Monthly Archives: July 2012

INDONESIA: Poor Health Care Deadly for Children

JAKARTA, 30 July 2012 (IRIN) – Poor knowledge of basic healthcare and lack of sanitation are contributing to the high number of deaths among children under the age of five in Indonesia. Among poorer households child deaths are more than three times higher than in richer ones.

According to Countdown 2015, a global collaboration to achieve health-related Millennium Development Goals, 151,000 Indonesian children died in 2010 before they reached the age of five – 35 out of every 1,000 live births. To reach the target of reducing child deaths by two-thirds of the 1990 death rate, seven more children out of every 1,000 births need to survive.

Causes of children under five years dying in 2010 included pneumonia, which accounted for 14 percent of deaths, preterm births caused 21 percent, injuries 6 percent, and measles and diarrhoea 5 percent each, according to the World Health Organization (WHO). The agency noted that 48 percent of children’s deaths took place in their first 28 days of life.

“Poor nutrition and lack of clean water are important contributors to child mortality in Indonesia,” said Isni Ahmad, a spokeswoman for the NGO, Plan International, in Indonesia.

“Efforts to prevent death from diarrhoea or to reduce the burden of diseases will fail unless people have access to safe drinking water and basic sanitation,” she told IRIN.

The 2010 Indonesia Health Profile revealed that 80 percent of the population were using clean water sources, but only 52 percent used hygienic, or “safe”, sanitation facilities.

The Indonesian Health Ministry says only around 12 percent of children aged between 5 and 14 wash their hands with soap after defecating, while 14 percent do so before eating. Improving the skills of health workers, especially those at community health clinics, is key to reducing child mortality.

A study by WHO noted in 2007 that diarrhoea cases could be reduced by 32 percent if more people practiced basic sanitation, 45 percent washed their hands with soap, and 39 percent treated household water. The government adopted a child illness management policy that focuses on disease prevention in addition to treatment.

Volunteers trained by local health departments organized monthly check-ups for mothers and children at more than 260,000 community health posts, but a perceived lack of support and waning volunteer interest have led to a decline in these services.

Plan Indonesia is working in 10 of the country’s 33 provinces where infant and maternal mortality rates are high by providing clean water, helping children access quality health services, and educating parents about child rearing, including nutrition.

Improved health policy and legislation, a renewed focus on reducing malnutrition, improved coverage of key maternal and child health services, such as antenatal care and control of common childhood illnesses; are all contributing to reductions in overall mortality, said the UN Children’s Fund (UNICEF).

Nuraini Razak, a UNICEF information officer in Jakarta, the capital, said the government is working with UNICEF to expand exclusive breast feeding, community newborn care, vaccinations, complimentary feeding, and access to clean water and sanitation.

[Courtesy of IRIN News]

HIV/AIDS:Mother-to-Child HIV Rates have Fallen 25% Globally

Fewer babies are being born HIV-positive, but treatment for the more than three million children living with HIV remains under-researched and underfunded. As part of efforts to boost access to paediatric HIV treatment, researchers are getting creative, moving to better pills, kid-friendly treatment “sprinkles”, micro-tabs and even medicine-dispensing pacifiers.

Ahead of the International AIDS Conference, Indian generic drug manufacturer Cipla announced that it would partner with the Drugs for Neglected Diseases initiative (DNDi), a not-for-profit research and development organization, to produce an improved first-line antiretroviral (ARV) combination therapy specifically adapted for infants and toddlers living with HIV. The partnership is just one of the developments in paediatric treatment highlighted at the 19th International AIDS Conference in Washington DC.

Mother-to-child HIV transmission rates have fallen by almost 25 percent globally since 2009, according to the latest UNAIDS report. Governments and donors celebrated these gains and pledged to eliminate mother-to-child – or vertical – transmission by 2015.

Former UN Special Envoy for AIDS in Africa, Stephen Lewis, speaking at the conference, criticized the lack of progress in improving treatment options for the 3.4 million children living with HIV.

“You can’t aim for the virtual elimination of paediatric HIV by 2015 at the continued expense of [treatment] scale-up for children living with HIV now, but that’s exactly what appears to be happening,” said Lewis. “[These children] deserve the right to life, they are not expendable causalities because they didn’t fit into prevention of vertical transmission programmes.”

The latest UNAIDS report shows that about 55 percent of adults living with HIV and in need of treatment are receiving ARVs globally, compared to just 25 percent of the children who need them. In some countries, patent laws still restrict access to some existing paediatric fixed-dose ARV combinations.

Paediatrician and researcher Dr Adeodata Kekitinwa, who works at the Mulago Referral Hospital in the Ugandan capital, Kampala, pointed out that HIV treatment for children is historically under-researched and less efficacious than adult formulations, making it harder to suppress HIV viral loads in children and infants compared to adult patients.

Cipla and the Clinical Trials Unit of the UK Medical Research Council have produced several ARV formulations for babies, and recently announced good results from a new granular, or sprinkle, formulation of lopinavir-ritonavir, a combination of ARVs.

In the recently released CHAPAS-2 trial, which compared the sprinkles with the conventional lopinavir-ritonavir syrup, caregivers reported that the sprinkles were easier for babies to swallow and easier for caregivers to transport and store than the syrup formulations.

According to Diana Gibb, a researcher on the study, the CHAPAS-2 trial also collected important data on how caregivers thought the sprinkles should be administered. For instance, many caregivers reported pouring sprinkles into the baby’s mouth and then immediately breastfeeding.

While this data is yet to be analyzed, Gibbs said it was important for drug manufacturers and developers to understand what treatment options worked best for families. Kekitinwa said these considerations might also factor into trial designs, possibly looking at how drugs interact with breast milk.

Cipla’s newly announced proposed four-in-one therapy will also be developed in sprinkle-form and have a child-friendly taste. The company aims to register the drug by 2015.

As more paediatric ARV formulations are developed, drug companies may be able to move beyond syrups and sprinkles to dissolving microfilms or bulk powders that would make it easier for healthcare providers to calculate doses based on children’s rapidly changing body weight.

Bulk powders could also make drugs cheaper, as pharmaceutical companies would not have to alter the manufacturing process to cater for different age and weight groups. Better-tasting drugs could also eventually be administered in pacifier dispensers.

With an urgent need for more paediatric ARV formulations, the UN World Health Organization (WHO) recently formed a technical working group to draw up guidelines on formulation and dosing in an effort to help guide research and development, said Lulu Muhe, who works in WHO’s Department of Child and Adolescent Health and Development.

[Courtesy IRIN News]

ZIMBABWE: Typhoid and Cholera Return

HARARE, 27 July 2012 (IRIN) – More than 100 people in the Zimbabwean capital Harare and Chitungwiza, a dormitory town 35km southeast of the city, have contracted typhoid this month, and the dilapidated water and sanitation systems are again being blamed for another round of water-borne diseases.

According to health officials cited in the local media, 83 cases of typhoid have been confirmed in Chitungwiza and a further 28 in Harare, of which 25 were linked to a supermarket in the Avenues area of the city centre.

Portia Manangazira, the chief disease control officer in the Health Ministry, told IRIN that in June 22 cases of suspected cholera, 10 of which were confirmed, were reported in Chiredzi – a town in Masvingo Province close to neighbouring South Africa – and one confirmed case of cholera was reported in Manicaland Province, which borders Mozambique.

“We are monitoring the situation very closely to make sure the cholera does not spread. The health sector is on high alert,” she said.

A year-long outbreak of cholera in 2008 killed more than 4,000 people and infected about 100,000 others and since then there have been regular outbreaks of waterborne diseases in both urban and rural areas. In January 2012 about 900 Harare residents were diagnosed with typhoid, but no fatalities were recorded.

Harare’s daily water requirement is estimated at about 1,200 million litres, but the city only has the capacity to provide on average about 620 million litres daily, forcing residents to find alternative sources.

Elizabeth Tembo, from the Harare township of Mabvuku where three people contracted typhoid, told IRIN: “Water supplies in this part of the city have been unreliable for many years and this has forced us to dig shallow wells. Unfortunately, those areas are also used by residents to relieve themselves because toilets do not have running water.” In the past decade or so, sanitation coverage in the city has fallen from 95 percent to about 60 percent, according to health officials.

However, there are also health concerns related to reservoirs supplying the city and other nearby urban areas. Harare’s town clerk, Tendai Mahachi, announced recently that a sanitation plant in Norton, a satellite town 40km west of the capital, had discharged 10 million litres of raw sewage into Lake Manyame, while industrial effluent and raw sewage had been discharged into Lake Chivero.
Donors have been supplying water treatment chemicals to urban and rural municipalities, but this support was scheduled to end in March 2012.

The government announced recently it would spend US$60 million rehabilitating and upgrading water and sanitation systems nationally, including in Harare, and part of that money would also be used for road repairs in areas affected by water-borne diseases.

Precious Shumba, director of Harare Residents Trust, an NGO campaigning for better municipal service delivery, told IRIN: “That figure of US$60 million might just cover part of what is needed to overhaul the Harare city water and sewerage reticulation system. We have reached a stage where we need to urge central government to prioritize the rehabilitation or complete replacement of all outdated systems in order to ensure that residents throughout the country have uninterrupted quality water.”

He said failure to comprehensively address Zimbabwe’s water and sanitation needs would ensure the cycle of “easily avoidable” water-borne diseases continued.

Courtesy of IRIN News

POLIO WORKER SHOT DEAD IN PAKISTAN

Child receiving oral polio vaccine drops in Balochistan, PakistanA local community worker who was part of the polio eradication initiative in Pakistan was shot and killed Friday (July 20), three days after a shooting incident in the same town injured two World Health Organization staff members.

Muhammad Ishaq’s death comes days after the campaign was suspended in parts of Gadap town in Karachi. He had worked as a Union Council Polio Worker, helping plan and implement vaccination drives to protect children from the disease.

In a joint statement, WHO and UNICEF said they were deeply saddened by the incident and called Ishaq — with his dedication and diligence to immunize “all children” in Pakistan against polio — a hero.

These violent incidents risk undermining gains made against the disease, which remains endemic in Pakistan. Elias Durry, head of the WHO polio eradication program in Pakistan, said that the decision to resume operations in the concerned areas will be “guided by the investigation and situation analysis by local and security-related administrations.”

Campaign activities in others parts of Karachi, however, have been “successfully conducted and completed,” Durry said.