Poverty and health

Nutrition for mothers and children
id21 Health News 131, July 2008

Article 25.2 of the Universal Declaration of Human Rights establishes that motherhood and childhood are entitled to special care and assistance. Yet maternal and child undernutrition are still highly prevalent in most developing countries. This article outlines the role of the World Food Programme (WFP) in tackling undernutrition. It concludes that WFP programmes can contribute to breaking traditional gender barriers, such as the view that caring for children is the sole responsibility of women. It can bring communities together around a common goal of improving maternal and child nutrition for the benefit of society. In communities where the WFP also operates School Feeding programmes, there are opportunities to link school feeding to wider nutrition issues and advocate the importance of nutrition throughout a person's lifecycle.

The Chronic Poverty Report 2008-2009
Chronic Poverty Research Centre CPRC - UK's Department for International Development (DFID)

Widespread chronic poverty occurs in a world that has the knowledge and resources to eradicate it. This report argues that tackling chronic poverty is the global priority for our generation. There are robust ethical grounds for arguing that chronically poor people merit the greatest international, national and personal attention and effort. Tackling chronic poverty is vital if our world is to achieve an acceptable level of justice and fairness. Currently, development research is mainly assessed in terms of its contribution to meeting the Millennium Development Goals, in particular MDG1: to halve absolute poverty by 2015. However, achieving the first MDG would still leave some 800 million people living in absolute poverty and deprivation – many of whom will be chronically poor. Their lives are extremely difficult and, being marginalised, their story is rarely told. This report tries to tell parts of their story. It does so through the lives of seven chronically poor people:Maymana, Mofizul, Bakyt, Vuyiswa, Txab, Moses and Angel. Chronic poverty is a varied and complex phenomenon, but at its root is powerlessness. Poor people expend enormous energy in trying to do better for themselves and for their children. But with few assets, little education, and chronic ill health, their struggle is often futile.

Why have donors committed so few direct investments to eliminate child undernutrition?
id21HealthNews 131, July 2008

The mandate of most international donors is to reduce poverty, suffering and inequity. Addressing child undernutrition falls within this. However, current donor investment to directly address undernutrition is estimated to be well under half of the resources required. Encouragingly, some new initiatives to increase investment and improve coordination are already underway. Several international agencies are working together to develop a Ten Year Strategy to reduce vitamin and mineral deficiencies. These include the United Nations Children's Fund (UNICEF), the Academy for Educational Development and the Global Alliance for Improved Nutrition (GAIN). They have completed a technical situation analysis (published in the Food and Nutrition Bulletin) and formed working groups to better coordinate their actions, including monitoring and evaluation activities.

Malnutrition among women in sub-Saharan Africa: rural-urban disparity
Uthman OA, Aremu O: Rural and Remote Health 8(931), 2008

Malnutrition is a serious public health problem, particularly in developing countries, linked to a substantial increase in the risk of mortality and morbidity. Women and young children are most often affected. Rural disadvantage is a known factor, but little attention has been paid to rural-urban disparity among women. To provide a reliable source of information for policy-makers, the current study used nationally representative data from 26 countries in sub-Saharan Africa to update knowledge about the prevalence malnutrition and its rural-urban disparities among women. The data sources were the demographic and health surveys of 26 countries conducted between 1995 and 2006.Overall, rural women were 68% more likely to be malnourished compared with their urban counterparts.

The burden of disease profile of residents of Nairobi's slums: Results from a Demographic Surveillance System
Kyobutungi C, Ziraba AK, Ezeh A and Yé Y: Population Health Metrics 6(1), 10 March 2008

With increasing urbanization in sub-Saharan Africa and poor economic performance, the growth of slums is unavoidable. About 71% of urban residents in Kenya live in slums. Slums are characteristically unplanned, underserved by social services, and their residents are largely underemployed and poor. Recent research shows that the urban poor fare worse than their rural counterparts on most health indicators, yet much about the health of the urban poor remains unknown. This study aims to quantify the burden of mortality of the residents in two Nairobi slums, using a Burden of Disease approach and data generated from a Demographic Surveillance System. Data from the Nairobi Urban Health and Demographic Surveillance System (NUHDSS) collected between January 2003 and December 2005 were analysed. Core demographic events in the NUHDSS including deaths are updated three times a year; cause of death is ascertained by verbal autopsy and cause of death is assigned according to the ICD 10 classification. Years of Life Lost due to premature mortality (YLL) were calculated by multiplying deaths in each subcategory of sex, age group and cause of death, by the Global Burden of Disease standard life expectancy at that age. The overall mortality burden per capita was 205 YLL/1,000 person years. Children under the age of five years had more than four times the mortality burden of the rest of the population, mostly due to pneumonia and diarrhoeal diseases. Among the population aged five years and above, HIV/AIDS and tuberculosis accounted for about 50% of the mortality burden. Slum residents in Nairobi have a high mortality burden from preventable and treatable conditions. It is necessary to focus on these vulnerable populations since their health outcomes are comparable to or even worse than the health outcomes of rural dwellers who are often the focus of most interventions.

The material and political bases of lived poverty in Africa: Insights from the Afrobarometer
Bratton M (editor): Afrobarometer 98, May 2008

The Afrobarometer has developed an experiential measure of lived poverty called the Lived Poverty Index (LPI). It measures how frequently people go without basic necessities during the course of a year. This is a portion of the central core of the concept of poverty not captured by existing objective or subjective measures. As an individual measure, the LPI is found to be valid and reliable. However, it exhibits only moderate external validity when compared with absolute measures of national wealth. Contrary to what appears to be the consensus among economists, GDP growth is accompanied by increases in lived poverty, and there is only a weak relationship between LPI and measures of human development or income poverty. At the same time, lived poverty is strongly related to country level measures of political freedom. This supports Sen's (1999) arguments about development as freedom and Halperin et al’s (2005) arguments about the “democracy advantage” in development. This paper concludes that this measure does well at measuring the experiential core of poverty, and capturing it in a way that other widely used international development indicators do not.

Alternatives to the food crisis
Angus I: Pambazuka News, 15 May 2008

The regressive food policies imposed on poor countries by the World Bank and IMF are codified and enforced by the World Trade Organization's Agreement on Agriculture (AoA). The AoA, as Afsar Jafri of Focus on the Global South writes, is "biased in favour of capital-intensive, corporate agribusiness-driven and export-oriented agriculture." AoA should be abolished, and Third World countries should have the right to unilaterally cancel liberalization policies imposed through the World Bank, IMF, and WTO, as well as through bilateral free trade agreements such as NAFTA and CAFTA.

Food insecurity, poverty and the Malawian Starter Pack: Fresh start or false start?
Harrigan J: Food Policy 33(3):237-249, June 2008

In the last decade a number of initiatives have been used in Malawi to tackle the issue of household food insecurity. One of the most controversial has been the Starter Pack programme launched in 1998. Initially consisting of a free handout of packs of improved maize seed, legumes and fertiliser to every small holder farm household in Malawi the scheme, under donor pressure, was subsequently scaled down to become a form of targeted social safety net programme. This paper analyses the strengths and weakness of both the original programme and its scaled down version.

Impact of school lunch programmes on nutritional status of children in Vihiga District, Western Kenya
Musamali B: African Journal of Food, Agriculture, Nutrition and Development 7(6), 2007

The objectives of the study were: to compare the nutritional status of participants (children who participate in the school lunch) and non-participants (children who do not participate in the school lunch) and to assess the diet quality of the school and home lunch. It was hypothesized that the nutritional status of participants was better than that of the nonparticipants. Three hundred and twenty pupils (index children) and their parents were randomly selected for the purpose of the study. Anthropometric measurements, 24-hour recall, interview schedules and observed weighed technique were the instruments used in data collection. The results indicated a positive association between the school lunch and nutritional status. The diet quality of the school lunch and nutritional status of participants were significantly higher than that of the non-participants. More schools and parents in similar environments should therefore be encouraged to venture into the SLP because of their positive outcome on nutritional status as well as the diet quality of participating children.

Is poverty a driver for risky sexual behaviour? evidence from national surveys of adolescents in four African countries
Nadise N, Zulu E, Ciera J: African journal of Reproductive Health, 2007

This article provides evidence on the link between poverty and risky sexual behaviour. It examines the effect of wealth status on age at first sex, condom use, and multiple partners using data from more than 19,000 adolescents from Burkina Faso, Ghana, Malawi and Uganda. The results show that the wealthiest girls in Burkina Faso, Ghana and Malawi have later sexual debut compared with poorer adolescents, but this association was not significant in Uganda. Wealth status is weaker among males and significant only in Malawi, where those in the middle income group had earlier sexual debut. Wealthier adolescents were most likely to use condoms, but wealth status was not associated with the number of sexual partners. The authors conclude that understanding patterns and motivations of early sexual debut, non-use of condoms, and multiple partnerships is an important contribution to HIV prevention strategies. From this study poverty appears to influence early sexual debut, especially among females, and the poor are less likely to be using condoms. Therefore, poverty, by influencing sexual behaviour and access to services, can influence the transmission of HIV infection.

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