Tag Archives: UNICEF

Heightened HIV risk for people with disabilities

Inaccessible health services for people with disabilities (PWD), combined with social stigma and violence, contribute to high HIV risk – a gap that must be filled if the disabled are not to remain disproportionately vulnerable to HIV/AIDS, say health experts and activists.
“People with disabilities are at increased risk for exposure to HIV infection. HIV, in some cases in itself, can cause disability,” said Jill Hanass-Hancock, a senior researcher at the Health Economics & HIV/AIDS Research Division (HEARD), a South African research institute.

Globally there are an estimated one billion people living with a mental or physical disability, according to the UN World Health Organization. Many live in low- or middle-income countries and have poorer health and little formal education compared to the general population.

“We cannot talk about reducing HIV and its co-morbidities if you exclude this 15 percent of the world’s population,” added Hanass-Hancock, speaking at the AIDS 2014 Conference, hosted by the International AIDS Society in Melbourne on 20-25 July.

Data are scarce; most national HIV monitoring or surveillance programmes do not specifically track incidence among people with disabilities.

An 2014 meta-analysis of data and data from STD testing by STDAware.com from Sub-Saharan African countries showed that PWD are 1.3 times (1.48 for women) more at risk of contracting HIV than people without disabilities.

The 2014 “Gap Report” published by the Joint UN Programme on HIV/AIDS (UNAIDS) listed PWD as one of the key populations “left behind” in the global HIV response.

The no sex myth

Central to the struggle of PWD to gain inclusion in HIV response is breaking down the assumption that they are not sexually active and therefore do not need HIV services.

A 2014 Human Rights Watch (HRW) report on Zambia documented PWD describing how healthcare workers thought of them as “asexual”.

“People with disabilities are people first. They have the same needs and desires when it comes to relationships and being sexually active,” said Rosangela Berman Bheler, senior adviser at the UN Children’s Fund (UNICEF).

Others caution that PWD are at greater HIV risk due to other factors.

“PWD are four times more vulnerable to sexual abuse and violence. This increases their risk for HIV infection,” said Muriel Mac-Seing, HIV/AIDS protection technical adviser of Handicap International.

According to UNAIDS, “vulnerability, combined with a poor understanding and appreciation of their sexual and reproductive health needs, places people with disabilities at higher risk of HIV infection.” A 2012 article in The Lancet showed that people with mental and intellectual disabilities were at particularly high risk of abuse and violence.

Access barriers

Betty Babirye Kwagala, a medical counsellor for The AIDS Support Organization in Uganda, said the root of the heightened risk for people with disabilities can be seen in basic infrastructure.

“Services are not accessible – literally. Many health facilities do not have ramps or doors wide enough to accommodate people in wheelchairs,” said Kwagala who has had a physical disability since a car accident when she was 19. Five years ago she was diagnosed with HIV.

In her work as a medical counsellor, Kwagala has seen first-hand the lack of information and education materials suited for the needs of PWD, and a parallel lack of knowledge among health workers about how to communicate.

“How can a health worker who does not know how to use sign language communicate with someone who is deaf? They usually use gestures. But you cannot use gestures when prescribing medication,” said Kwagala.

Hanass-Hancock acknowledges bridging communication and understanding between health workers and PWD is critical to increasing the uptake of HIV services. But, she warns, such interventions need to take social conditions into consideration.

“People with disabilities often depend on a care-giver. This has a great impact on getting information privately and confidentially,” said Hanass-Hancock, adding that strategies such as SMS outreach and counselling for hearing impaired people, or easy-to-understand picture books for people with intellectual disabilities need to be developed.

Data gap

HRW’s research in Zambia, where one in 10 people has a disability, recommends a “twin-track approach starting with existing healthcare services more accommodating to PWD by simple things like widening doors”. PWD-specific interventions should be developed as well, they argue, and needs for either approach should be supported by improved data.

“We need to disaggregate the data to break it down by disability because all disabilities are different and will require different interventions. Then we can talk about creating tailor-fit services for them,” said Rashmi Chopra, a researcher on disability rights at HRW.

Lack of information – including about health and HIV – can leave PWD especially vulnerable inhumanitarian emergencies.

The Sphere Standards, which set out best practice in the delivery of humanitarian aid, encourage humanitarian actors to disaggregate data in their assessments, programming, and monitoring and evaluation tools by, among other things, noting if there is a disability involved.

However, Handicap International has critiqued the Sphere recommendation as insufficient to “mainstream a highly heterogeneous group such as [people with disabilities]”, and says recording the type of disability is crucial.

Despite the data gap, campaigners remain hopeful, saying the discussion has advanced from the days when the intersection between HIV and PWD was not even recognized.

“We must not forget that this is a dignity and human rights issue: most countries in the world – including donor countries – have ratified the UN convention on the rights of persons with disabilities (CRPD). It’s time for them to be responsible for their disabled citizens,” said Muriel Mac-Seing, HIV and AIDS protection and technical adviser for Handicap International.

CRPD, which has been ratified by 147 countries, mandates that governments “provide persons with disabilities with the same range, quality and standard of free or affordable health care and programmes as provided to other persons, including in the area of sexual and reproductive health and population-based public health programmes.”
[Courtesy IRIN]

Somalia: Polio Outbreak Thwarts Global Eradication Effort

The global community came tantalizingly close earlier this year to ridding the world of polio. But then in May, the eradication effort took a powerful blow. The virus turned up again in the Horn of Africa, first in Somalia.

The Banadir region of Somalia, which includes a Mogadishu refugee camp, is thought to be the so-called “engine” of the Horn of Africa polio outbreak.

In June, three-year-old Mohamed Naasir became ill. His mother, Khadija Abdullahi Adam, said soon after one leg became permanently disabled.

“My son was fine, but he started having a high fever which lasted for almost four days,” she explained. “I gave him medicine, but there was no change. The following morning he said to me ‘Mom, I can’t stand up.'”

The virus has spread at a rapid pace, triggering massive vaccination efforts.

Earlier in 2013, polio was confined to three so-called “endemic countries” — Nigeria, Afghanistan and Pakistan — where the virus has never been snuffed out. Combined there were fewer than 100 cases in those three countries.

Since the virus re-emerged in the Horn of Africa, there have been at least 160 polio cases in Somalia alone, and the virus has spread to Kenya and Ethiopia.

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Timor-Leste: Maternal Mortality Crisis

DILI, 8 July 2013

Greater efforts are now needed to tackle the many challenges women     face in accessing health care in Timor-Leste, which has one of the highest maternal mortality ratios (MMR) in the world, experts say.

“Although there are 2.3 health workers for every 1,000 people, which meets the international minimum standard set by the World Health Organization (WHO), the quality and competency of these health professionals is questionable given the training available and shortage of trained doctors,” Jannatul Ferdous, a maternal and child health adviser at HADIAK, a locally implemented health project, working with the Ministry of Health, told IRIN.

“The main problems with providing emergency and child health services include the poor quality of health service providers, the shortage in trained health professionals and the logistics involved in accessing services,” Ferdous said.

According to a recent report entitled Trends in Maternal Mortality, only 30 percent of women give birth with a skilled birth attendant present.

Seventy percent of the country’s 1.1 million inhabitants live in remote areas.

“Health-seeking behaviour is one of the major issues, reflected by a low utilization of health services for antenatal and postnatal care. Some factors for low utilization of health services include concern about the availability of drugs; availability of healthcare providers, especially female health providers; distance to health facilities; and concern about getting permission to go for treatment from husbands and other family members,” Hongwei Gao, country representative for the UN Children’s Fund (UNICEF), explained.

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165 million children under the age of five globally malnourished.

Hunger kills more people worldwide than HIV, tuberculosis, and malaria combined, and children are the most vulnerable. According to the World Health Organization, an estimated 104 million children around the world are undernourished and 175.5 million suffer from stunted growth because their bodies do not have enough nutrients. Malnutrition and hunger-related diseases account for 35 percent (3.1 million) of the 8.8 million deaths of children younger than five each year. Malnutrition is a complex disease that can be caused by lack of adequate food, illness, and poor caring practices – but it is preventable and curable.

Stunting can lead to irreversible brain and body damage in children, making them more susceptible to illness and more likely to fall behind in school. Based on UNICEF’s report, IRIN has put together a round-up of the nutrition situations in six East and Central African countries that are among 24 countries with the largest burden and highest prevalence of stunting.

Burundi: Under-five mortality in this small central African country dropped from 183 deaths per 1,000 live births in 1990 to 139 per 1,000 live births in 2012. This is far short of the 63 deaths per 1,000 live births necessary for the country to achieve UN Millennium Development Goal (MDG) 4, which aims to reduce child mortality by two-thirds by 2015. An estimated 58 percent of children under age five are stunted, compared with 56 percent in 1987, according to demographic and health surveys from those years.

According to the UNICEF report, Burundi has made “no progress” on MDG 1, which aims to eradicate extreme poverty and hunger.

Central African Republic (CAR): An estimated 28 percent of under-five deaths in CAR occur within the first month of a child’s life; the biggest killers of children under five are malaria, diarrhoea and pneumonia. The percentage of children under age five who are stunted has changed little since 1995, standing at 41 percent in 2010, as has the percentage of children who are underweight, which has remained at about 24 percent for the last 18 years.

There has, however, been significant progress in the number of mothers exclusively breastfeeding their infants. In 2010, 34 percent of infants under six months old were breastfed, compared to just 3 percent in 1995. According to UNICEF, infants who are not breastfed in the first six months of life are “more than 14 times more likely to die from all causes than an exclusively breastfed infant”.

Democratic Republic of Congo: Africa’s second-largest country bears 3 percent of the global stunting burden, with 43 percent of children under age five suffering from stunting and 24 percent being underweight. Stunting is significantly higher (47 percent) in rural areas than it is in urban areas (34 percent).

The percentage of children who are underweight dropped from 34 percent in 2001 to 24 percent in 2010. DRC’s progress towards MDG 1 is described as “insufficient”.

Ethiopia: The Horn of Africa nation, which bears 3 percent of the global stunting burden, has seen a steep drop in stunting levels, from an estimated 57 percent in 2000 to 44 percent in 2011. The percentage of underweight under-fives has also dropped significantly, from 42 percent in 2000 to 29 percent in 2011. Between 2000 and 2011, under-five mortality was cut from 139 deaths per 1,000 live births to 77 per 1,000 live births – within striking distance of its MDG 4 target of 66 per 1,000.

A national nutrition programme launched in 2008 has been key to reducing national food insecurity, a major cause of stunting. The country’s health service extension programme has also played a role in bringing nutritional interventions to villages.

Rwanda: Community interventions – such as kitchen gardens and increasing the availability of livestock, as well as measures to boost healthy infant feeding practices like exclusive breastfeeding and the provision of nutritional supplements – saw the percentage of underweight under-fives in Rwanda drop from 20 percent in 2000 to 11 percent in 2010. Enhanced data collection and analysis has also enabled the government to improve its planning and monitoring of child malnutrition.

The report describes the country as “on track” to meet MDG 1.

Tanzania: Bearing 2 percent of the world’s stunting burden, Tanzania has made significant strides in improving child nutrition. An estimated 50 percent of infants under six months old were breastfed in 2010, compared to 23 percent in 1992. The country has also brought under-five stunting levels down from 50 percent in 1992 to 42 percent in 2010, but continues to suffer significantly higher stunting in rural children (45 percent) compared to urban children (39 percent).

Tanzania’s under-five mortality rate dropped from 158 per 1,000 live births in 1990 to 68 deaths per 1,000 live births in 2010, putting it close to its MDG 4 target of 53 deaths per 1,000 live births. UNICEF’s report says the country is “on track” to meet its MDG 1 targets.

[Courtesy of IRIN]

Uganda’s midwives struggle to meet demands

 

8 April 2013  – Despite the significant role midwives play in Uganda’s maternal health programmes, they face numerous challenges, including lack of training, inadequate facilities and poor pay.

According to the Africa Medical Research Foundation (AMREF) just 38 percent of Uganda’s estimated 11,759 midwives are either registered or have a college education. Yet they attend to 80 percent of all births in the country’s urban areas and 37 percent of all births nationally.

Esther Madudu, a midwife in Uganda’s rural Soroti District, explained to IRIN that many go to great lengths to help women deliver.

“Health centres lack electricity, water and other essential medical commodities to assist in delivery. In the past, I used to [hold] my cell phone in my mouth [and use its] torch to [assist delivering] mothers at the health centre,” she said.

A 2009 analysis by the UN Population Fund (UNFPA) found Uganda’s health system “unsupportive to midwives, as characterized by poor remuneration, poor health service infrastructure, lack of essential equipment and supplies, eg, gloves, drugs – especially in public health facilities – inadequate protection from infections, high workload owing to few qualified staff” and lack of supervision or training opportunities.

Maternal deaths

Uganda grapples with high rates of pregnancy-related complications and maternal deaths, consequences of poor healthcare investment by the government, low education levels and an unmet need for reproductive health services.

Uganda’s 2011 Demographic and Health Survey showed the maternal mortality rate at between 310 and 480 deaths per every 100,000 live births.

According to the Ministry of Health, 24 percent of these deaths are the result of severe bleeding, and many are due to infection, unsafe abortion, hypertensive disorders and obstructed labour.

Experts say much more must be done if Uganda is to meet Millennium Development Goals 4 and 5 – the goals on reducing child and maternal mortality and achieving universal access to reproductive healthcare – by the 2015 deadline.

“Death resulting from pregnancy-related [complications] is a big issue in Uganda that requires urgent attention,” health commissioner Anthony Mbonye said, noting that these deaths are preventable “with improved access to [quality] healthcare to the population and… positive attitudes towards… health workers.”

Too few health workers

Midwives say their small number has them struggling to meet demand. They have called on the government to recruit more midwives.

“We are only three midwives working day and night with [the] assistance of two nursing assistants,” said Lydia Tino, a health supervisor and midwife working at a centre with 20 maternity beds in the rural Gulu District.

In 2006, the government stopped midwifery trainings, arguing that nurses could be given additional skills to take up the roles played by midwives. This has not happened.

And the few who have midwifery skills often leave the country.

“Uganda has trained many midwives, but [the] majority opt to work in places outside the country where facilities and remuneration are better,” Mary Gorettie Musoke, senior midwife and trainer, told IRIN.

n a progress report by Uganda’s Ministry of Health, tabled before a parliamentary committee in February, the government indicated that it had employed an additional 5,707 health workers to help plug the gap.

But many rural health facilities are still unable to perform either basic or comprehensive emergency obstetric and newborn care.

Government obligation

Government officials told IRIN it plans to carry out a countrywide maternal health audit as part of its efforts to deal with the problem.

“We are under obligation to perform our duties, so the government doing everything possible to address problem,” said Sarah Kataike, the health minister.

While government health facilities in Uganda are supposed to provide free services, they are understaffed and lack essential medical supplies. At times, patients are forced to pay extra fees before they can receive services.

Florence Akio, 34, had to be transported to a private facility some 45km away after failing to receive any assistance at a nearby government facility.

“My labour started in the middle of the night, but I couldn’t make to Atiak Health Center III. I waited until morning, when my husband borrowed a bicycle and carried me to the health centre. But, reaching the health centre, there was no sight of any staff to attend to me,” she told IRIN.

In a landmark 2011 case, civil society organizations sued the government over the high maternal mortality rate, but the case was dismissed. The organizations had argued the government had failed to provide essential medical commodities and services to pregnant women.

[Courtesy of IRIN]

Congo Healthcare Initiative

6 April – The British government has announced a major new programme aimed at providing essential healthcare to six million people in the Democratic Republic of Congo (DRC). The five-year, US$270.7 million project will focus on rebuilding health facilities, training health workers, and supplying drugs and equipment.


Civil war has destroyed much of the country’s health infrastructure, as well as the road networks and vital services such as electricity, meaning patients often have to travel long distances to health centres that may not be equipped to handle their complications.

IRIN has put together a list of five health issues in DRC that require urgent attention:

Maternal and Child Health
 –
DRC’s maternal mortality ratio is 670 deaths per 100,000 live births, with an estimated 19,000 maternal deaths annually. The country has a severe shortage of health workers – less than one health professional is available per 1,000 people. 

With 170 out of every 1,000 children dying before they reach the age of five and 10 percent of infants underweight, DRC has one of the worst child health indicators in the world. It is one of five countries in the world in which about half of under-five deaths occur. Some of the biggest killers of children are diarrhoea, malaria, malnutrition and pneumonia.

Sexual violence – Several studies report high levels of sexual violence perpetrated against women, children and men in DRC, both by armed groups and within the home; one study, conducted in the North and South Kivu and Ituri in 2010, found that 40 percent of women and 24 percent of men had experienced sexual violence. 

Between the stigma of rape and the dearth of decent health services in DRC, sexual violence often leaves survivors injured, infected with sexually transmitted illnesses and severely traumatized. Some of the main requirements are first aid and trauma services, counselling, diagnosis and treatment of sexually transmitted infections, HIV post-exposure prophylaxis and access to contraception.

During a recent visit to eastern DRC, UK Foreign Secretary William Hague announced $312,110 in new funding to support the NGO Physicians for Human Rights, which works at Panzi Hospital in South Kivu Province, “to help efforts to develop local and national capacity to document and collect evidence of sexual violence”.

Diarrhoeal diseases – The consumption of unsafe water is one of the main causes of the diarrhoeal diseases – such as cholera – that infect and kill children and adults in DRC. A cholera epidemic that started in June 2011 has infected tens of thousands and killed more than 200 people. In the capital, Kinshasa, which has been hit by the epidemic, less than 40 percent of people have no access to piped water. According to the UN Children’s Fund, UNICEF, 36 million people in DRC live without improved drinking water, and 50 million without improved sanitation.

Some of the measures to boost access to safe water and sanitation include hygiene awareness campaigns, rehabilitation of water supply and of sanitation facilities, disinfection of contaminated environments, chlorination of water, and distribution of soap.

Immunization – Despite the existence of an effective vaccine for measles at a cost of roughly $1 per vaccine, the disease is one of the leading killers of children in DRC. According to the Global Alliance for Vaccines, 20-30 percent of children in DRC do not have access to immunization. Some challenges to universal vaccine coverage include the poor road network, the size of the country (DRC is Africa’s second largest country), unreliable electricity for vaccines that require refrigeration, and low awareness within the population.

HIV – More than one million people in DRC are living with HIV; 350,000 of these qualify for life-prolonging antiretroviral drugs, but only 44,000 – or 15 percent – are actually on treatment. Just 9 percent of the population knows of their HIV status, largely because of low awareness, but also because of a shortage of facilities – for instance, only one laboratory in the country is equipped to carry out polymerase chain reaction tests for early infant diagnosis.

Just 5.6 percent of HIV-positive pregnant Congolese women receive ARVs to prevent transmission of HIV to their babies; according to government figures, the mother-to-child transmission rate is about 37 percent.

Humanitarian agencies have called on the government and donors to urgently boost funding for HIV prevention, treatment and care.

[Courtesy of IRIN]

Guinea Bissau: Cholera On the Rise

Bissau — As cholera case rates decline in Guinea and Sierra Leone, they are on the rise in Guinea-Bissau, with 1,500 cases reported and nine deaths as of 11 November, according to the Ministry of Health.

Adelino Gomes, a doctor in charge of cholera treatment at the Simão Mendes national hospital in the capital Bissau, says he has treated 500 cases in recent weeks and believes the epidemic may not yet have reached its peak.

Guinea-Bissau’s low-lying capital with its minimal to non-existent water and sanitation facilities makes it an ideal breeding ground for cholera.

François Bellet, a water, sanitation and hygiene (WASH) specialist with the UN Children’s Fund (UNICEF) in West Africa, says the strain was probably passed on from fishermen in Sierra Leone and Guinea, though this has not yet been confirmed.

The outbreak has spread across seven of Guinea-Bissau’s nine administrative areas, according to the Ministry of Health.

Simão Mendes is short on medicines to help victims, said Gomes, adding that Médecins Sans Frontières (MSF) is helping to treat patients. UNICEF and the World Health Organization are also supporting treatment, as well as helping detect cases and giving public hygiene messages to prevent the spread.

The government spends 6 percent of its budget on water and sanitation, according to the Finance Ministry. WASH facilities are “catastrophic” said one aid worker, but prevention at the household level has improved incrementally since 2009, said Bellet.

A 2008 cholera epidemic in Guinea-Bissau affected 14,222 people and killed 225, according to MSF research wing Epicentre.

Courtesy  All Africa News