GlobalHealthAfrica

Posts Tagged ‘Africa’

Elimination of Child Labor in Africa – An Ongoing Challenge

In Child Labor, Children on May 26, 2014 at 5:47 pm

In Part 1, GHA Contributor Neha Ahmed called attention to the multitude of health hazards child gold miners faced in Tanzania. In Part 2, Neha explores viable solutions that could possibly eliminate child labor in Africa.

Moving wood for the family, for the economy. Image by  IamNotUnique

Moving wood for the family, for the economy. Image by IamNotUnique

June 12 commemorates World Day Against Child Labor, which was first launched in 2002 by the International Labour Organization (ILO) to draw attention to the practice of child labor around the world. The eradication of all forms of child labor has been a major aim of the ILO since its inception in 1919. Yet, the 2014 UN report on the State of the World’s Children acknowledges that more than fifteen percent of the world’s children are currently engaged in child labor. This translates into one in every 6 children in the world today being involved in some form of work.

Although child labor is thoroughly global and affects every part of the world, Sub-Saharan Africa continues to be the region with the highest proportion of children engaged in child labor, with over 21% of the child population or 51 million children, still doing work that meets the definition of child labor. Although there has been a drop in the prevalence of child labor since the early 1990s, the world remains far from the goal of eliminating child labor.

The phenomenon of child labor in Africa is complex and is closely linked to poverty, inequality and global economic forces. The need to make ends meet forces children to seek work, often at the expense of their education as well as their health. The prevalence of child labor differs significantly between countries in Africa, as shown in the table below. There are also major differences in the conditions and pathways that are thought to lead to child labor as well as the kinds of work children are engaged in. In many parts of Sub-Saharan Africa, increases in poverty and the devastating effects of HIV/AIDS have led to more children being pushed into the workforce.

In Kenya, for instance, children are engaged in some of the worst forms of child labor, including working in mines, tea plantations, construction and as domestic servants. There are reports that children are used to traffic drugs and weapons. Children are also especially vulnerable to human trafficking and all forms of abuse. It is estimated that up to 18,000 children in Kenya are engaged in commercial sexual exploitation. In countries such as Somalia, which continue to experience conflict, children are often systematically conscripted for armed groups and militias. Child labor in Egypt, on the other hand, appears to be concentrated in the agricultural sector, where children may have to work long hours and be exposed to hazardous chemicals and pesticides.

The last few years have seen some progress towards eliminating child labor, particularly in its worst forms. However, the recent global economic crisis is thought to have had a detrimental effect on child labor. By increasing unemployment and pushing more families into poverty, the economic downturn forced children to turn to work in order to assist their households. Although the enforcement of labor laws and the creation of policy initiatives are an important aspect of addressing the problem of child labor, there is considerable skepticism that these factors alone will improve the lives of children. Given that complex global economic forces shape the lived reality of populations around the world, the elimination of child labor must be tied to more fundamental changes to global trade relations and the distribution of wealth.

Click here to access data on child labor in African countries.

Tackling the Health and Economic Risks of Child Marriage

In Healthcare, Youth on March 29, 2014 at 3:52 pm

What will it take to end child marriage? GHA blogger, Sophie Okolo, points out the recent change in dialogue and highlights the health and economic risks of child marriage in Africa.

Early this year, the conversation about child marriage shifted from human rights to that of health and education. Child marriage is still a hot button issue in many African countries hence this change was significant. By shifting the conversation, public health professionals can address this issue in a tactful way since cultural beliefs are difficult to change. Like any important issue of our time, finding creative ways to address such issues can lead to a change of heart and eventually, cultural transformation.

girl

Despite recent condemnation of child marriage in many African countries, tradition and beliefs continue to ruin young lives in remote regions. For example, child marriage is prohibited under Nigeria’s Child Rights Act (enacted in 23 of 36 Nigeria’s 36 states), which bans marriage or betrothal before the age of 18. But federal laws compete with age-old customs, as well as a decade of state-level sharia law in Muslim states. Last year, the Nigerian Senate came under attack for failing to include the age at which girls can get married thereby condoning child marriages. These customs and laws should be challenged although health information can go a long way in addressing this critical issue. For instance, girls who marry too young are denied the educational opportunities of their peers and are put at greater health risks, such as HIV and teen pregnancy. Teen pregnancy may lead to a difficult and prolonged labor which can result in a fistula, an abnormal connection between an organ, vessel, or intestine and another structure that causes uncontrolled urination or defecation. According to Dr Mutia, one of two practicing fistula surgeons in Zamfara, Nigeria, “fistulas can happen to anyone, but are most common among young women whose pelvises aren’t at full capacity to accommodate the passage of a child.” In the development community, studies have shown that child marriage is also linked to poverty. Rachel Vogelstein, a Fellow for Women and Foreign Policy at the Council on Foreign Relations, states that “Recent research suggests that families in crisis situations are more likely to marry their daughters early, either to preserve resources by offloading economic responsibility for their girl children or in an attempt to ensure their daughters’ safety from conflict-related sexual violence.” Clearly, child marriage is a complex issue.

Although the number of global child marriages is declining, rates are staggering in countries like Chad, Niger and the Central African Republic. More than two out of every three girls are married before eighteen. Roughly half of the girls married early in Niger do so before turning fifteen. Since there is no magical solution to child marriage, combined efforts may help women and girls lead healthy and successful lives. The goal is to help African societies fully comprehend the seriousness of the issue.

Improving Health Outcomes in Africa through Intersectoral Collaboration

In Accidents, Health Policies, Healthcare on January 20, 2014 at 5:42 pm

Global Health Africa blogger – Ifeoma Ozodiegwu – shares some of her reflections on improving health outcomes in Africa. She is currently based in Zambia.

collaboration

Here in Zambia, I have spent the past 5 months observing, reading and reflecting on how best to improve the health outcomes in Africa. I am currently obsessed with learning and highlighting best practice ideas to tackle preventable diseases.

It appears to me that part of the answer lies not in solely improving the health sector but in improving all sectors in a country. The death of a hypothetical young mother from undiagnosed HIV is strongly associated to the economic, financial and social structures prevalent within a nation. I am viewing this problem from the angle of poverty and the lack of safety nets that prevented this hypothetical lady from being educated and led her into impoverishment. At this point, she is unable to afford care and consequently, her first point of call when she is ill is the traditional medicine man, who may attribute her illness to spiritual forces.

Health outcomes have deeper roots than an individual’s decision or the state of a health sector. In the words of Dr. Margaret Chan, the WHO Secretary General, “……the threats to health are more numerous, the causes more ominous and the burden more onerous”. Echoing the same sentiment in their treatise on the evolution of health in all policies, IIona Kickbusch and Kevin Buckett write about “wicked problems” in the context of health systems. They define these problems as “difficult to define, may be socially complex, are often multicausal with many inter-dependencies, have no clear solution and are not the responsibility of any one organization or government department”

Consequently, to address the present day health challenges calls for a broader and more collaborative approach by stakeholders – African Governments, donors, health ministries, international and local NGOs. Governments in the region need to create the enabling environment for multi-sectoral collaboration to thrive. Policy-makers can see the results of such collaboration from the Singaporean experience as documented by William Haseltine in his book – Affordable Excellence.  In the book, Haseltine writes about an “unusual degree of unity” that existed within the country’s ministries as far back as the 1980s. This unified front created room for discussion and collaboration on multi-sectoral issues and development of policies that “reaches across ministries”.  In its 2000 World Health Report, the World Health Organization ranked Singapore as sixth on its overall health system performance ahead of several developed countries.

Involving other sectors to work in public health has the potential to bring about exponential improvements in the health of citizens in African countries. For example, collaborations between ministries of transportation and health could be the first step in addressing the high mortality rate from accidents in Africa. See more about accident statistics in Africa.

Such alliances could result in improved availability and response time of emergency care at frequent accident sites. In addition, research collaboration between both ministries can help determine accident risk factors and develop programs to address them. Indeed, one of the proverbs we are fond of in Africa goes: “If you want to go fast, go alone. If you want to go far, go together”.

References

http://www.brookings.edu/~/media/press/books/2013/affordableexcellence/affordableexcellencepdf.pdf

http://www.fic.nih.gov/News/GlobalHealthMatters/november-december-2013/Documents/2013-12.htm

http://www.who.int/sdhconference/resources/implementinghiapadel-sahealth-100622.pdf

http://www.who.int/whr/2000/en/whr00_en.pdf

An African Public Health Story-The Zambia Malaria Initiative Part 1

In Health Policies, Malaria, News on March 10, 2013 at 6:39 pm

The Zambian National Malaria Control Programme appears to be a growing success.  Estimates from the Zambian Demographic Health Surveys indicate a 29% reduction in under-5 mortality for the period, 2001-2007. Even more, a research paper in the American Journal of Tropical Medicine and Hygiene highlights the improvements in household and individual adoption of malaria prevention tools such as insecticide treatment nets (ITN) and Intermittent preventive treatment in pregnancy (IPTp). By 2008, 60% of households in Zambia had at least one ITN and over 60% of pregnant women had received 2 or more doses of IPTp. However, an increase in malaria cases was reported in 2010.

Having read bits and pieces of Zambia’s efforts in combating malaria in the news media, I set out to understand and share, from public health literature, some of the factors that were responsible for their public health gains. In part 2, I will examine the implications of these factors, which I call the building blocks, and the challenges that lie ahead for Zambia and other African nations.

The Building Blocks

National Commitment

After the launch of the Roll Back Malaria Partnership in 1998, the Zambia Government put in place structures that demonstrated a commitment to the elimination of malaria. These included the establishment of a ministerial task force to coordinate the development of the 2000-2005 National Malaria Strategic Plan (NMSP) and the founding of the National Malaria Control Centre (NMCC) in 2002. The National Government also went ahead to eliminate taxation on ITNs and on corresponding insecticides while adopting artemesinin- based combination therapy (ACT) as its front-line anti-malaria therapy recommendation.

By 2005, the National Malaria Control Centre set out to reduce malaria incidence and under-5 mortality in five years by 75% and 20% respectively. These goals were set to be achieved through a combination of prevention strategies that included insecticide treated nets (ITN), indoor residual spraying (IRS) and prompt malaria diagnosis and treatment with Rapid Diagnostic Kits and artemesinin-based combination therapy (ACT). Coverage targets outlined in the 2006-2011 NMSP included: greater than 80% of households with an average of 3 ITNS/HH, greater than 80% of pregnant women receiving greater than or 2 doses of IPTp, greater than 80% of pregnant women sleeping under ITN or in a house with IRS, greater than 80% of children under 5 years sleeping under ITN or in a house with IRS and greater than 80% of sick persons treated with effective anti-malarial within 24 hours of onset.

To further along their goals to eliminate malaria, The Zambia Government also increased allocations for the malaria control initiatives. By 2008, budget allocations for malaria from the Zambia Government had come to $25.4 million.

These actions by the Government of Zambia provided evidence of its dedication to eliminating malaria and improving the health outcomes of Zambians.

 International community support

Zambia’s efforts to build the infrastructure for national scale malaria control program attracted substantial donor support. Donors included the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM), the U.S Agency for International Development (USAID), the Bill and Melinda Gates Foundation through the Malaria Control and Evaluation Partnership in Africa (MACEPA), the World Bank, the U.S President Malaria Initiative (PMI), and the World Health Organization. Donations from these international organizations combined with domestic funds from the Zambian Government ensured that crucial aspects of the malaria control program were funded.

However, support for malaria control initiative in Zambia was also the result of a desire by the international community to have a successful model of a national scale malaria control initiative which can be replicated by other countries within the region.

Staying the course

 From 2002, Zambia began a nation-wide roll out of insecticide treated nets (ITNs), indoor residual spraying (IRS) and Rapid diagnostic Tests (RDTs) kits. In the following years, efforts were made to expand the distribution of these key aspects of the malaria control program to ensure adequate population coverage. However, the inconsistent nature of donor funding impacted the distribution of bed nets for years 2004 and 2008.

Rollout of ITNs, IRS and RDTs at the National Level

Image

Source: National Bureau of Economic Research

To ensure access to treatment for diagnosed malaria cases, ACTs were made free to all those seeking care within the public health sector.

 Data-Informed Decision-Making

Using the National Health Management Information Systems as well as sentinel surveys like the Zambian Demographic and Health Survey (ZDHS) and the Malaria Indicators Surveys, the Zambian Government and its International partners were able to monitor the progress of the nation-wide malaria control efforts.

Some data points captured by these data tracking tools include under-five child malaria mortality, yearly malaria in-patients from all facilities, and distribution, ownership and use of ITNs.

Climatic Advantages

Zambia has 3 distinct seasons within its tropical climate-a hot, rainy season (November-April), a cool dry winter (May-August), and a hot, dry season (September-October). These seasonal variations influenced the transmission of malaria by Plasmodium infected mosquitoes. Mosquitoes were abundant from September to April but markedly reduced during the cold winters from May to August. As a result, efforts to reduce population malaria parasitemia during those winter months may induce reduced transmission during the other months.

To be continued

Sources

http://www.ncbi.nlm.nih.gov/pubmed/18606763

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2929038/

http://www.nber.org/papers/w16069

http://www.pmi.gov/countries/mops/fy13/zambia_mop_fy13.pdf

http://www.hindawi.com/isrn/pm/2013/495037/

http://www.malariajournal.com/content/12/1/10

Autism in Africa

In Mental Health on November 10, 2012 at 4:02 am

Autism is a popular topic in developed countries. My perception was that it was a phenomena confined to the West with little or no occurrence in Africa. Therefore, I was surprised to watch a TED video of someone, who I suspect to be originally from Nigeria, share her experience with Autism. I was intrigued  to learn more about this disorder and its impact on Africans.

Autism is a developmental disorder which usually manifests in early childhood. Children with autism exhibit repetitive behaviour  patterns and interests, and obvious deficits in communication and social interaction. The earliest research on autism in Africa was carried out by Victor Lotter as far back as 1978. His research was carried out in 6 African countries. The result of his research was a low prevalence of autism. However, his research methods appeared to be flawed. Since then, not a lot of a studies has been carried out on this disorder. The prevalence rate in the various countries on the continent is unknown. Outside the African continent, it has been observed that children born to Africans immigrants in Europe exhibit a higher prevalence of autism compared to the indigenous population.

There is a need for research to be carried out to determine the burden of Autism in Africa. Also, it is important that health care providers are trained to identify and address cases. Policymakers also need to focus on providing the necessary infrastructure to manage this condition. In the video below, Faith Jegede shares her experience of living with 2 brothers with Autism.

Dare to Care: Becoming Part of the Solution for Mental Illness

In Mental Health on September 17, 2012 at 12:13 pm

“I decided to seek help because I was hearing voices and seeing people who were not there. Finding it difficult to distinguish what was real and what was not. I told my parents and they decided I go to church and see our Pastor, you know seek divine help, hoping I was still in shock over a nightmare”- I am not Crazy!”: Diary of a Bipolar Menace.

The issue of mental health is yet to be fully addressed in the various nations of Africa. Individuals with mental illness are often viewed as having demonic possession or they are stigmatized and ostracized from their families. For those that seek medical care, there are usually little or no available services. However, various events and current research show that there is an increased need for mental health services in Africa especially in conflict and post-conflict areas. A recent report by Voice of America (VOA) illustrates the great need for mental health services and the lack of adequate capacity to address mental health concerns in the region. VOA reports that former combatants in South Sudan exhibit symptoms of Post Traumatic Stress Disorder (PTSD) which could  lead to suicide and various forms of violence including maiming and killing others. South Sudan has psychologists but not a single psychiatrist nor adequate mental health facilities and psychiatric medication. As a result, these psychologists have no option but to sedate mental health suffers and if that does not work, they are sent to prison in the capital city, Juba. The same story holds for Liberia and the Democratic Republic of Congo.

But can we do something about it? Vikram Patel, the Co-director of the Centre for Global Mental Health says yes. In his talk seen below, Dr. Patel describes a model of care which trains ordinary people in resource-poor areas with the aim of empowering them to protect the health of their communities. He has also published a book titled “Where There is No Psychiatrist”, which provides readers with a guide to problem-solve various clinical disorders.

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