http://www.irinnews.org/irin-fp.aspxUpdated everydayen-gbThu, 05 Nov 2009 14:13:59 GMTKABUL Thursday, November 05, 2009 (IRIN) - The average per capita monthly expenditure of nine million Afghans is less than 66 US cents a day, and millions of other Afghans spend about $42 a month, according to a summary of Afghanistan’s new National Risk and Vulnerability Assessment (NRVA).KABUL Thursday, November 05, 2009 (IRIN) - The average per capita monthly expenditure of nine million Afghans is less than 66 US cents a day, and millions of other Afghans spend about $42 a month, according to a summary of Afghanistan’s new National Risk and Vulnerability Assessment (NRVA).

NRVA 2007/08 was produced by the government with European Union funding and in collaboration with aid agencies.

A bleak picture is painted:

26 percent literacy rate (12 percent female and 39 male)
24 percent of all child deliveries are attended by a skilled birth attendant
Less than 30 percent of people have access to safe drinking water
Over 90 percent do not have access to proper sanitation
About 20 percent have electricity in their homes.
Half of the estimated population of 25 million is under 15

“NRVA is an effective tool for… poverty alleviation and development programmes,” Naseer Ahmad Popal, an official from the Ministry of Rural Rehabilitation and Development, told IRIN.

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http://www.irinnews.org/report.aspx?ReportId=86889CAIRO Thursday, November 05, 2009 (IRIN) - Despite a number of positive economic indicators, Egypt has a hunger problem: Nearly a third of all children are malnourished, according to a new report compiled by the Ministry of Health and the UN Development Programme (UNDP).CAIRO Thursday, November 05, 2009 (IRIN) - Despite a number of positive economic indicators, Egypt has a hunger problem: Nearly a third of all children are malnourished, according to a new report compiled by the Ministry of Health and the UN Development Programme (UNDP).

The Egyptian Demographic Health Survey (EDHS) 2008, [http://www.measuredhs.com/pubs/pdf/FR220/FR220.pdf] published in March 2009, recorded a 6 percent increase in undernourishment severe enough to stunt growth in children under five, pushing the percentage of stunted Egyptian toddlers to 29 percent from 23 percent in 2000.

The survey collected data in 2007/2008, when gross domestic product (GDP) grew by 7.2 percent, indicating that strong economic growth had not benefited ordinary Egyptians. A slower GDP growth of 4.7 percent is forecast for 2008/2009.

“Within the recent context of economic crises and economic slowdown, in addition to the growing epidemics of avian and H1N1 influenza, nutrition is not treated as a priority,” said Hala Abu Khatwa, head of communications in Egypt for the UN Children’s Fund (UNICEF).

Government-run food programmes are in place: In partnership with the World Food Programme (WFP), fortified date bars have been distributed in high-risk schools since 1963; and government-subsidized flour and cooking oil - used to make ‘baladi’ bread - are fortified with iron/folic acid and Vitamins A and D.

Chicken cull

Yet some government policies have adversely affected the nutrition of the poorest.

UNICEF and WFP said the EDHS report of a spike in malnourished children was partly attributable to the government’s decision to cull millions of chickens in 2007.

“The culling had a significant and substantial impact on household consumption of poultry and eggs, especially [on] young children, and also put considerable strain on household resources since poultry sales accounted for nearly half of the incomes of many Egyptian households,” said UNICEF’s Abu-Khatwa citing a 2007 study by the Food and Agriculture Organization (FAO) entitled Livelihood Impact Assessment in Egypt. [http://www.fao.org/docs/eims/upload//239037/ai294e.pdf]

Gianpietro Bordignon, the director of WFP in Egypt, attributed growing malnutrition among children to “the successive series of shocks that affected people, especially the poorest. This started with the outbreak of avian flu and the subsequent killing of poultry that lowered the intake of protein, and then the financial and food crises that followed.”

No data has yet been collected on the nutritional status of the estimated 70,000 unofficial garbage collectors and pig farmers in the Cairo area [http://www.irinnews.org/Report.aspx?ReportId=86742] who relied on pigs for meat, income and organic waste.

Economic reforms

Since 1991 Egypt has embarked on economic reform programmes which have not necessarily helped the poorest in society.

A July report by Egypt’s General Authority for Investment and Free Zones, seen by IRIN and entitled Towards Fair Distribution of the Fruits of Growth, found that 66 percent of the wealth generated in Egypt is sector specific, benefiting only those directly employed by the sector rather than the economy as a whole.

“Between 2005 and 2008, the risk of extreme poverty increased by almost 20 percent. Poverty levels are highest in Upper [southern] Egypt where 70 percent of the country's poor live,” Abu Khatwa said. Upper Egypt is home to about 17 percent of the country’s 82 million people.

WFP’s Bordignon also pointed out that since Egypt is not a “least developed country”, it misses out on international food aid.

According to the 2009 UNDP Human Development Report, [http://hdrstats.undp.org/en/countries/country_fact_sheets/cty_fs_EGY.html] 23 percent of the population are below the poverty line. Food riots [http://www.irinnews.org/Report.aspx?ReportId=77691] in 2008 were symptomatic of widespread poverty.

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http://www.irinnews.org/report.aspx?ReportId=86893WAJIR EAST Thursday, November 05, 2009 (IRIN) - The sound of the evening bell at a local boarding high-school in Wajir, in the northeast of Kenya, did not always signal the end of the day's classes. Instead it marked the end of the evening bathroom break as “bucket toilets” were emptied for the day. WAJIR EAST Thursday, November 05, 2009 (IRIN) - The sound of the evening bell at a local boarding high-school in Wajir, in the northeast of Kenya, did not always signal the end of the day's classes. Instead it marked the end of the evening bathroom break as “bucket toilets” were emptied for the day.

Such stories are commonly told with a mixture of humour and concern in the semi-arid region of Wajir, where most residents have little access to improved sanitation - with serious health implications.

"Wajir is prone to diarrhoea outbreaks," Francis Njoroge, Wajir East medical health officer, told IRIN. "Diarrhoeal diseases are [the] third [most] common illness in children below five years.

"Several factors could be contributory: the town lacks a sewerage system [and] uses a bucket system... people depend on boreholes... and many of the community water wells are not protected, exposing them to contamination," Njoroge said.

Outside the town, people use water from open dams, which they share with animals. "During the rainy season, run-off water washes animal waste into the dam, contaminating it," he said.

Wajir residents rely on shallow wells, due to increasing water salinity at depth, which are exposed to contamination during flash floods and from seepage.

The larger Wajir, which borders Somalia, Ethiopia, as well as the Kenyan towns of Mandera, Moyale, Isiolo and Garissa, lies in an area with large aquifers supplied by perennial rivers and dry seasonal river basins - also sources of contamination.

Like most of northern Kenya, Wajir has experienced a prolonged drought and livestock deaths. Animal carcasses litter watering points, posing a further health risk.

Contamination

Wajir South Development Association (WASDA) programme manager, Haretha Bulle, told IRIN of the challenges.

"There are [largely] no flush toilets and no pit latrines," Bulle told IRIN. A few flush toilets can be found in some hotels and in newer settlements but are rare in households.

According to a UN World Health Organization report, latrine coverage in rural Wajir is about 5 percent and just a little higher in the town.

Because of the high water table, pit latrines are not viable, and residents mainly rely on unhygienic bucket toilets - improvised from plastic jerry cans.

"Waste is collected from the bucket latrines by a tractor, which serves the whole town," Bulle noted. The town has a population of about 220,000.

"Households are not able to dispose of waste [and] are forced to dispose it anywhere," she said. "When it rains, the whole town smells. The water gets contaminated more easily and changes colour."

Refuse pit and open pit dumping is prevalent.

El Niño threat

According to Wajir town resident, Khadijah Ibrahim, ongoing El Niño-related rains will only exacerbate the situation. Her family of eight shares one bucket toilet with three other households - about 24 people in total.

"Sometimes the municipal council comes to empty the bucket after a week or 15 days. By the time the waste collectors come, the bucket toilet is already overflowing," Ibrahim said.

Her children, the youngest of whom is three, have been trained to wear shoes before going to the toilet to protect themselves, "but they only use soap to wash their hands before they eat", Ibrahim said.

Eco-toilets

The Arid Lands Development Focus (ALDEF) NGO is piloting eco-toilets, which use heat trapped by solar panels to burn human waste, reducing it to ash.

The toilets do not use water, instead relying on a dehydration/evaporation system. Diyad Hujale, ALDEF programme manager, told IRIN the target was mainly the town centre, which requires about 5,000 toilets.

Hujale recommended that Wajir town’s by-laws should make it compulsory for any upcoming construction to have an eco-toilet facility. The challenge, he said, is "how to get rid of the bucket toilet".

However, the cost of setting up an eco-san unit, about KSh60,000 (US$800), is prohibitive for private households.

Health education

Past recommendations to improve drainage and sanitation in Wajir have not yielded much, according to Bulle of WASDA. "It is one disaster after the other. When the rains come, we think of the drainage but forget about it when the drought comes."

At present, village elders in Wajir are being taught how to chlorinate the community wells, according to health officer Njoroge. Health education on the importance of protecting the wells is also being provided.

He said the construction of more toilets is being encouraged in new settlements, where communities are provided with water treatment chemicals.

"Health education is ongoing. Of importance is that there is continued disease surveillance in the district," he said. The solution lay in "providing clean water to the community and safe disposal of human waste via a sewerage system".

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http://www.irinnews.org/report.aspx?ReportId=86896NOUAKCHOTT Wednesday, November 04, 2009 (IRIN) - At the health centre in Dar Naim, a working class neighbourhood of Nouakchott, the building for malnourished children is always full: in rural areas the seasons and crops affect malnutrition levels whereas in the capital this phenomenon remains constant throughout the year. NOUAKCHOTT Wednesday, November 04, 2009 (IRIN) - At the health centre in Dar Naim, a working class neighbourhood of Nouakchott, the building for malnourished children is always full: in rural areas the seasons and crops affect malnutrition levels whereas in the capital this phenomenon remains constant throughout the year.

The most recent nutrition survey carried out in July by the Ministry of Health and the UN Children’s Fund (UNICEF) using SMART methodology focused on assessing the nutritional situation for children between harvests.

The survey revealed that three regions of the country (southeast, south and centre) had the highest rates of global acute malnutrition (GAM). In central areas the rate was 19.2 percent, well above the World Health Organization’s emergency threshold of 15 percent.

In rural areas there tends to be various causes for malnutrition, notes Mohamed Moustapha Kane, head of the Health Ministry nutrition service.

General poverty levels in the country – more than 46 percent of the population live below the poverty threshold, according to the UN – and the lean season both contribute to malnutrition, but in addition in rural areas, although they are "agropastoral regions, not everyone has [cattle or land]. People also lack knowledge…of [good nutritional practices]. Isolation and lack of infrastructure are also an issue: access to health, drinking water or [hygiene]".

According to the July 2009 study the GAM rate in Nouakchott (7.9 percent) is much lower than in other areas. However the difference is that in the capital, as opposed to in rural areas, the seasons have little influence on the phenomenon: the December 2008 SMART study during a post-harvest period showed a 5.9-percent rate in Nouakchott compared to 11.9 percent in the central region.

Many observers have noted that the time of year does not affect food availability in urban areas. According to Nené Koné, who has been in charge of child nutrition at the Dar Naim health centre since 1991, in large part a lack of money perpetuates the problem in Nouakchott.

When mothers arrive at the centre with their children, "the main issue that comes across is their extreme poverty,” Koné told IRIN. "If the mother is hungry because she has not been able to eat, then she has no milk [to breastfeed]".

"Families are heavily in debt throughout the year,” said Isabel Marco of Communauté des Filles de la Charité, who support the centre. The huge increase in global food prices in 2008 has made the situation even worse for urban families who do not produce any food and have buy everything: 25 litres of milk cost 35,000 ouguiya (US$134), compared to $53 in 2004, said Marco. Today it costs 24,000 ouguiya ($92) – the equivalent of one month’s minimum wage in a country where "traditionally we drink a lot of milk”.

Child malnutrition in urban areas is also linked to the financial situation of many Mauritanians deteriorating over the last few decades. Tahya Sidiekhreye, in her 50s, has brought up "lots" of children. She arrived at the Dar Naim centre at the start of October with her grandson, who is 15 months old and suffering from acute severe malnutrition.

"I never had these problems with my children: my husband and I always managed to get by [to feed them], but now it’s too hard,” she said. "[My grandson] has been ill for four months and I haven’t got the money to care for him. [His mother] doesn’t work and his Dad is unemployed, so they cannot care for him.”

She is looking after her grandson because her daughter does not know what to do, she told IRIN; the child’s mother is 15. When mothers lack nutritional knowledge and do not have enough milk they are unable to breastfeed, many experts have noted. And in urban areas in particular certain practices that lead to malnutrition have become common.

"In the past breastfeeding was highly socially valued, but there is now a trend of using milk substitute,” Brahim Ould Isselmou, communications officer at UNICEF, told IRIN. Despite the cost of this practice – a tin of baby milk that lasts five days is sold for around 1,600 ouguiyas ($6) – it also changes habits. "After a few months some mothers become confused and sometimes you see [some of] them giving meat to six-month-old babies.”

While health services are more accessible in urban areas than rural, the quality of care and support for malnutrition is not always guaranteed, as Sidiekhreye discovered. Before finally getting care for her grandson at the Dar Naim health centre she spoke with a private doctor who referred her to a hospital as the child was showing worrying symptoms. "He was vomiting a lot and was dehydrated but they did not hospitalize him: they just gave me a prescription for [paracetamol] and sent me away,” she told IRIN.

In order to standardize care and support services for malnutrition and among other things improve quality, the authorities developed a national protocol in 2007, which all centres are expected to follow. The protocol called for standardizing how malnutrition is assessed, referred and monitored and how care and support are provided. At Dar Naim and other health centres staff have been trained on this protocol with support from UNICEF.

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http://www.irinnews.org/report.aspx?ReportId=86874NOUAKCHOTT Wednesday, November 04, 2009 (IRIN) - Adama Ndiaye, 20, is originally from the Kaédi region in the south of Mauritania – one of the regions worst affected by malnutrition. After losing her first two children she decided to go to the capital Nouakchott to care for her twins and her youngest child.NOUAKCHOTT Wednesday, November 04, 2009 (IRIN) - Adama Ndiaye, 20, is originally from the Kaédi region in the south of Mauritania – one of the regions worst affected by malnutrition. After losing her first two children she decided to go to the capital Nouakchott to care for her twins and her youngest child.

"My twins are [21 months] and my baby is one month old. I had two children before; the first died at one year and the other lived a month and a half. They were ill and had fever. They refused to breastfeed and then they passed away [due to complications linked to malnutrition].

"My husband is a farmer [near Kaédi] and he grows millet and peanuts. Sometimes we have food but at other times birds eat the seeds and nothing grows. In our region the majority of people eat only once a day, myself included.

"As I wasn’t eating much I didn’t have enough milk for the twins. [Shortly after they were born] the girls became ill so I decided to come to Nouakchott to look after them. I took them to Dar Naim [a health centre in a Nouakchott suburb managed by the State with support from aid agencies and donors including the UN Children’s Fund] each day.

"After six months my twins had recovered so I went back to my husband. I then became pregnant again. But my twins started to get sick again so I returned to Nouakchott. I’ve been here for five months now staying with [relatives]. I come to the centre nearly every day. The twins get porridge made from rice, fish and vegetables and there’s [baby] milk for the little one.

"As soon as my children get better I will go back to the village. I came here just to care for them but I don’t want to stay. I want to go home. My husband and I will get by with the kids.”

ail/lc/nphttp://www.irinnews.org/report.aspx?ReportId=86876GABORONE Wednesday, November 04, 2009 (IRIN) - Katlego Lally*, 17, belongs to a club for HIV-positive teenagers run by the Baylor Children's Clinic Centre of Excellence in Gaborone, Botswana's capital. She talked to IRIN/PlusNews about how the club has helped her overcome feelings of isolation and depression.GABORONE Wednesday, November 04, 2009 (IRIN) - Katlego Lally*, 17, belongs to a club for HIV-positive teenagers run by the Baylor Children's Clinic Centre of Excellence in Gaborone, Botswana's capital. She talked to IRIN/PlusNews about how the club has helped her overcome feelings of isolation and depression.

"I was born in 1992. Back then, there was no PMTCT [prevention of mother-to-child transmission] so I got the [HI-]virus from my mother, but I wasn't diagnosed then. I just grew up falling sick every time, and we didn't know why.

"In 2003 we did some tests and then they found out that I had the virus, and my mother also. I don't think I understood at that time ... But as time went by I came to understand the disease, and that's when I told my brain: 'Okay, this is a death sentence', and that's when I became depressed.

"I remember in 2007, I was falling sick often and my exams were about to come, so I was a bit down, always just kicking myself – 'Why? Why me? What have I done?' - I was just living in a dark tunnel, waiting for the day I would die.

"Then last year I was referred to Baylor [Children's Clinic] and that's when I think my life changed. The doctor told me about Teen Club; then I came and I saw a whole new world that I never knew.

"I didn't realize - I thought it was just me - but I saw a whole lot of excited and happy teenagers, and I also got that energy, that positive thinking, from them.

"This year I was elected to be a [Teen Club] leader. I have to be a role model to the younger teen members, I help with serving lunch, lead ice-breakers and train other teen leaders from satellite clubs.

"I've made a lot of friends - they're like my family. Everyone is open with each other, because when you're in the same situation you understand each other. We don't normally talk about HIV or medications here in Teen Club; we sometimes go on trips, listen to music, or sometimes we get life skills.

"Being a teenager is very hard - you have to keep up with the changing life, do what the others do. My school friends don't know [about being HIV-positive], but just like most people here generally in Botswana, especially teachers when they talk about HIV, they bring it up in a whole negative way.

"I have friends who drink, who have sex, and sometimes you try to tell them: 'this is not good'. But how are you going to make them understand? You'd maybe have to start by saying, 'I'm HIV positive and you don't want to be HIV-positive', and that would be like, ugh, so I just leave it.

"Teen Club helps me. I know I don't have to go to the bar and drink alcohol, I don't need drugs to get me high, because I have a happy life and I have a lot of goals for myself. First of all I want to be a lawyer, but if not law, then radio journalism, and if not, then accounting ... or I want to be a movie star.

"I go on dates, but sometimes I can just be out of the dating mode. I want a person I can spend the rest of my life with, but when the time comes for us to maybe have sex, how am I going to disclose my status?

"You never know what they'll think. What if that person is not that trustworthy? Once you tell him he'll get really angry and start to spread rumours about you, so I just have to leave it.

"Right now I'm writing my final exams so after then, that's when I'll start seeing what to do. If I fall in love with someone who's negative, I'll see if I disclose my status to that person, how they will react."

*Not her real name

ks/he http://www.irinnews.org/report.aspx?ReportId=86881DHAKA Tuesday, November 03, 2009 (IRIN) - A new report by the UN Children’s Fund (UNICEF) says most children in Bangladesh are regularly exposed to physical abuse at school, at home or where they work. DHAKA Tuesday, November 03, 2009 (IRIN) - A new report by the UN Children’s Fund (UNICEF) says most children in Bangladesh are regularly exposed to physical abuse at school, at home or where they work.

The study [http://www.unicef.org/bangladesh/media_5661.htm] entitled Opinions of Children of Bangladesh on Corporal Punishment involved nearly 4,000 families and was published on 8 October 2009.

“In all regards, the children of Bangladesh are in a very vulnerable position,” Mohammad Kafil Uddin, director of Bangladesh Children’s Rights Forum, an organization of 235 NGOs working in the children’s rights sector, told IRIN in Dhaka.

According to the report, 91 percent of the children surveyed faced various levels of physical abuse at school, while 74 percent were abused at home.

The report found that 87.6 percent of schools still used switches and sticks to discipline students, and that the most common forms of punishment were: hitting with a switch or stick, pinching or pulling an ear, hair or skin, and slapping.

Some 23 percent of students said they had to face different forms of corporal punishment every day. Seven percent reported injuries and bleeding resulting from the punishments administered by teachers.

The threat of corporal punishment was a major reason why children played truant or had lost interest in their studies, the report said, adding that only 75 percent of enrolled students regularly attended school.

“They [teachers] beat us with wooden and steel rulers and sticks,” Ishrat Jahan Ima, a seven-year-old second year student at the Sher-E-Bangla Nagar Government Girls’ School in Dhaka, claimed, recalling how one teacher proudly showed off a broken switch bragging that he had broken it by beating a fifth-year student.

In the workplace

Although child labour is illegal in Bangladesh, the practice is prevalent, say child rights activists, and the report indicated that about 10 percent of the children had jobs.

Of these - apart from having to put up with a heavy workload, poor wages and dangerous working conditions - a quarter of them were regularly beaten; 65 percent said they were punished in one form or another in their workplaces.

In the home

At home the survey found that 99.3 percent of the children reported being verbally abused and threatened regularly by their parents. Slapping was a common form of discipline for 70 percent of the children, while 40 percent were regularly beaten or kicked.

“Physical abuse of children is a daily occurrence and this is a problem which needs a complete mindset change… The level of awareness among the people of Bangladesh regarding the rights of children is very low,” Bangladesh Children’s Rights Forum director Mohammad Kafil Uddin said.

The report also correlated the household income and education of the parents with physical punishment: Parents from poorer and less educated households were more likely to resort to corporal punishment.

Bangladesh was one of the first countries to ratify the UN International Bill of Rights for Children in the 1989 UN Convention on the Rights of the Child (UNCRC). [http://www.unicef.org/crc/] The UNCRC states that all forms of physical and mental abuse against children must be prohibited, and a 2006 UN report recommended a target date of 2009 for the universal prohibition of corporal punishment.

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http://www.irinnews.org/report.aspx?ReportId=86850GABORONE Tuesday, November 03, 2009 (IRIN) - Raging hormones, peer pressure and coming to terms with a changing body image - growing up is difficult enough without the added burden of living with HIV, and keeping it hidden from friends and classmates. GABORONE Tuesday, November 03, 2009 (IRIN) - Raging hormones, peer pressure and coming to terms with a changing body image - growing up is difficult enough without the added burden of living with HIV, and keeping it hidden from friends and classmates.

"Being a teenager is very hard; you have to keep up with the changing life, do what the others do," agreed Katlego Lally*, 17, in Botswana's capital, Gaborone, who was born with HIV but only learned of her status six years ago. "My school friends don't know; if you bring up HIV they're quite ignorant."

As one of the first countries in southern Africa to start rolling out a national antiretroviral (ARV) treatment programme that now reaches nearly 100 percent of those who need the medication, Botswana has a rapidly growing population of children infected at birth who are surviving into adolescence.

Simply referring these teenagers to adult clinics and ignoring their special needs could lead to a reversal in the gains Botswana has made in combating HIV, argues Ed Pettitt, coordinator of the Teen Club programme at the Botswana-Baylor Children's Clinic Centre of Excellence in Gaborone.

"Adolescence, as a period of development, has the highest risk for therapeutic failure - not just for ARVs, but any medication for a chronic illness," he told IRIN/PlusNews.

"I call it the 'inconvenient truth' of paediatric HIV - it's great that you can put children on ARVs, but you have to realize that one day they're going to grow up and become teenagers, and all the challenges and headaches that come with adolescence are going to impact on their behaviours."

Julia Rosebush, a doctor at the Children's Clinic, which provides care and treatment to HIV-infected infants and children through a partnership between the Baylor International Pediatric AIDS Initiative and the Botswana government, has already seen how teenage rebellion can translate into treatment failure. "A lot of kids throw away their pills - we're finding a lot who are failing first-line treatment already."

Pettitt said only three lines of drugs for treating HIV were available in Botswana, and if interrupted treatment caused resistance to these to develop during adolescence, "your long-term prognosis doesn't look good".

A whole new world

The first Teen Club started in Gaborone in 2005 with just 23 teenagers, but now has over 400; that number is expected to reach over 1,000 by 2012, and five satellite clubs have launched in other parts of the country.

Clinic staff and some of the older teenagers who serve as "teen leaders" run monthly events at the clubs, providing support and sanctuary to the vast majority of members who have never disclosed their status to anyone besides their caregivers.

"When there's only one other person that knows their status, they're leading kind of double lives," said Pettitt. "They can't even tell their best friend because they fear that friend will tell others, and they'll never be able to go back to school."

For Lally, who started coming to Teen Club last year, realizing that there were other teenagers like her was life changing. "I was just living in a dark tunnel, waiting for the day I would die," she said. "The doctor I was seeing told me about Teen Club and I saw a whole new world ... I thought it was just me, but I saw a whole lot of excited and happy teenagers."

She is now a teen leader and thinks of her friends at the club as "like my family". "Everyone is open with each other, because when you're in the same situation you understand each other," she said. Mostly they talk about "normal teen stuff" rather than their HIV status.

The monthly events are usually focused on fun and general life skills rather than HIV-related issues. Past activities have included pool parties, salsa classes and movie nights, although the most recent event focused on how to disclose one's status to friends and family.

After a panel discussion in which several adults and one teen leader shared their experiences of disclosure, the teenagers broke into small groups to act out skits where they practised disclosing to best friends, girlfriends, teachers and cousins.

Sexuality and relationships are particularly fraught for HIV-positive teenagers, but giving them tools for disclosing to romantic partners is vital if they are to use prevention methods, said Pettitt.

Mpho Mosala*, 17, another teen leader at the Gaborone Teen Club, has been dating the same girl at his school for the past two years but he has yet to tell her of his status. "Right now, I don't think it's so important because we're not doing anything that would expose her," he said. Lally has decided to stay "out of the dating mode", at least until she finishes school.

While younger club members attended the session on disclosure, older teenagers were busy clearing undergrowth from a plot across the street where a drop-in centre for HIV-positive adolescents is to be built. They were joined by volunteers from Barclays Bank, which contributes part of the funding for the programme as well as financial literacy training to the teenagers.

The centre will provide a much needed place where teenagers and their caregivers can come between clinic appointments and monthly events for counselling, training and sports, or just to hang out.

Model programme

The success of Botswana's ARV programme and its prevention of mother-to-child transmission (PMTCT) programme means that while the number of infants born with HIV is dwindling, the number of HIV-positive adolescents is growing every year. "In three or four years we'll pretty much be an adolescent clinic," said Pettitt.

Recognizing the growing need, Botswana's Ministry of Health is partnering with Baylor to develop an adolescent care package to train health care workers at government ARV clinics in how to cater for teenage patients.

While Botswana is slightly ahead of the curve, other countries in the region are also dealing with growing numbers of HIV-positive adolescents and looking for models they can adapt.

Baylor has launched similar clubs attached to its Children's Clinics in Swaziland, Lesotho, Malawi and Uganda, and a number of other countries and organizations have requested materials on adolescent care and support.

Pettitt welcomes the interest, saying: "A lot more attention and resources needs to be put towards finding ways to keep adolescents adherent and prevent them from infecting others."

*Not their real names

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http://www.irinnews.org/report.aspx?ReportId=86861DAKAR Monday, November 02, 2009 (IRIN) - Health organizations have joined forces to launch the first World Pneumonia Day, urging governments, donors and civil society to act to prevent and treat the world’s leading child killer.DAKAR Monday, November 02, 2009 (IRIN) - Health organizations have joined forces to launch the first World Pneumonia Day, urging governments, donors and civil society to act to prevent and treat the world’s leading child killer.

Pneumonia kills over 4,000 children daily – more than measles, malaria and AIDS combined, says the UN Children’s Fund (UNICEF). However, to date, stamping it out has not been prioritized by policy-makers or donors, says the coalition of over 50 health organizations launching the pneumonia movement.

“There has been little traction on the pneumonia issue for years but it now feels like we are at a tipping point,” Orin Levine, executive director of the pneumonia research programme at Johns Hopkins Bloomberg School of Public Health, told IRIN. "Now it is critical for donors, international partners and countries to make protection, prevention and treatment available to all children everywhere with no delay.”

UNICEF and the World Health Organization (WHO) in a Global Action Plan for the Prevention and Control of Pneumonia are calling on donors and national governments to commit US$39 billion to improve prevention and treatment in 68 high-prevalence countries between now and 2015.

Preventing pneumonia requires increasing the number of children vaccinated against common causes of pneumonia, such as streptococcus pneumonia (pneumococcal disease) and Haemophilus influenzae type b (Hib), and improving community-level treatment of pneumonia through training and access to antibiotics, according to the plan.

The plan also calls for improving health, hygiene and nutrition practices by promoting exclusive breastfeeding, hand-washing, reducing indoor air pollution and giving zinc to children during diarrhoea outbreaks.

“Nearly half of [pneumonia] deaths could be prevented with existing vaccines and the vast majority of cases could be treated with inexpensive antibiotics,” Save the Children Board member and former US Senator Bill Frist said in a communiqué launching Global Pneumonia Day. “Yet lives continue to be lost from this preventable and treatable disease, and until recently there was very little outcry.”

Research groups specializing in pneumonia say vaccine roll-out in Africa and Asia has been slow due to lack of money and awareness.

Vaccines

Vaccines against two of pneumonia’s common bacterial causes, Hib and pneumococcus, are routinely used in industrialized countries but are not yet available in most of the developing world, according to GAVI Alliance, a public-private partnership providing immunization and health system support worldwide.

"Vaccine coverage is improving but at a “slower pace than we would like to see," WHO spokesperson Olivia Lawe-Davies told IRIN.

GAVI plans to speed up the introduction of pneumococcal vaccines in 42 countries to reach 130 million children by 2015.

“Millennium Goal four cannot be met without this investment...Immunization is one of the most cost-effective ways to save lives. And improved health is a fundamental driver for long-term development,” said Julian Lob-Levyt, head of the GAVI Alliance, in a 2 November communiqué.

Millennium Goal four aims to reduce by two-thirds the deaths of under-five children by 2015.

Affordable treatment

GAVI Alliance has developed a funding mechanism to encourage pharmaceutical companies to produce a pneumococcal vaccine at 10 percent of the normal price, costing developing country governments on average 15 cents per dose.

For those children who contract pneumonia the antibiotics that could save their lives cost less than $1, but currently less than 20 percent of children receive them, according to WHO and UNICEF.

''Pneumonia contributes to 60 percent of the in-patient admissions in any hospital in Uganda, and the worst scenario is seeing a mother walk into the emergency unit…because she was not aware of the seriousness of her child's illness, and seeing that child pass away because it was too late to intervene,” said Sabrina Bakeera-Kitaka, President of the Uganda Paediatrics Association in a 2 November statement.

Donors who sign on to the Global Action Plan at the 2010 World Health Assembly would agree to increase the supply of antibiotics to health clinics in hard-hit countries and train community health workers in pneumonia case management.

“With increased donor support, we can save many more lives and make an incredible leap towards further reducing child mortality in the world. This is an historic opportunity we must not ignore,” said GAVI’s Lob-Levyt.

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http://www.irinnews.org/report.aspx?ReportId=86838LAHORE Sunday, November 01, 2009 (IRIN) - Like most blind and low-vision children in Pakistan - as well as many with correctable vision - Kaneez Fatima, 10, does not go to school. “She cannot see the blackboard clearly. We do not know why. So her teacher said she could not learn,” Kaneez’s mother, Bushra Bibi, told IRIN.LAHORE Sunday, November 01, 2009 (IRIN) - Like most blind and low-vision children in Pakistan - as well as many with correctable vision - Kaneez Fatima, 10, does not go to school. “She cannot see the blackboard clearly. We do not know why. So her teacher said she could not learn,” Kaneez’s mother, Bushra Bibi, told IRIN.

Bushra and her husband have never considered the possibility that their daughter’s sight problem could merely be a refractive error, easily corrected with a pair of glasses. The couple, who have little formal education, have two other children.

“We have no money to take Kaneez to a doctor or buy glasses,” said Bushra. The family’s income is Rs 8,000 (US$100) a month.

According to Niazullah Khan, country director in Pakistan of the UK-based charity Sight Savers International, there are 1.4 million blind people in Pakistan. Of these, 45,000-48,000 are children under 15.

“Three times that number of children has low vision,” he told IRIN.

The World Health Organization (WHO) defines low vision "as visual acuity less than 6/18 and equal to or better than 3/60 in the better eye with best correction". It also notes there is, globally, a “high burden” of refractive error - which can be rectified with appropriate optical correction.

“We often see children with eye problems and though we refer them to free eye clinics not all parents take [their] children there. They are not aware poor sight can affect learning and quality of life,” said Dr. Nishat Kausar, a general practitioner. “Often people just try to buy cheap glasses from roadside sellers,” she said.

There are at present only 64 schools for blind and visually impaired children in Pakistan (population 165 million).

“We are trying, under new government policies, to facilitate education in mainstream schools for children with low to moderate vision, because the environment in schools for the disabled is not right for them. They need to live with normal people and learn how to manage,” Khan said.

Cataracts

Aroosa Haroon, 12, was diagnosed with cataracts in both eyes a year ago. Her parents, both librarians, were able to pay for surgery, performed on an outpatient basis at a private hospital, and Aroosa says “I can see perfectly again.”

She is fortunate. There are 9,000-10,000 cataract blind children in Pakistan. Cataracts account for 53 percent of all blindness in the country.

According to Sight Savers, 3000-4,500 paediatric cataract surgeries take place annually.

However, there are also other threats to sight, some of them linked to poverty. This is one reason why Kaneez, from a low income family, struggles with an uncorrected vision error, while Aroosa, from a more privileged background, was treated before poor sight could affect her education.

The link between poverty and blindness has been established by some scientific studies.

Vitamin A deficiency

One of the reasons for this is a widespread Vitamin A deficiency, experts believe. Globally, WHO notes, this is the leading cause of childhood blindness.

“Clinical deficiency of Vitamin A causes night blindness that may ultimately end up with loss of vision,” Azhar Abid Raza, health officer for the UN Children’s Fund (UNICEF) Pakistan, told IRIN. “According to the National Nutrition Survey 2001-2002, 12.5 percent of children showed evidence of being vitamin A deficient,” he said.

Pakistan has, with UNICEF support, run a Vitamin A supplementation programme, linked to National Polio Immunization Days, since 1999.

The battle against blindness is being waged in both the public and private sectors, with organizations such as the charitable Layton Rahmatullah Benevolent Trust running 56 eye clinics and hospitals across the country.

“We treat one in every three eye patients [in the country] and our mission is to offer quality eye-care to anyone who needs it,” said Najmus Saquib Hameed, a trustee of the organization.

But despite these efforts, children like Kaneez Fatima remain out of school. “I wish I could see enough to read, like my sisters can,” she said.

kh/at/cbhttp://www.irinnews.org/report.aspx?ReportId=86829GOZ BEIDA Friday, October 30, 2009 (IRIN) - A three-day nationwide polio vaccination campaign began on 30 October throughout Chad, including in the east where according to the World Health Organization the rate of routine immunizations is among the weakest nationwide.GOZ BEIDA Friday, October 30, 2009 (IRIN) - A three-day nationwide polio vaccination campaign began on 30 October throughout Chad, including in the east where according to the World Health Organization the rate of routine immunizations is among the weakest nationwide.

On 27 October lab results confirmed six new polio cases, bringing the number of confirmed cases in Chad in 2009 to 30. Two regions are newly infected, Wadi Fira in the east and Batha in central Chad.

“Type 3 [poliovirus] has broken out in regions with poor routine vaccinations,” Mohamed Mohammedi, WHO’s polio technical expert covering eastern Chad, told IRIN. Fewer than half of the children living in the eastern districts of Wadi Fira, Ouaddai and Dar Sila have had routine polio immunizations, according to WHO’s weekly polio bulletin as of 25 October.

There are three known strains of the polio virus. Type 3 is not as widespread but is as dangerous as type 1, Mohammedi said.

Vaccination campaigns in Chad have helped to wipe out type 1 cases nationwide, with 18 in 2007 to none thus far in 2009. But the number of type 3 cases has increased 10 times in that period.

The most affected areas are the capital N’djamena, which has half the cases, and Chari Baguirmi in southwestern Chad with eight.

Polio vaccinations are to continue till 1 November. The next round is scheduled to begin on 4 December.

Once established in the intestines, poliovirus can enter the bloodstream and invade the central nervous system – destroying nerves and leading to permanent paralysis in about one in 200 infections, according to the Global Polio Eradication Initiative. There is no known cure.

pt/nphttp://www.irinnews.org/report.aspx?ReportId=86821BISSAU Wednesday, October 28, 2009 (IRIN) - Contraceptive use is on the rise in both urban and rural areas in Guinea-Bissau, as access to reproductive and infant healthcare improves and family planning messages start to sink in, say health officials and UN staff.BISSAU Wednesday, October 28, 2009 (IRIN) - Contraceptive use is on the rise in both urban and rural areas in Guinea-Bissau, as access to reproductive and infant healthcare improves and family planning messages start to sink in, say health officials and UN staff.

In Guinea-Bissau 98 of 114 health centres now offer family planning services and 10 percent of women use contraception which while low is an improvement, said Antonieta Martins, a UN Population Fund (UNFPA) adviser to the Ministry of Health.

UNFPA estimates that giving women access to modern contraception could prevent 40 percent of maternal deaths worldwide.

In Guinea-Bissau one in 13 women dies in pregnancy or childbirth, according to the UN – one of the highest rates in the world.

The service

At San Domingos government hospital 90km north of the capital Bissau, health staff distribute the birth control pill, condoms and contraceptive implants, said hospital director Inghala Na Uaie.

UNFPA helps fund the provision of free contraception nationwide, trains health workers on family planning and reproductive health and advises the Health Ministry.

Health workers in San Domingos use several methods to spread family planning messages, Na Uaie said, including speaking to teenagers in schools about the dangers of starting a family too young and suggesting contraception options to women who have come to the hospital with pregnancy-related or birthing problems.

They also try to spread the message in non-reproduction-related health visits as part of a government and UNFPA drive to mainstream family planning messages.

“Women want family planning here – we meet with very little resistance to our messages,” he told IRIN.

But with inconsistent stocks the hospital cannot guarantee contraception to all who want it, he said.

Dada Saar, 36, mother of five children, spoke to IRIN while waiting to receive her next contraceptive implant at Simao Mendes hospital in Bissau.

“Five [children] is enough,” she told IRIN. “We don’t have enough money to support them. My husband has no fixed job. Even if one of my children were to die, I wouldn’t want more.”

Next to Saar sat Florence de Silva, 28, who has one daughter and wants another child, but plans to stop at two. “Otherwise I will not be able to educate them…even if I have just two and they are both educated, they will be able to look after me when I am older.”

Economic security or better health?

Economics increasingly sways urban families’ decisions to expand or not, said Alfredo Claudino Alves, director of health and reproductive services in the Ministry of Health.

“In towns people are more conscious that they want fewer children. They understand life is expensive.”

But receptivity to the family planning message has a lot to do with contraception being free, and with reproductive and infant health improving. “People have more faith in medicine working, so are starting to think their babies won’t necessarily die [when ill],” Alves said.

Far more women now come to San Domingos hospital to give birth than did a few years ago, Na Uaie said. And while statistics cannot be confirmed – a countrywide survey is due out in 2010 – health workers told IRIN maternal and under-five mortality is declining across the country.

While reportedly dropping, however, under-five death rates are still high in Guinea-Bissau; mothers still have a one-in-five chance of losing a child before the child reaches age five, according to UNICEF. This perpetuates high birth rates, Martins said.

Choices

Concerned about the slow progress of international efforts to reduce maternal mortality to meet 2015 Millennium Development Goals, health ministers, government officials, UN and NGO representatives from around the world gathered in Addis Ababa on 27 October to urge governments to make family planning a priority.

Reducing the rate of unintended pregnancies and stopping women from dying in childbirth worldwide would cost US$23 billion per year, they said in a communiqué.

However in Guinea-Bissau, where ministry budgets are small and in some cases are almost 100 percent dependent on donor funding, deciding priorities is difficult, said Alves.

Martins said: “The government is committed [to family planning], but there is always something else to prioritize first because this country has so many other problems.”

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http://www.irinnews.org/report.aspx?ReportId=86788DERA ISMAIL KHAN Monday, October 26, 2009 (IRIN) - Thousands of displaced children from South Waziristan have received measles vaccinations for the first time.DERA ISMAIL KHAN Monday, October 26, 2009 (IRIN) - Thousands of displaced children from South Waziristan have received measles vaccinations for the first time.

So far, 180,000 children, from both internally displaced persons’ (IDP) and host families in North West Frontier Province (NWFP), have been vaccinated against measles, according to the UN Office for the Coordination of Humanitarian Affairs (OCHA), and further vaccination campaigns are planned.

“These people have often never had any kind of contact with healthcare workers. Access to them has been impossible due to the fighting in Waziristan and the resistance of militants to vaccinators,” said Taufiq Khan, a volunteer doctor who is helping care for the IDPs.

Some 139,000 people have so far fled fierce fighting in South Waziristan and arrived in the neighbouring districts of Tank and Dera Ismail Khan in NWFP, according to OCHA.

“Over 57,600 have been registered in those two districts in the past 10 days. IDPs from South Waziristan are living in host communities, with friends and families, or in rented homes, as has been the pattern with other recent conflict displacement in Pakistan,” OCHA said in a statement on 24 October. [http://wwww.reliefweb.int/rw/rwb.nsf/db900SID/MYAI-7X62YH?OpenDocument]

Low literacy rate

According to government statistics, [http://www.fata.gov.pk/subpages/socioeconomic.php] the literacy rate for Pakistan’s Federally Administered Areas is 17.42 percent, compared with 35 percent for the NWFP. South Waziristan is one of seven tribal agencies located on the Pakistani-Afghan border. Only 3 percent of women are literate and there is only one doctor for every 7,670 people.

“I have never been to a doctor or even seen one. There is no doctor in our village, though I had heard about vaccinations for children,” said Nazeer Mehsud, 70, an IDP. He said his grandchildren had been sick with coughs when the family arrived in Dera Ismail Khan two weeks ago.

“But a doctor has now given us medicine and their fever is down. We have also received all kinds of other items, like biscuits and dried milk, and we are grateful for all this assistance because we had no idea what things would be like for us.”

The UN Children’s Fund (UNICEF) said most of those displaced are women and children.

“Especially vulnerable”

Luc Chauvin, deputy head of UNICEF in Pakistan, said in a statement [http://www.unicef.org/media/media_51520.html?q=printme] the IDPs “have already lived through years of insecurity in one of the remotest and poorest parts of Pakistan which has left them especially vulnerable. Now, we must ensure they are protected from the effects of poor nutrition, sanitation and disease, not to mention the terrible upheaval of displacement and violence.”

He added that less than 60 percent of children in South Waziristan received routine immunizations.

Host families who have opened their doors to the displaced, as their tribal code of hospitality demands, are also benefiting from the assistance being given to the IDPs. “My children were also given warm blankets and some shots they needed by a health team,” said Jahanzeb Khan, who is hosting a family of 10 in his three-room house.

“We do not know these people, but they were in need and despite some security concerns because they could be militants escaping the army, I am happy to do what I can to help,” he said.

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http://www.irinnews.org/report.aspx?ReportId=86751GOMA Friday, October 23, 2009 (IRIN) - Looking at herself in the mirror, nine-year-old Helena squealed with delight at her reflection, standing upright with just the slightest support of her therapist. A year before, Helena was diagnosed with cerebral palsy and identified for therapy in Mugunga II IDP camp in Goma, eastern Democratic Republic of Congo. Helena, able only to crawl, had been confined to very specific spaces due to the lava in the IDP camp.GOMA Friday, October 23, 2009 (IRIN) - Looking at herself in the mirror, nine-year-old Helena squealed with delight at her reflection, standing upright with just the slightest support of her therapist. A year before, Helena was diagnosed with cerebral palsy and identified for therapy in Mugunga II IDP camp in Goma, eastern Democratic Republic of Congo. Helena, able only to crawl, had been confined to very specific spaces due to the lava in the IDP camp.

Helena was one of the lucky few to have received regular treatment. Robert Golden, a doctor, states in the 2008 UN Children’s Agency (UNICEF) report, Monitoring Child Disability in Developing Countries, that it is an “important but largely unaddressed issue”. This is especially true in DRC where child disability receives little attention among the myriad crises befalling the country.

According to the UN Organization for the Coordination of Humanitarian Affairs (OCHA), two million people are displaced in the eastern DRC. Combine this figure with World Health Organization (WHO) data that 10 percent of the world’s population suffer some form of disability, and that would mean 200,000 disabled people among the displaced, many of them children.

“Attention and funding for programmes addressing disability are largely under-funded worldwide, and particularly in Congo,” says Heal Africa’s Laura Keyser.

“The international community might not see disability as an emergency worth focusing on now, but it will become a full emergency if nothing is done,” said Loran Hollander of Heal Africa’s hospital in Goma.

Increasing Risk Factors

While funding for treatment remains minimal for agencies specializing in treating disabilities, the number of disabled children and those at risk continues to grow due to the increased risk factors brought on by the breakdown of the health infrastructure, ongoing violence and displacement in the eastern DRC.

Minimal access to healthcare, clean water, and overall poor nutrition during pregnancy lead to common congenital disabilities in children such as spina-bifida and limb deformities, and young children predisposed to early childhood diseases such as meningitis and polio, explained Keyser.

Access routes to health centres are often blocked for patients and medical teams. This lack of access leads frequently to birthing complications, child developmental delays and maternal mortality.

Furthermore, the prevalence of rape in the DRC is also linked to a probable increase in child disability. “Frequently women pregnant from rape do not seek pre- or peri-natal care, which can lead to the problems aforementioned, as well as birth trauma - either to the baby (ie lack of oxygen leading to cerebral palsy or some type of developmental delay) or to the woman (ie a fistula, which may or may not leave them incontinent),” said Keyser.

Vulnerability

“Unfortunately, disabled children are more vulnerable to abuse, exploitation, neglect and discrimination. They face reduced social participation and have less access to education and other social services than children without disabilities,” states Golden.

In addition, according to Handicap International and Heal Africa, inside the camps as well as outside, children with a disability struggle daily with social stigma and discrimination.

Proper treatment, according to UNICEF, Handicap International and Heal Africa, provides the children with the physical ability to function more fully in society while also educating the community to break down stigma and social restrictions.

UNICEF notes that “early detection and intervention might confer benefits to children at risk for disability and prevent long-term functional limitations”.

Jusbeen, 4, came to the Heal Africa’s clinic with a serious infection, a noma, which had “scarred down” his mouth, making it difficult to eat or drink. Therapists discovered that Jusbeen also suffered from developmental delays. However, since his disability was caught early, he has undergone a significant transformation. With ongoing therapy and constant encouragement from his mother, Keyser notes, “he is now able to walk with hand-held assistance, smiles, laughs and engages in play activities which were impossible before”.

Due to minimal international attention to child disability amid the numerous crises afflicting the DRC, children like Jusbeen and Helena, who received treatment, remain among the minority. “These children need all the help they can get,” says UNICEF. At present, that help is limited.

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http://www.irinnews.org/report.aspx?ReportId=86710ADDIS ABABA Friday, October 23, 2009 (IRIN) - With non-skilled jobs in the Ethiopian capital, Addis Ababa, paying as little as US$16 per month, the financial incentives to engage in commercial sex work are overwhelming - earning 30 times a domestic worker’s salary.ADDIS ABABA Friday, October 23, 2009 (IRIN) - With non-skilled jobs in the Ethiopian capital, Addis Ababa, paying as little as US$16 per month, the financial incentives to engage in commercial sex work are overwhelming - earning 30 times a domestic worker’s salary.

Many of the women entering into sex work in Addis are rural migrants who have failed to secure formal employment, or are escaping poor-paying jobs in the city or unwanted marriages in the country, according to a 2008 article [http://download.interscience.wiley.com/cgi-bin/fulltext?ID=119387830&PLACEBO=IE.pdf&mode=pdf] published by the UK's Royal Geographical Society.

Teguest, a 16-year-old girl from Gonder, a town 700km northwest of Addis Ababa, fled to the capital four months ago after the death of her parents and a dispute with her brothers.

The relative she contacted in the capital was already engaged in sex work, so the decision to enter the trade was an easy one. Teguest charges 10 Ethiopian Birr or $0.80 per client and has sex with as many as 20 men a day in her tiny room; she is adamant that under no circumstances would she have unprotected sex.

"No, I would not do that for any money. I need my life," she said. "They sometimes offer 200 Birr [$16] and beg me, but life is more important than money."

Teguest says in the past four months, at least 10 men have asked her for unprotected sex at a higher fee.

The good news, according to research by Wise-UP - a condom-promotion project implemented by local NGO Timret Le Hiwot [http://timretlehiwotet.org] and funded by social marketers DKT-Ethiopia [http://www.dktethiopia.org] - is that 99 percent of sex workers in 42 Ethiopian cities said they used a condom with their last paying partner, compared with 91 percent in 2002.

Shame factor

But according to health workers, not all sex workers are as fastidious about condom use as they claim. When Abeje Israel, monitoring and evaluation officer at Wise-Up, posed as a paying customer for random surveys, some women did agree to have sex without a condom for a higher fee.

A 2006 study [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2576726] published in the British Medical Journal found that results of sex worker studies obtained using surveys and questionnaires may be biased as they will not always reveal the truth because of "pride, fear, or shame".

"They may say that they do not have sex without a condom, but the reality may be different; they may pretend and not show the real circumstances," Abeje said.

"All these [sex] workers are very vulnerable," he added. "They are not very powerful and they receive a very small sum of money; if you offer them more money, they may be willing to have sex without a condom."

Education vital

Further investigation makes it clear that the city's sex workers still need education on protecting themselves from sexually transmitted infections.

Meron, 25, also says she would never have sex without a condom, but added that she took the “precaution” of insisting her clients used two condoms - a practice roundly advised against as it increases the chances of a condom tearing.

Low levels of education and alcohol use also affect the likelihood of female sex workers using condoms, according to a study [http://ejhd.uib.no/ejhd-v20-n2/93_98_EJHD_20%20no%202%20final.pdf] by Addis Ababa University.

Wise-UP aims to achieve 100 percent condom use among sex workers in the capital, which has an HIV prevalence rate of 7.5 percent, almost four times the national average of 2.1 percent.

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http://www.irinnews.org/report.aspx?ReportId=86718SAN Friday, October 23, 2009 (IRIN) - Have you checked in with your breastfeeding support group? If you were a woman who gave birth in one of Mali’s 48 “baby-friendly hospitals”, you should have been assigned to one that checked up on you - often as soon as minutes after the delivery.SAN Friday, October 23, 2009 (IRIN) - Have you checked in with your breastfeeding support group? If you were a woman who gave birth in one of Mali’s 48 “baby-friendly hospitals”, you should have been assigned to one that checked up on you – often as soon as minutes after the delivery.

In San village, 380km north of the capital Bamako, dozens of mothers in 2005 formed the “Good Mothers” group – known in the local language as Denbanyuma –to tell new mothers about the all-milk rule; 660 mothers across the country are trained to do the same as part of a government child survival programme adopted in 2007, according to the Health Ministry.

“Before, women fed their newborns tea and water without knowing the consequences of this practice,” San mothers’ group leader Aïssa Tangara Traoré told IRIN. The UN has estimated that 300,000 babies could be saved every year in West Africa if they were fed only mother’s milk for the first six months rather than formula, tea, water or food as is generally the case.

Exclusive breastfeeding has been proven to boost a newborn’s defences against malnutrition and infections, yet according to the UN only 20 percent of mothers in West Africa and Central Africa report practicing it. Mali’s Sahelian neighbours have among the lowest numbers: 6 percent in Burkina Faso, 4 percent in Niger.

In a 2006 Mali government survey, 38 percent of women said they breastfed exclusively. The Health Ministry is conducting a new nutrition survey to be completed in 2010.

To date 48 maternity centres in Mali have been accredited – and 26 are in the review process – as baby-friendly hospitals, which is a UNICEF initiative  launched in 1991 to encourage breastfeeding. One of the requirements for accreditation is to form breastfeeding support groups.

“As soon as the baby is washed, we ask the mother to start breastfeeding,” San mothers’ group member Oumou Dembélé, 35 and mother of four, told IRIN. “We visit the mothers every day until they leave the maternity ward.” She added that one Sunday of each month, the Good Mothers group organizes a talk at the San health centre to help convince mothers. “We still have the grandmothers who demand their daughters give babies tea or water,” said Dembélé.

Change

Still perspiring from childbirth at the commune five health centre in Bamako, Diaminatou Cissé rested under her mosquito net with her newborn at her chest. She told IRIN the baby girl would not be fed the same things her older brother was. “My grandmother gave him cow’s milk and tap water. She is no longer alive, but my mother shares her views.” She said she has learned from the centre’s mother mentors that there is already water in milk.

The centre’s midwife, Djeneba Samaké, told IRIN that at baptisms a mothers’ support group talks about breastfeeding. She said economics helps promote breastfeeding: mother’s milk is free. “But even the richest women here who consider powdered milk as a status symbol and sign of progress are now choosing to breastfeed exclusively.”

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http://www.irinnews.org/report.aspx?ReportId=86724DAKAR Friday, October 23, 2009 (IRIN) - UN aid agencies are expanding assistance to Ivoirian refugees in Guinea, for whom aid plans have been thrown off repeatedly by gridlock over elections and general uncertainty in Côte d’Ivoire.DAKAR Friday, October 23, 2009 (IRIN) - UN aid agencies are expanding assistance to Ivoirian refugees in Guinea, for whom aid plans have been thrown off repeatedly by gridlock over elections and general uncertainty in Côte d’Ivoire.

Following an appeal to donors, the UN Refugee Agency (UNHCR) in Guinea recently doubled its funds – to $US390,000 – for health, education and vocational assistance to the some 3,300 Ivoirians at Kouankan II camp in the southeastern N’zérékoré region. Prior to the new funding UNHCR had said its resources for Kouankan II would not last past mid-2009.

The World Food Programme, which had planned to stop food aid at Kouankan II at the end of 2009, has extended its assistance to December 2010, according to WFP-Guinea. Ivoirians at Kouankan receive monthly rations of cereals, oil, beans and sugar.

Aid programming for Ivoirian refugees in Guinea has been based largely on planned presidential elections in Côte d’Ivoire and the ensuing return of most of the refugees, according to Pierre Njouyep, head of UNHCR in N’zérékoré. But elections have been cancelled twice and it is uncertain whether they will take place on the new date of 29 November.

Elections had previously been set for November 2008; in a 2008 update UNHCR estimated that 2,000 Ivoirian refugees would voluntarily return home in the following months. The agency now projects that repatriation of those wishing to return will take place between February and June 2010, said Njouyep. “This depends heavily on the holding of elections on 29 November as planned.”

The additional funding for Kouankan II is to be used for agriculture and income-generating projects, medicines, academic scholarships, rehabilitation of school buildings in the camp, and to expand skills training at a vocational centre.

Ivoirians at Kouankan II have long called for training activities to be maintained at the centre, after NGO Jesuit Refugee Services – which funded and ran it – left in December 2007.

Not ready

B. Toualy Apolinaire, an Ivoirian living at Kouankan II, said many at the camp are far from ready to return to Côte d’Ivoire.

“We did not choose to become refugees,” he told IRIN from N’zérékoré. “But I and many of us saw unbelievable violence and we cannot simply pick up and return, especially given the continued uncertainty.”

Uncertainty has now crept into the refugee camp, Toualy told IRIN. Tensions in Guinea following the 28 September deadly military crackdown have Ivoirians concerned about potential further unrest and how it could affect them.

As yet unaware of plans to continue food aid, he said: “Were food aid to stop at end of 2009 you would find a lot of people in a critical condition here.”

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http://www.irinnews.org/report.aspx?ReportId=86726BAGHDAD Thursday, October 22, 2009 (IRIN) - Panic over the possible spread of H1N1 influenza has prompted the closure of more than 2,000 schools in Iraq, according to officials. BAGHDAD Thursday, October 22, 2009 (IRIN) - Panic over the possible spread of H1N1 influenza has prompted the closure of more than 2,000 schools in Iraq, according to officials.
 
Education Minister Khudhair Al-Khuzaie said the unauthorized closure of schools was “illegal and unprofessional” and blamed “exaggerated media reports that have created such a panic”.

“Over the past week, we diagnosed four cases of H1N1 influenza among school students in the southern province of Kut, then the number increased to 25 cases and that prompted us to quarantine and shut down the school [where the cases were detected],” said Ihsan Jaafar, a senior Health Ministry official.
 
A few days later, other cases were confirmed in six Baghdad schools. “We’ve also closed them and that brings the total number of schools closed based on decisions issued by the Health Ministry to seven,” Jaafar told IRIN.
 
“Unjustified panic” had prompted some officials in southern Iraq to close schools where no H1N1 cases had been detected, a measure “unacceptable to the Health Ministry,” Jaafar said.
 
On 20 October, two local officials in the southern provinces of Thi Qar and Kut said that nearly 2,500 schools and kindergartens would be closed to prevent the disease from spreading.

Muthana Hassan Mahdi of Kut education directorate said a five-day precautionary shutdown had been in force since 21 October in 950 schools and kindergartens.

Meanwhile, Hadi Al-Riyahi, a local health official, said 1,477 schools would be closed in Thi Qar for 10 days from 22 October.

Kut is 160km and Thi Qar is 320km south of Baghdad.
 
Precautionary measures

Schools should only be closed for a week if a teacher and 2-3 students have the disease, Jaafar said. Those infected would be quarantined and the school sterilized. Students and infected students' families would be closely monitored, he added.
 
Tamiflu stocks were sufficient for 300,000 cases; another batch of 150,000 doses was expected in the next few days, he said.

According to the Health Ministry, the total number of confirmed H1N1 cases in Iraq is 523, of whom 113 are Iraqis and the rest foreigners, including members of the US forces. The death toll stands at three.
 
Education Minister Al-Khuzaie said overcrowding due to a shortage of school buildings represented an increased risk factor. He said US$4 billion was needed to build more than 4,500 new schools to ease overcrowding in Iraq’s roughly 19,000 schools.
 
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http://www.irinnews.org/report.aspx?ReportId=86693TEL AVIV Thursday, October 22, 2009 (IRIN) - Israeli Interior Minister Eli Yishai has said he will not grant legal status to some 1,200 children of migrant workers, triggering an anti-deportation campaign led by several NGOs. TEL AVIV Thursday, October 22, 2009 (IRIN) - Israeli Interior Minister Eli Yishai has said he will not grant legal status to some 1,200 children of migrant workers, triggering an anti-deportation campaign led by several NGOs.

The 1,200 are not included in the 2006 government scheme that granted legal status to over 600 children of migrant workers.
 
“Their parents are using them to gain legal status in Israel… If we do not deport them, migrant workers will continue to exploit the kindness of the state of Israel,” Yishai said.
 
A clause in most migrant workers’ contracts forbids them from having children in Israel and says pregnant women must leave the country. Many NGOs say the clause is inhumane and draconian.
 
Nevertheless, an estimated 2,000 children of migrants were said to have been born in the past decade in Israel, according to the Tel Aviv Education Authority.
 
Some 250 families face deportation along with hundreds of children born in the past three years in Israel, according to activists campaigning for migrants’ rights.
 
In July, OZ (the new immigration enforcement unit) launched an operation aimed at deporting nearly 300,000 illegal migrants and visa violators, according to Tziki Sela, head of OZ in Israel’s Immigration Authority.
 
Criticism by some members of parliament, and religious and community leaders, forced Prime Minister Benjamin Netanyahu to postpone the deportation of families of migrant foreign workers with children: Due to begin on 1 August, it was halted for three months.
 
Meanwhile, an official OZ report seen by IRIN on 21 October said 700 migrant workers without children had been deported since 1 June 2009, and 2,000 had "left willingly".
 
On 12 October, a parliament committee on migrant workers decided to start deporting children by the middle of 2010 when schools close.

Anti-deportation campaign
 
Deportations are set to take place despite a "massive" (according to top Israeli officials) anti-deportation campaign led by several NGOs and aid organizations, including Moked, the hotline for migrant workers.
 
Karen Tal, manager of the Bialik-Rogozin public school in southern Tel Aviv, told reporters some 302 children in the school (out of 784) are up for deportation if Yishai does not change his mind. Tal spoke about the hardships and uncertainty faced by the children since June, when the intention to deport them was revealed.
 
Sources in the Immigration Authority and the OZ unit told IRIN they had no intention of operating within schools despite the relative ease of detaining children and parents there.

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http://www.irinnews.org/report.aspx?ReportId=86694CAIRO Thursday, October 22, 2009 (IRIN) - The Egyptian ministries of health and education have ordered all schools in Cairo to halve the number of children in each class to mitigate the possible spread of H1N1 influenza - no small challenge in this overcrowded city of 20 million.CAIRO Thursday, October 22, 2009 (IRIN) - The Egyptian ministries of health and education have ordered all schools in Cairo to halve the number of children in each class to mitigate the possible spread of H1N1 influenza - no small challenge in this overcrowded city of 20 million.

The resulting uncertainty has led schoolchildren to attend classes on three alternate days a week instead of six under a long-running double-shift system designed to ease overcrowding.

“I go to school on the second shift on Sunday, Tuesday and Thursday now,” Toqa Ali, 13, a student at Abdullah Ibn Rawaha School in the Imbaba area of Cairo, told IRIN. She said she used to have up to 80 children in her class but there were now around 25 as children were attending on alternate days and some were staying at home for fear of catching H1N1.

Toqa said she and many other children wore surgical masks in play time but tended to take them off in classrooms, which now have the windows open and fans on most of the time.

The UN Children’s Fund (UNICEF), in conjunction with the Health Ministry, has run an extensive awareness campaign with TV advertisements, public service announcements and awareness kits.

“We are distributing awareness kits in all schools in Egypt on avian flu and H1N1. In fact, we already had a distribution network set up for avian flu so now we are just adding H1N1,”said Hala Abu Khatwa, chief of communications for UNICEF in Egypt.

WHO school guidelines

A World Health Organization (WHO) briefing note in September for schools said schools could serve as a vector for spreading the virus.

It recommends hand hygiene, respiratory etiquette, proper cleaning, good ventilation, isolation of staff or students who fall ill and measures to reduce overcrowding.

“Decisions about if and when schools should be closed during the pandemic are complex and highly context-specific. WHO cannot provide specific recommendations for or against school closure that are applicable to all settings.”

However, it said that the timing of school closures was critically important and that “modelling studies suggest that school closure has its greatest benefits when schools are closed very early in an outbreak, ideally before 1 percent of the population fall ill.”

To close or not to close?

“While slowing the speed of spread of H1N1 by schools’ closure can buy some time as countries intensify preparedness measures, there are a lot of discrepancies about it, as school closure is associated with social and economic impacts,”said Rana Zaqout, head of the Pandemic Influenza Contigency (PIC) unit for the Middle East and North Africa, which is part of the UN Office for the Coordination of Humanitarian Affairs (OCHA).

“As a parent, while I am concerned about the academic year, I believe that school closure should reduce the transmission of the disease if accompanied by policies that include measures that limit congregation of students outside schools,” she added.

On 14 October, Education Minister Youssri el-Gamal told the Middle East News Agency: “There is no intention of closing schools at the beginning of the winter season.” He said only 10 children out of 20 million primary and secondary students in the country had been infected.

Two days later, La Mère de Dieu girls’ school in Cairo became the first school in Egypt to be closed after three H1N1 cases were discovered. The 1,200 pupils were ordered to stay at home for two weeks.

On 22 October, four private schools in the greater Cairo area were closed for two weeks.

“The main issue is that people do not trust the government or the Health Ministry. They don’t feel they are transparent,” Abu Khatwa of UNICEF told IRIN.

A number of classrooms in schools in Cairo and Alexandria have also been closed for two weeks on orders from their respective city governors.

Exams

Ahmed Ali, a teacher at Youssri al-Gamal School in Imbaba (Cairo), felt that overcrowding was the enduring problem. While he was happy to see his 70-children classes more than halved this term, he still had concerns:

“I can’t teach them the same curriculum in half the time. The Education Ministry will have to delay exams this semester so the students will have a chance to pass,” Ali said.

Meanwhile, the Egyptian Health Ministry said it would be receiving its first batch of H1N1 vaccinations - some 80,000 doses - on 23 October.

“Priority will be given to pilgrims going on Hajj, doctors treating H1N1 cases, people who work in public transport and public services, journalists, and school and university students with chronic illnesses, health complications or a weak immune system,” Health Minister Hatem el-Gabali said in a statement.

As of 17 October, WHO reported 14,739 laboratory-confirmed cases of H1N1 in its 22-country Eastern Mediterranean Region. Egypt had the fourth highest number of cases - 1,053 - and two deaths.

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http://www.irinnews.org/report.aspx?ReportId=86695JOHANNESBURG Wednesday, October 21, 2009 (IRIN) - When a place is so remote that you can only reach it on foot or horseback, a cash-in-transit operation is a real challenge - but Lesotho's Child Grants Programme (CGP) has overcome it with air support.JOHANNESBURG Wednesday, October 21, 2009 (IRIN) - When a place is so remote that you can only reach it on foot or horseback, a cash-in-transit operation is a real challenge - but Lesotho's Child Grants Programme (CGP) has overcome it with air support.

In Thaba Khubelu, a tiny village in the mountainous district of Qacha's Nek, about 400km from the capital, Maseru, some 250 households eagerly watched as a military helicopter touched down to deliver their first quarterly instalment of 360 maloti (US$48) each.

"It is a gift from the sky! Now I can buy clothes for myself and my brothers so we will look like all the other children when we go to school," said Mamello, 16, who received the cash in phase two of the CGP, launched on 20 October.

"I am so happy to get this money, we need it so much," she said. The programme aims to supplement the income of the poorest households caring for orphans and other vulnerable children (OVC) to ease the poverty that has prevented them from having enough to eat, staying healthy and going to school.

Unfortunate to be so lucky

Yet even with the free money Mamello was hardly the envy of the village: she lost both her parents and now has to care for two younger brothers. "They [parents] were very sick and it was painful to see them suffer. I had to stay out of school for some time," she said.

Speaking at the launch, Ahmed Magan, Lesotho representative of the UN Children's Fund (UNICEF), said: "We need to ensure the most needy families and children are the ones that are being reached and that benefit from social protection programmes."

This is not easy, considering the depth of poverty in this tiny landlocked country. UNICEF has noted that over half the population live below the poverty line and in a state of chronic food insecurity, which has been worsened by the global economic crisis.

Mphu Ramatlapeng, the Minister for Health and Social Welfare (HSW), said: "The grant is meant to benefit the most vulnerable and disadvantaged, not anyone else."

According to his department, Lesotho has more than 180,000 orphaned children, of which 55 percent have lost one or both parents to HIV/AIDS-related illnesses. About 23.2 percent of the country's nearly two million people are HIV positive - one of the highest prevalence rates worldwide.

Ambitious scale-up

The project started in April 2009 with payments in the western district of Mafeteng, where access was not an issue. Now, having covered the most remote of the three pilot districts, the government hopes to extend the programme throughout the country.

Mohemmad Farooq, a UNICEF social policy specialist who helped design the project, said the current budget was expected "to take the programme to five districts of the country, and reach around 24,000 OVC in approximately 8,000 households by 2011". The European Commission donated $7.3 million to the initiative and UNICEF is providing technical assistance.

The pilot phase would help develop and test the systems for targeting, enrolment and payment of beneficiaries; monitoring, procurement and financial management; training stakeholders, public information and education. "Lessons learned will guide refinement of the Cash Grant in preparation for expanding into other districts," Farooq told IRIN.

"Social cash transfer programmes provide a predictable income for the poorest and most disadvantaged families to alleviate the burden of poverty, meet their basic needs and invest in children ... it will [also] create economic activity to contribute to the overall development of the country," he said.

"The Government is already looking at strategies for fund-raising, and for absorbing the cost of the programme in their national budget."

Ramatlapeng was optimistic that the project could be rolled out sustainably: "Through the grant, the government is aiming to reach about 60,000 children and ensure they attend school, access services and receive counselling and nutrition support."

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http://www.irinnews.org/report.aspx?ReportId=86677DAKAR Wednesday, October 21, 2009 (IRIN) - Yellow fever is a “ticking time bomb”, while measles has been eliminated three years ahead of schedule in parts of Africa and the Eastern Mediterranean. These are among the highlights of the most recent World Health Organization (WHO) report, State of the World’s Vaccines and Immunization:DAKAR Wednesday, October 21, 2009 (IRIN) - Yellow fever is a “ticking time bomb”, while measles has been eliminated three years ahead of schedule in parts of Africa and the Eastern Mediterranean. These are among the highlights of the most recent World Health Organization (WHO) report, State of the World’s Vaccines and Immunization:

One quarter of the annual under-five deaths, or about 2.5 million, are caused by diseases that can be prevented with vaccines.

Immunization currently saves between two million and three million lives per year.

There are about 20 vaccines currently in use globally. Another 20 new or improved vaccines are expected to be available by 2015.

There is no treatment for yellow fever and an “insecure” vaccine supply in Africa where about 27,000 die annually from the disease. There is a gap of 10 million doses every year to meet demand in Africa. An additional six million is needed for any outbreaks.

Eradicating smallpox cost US$100 million over a 10-year period up to 1977 and has since saved $1.3 billion annually in treatment and prevention costs.

Nine African countries have eliminated neonatal tetanus.

Two H5N1 flu vaccines have been developed in the US and Europe. Six vaccine manufacturers in developing countries have started H5N1 vaccine development as of early 2009 as part of a WHO technology transfer initiative.

In 2007 an estimated 105 million children under the age of one were vaccinated with diphtheria-tetanus-pertussis (DTP3) vaccine, protecting them against infections that can lead to illness, disability or death; another 24 million children under the age of one did not receive the DTP3 vaccine doses in 2007. About three-quarters of the non-vaccinated children live in 10 countries ? Bangladesh, China, Democratic Republic of the Congo, Ethiopia, India, Indonesia, Niger, Nigeria, Pakistan and Uganda.

On average 1.3 million infants and young children die every year from pneumococcal disease and rotavirus diarrhoea, for which vaccines exist.

The Meningitis Vaccine Project is working on a new vaccine for meningococcus, which is endemic in every country in the world. Clinical tests are ongoing for a vaccine to prevent the strain Meningitis A, which leads to large deadly epidemics every seven to 12 years in sub-Saharan Africa.

The Eastern Mediterranean region – which includes countries such as Afghanistan, Pakistan, Somalia, and Sudan – has cut measles deaths by 90 percent from 2000 to 2007, already achieving the UN goal of cutting measles deaths by 90 percent by 2010. But despite a global measles vaccination rate of 82 percent, there were still 197,000 reported deaths from measles in 2007.

Worldwide incidence of poliomyelitis has dropped by 99 percent, from 350, 000 cases reported in 1988 to 1,655 cases in 2008. It remained endemic in four countries as of June 2009: Afghanistan, India, Nigeria and Pakistan.

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http://www.irinnews.org/report.aspx?ReportId=86679HARADH Tuesday, October 20, 2009 (IRIN) - Fatma Abdullah’s daughters Salma, aged 9, and Khadija, 11, are going to school for the first time in their lives in al-Mazraq camp for internally displaced persons (IDPs) in Haradh District, Hajjah Governorate, northern Yemen.HARADH Tuesday, October 20, 2009 (IRIN) - Fatma Abdullah’s daughters Salma, aged 9, and Khadija, 11, are going to school for the first time in their lives in al-Mazraq camp for internally displaced persons (IDPs) in Haradh District, Hajjah Governorate, northern Yemen.

They had never been to school in their home area in Malihidh District, Saada Governorate, near the border with Hajjah, the scene of clashes between government troops and Houthi-led Shia rebels.

Salma and Khadija have enrolled in grade one, rather than grades three and five that children their age would normally be in.

"Before we fled our homes, my children received no education… They couldn't go to those faraway schools in neighbouring villages," said 50-year-old Fatma, a mother of nine.

"It is better for us to live in this camp than in our home district… I would like to see our little girls reading things to us and the other seven family members, including the three boys, who have never been to school."

UN officials said they were pleased: "I am pleased to see more than 80 little girls with their books in this classroom… It is our duty to teach children about their right to have education, food and protection,” Mahmoud Kabil, regional goodwill ambassador for the UN Children’s Fund (UNICEF), said on 19 October during a visit to the camp, some 300km northwest of the capital, Sanaa.

Poor conditions

"I saw children [in al-Mazraq camp] on the brink of death due to acute malnutrition and dehydration... I have never seen such a sight since I became UNICEF regional goodwill ambassador in 2003 - not when I was in Darfur five years back, or anywhere in this region," said Kabil in a statement on 20 October.

UNICEF said the latest estimates from Hajjah Governorate suggested there were up to 14,000 IDPs in and around al-Mazraq camp.

A daily influx of newcomers to the camp was weakening the already basic infrastructure.

"One month ago, there were only 1,000 IDPs in the camp, but now their number exceeds 7,000, most of whom are children," Nasim Ur-Rehman, chief communications and information officer for UNICEF in Yemen, told IRIN on 19 October.

Burgeoning numbers

Yarmouk primary school in the camp originally served 135 local children, but now caters for some 950 (777 displaced and 165 locals), according to Ibrahim Qadash, a teacher at the school.

UNICEF, in cooperation with other aid agencies and local authorities, has provided tents, blackboards and teachers so that the school can cope with the growing numbers.

"We provided extra teachers and pay them to teach displaced children," said Ur-Rehman. "Between 30 and 40 displaced children apply for enrolment every day… Now, the school has 11 teachers, compared to only five who were teaching at the school before the displacement."

Children in classrooms or tents sit on the ground as there are not enough chairs. "Chairs don't matter, and they can learn without chairs," al-Qadash told IRIN. "The most important thing is that they get an education."

Schools damaged

Dozens of schools in Saada Governorate, where the fiercest fighting is taking place, have been damaged or completely destroyed in five years of intermittent conflict, said Abdullah Dhahban, a local councillor. "The war deprived tens of thousands of children of their right to education."

However, Dhahban noted that around 50 percent of school-age children in rural areas in Saada did not go to school even before the war and that at least half of those that did go to school, dropped out before grade seven.

According to UNICEF, at least half of the estimated 150,000 IDPs in northern Yemen are children.

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http://www.irinnews.org/report.aspx?ReportId=86656NAIROBI Monday, October 19, 2009 (IRIN) - Julia Nyaberi's* "clinic" in Majengo, a slum in Kenya's capital, Nairobi, caters to one type of client only - pregnant women seeking abortions.NAIROBI Monday, October 19, 2009 (IRIN) - Julia Nyaberi's* "clinic" in Majengo, a slum in Kenya's capital, Nairobi, caters to one type of client only - pregnant women seeking abortions.

Young women writhe in pain on the floor of the poorly lit house; the neighbours all know what happens here and have become immune to the moans and wails.

"They come to me and each pays me 50 shillings [US$0.70]," Nyaberi told IRIN/PlusNews. "Most of them are sex workers who operate here in Majengo and have conceived by mistake."

She uses a concoction of herbs to induce abortion, and admits there have been fatalities. "Even qualified drivers at times cause accidents; I do not do this job to kill anyone, but at times some are unlucky and go together with the child they came to abort," she said.

Diana Awuor*, 21, is a sex worker in Majengo, and fell pregnant after unprotected sex with a regular client.

"Not that I have sex without a condom every day but there are some regular clients you can excuse at times and I think that is how I became pregnant," she said. "We cannot do our work while pregnant because nobody will want you, so I have to abort to stay in business, and also, I don't want a baby."

Back-street clinics

Ministry of Health statistics put the number of Kenyan girls and women who have abortions every year at 300,000; abortion remains illegal so many of these take place in back-street clinics like Nyaberi's. According to the International Planned Parenthood Federation, http://www.ippf.org/NR/rdonlyres/8D4783F5-D516-47D3-8B34-61F6D510202A/0/Death_Denial_unsafe_abortion_poverty.pdf, unsafe abortions account for between 30 and 50 percent of maternal deaths in Kenya.

"One person attending to up to even five women without sterilizing whatever instruments are being used can spread HIV," said Jacky Abuor, a counsellor at the faith-based Kenyan NGO, Crisis Pregnancy Ministries, which works with young women dealing with unwanted pregnancies.

The legalization debate

A recent study by the local NGO, Centre for the Study of Adolescence (CSA), http://www.csakenya.org found that four in 10 Kenyan girls had sex before the age of 19, many with multiple partners and often in exchange for gifts such as mobile phone airtime or food. Along with the predictable public outcry, http://allafrica.com/stories/200910131192.html the report re-ignited the legalization debate.

Women's rights groups have long urged the government to legalize abortion to prevent the high number of maternal deaths from unsafe procedures. A Reproductive Health and Rights Bill proposing that "safe and accessible abortion-related care" be enshrined in the constitution as a reproductive right was tabled in Parliament in 2008 by the Federation of Women Lawyers and the Coalition On Violence Against Women; MPs have yet to vote on the issue.

The country's anti-abortion movement has powerful backers, from religious leaders to politicians, such as Vice-President Kalonzo Musyoka.

Sex education

"When you say four out of 10 girls have engaged in sex, how do we keep the remaining six from being lured into early sex? The window lies in counselling and education," said Anne Muisyo, “Abstinence and worth the wait” programme coordinator at Crisis Pregnancy Ministries.

"Sex education at the early stages of life and especially targeting young people can significantly turn the tide and prevent new cases of HIV," Paul Mitei, head of gynaecology in western Kenya's Nyanza Provincial Hospital.

Kenya's Ministry of Education has an HIV/AIDS prevention and sex education curriculum that focuses on upper-primary and secondary school, but no specific time is set aside for this during the school day, leaving teachers and school heads to fit in the subject at their discretion.

Speaking at a recent meeting in Nairobi, Kenya's director of public health, Shanaaz Sharif, admitted that opposition from parents, religious groups and some civil society bodies had led to a "censored sex education campaign" in schools.

Agnes Odawa, in charge of guidance and counselling at the education ministry, told IRIN/PlusNews the government had plans to introduce a more detailed sex education package as part of the school curriculum.

Responding to the CSA's findings, the head of the National AIDS Control Council, Alloys Orago, said the government was also looking into the promotion of condom use among teenagers.

Currently the government's HIV prevention programme for teens revolves around the promotion of abstinence, with a nationwide media campaign urging young people to "chill", or abstain, from early sex.

"Many young girls and even boys in rural areas and poor settings do not really know about contraception; those of them who use the condom only know it as a means of preventing HIV," said Mitei. "There is a need to promote condoms to young people both as an HIV preventive measure and birth control measure."

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* not her real name

http://www.irinnews.org/report.aspx?ReportId=86641DAKAR Thursday, October 15, 2009 (IRIN) - For decades diarrhoea has been a stealth killer, claiming more under-five children than AIDS, malaria and measles combined, yet it remains a neglected disease, according to World Health Organization diarrhoea specialist Olivier Fontaine. "We made huge progress in the 1980s, but donor investment decreased in the 1990s as attention was diverted to AIDS, tuberculosis and malaria."DAKAR Thursday, October 15, 2009 (IRIN) - For decades diarrhoea has been a stealth killer, claiming more under-five children than AIDS, malaria and measles combined, yet it remains a neglected disease, according to World Health Organization diarrhoea specialist Olivier Fontaine. “We made huge progress in the 1980s, but donor investment decreased in the 1990s as attention was diverted to AIDS, tuberculosis and malaria.”

Diarrhoea received less than 5 percent of total disease research and treatment funding in 2007, a fraction of the funding put toward other diseases that claimed far fewer lives.

The most severe forms of diarrhoea – which can lead to dehydration – kill an estimated 1.5 million under-five children every year. Most children recover from milder forms – more than four billion children get diarrhoea every year. “There is no reason for these deaths,” said WHO’s Fontaine. “There are 20th-century revolutionary medical miracles that should have wiped out [diarrhoea] by now.”

Zinc

But treatments like oral rehydration therapy (ORT), salty liquids, reach less than 40 percent of children who need them in Asia and Africa, according to UN Children’s Fund (UNICEF).

In recent years zinc tablets have been proven to boost ORT’s efficacy. “Zinc is the most ubiquitous mineral in the body,” said Fontaine. “It is responsible for activating more than 300 enzymes. Every level of metabolism needs it and the immune system is dependent on it.”

Recommended five years ago by World Health Organization to accompany ORT, the zinc tablet – costing less than 2 US cents – has been studied in diarrhoea treatments since 2007 in countries from Bangladesh to Brazil, said Fontaine. In Mali, US-based Johns Hopkins School of Public Health is carrying out a three-year study on zinc scheduled to finish in June 2010.

But despite a donor push to get zinc into at-risk communities – UNICEF purchased almost 160 million zinc tablets in 2008 – the agency has said need outstrips supply and that both zinc and ORT have been slow to roll out in some of the worst-affected areas.

Director of nutrition services at Mali’s Health Ministry, Racky Ba Samaké, told IRIN that while zinc is used to treat diarrhoea in Mali, it is not yet distributed widely as a supplement because of cost.

But WHO’s Fontaine told IRIN zinc can be a money-saver, and has helped cut the cost of treating diarrhoea by one-fourth in India. “In Mali we have parents who actually complain to us that their children have too much of an appetite. Zinc boosts appetites and [helps avoid] unnecessary drugs and long hospital stays.”

In a recent report on diarrhoea, UNICEF outlined a seven-point plan to treat and prevent childhood diarrhoea that includes the rotavirus vaccine  – which can help prevent one of the most common viral causes of diarrhoea; exclusive breastfeeding and Vitamin A to boost children’s immune systems; hygiene through hand-washing, safe water and a clean environment; and oral rehydration therapy and zinc to nurse children to health.

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