical officer who worked in rural Doti District for two years.
 
To ensure that patients will visit the distribution centre, get tested, and receive ongoing counselling, ART medicines are dispensed on a monthly basis. Nepal currently reports a “lost cases” rate of 9 percent – patients who start on ART and then do not return for three consecutive months.
 
A variety of reasons can cause patients not to adhere to their regimen. In some areas, difficult terrain makes travelling to the nearest ART distribution centre costly and time-consuming. Bishnu Pokhrel*, who lives in a village in the Doti area, has to walk for a whole day to reach the nearest ART distribution centre. Public transportation is too expensive, and can also be unreliable due to landslides and strikes, he said.
 
When travel is impossible, some patients turn to HIV-positive friends to borrow doses of drugs. “Borrowing is not good practice. It encourages irregular taking of medication and patients aren’t medical professionals, so they might take the incorrect dose or incorrect pills,” Pant explained.
 
Breaking away from ART can harm the positive health effects of following a regular regimen. “We sometimes see a drop-off or a gap in adherence after the first six or seven months,” said Pant. “When patients feel better, they sometimes think they are cured.”
 
Clinician adherence
 
ARV treatment illiteracy on the part of clinicians can also cause problems. Dilip Gurung, the executive director of a community support group in the city of Pokhara, reports that he has sometimes seen clinicians change ART regimens several times to try to get the patient to feel better.
 
“Changing ART regimens can lead to fear among patients, confusion about how to properly administer the new drugs, and drug resistance,” Gurung said.
 
Public health officials agree. “It scares us if people are administering combinations that are not part of the national guidelines. If the patients on these drugs have problems or build resistance, we can’t help them – the national system can only help people within its guidelines,” said Hemant Ojha of the National Centre for AIDS and STD (sexually transmitted diseases) Control (NCASC)
 
Some outreach workers say drugs alone are not enough. “Clinicians sometimes act as if ART is a solution alone,” said Ekta Mahat, a programme officer at NAP+N. “It’s not – you need nutrition, a realistic access plan based on the patient’s life, education about possible side effects, and discipline to take the medication at the right time.”
 
Policy adherence
 
According to the NCASC, Nepal has approximately 196 HIV testing and counselling centres [ ], as well as 35 ART distribution centres and sub-centres located throughout the country. All ART drugs are distributed free of charge.
 
But “availability is not necessarily accessibility”, Mahat said. Policies that neglect the comprehensive nutritional, financial, educational, and pharmaceutical needs of people living with HIV/AIDS amount to treatment illiteracy at the policy level.
 
Moreover, government guidelines and the strategies of some HIV NGOs do not always take the same approach. “When we get a call from a patient whose ART isn’t working, we mobilize to get that person help,” said Khafle of NAP+N. “It’s not a public health approach, it’s a humanitarian approach.”
 
Observers fear the positive results from national HIV efforts could be diluted if tensions over the administration of HIV programmes continue, and adherence issues hamper implementation.
 
“Nepal has done extremely well in the last decade,” said Marlyn Elena Filio-Borromeo, UNAIDS country coordinator, “but these gains are fragile.”
 
*not his real name
 
kk/ds/he
source www.irinnews.org

Posted in AA > News and News analysis | Leave a Comment »

 
Follow

Get every new post delivered to your Inbox.

Join 185 other followers

%d bloggers like this: