This report lays out a seven-point plan that includes a treatment package to reduce childhood diarrhoea deaths and a prevention strategy to ensure long-term results: fluid replacement to prevent dehydration; zinc treatment; rotavirus and measles vaccinations; promotion of early and exclusive breastfeeding and vitamin A supplementation; promotion of hand washing with soap; improved water supply quantity and quality, including treatment and safe storage of household water; and community-wide sanitation promotion. Dr Margaret Chan, Director-General of the World Health Organization, said: ‘We know where children are dying of diarrhoea. We know what must be done to prevent those deaths. We must work with governments and partners to put this seven-point plan into action.’ Yet, despite the known benefits of improving water supply and sanitation, some 88% of diarrhoeal diseases worldwide are attributable to unsafe water, inadequate sanitation and poor hygiene. As of 2006, an estimated 2.5 billion people were not using improved sanitation facilities, and nearly one in every four people in developing countries was practicing open defecation.
Poverty and health
Five years ago, pregnant women in the village of Sauri, in western Kenya's Nyanza Province, had access to just one rundown and poorly staffed sub-district hospital. Few chose to use it, instead giving birth at home, risking complications during delivery and, for those living with HIV, passing it on to their child. Sauri is now part of the Millennium Villages Project, which, since December 2004, has established maternity wards in nine health facilities across Yala division. The village project, part of the United Nations (UN) Millennium Project, aims to lift communities out of extreme poverty through community-led initiatives to improve health, agriculture, education, gender equality and environmental sustainability. ‘With the improvement of these health facilities through the provision of free maternal services, 64% of expectant women in Sauri now come to deliver in health centres,’ said Patrick Mutuo, science coordinator and team leader of the Sauri cluster. ‘Right now those mothers still delivering at home are doing so not because of cost or distance. It could be due to cultural beliefs or other reasons. We have also initiated door-to-door voluntary testing and counselling services and health education,’ he added.
Treating household water with low-cost, widely available commercial bleach is recommended by some organisations to improve water quality and reduce disease in developing countries. This study analysed the chlorine concentration of 32 bleaches from twelve developing countries. The average error between advertised and measured concentration was 35% (range = -45%–100%; standard deviation = 40%). Because of disparities between advertised and actual concentration, the use of commercial bleach for water treatment in developing countries is not recommended without ongoing quality control testing.
The drought that has ravaged parts of northeastern Kenya, killing a large number of livestock, has affected the availability of milk, in turn undermining child nutrition, say officials. Most of the rural population in the areas where Save the Children is working is heavily dependent on relief food and many children are eating only one meal a day, of corn porridge. ‘This poor diet means they are missing out on vital nutrients, which can mean they grow up stunted and their brains and bodies can suffer permanent damage,’ the organisation said. Since July, the number of severely malnourished children seeking treatment at its northeastern emergency feeding centres has increased by 25%. ‘The government and donors need to be aware of the changing climate now and in future, and shape their policies accordingly,’ Philippa Crosland-Taylor, head of Oxfam in Kenya, said in August. ‘Emergency aid is urgently needed now, but in the long term we need to rethink policies to focus on mitigating the risks of droughts before they occur, rather than rushing in food aid when it is too late.’
Context matters with regard to foreign aid. The implications are only slowly coming to the fore: external funders are realising that they will not find a magic wand or global prescription or best practice by which they can unleash the change that will reduce poverty on a significant and sustainable scale. Context – the institutional, social, political, cultural and economic fabric of society – matters, and its significance is much greater than that of aid from external partners. So, the problem for funders in dealing with context seems to be first and foremost dealing with their own context that forces them to try to do more than they objectively can. The challenge is to find ways to change the political and systemic factors that constrain the capacity and willingness of funders to act with modesty, realism and humility. This requires an environment in which their stakeholders are genuinely happy to be small contributors to processes that mainly depend on everything but funders and aid.
This paper estimates the economic impact of HIV and AIDS on the KwaZulu-Natal province and the rest of South Africa. It extended previous studies by employing: an integrated analytical framework that combined firm surveys of workers' HIV prevalence by sector and occupation; a demographic model that produced both population and workforce projections; and a regionalised economy-wide model linked to a survey-based micro-simulation module. Results indicate that HIV and AIDS greatly reduces annual economic growth, mainly by lowering the long-run rate of technical change. However, impacts on income poverty are small, and inequality is reduced by HIV and AIDS because high unemployment among low-income households minimises the economic costs of increased mortality. By contrast, slower economic growth hurts higher income households despite lower HIV prevalence. The increase in economic growth that results from addressing HIV and AIDS is sufficient to offset the population pressure placed on income poverty. Moreover, incentives to mitigate HIV and AIDS lie not only with poorer infected households, but also with uninfected higher income households. The findings confirm the need for policies to curb the economic costs of the pandemic.
Violence and injuries are the second leading cause of death and lost disability-adjusted life years in South Africa. With a focus on homicide, and violence against women and children, this paper reviews the magnitude, contexts of occurrence, and patterns of violence, and refer to traffic-related and other unintentional injuries. The social dynamics that support violence are widespread poverty, unemployment, and income inequality; patriarchal notions of masculinity that valourise toughness, risk-taking and defence of honour; exposure to abuse in childhood and weak parenting; access to firearms; widespread alcohol misuse; and weaknesses in the mechanisms of law enforcement. So far, there has been a conspicuous absence of government stewardship and leadership. Successful prevention of violence and injury is contingent on identification by the government of violence as a strategic priority and development of an intersectoral plan based on empirically driven programmes and policies.
This collection of articles includes an article on food security in Kenya. Since 2006, the rains in Kenya’s Central Highlands have become less reliable. The March and April rains regularly arrive late, and the season is much shorter. In 2008, there were only four days of rain. The seasonal rivers that provide water for irrigation, livestock and domestic uses have mostly dried up, leading to water and food shortages. These burgeoning problems are pointing in one direction – poverty, malnutrition and health problems for the nation’s poor. Declining production, and the limited access and affordability of imported food, mean food security has declined, with many impacts. The government should store grain during bumper harvests to provide food in poor seasons; processing this surplus can also add value and avoid wastage.
If the South African government wants to alleviate poverty, it should increase the number of people accessing social grants, according to recent submissions by a coalition of non-governmental organisations before the South African Human Rights Commission. The coalition, dubbed the National Working Group on Social Security, pointed out that President Jacob Zuma acknowledged that social grants remain the main effective form of poverty alleviation. However, they noted that no extension of the child support grant to children aged 15 to 18 has been announced, despite the importance of secondary school enrolment. Some people with HIV were alleged to be defaulting on their antiretroviral treatment to retain disability grants, because if they regain their health and their CD4 counts improve, social security stops issuing their HIV and AIDS grant. The Steve Biko Centre for Bioethics has called for a basic income grant and other poverty alleviation programmes that will include sex workers.
The consequences of malnutrition for the efficacy of anti-retroviral therapy (ART) are poorly understood, and evidence regarding the impact of food supplementation on ART outcomes is still limited. The World Health Organization and World Food Programme have issued guidance on food support in ART programmes: every newly enrolled patient should have a nutritional assessment that includes measurement of weight and body mass index, along with nutritional counselling and monitoring. Promotion of activity that increases ability to maintain and expand food supplies, either through growing crops or trading (`livelihoods`) may be a more appropriate response to malnutrition in people with less-advanced HIV disease, with cash transfers also being used as a means of addressing food insecurity. Households affected by HIV often experience multiple threats to their livelihoods. All nutritional support programmes need realistic strategies to avoid dependency and promote long-term food security.