Poverty and health

Nutrition in the WHO Africa Region
World Health Organisation Regional Office for Africa: Brazzaville, 2017

This report explores the current nutrition status of countries in the WHO African Region in relation to the six primary outcomes achievable by 2025 and the other global nutrition monitoring framework indicators. The aim is to highlight where action is needed to drive progress on the global targets for 2025 and Sustainable Development Goal No. 2 that calls on countries to end hunger through achieving food security, improving nutrition and promoting sustainable agriculture. A complementary objective of the report was to evaluate existing data sources that countries use to monitor programme performance and track progress on the global targets. A key finding in this report is that undernutrition is still persistent in the WHO African Region, with major implications for health, particularly among poor and vulnerable population groups. It finds that persistent drought, famine, flooding, and civil crises will make it difficult for many countries to achieve the target of reducing and maintaining wasting at less than 5%. Along with persistent undernutrition, the prevalence of overweight among children under 5 years of age (as well as the overall number of children affected) is rising, whereas the target is to halt its increase. WHO AFRO assert that In the absence of survey data, properly functioning routine surveillance systems could provide invaluable real-time information for decision making in policy and programme design and implementation in this area.

Attitudes towards help-seeking for sexual and gender-based violence in humanitarian settings: the case of Rwamwanja refugee settlement scheme in Uganda
Odwe G; Undie C; Obare F: BMC International Health and Human Rights 18(1) doi: https://doi.org/10.1186/s12914-018-0154-6, 2018

This paper examined the association between attitudes towards seeking care and knowledge and perceptions about sexual and gender-based violence (SGBV) among men and women in a humanitarian setting in Uganda. A cross-sectional survey was conducted from May to June 2015 among 601 heads of refugee households in Rwamwanja Refugees Settlement Scheme, South West Uganda. Results showed increased odds of having a favorable attitude toward seeking help for SGBV among women with progressive attitudes towards SGBV; who felt that SBGV was not tolerated in the community; those who had not experienced violence; and those who were aware of the timing for post-exposure prophylaxis. In contrast, results for the male sample showed lack of variations in attitude toward seeking help for SGBV for all independent variables except timing for post exposure prophylaxis. Among individuals who had experienced SGBV, the odds of seeking help was more likely among those with favorable attitude towards seeking help than among those with unfavorable help-seeking attitudes. The findings of the paper suggest that targeted interventions aimed at promoting awareness and progressive attitudes towards SGBV are likely to encourage positive help-seeking attitudes and behaviours in humanitarian contexts.

Factors associated with household food insecurity and depression in pregnant South African women from a low socio-economic setting: a cross-sectional study
Abrahams Z; Lund C; Field S; et al: Social Psychiatry and Psychiatric Epidemiology, doi: https://doi.org/10.1007/s00127-018-1497-y, 2018

This study aimed to assess factors associated with food insecurity and depression in a sample of pregnant South African women in a low-income suburb in Cape Town. Pregnant women attending a local clinic for their first antenatal visit were invited to participate. The shortened form of the US Household Food Security Survey Module was used to measure food insecurity. The Expanded Mini-International Neuropsychiatric Interview was used to diagnose depression, anxiety, alcohol and drug dependence, and assess for suicidal ideation and behaviour. Logistic regression modelling was conducted to explore factors associated with food insecurity and depression in separate models. The authors found that 42% of households were food insecure and that 21% of participants were depressed. The odds of being food insecure were increased in women with suicidal behaviour, with depression and in those with three or more children. The odds of depression was greater in women who were food insecure, substance dependent or diagnosed with an anxiety disorder. Food insecurity and depression are strongly associated in pregnant women. The relationship between food insecurity and depression is complex and requires further investigation. Interventions that improve both food security and mental health during the perinatal period are likely to benefit the physical and mental well-being of mothers and children.

Psychosocial support for adolescent girls in post-conflict settings: beyond a health systems approach
Samuels F; Jones N; Hamad B: Health Policy and Planning 32(Suppl 5) v40–v51 2017

This paper focuses on the importance of psychosocial support services for adolescent girls in fragile contexts. Its starting point is that adolescence is a pivotal time in the life course but given the physical, cognitive and emotional changes triggered by the onset of puberty, it can also be a period of heightened sensitivity and vulnerability to trauma, social isolation, bullying by peers, a lack of supportive adults and gender-based and sexual violence. The authors’ findings highlighted why humanitarian and biomedical approaches in their current form are inadequate to address these complexities. Drawing on qualitative fieldwork, the authors argued that going beyond biomedical approaches and considering the social determinants of health, including approaches to tackle discriminatory gendered norms and barriers to service access, are critical for achieving broader health and wellbeing. While all three case study countries are classified as post-conflict, the political economy dynamics vary with associated implications for experiences of psychosocial vulnerabilities and the service environment. The study concludes by reflecting on actions to address psychosocial vulnerabilities facing adolescent girls through tailoring services to ensure gender and age-sensitivity, investing in capacity building of service providers to promote service uptake and enhancing strategies to regulate and coordinate actors providing mental health and psychosocial support services.

World's poor to suffer most unless developed countries act fast on climate change
Khan A: Pambuzuka News, December 2017

Storms and hurricanes are becoming more severe due to warmer sea temperatures. Low lying island nations, like the Maldives, now experience annual flooding with the seawater contaminating groundwater supplies. Whether flooding, drought or other climate-related catastrophic events, the author observes that low income countries nations and their populations suffer most, given their lack of resources, infrastructure, emergency services and preparedness. They also point to a further consequence relating to the quality of food. Rising CO2 levels speed up plant growth increasing carbohydrates through plant sugars and diluting nutrition due to reduced minerals and protein. The nutrient quality of our food is expected to fall as CO2 levels rise this century. The effect will be worst felt by the world's poorer populations relying on a plant diet. Extreme weather events affect production, distribution, spoilage and contamination. The author notes that those most affected will be people in Africa, Asia and the Americas.

“If it's issues to do with nutrition…I can decide…”: gendered decision-making in joining community-based child nutrition interventions within rural coastal Kenya
Muraya K; Jones C; Berkley ; et al.: Health Policy and Planning 32 (Suppl 5) ppv31–v39 2017

This qualitative study undertaken in rural Coastal Kenya aimed to explore the interaction between household gender relations and a community-based child nutrition programme. It focused on household decision-making dynamics related to joining the intervention. Fifteen households whose children were enrolled in the programme were followed up over a period of 12 months. Over 60 household visits, group and individual in-depth interviews were conducted with a range of respondents, supplemented by non-participant observations. Data were analysed using a framework analysis approach. Engagement with the intervention was highly gendered with women being the primary decision-makers and engagers. Women were responsible for managing child feeding and minor child illnesses in households. As such, involvement in community-based nutrition interventions and particularly one that targeted a condition perceived as non-serious, fell within women’s domain. Despite this, the nutrition programme of interest could be categorized as gender-blind. Gender was not explicitly considered in the design and implementation of the intervention, and the gender roles and norms in the community with regards to child nutrition were not critically examined or challenged. In fact, the authors argue that the intervention might have inadvertently reinforced existing gender divisions and practices in relation to child nutrition, by excluding men from the nutrition discussions and activities and thereby supporting the notion of child feeding and nutrition as “women’s business”. To improve outcomes, community based nutrition interventions are argued to need to understand and take into account gendered household dynamics, and incorporate strategies that promote behaviour change and attitude shifts in relation to gendered norms and child nutrition.

The Power of 'Know-Who': Adaptation to Climate Change in a Changing Humanitarian Landscape in Isiolo, Kenya
Mosberg M; Nyukuri E; Naess L: IDS Bulletin 48(4), doi: 10.19088/1968-2017.154, 2016

This article examines adaptation to climate change in view of changing humanitarian approaches in Isiolo County, Kenya. While humanitarian actors are increasingly integrating climate change in their international and national-level strategies, less is known about how this plays out at sub-national levels, which is key to tracking whether and how short-term assistance can support long-term adaptation. The article suggests that increasing attention to resilience and adaptation among humanitarian actors may not lead to reduced vulnerability because resources tend to be captured through existing power structures, directed by who you know and your place in the social hierarchy. In turn, this sustains rather than challenges the marginalisation processes that cause vulnerability to climate shocks and stressors. The article highlights the important role of power and politics both in channelling resources and determining outcomes.

Characteristics of community savings groups in rural Eastern Uganda: opportunities for improving access to maternal health services
Mutebi A; Kananura R; Ekirapa-Kiracho; et al.: Global Health Action 10(S4)82-91, 2017

Data on the characteristics of community-based savings groups were collected from 247 community-based savings group leaders in the districts of Kamuli, Kibukuand Pallisa using a self-administered open-ended questionnaire, and in-depth interviews with seven community-based savings group leaders. Ninety-three percent of the community-based savings groups said they elected their management committees democratically to select the group leaders and held meetings at least once a week. Eighty-nine percent used metallic boxes to keep their money, while 10% kept their money in mobile money and banks. The community-based savings groups were formed mainly to increase household income, to develop the community and to save for emergencies. The community-based savings groups faced challenges of high illiteracy among the leaders, irregular attendance of meetings, and lack of training on management and leadership. Saving groups in Uganda are reported to have the basic required structures, but with challenges in relation to training and management of the groups and their assets, calling for technical support in these areas.

If you miss them, then you’re missing out
Riria J: Daily Nation, 7 November 2017

The author reports an estimated 65 per cent of women-led small and medium-sized enterprises (SMEs) in the developing economies that are either unserved or underserved financially. SMEs provide 80 per cent of Kenya’s employment and contribute 20 per cent of our GDP, according to latest reports from African Economic Outlook. Data on registered firms shows that women hold ownership roles in 48 per cent of Kenyan SMEs. The World Bank says that only 51 per cent of Kenyan women have access to a simple bank account, much less a business loan or insurance to protect them financially. The author notes that microfinance can address this deficit through loans designed specifically for women-led SMEs that need access to working capital to expand their businesses, that have flexible monthly repayment amounts, security and collateral requirements, and longer repayment periods.

Tuberculosis, human rights and ethics considerations along the route of a highly vulnerable migrant from sub-Saharan Africa to Europe
Wild V; Jaff D; Shah NS; et al.: International Union Against Tuberculosis and Lung Disease 21(10)1075-1085, 2017

Migrant health is a critical public health issue, and in many countries attention to this topic has focused on the link between migration and communicable diseases, including tuberculosis (TB). This paper traces a commonly used migration route from sub-Saharan Africa to Europe, identifying situations at each stage in which human rights and ethical values might be affected in relation to TB care. The authors highlight three strands of discussion in the ethics and justice literature in an effort to develop more comprehensive ethics of migrant health. These strands include theories of global justice and global health ethics, the creation of ‘firewalls' to separate enforcement of immigration law from protection of human rights, and the importance of non-stigmatization to health justice.