Across the country, there have been at least 31,342 suspected or confirmed cholera cases and 230 deaths in the first seven months of 2023 – many of them children.
The worst affected province, North Kivu, has seen more than 21,400 confirmed or suspected cases, including more than 8,000 children under five, according to the Ministry of Public Health. This compares to 5,120 total cases in all of 2022, with 1,200 of them children under five.
“The size of the cholera outbreak and the devastation it threatens should ring alarm bells,” said Shameza Abdulla, UNICEF DRC Senior Emergency Coordinator, based in Goma.
“If urgent action is not taken within the next months, there is a significant risk that the disease will spread to parts of the country that have not been affected for many years.”
Urgent aid for displaced
The DRC, which shoulders the worst displacement crisis in Africa, is among the worst globally, with more than 6.3 million displaced people across the country. Displacement camps are generally overcrowded and overstretched, making them ripe for cholera transmission.
“There is also the danger it will continue to spread in displacement sites where systems are already overwhelmed and the population especially children, is highly vulnerable to illness and, potentially, death. Displaced families have already been through so much”, added Ms. Abdulla.
UNICEF is calling for $62.5 million to scale up its prevention and response activities to the cholera and sanitation crisis over the next five months.
The agency aims to reach 1.8 million people, including one million children, with safe water, hygiene kits, latrines, medical supplies, and child-friendly cholera care. Currently, the appeal is just nine per cent funded.
Women outside an emergency vehicle aimed at helping those affected by flooding. CREDIT: Ashfaq Yusufzai/IPS
by Ashfaq Yusufzai (peshawar, pakistan)
Inter Press Service
PESHAWAR, PAKISTAN, Aug 18 (IPS) – Torrential monsoon rains have left the people, especially women, in crisis as they are still grappling to recover from the last year’s floods in Pakistan.
“We are yet to return to normal lives after devastation caused by severe rains in June 2002 when the new series of rains have started only to further aggravate our problems,” Jannat Bibi, a resident of Kalam in the Swat Valley, told IPS.
Bibi, 44, a housewife, along with co-villagers, must walk about a kilometre twice a day to collect drinking water for her 10-member family. She says they want the government to provide them with essential needs like food, water, shelter, and medication.
“A new ongoing wave of monsoon rains has left us high and dry as we are facing a host of ailments due to contaminated water.”
“Some non-governmental organisations have given us mineral water, utensils and foodstuff last year in June when torrential rain damaged our mud-built houses, but this year, there’s nobody to extend us a helping hand despite severe floods,” she says.
Most people in the neighbourhood fear that more rain would bring more misery for them as the people have yet to rebuild their homes while roads and health facilities were in shambles.
Dr Farooq Khan in Swat district says the people desperately require clean drinking water as cases of diarrhoea have been increasing among them.
“There are more cases of vector-borne diseases, such as malaria, dengue, haemorrhagic fever (DHF) and Leishmaniasis because the people are exposed to mosquitoes-bites, the transmitters of these diseases, due to pools of stagnant water which serves as breeding grounds for mosquitoes,” Khan said.
Power breakdowns create problems because people cannot get drinking water from wells, and they often store it in uncovered pots, which serve as breeding spots for mosquitoes. “Khyber Pakhtunkhwa recorded 18,000 dengue Haemorrhagic fever patients and 18 deaths in 2022,” he said.
National Disaster Management Authority says at least 86 people, including eight children, have been killed by floods and landslides triggered by monsoon rains that have lashed Pakistan since last month. In June 2022, a flood killed 289 people, it says.
“Women are the worst victim of climatic changes as they stay home and have to prepare food, wash clothes and look after children, therefore, we need to focus on their welfare,” Dr Javid Khan, a local physician in Malakand district, which is adjacent to Swat, says.
According to him, about 20 cholera cases have been recorded because people use water contaminated by sewerage pipes during floods.
“The World Health Organization is establishing two diarrhoea treatment centres to prevent outbreaks of food and water-borne diseases,” he said.
Munir Ahmed, a local environmentalist, says that women, representing about half of the country’s population, are the worst affected by torrential rains.
Last year, massive flooding affected nearly two-thirds of the country’s population in Pakistan, as it submerged the low-lying areas inhabited by poor people, he says.
Rains destroyed 1.7 million homes in Sindh, Punjab, Balochistan, and Khyber Pakhtunkhwa provinces which also damaged the water sources and cultivable land, he says.
“As the people were recovering from the past year’s devastation caused by flood, a new spell has started dampening their hopes of recovery,” Ahmed says.
More than 1 300 health facilities and 3 000 schools destroyed by 2022’s floods are yet to be built.
“More than 50 000 pregnant women are finding it hard to undergo mandatory checkups at hospitals because of bad roads and lack of transportation in the country,” according to the Ministry of Health. It says the government is providing alternate sources in the shape of mobile vehicles to ensure their home-based clinical examinations.
Jabina Bibi, of the remote Chitral district, waited in stayed at home despite being six months into her pregnancy and didn’t receive a medical checkup until a local NGO sent a team to her locality, and she managed to source iron tablets for the treatment of severe malnourishment.
“The NGO’s doctors proved a blessing for me, and I delivered a normal baby because they carried out an ultrasound which enabled me to know the date of delivery for which I was taken to the hospital located 50 km away,” she said.
Other women also benefited, but the facilities are scarce, she said.
Chitral experienced more floods in July this year, which killed at least ten people. Water-Aid, and non-profit organisation, says that the floods have left almost 700 000 pregnant women in the country without getting maternal healthcare, leaving them and their newborns without support, food, security, and basic medical care. The miscarriage rate also skyrocketed during this period.
Floods causing landslides also resulted in the displacement of people and the loss of millions of livestock.
In Mansehra district, extensive damage rendered many roads unusable, creating significant transportation difficulties.
“We need to find work because construction activities have stopped, and it’s extremely to travel to other districts to find jobs,” Mushtaq Ahmed, 24, a resident of Mansehra, said. Pakistan is the second country with the most melting glaciers due to global warming, and Mansehra is one of the affected districts.
Climate experts believe that women and children are at a much higher risk of losing their lives during a disaster due to their limited access to resources during emergencies. The situation regarding monsoon rains has been under control as of now, but there are forecasts of potential rains in the coming days, which can hammer the last nail in the coffin of those madly hit by rainwaters last year.
Climate change brings, in its wake, deprivation of people from food security, health, education, and jobs, besides exposing women to violence, displacement, and mental health issues, and the government needs to protect the people from the ill effects of floods, experts say.
Speaking at the event on Thursday, WHO Director-General Tedros Adhanom Ghebreyesus underscored the “enormous” contributions of traditional medicine to human health and its understanding of the “intimate links” between health and the environment.
Tedros stressed the importance of the gathering for “bringing together ancient wisdom and modern science for the health and well-being of people and planet”.
Echoing his words, the Director-General of the World Trade Organization (WTO), Ngozi Okonjo-Iweala said that traditional medicine is not opposed to modern medicine, but rather complementary.
Ancient roots of modern medicine
Recalling that traditional medicine was “as old as humanity itself”, the WHO chief noted that many modern drugs trace their roots to ancient healing practices.
He gave the example of bark from the willow tree, used by Sumerians and Egyptians as a pain reliever and an anti-inflammatory over 3,500 years ago. “Then in 1897, the chemist Felix Hoffmann synthesized aspirin and the drug has gone on to improve, and save, the lives of millions of people every day,” Tedros said.
He also cited a 1971 breakthrough for malaria remedies, when China’s Tu Youyou read about the use of sweet wormwood to treat fevers in traditional Chinese medical literature. This led her team to isolate the compound artemisinin, which has become the “backbone” of malaria treatment.
‘Growing demand’
The WHO Director-General insisted that far from being a thing of the past, traditional medicine is the object of growing demand worldwide. He highlighted its importance for mental health, healthy aging, and preventing and treating non-communicable diseases.
“This is not a new area for WHO”, he said, recalling that back in 2014, the organisation’s Member States approved the first global ten-year strategy for traditional medicine, adding that a new strategy will be developed by 2025.
Integrate traditional medicine
Through the summit – and the WHO Global Centre for Traditional Medicine launched in the Indian city of Jamnagar last year – the UN agency has been working to “inform policies, standards and regulations for the safe, cost-effective, and equitable use” of traditional remedies, Tedros said.
He urged countries to examine how best to incorporate traditional and complementary medicine into their health systems and “unlock [its] power through science and innovation”.
The WHO chief said that the Gujarat Declaration, which is expected to be adopted by the end of the summit, has the potential to enhance the “appropriate integration” of traditional medicine into states’ healthcare services.
‘Scientific validation’
WHO wrote on the social platform X that their work aimed to bring evidence and scientific validation around traditional medicine so that millions of people around the world who use it “understand whether it’s safe and effective and are better protected”.
“When scientifically validated, traditional medicine has the potential to bridge [healthcare] access gaps for millions around the world,” the agency said.
Togotia, a forgotten African leafy vegetable, has found its way back into markets as its high nutritional value could help address food security. CREDIT: Egerton University
by Wilson Odhiambo (nairobi)
Inter Press Service
NAIROBI, Aug 16 (IPS) – Kenya’s fight for food security may have just gone ‘Old School’ as Egerton University dons win a grant to help bring back a pre-colonial delicacy that was gradually sliding its way off consumers’ plates.
Their project, dubbed ‘Exploring Potential of Togotia (Erucastrum arabicum), a forgotten African leafy vegetable for nutritional security and climate adaptation in Kenya,’ won the grant in October last year in a bid to help farmers and consumers realise the importance of the crop that many, today, term as a weed.
According to the project’s lead researchers, Togotia falls among the forgotten African leafy vegetable (fALVs), which have been ignored in formal research and policy and their nutritional values.
The project focuses on Togotia’s nutritional value and hardy nature compared to other vegetables such as cabbage, kale and spinach that are exotic to Kenya.
It involved the expertise of Prof. G Mendiodo (University of Nottingham), Dr Maud Muchuweti (University of Zimbabwe), Dr Miriam Charimbu (Egerton University) and Dr Charles Kihia (Egerton University).
The grant, worth Ksh 4.9 million (about USD 37 000) was awarded to the institution by the Global Challenge Research Fund (GCRF) UK.
“Togotia and many other traditional vegetables have their roots embedded deep in the pre-colonial era, where they formed a daily delicacy for many. However, the colonial period brought exotic crops that quickly became a favourite for many, majorly due to their high market demands,” Kihia told IPS.
Between 1960 and 1980, these exotic vegetables flooded the local markets, especially in towns, thus relegating Bogota and other traditional vegetables to the rural areas.
And, due to high market demand for the exotic vegetables, farmers in the villages also transitioned to cash crop farming, a move that saw Togotia gradually cast out as a weed.
However, the current global changes in climate conditions have seen many farmers suffer the consequences of unpredictable weather patterns that have seen crops dwindle in the local markets.
Most food crops that serve towns come from rural areas where farmers rely heavily on weather patterns to meet the market demands.
Kenya is currently facing one of the worst drought periods in its history, making food production a burden for the farmers who town dwellers rely on for their needs. Lack of rainfall means low food production, which leads to high food prices in the market.
“The drought has led to a scarcity of many vegetables, such as kale and spinach, which have the highest demand in town. The ones that we are getting right now have tiny leaves, which customers complain about,” said Nancy Mulu, a local grocer in Nairobi.
“We are forced to sell them in small bunches at high prices due to the trouble we go through to get them,” she explained to IPS.
“The only traditional vegetable I sell in my shop are Terere (Amaranthus), Managu (Solanum), Saga (Cleome), and Kunde (Vigna). I have never come across a fellow vendor selling Togotia in town. They are mostly found in the village areas, and even there, many still treat them as weed,” she added.
Despite the rains that recently kicked off, the meteorological department warned farmers that it may not be enough to meet their agricultural demands.
Charimbu told IPS that if embraced, Togotia will be important in helping the country meet both the supply and nutritional demand of the people.
“Emergence and intensification of climate change with associated unreliable rainfall (either too much or too little) limit capacity of local farmers, not only to produce their own food but also surplus for sale, resulting in impoverishment,” she explained.
“The high cost of farm inputs required for the exotic vegetable also makes them an expensive and unsustainable venture during draught seasons such as the one the country is experiencing. Being a hardy crop, Togotia easily has an edge over them.”
“They flourish in marginal soils, require limited agrochemical input, are fast maturing (takes two weeks), widely occurring and are resistant to many local pests, and hence are ideal candidates for sustaining nutritional and household food security even during such draught periods, Charimbu added.
In major crop production towns like Molo and Kuresoi, known for maize, potatoes, carrots, onions, kales, and cabbages, Togotia is usually considered a weed and farmers prefer to get rid of it or feed it to the livestock. Few people in the area consider it a food crop.
From their analysis, the dons found out that apart from being hardy, Togotia was a rich source of vitamin C, iron, zinc, protein and calcium, which are important for the human body.
Kihia believes that the project will not only help to redefine the current understanding of the use and ecology of Togotia but also identify and develop appropriate agronomic cropping protocols suitable for adoption among small-scale farmers in Kenya and elsewhere.
“For a farmer with a healthy crop of maize targeted for sale in the lucrative Nairobi market, it is a weed. But when the same farmer hires a number of locals to do weeding at his farm, they remove the weed and eat it. Similarly, when there is massive crop failure and the maise crops do poorly, this weed becomes an important survival crop for the farmer and the community,” Kihia added.
In counties like Baringo, which falls among the hardest hit by the drought, Togotia is one of the residents’ main vegetables to supplement their needs. If this can be incorporated in other drought-prone areas like Turkana, Marsabit and Samburu, it will go a long way in helping address the recurring food crisis in Kenya.
“Incorporation of Togotia and other fALVs into current land-use will not only increase farms agrobiodiversity and household food diversity but also provide important forage crop for bees and other pollinators that are disappearing from Kenyan landscapes,” he concluded.
The project will involve setting up demonstration farms at the university and sensitising local farmers and communities around on their importance in helping supplement their nutritional needs.
They aim to produce Togotia varieties that are responsive to environmental needs in terms of resistance to pests, diseases, and drought.
Categorizing countries into “low- and middle-income countries” and “high income countries” is not appropriate for studying healthcare systems and population health. It is misleading to categorize countries for convenience of data analysis and interpretation. Credit: Charles Mpaka/IPS
Opinion by Ifeanyi Nsofor, Sowmya R Rao (abuja)
Inter Press Service
ABUJA, Aug 11 (IPS) – A recent publication in the journal PLOS Medicine reviewed the relationship between COVID-19 and mental health in eight low- and middle-income countries, collectively referred to as LMICs. As important as this publication is, we are appalled by the widespread use of the term “low- and middle-income countries” utilized in this article, and indeed in the majority of the global health literature and discourse.
This term vastly oversimplifies the relationship both between individual LMICs, and between LMICs and High-income countries (HICs). It isn’t an exaggeration to say that the term is colonial and racist. It divides rather than unites. It is time to change the narrative and use an equitable term to describe countries in the Global South.
We are both from the Global South and now work in the Global North. Sowmya is from India while Ifeanyi is from Nigeria. We both live in the U.S. Indeed, Sowmya has lived there for more than 30 years. In our global health careers, we have experienced inequities meted to us and people like us simply because of where we are from.
Terms such as “low- and middle-income countries” perpetuate these inequities and use the same brush to paint 85% of the world’s population as the same. The Global South has almost six times the population of the Global North, is incredibly diverse, and has pockets of high-, middle- and low-income communities. Even within a single LMIC there is incredible diversity.
Without a doubt, categorizing countries into “low- and middle-income countries” and “high income countries” is not appropriate for studying healthcare systems and population health. It is misleading to categorize countries for convenience of data analysis and interpretation.
According to Google Scholar, so far in 2023, over 12,100 publications have used “low-and-middle income countries ” in their titles or in the text. A couple of editorials calling for a change in the classification were published in 2022 and yet, the same journal has over 15,000 publications since 2022 (more than 6000 in 2023) using these terms. Is this classification appropriate for healthcare-related research? We also do not believe that World Bank classification of countries using the gross national income (GNI) is appropriate in this scenario.
Furthermore, funding agencies and peer-reviewed journals perpetuate this problem by requiring the investigators to generalize studies conducted in one country (even one city/town/village) to not only the entire country but beyond that to other “low- and middle-income countries”.
Countries vary in their population sizes, demography, cultures, type of governments, education systems, health care policies, health care access, diseases, and socio-economic problems. Summarizing data across these countries and studying them as a unit to find a one-size-fits-all solution undermines the problems.
For instance, Nigeria has an estimated population of more than 200 million, more than 250 ethnicities that speak over 500 languages. On the other hand, India is the most populous country in the world, with a population of over 1.4 billion. It has more than 2000 ethnic groups that speak over 19,000 languages or dialects.
First, begin to rectify this issue by ensuring that studies are customized to each country so appropriate policies can be implemented to improve healthcare in the country being studied. Most problems and solutions are local and must be studied in this context.
Second, funding institutions and peer-reviewed journals should not insist on generalizability of the results beyond the targeted populations but focus on the possibility of the solutions being adaptable to different populations and situations.
Studies that can positively impact these populations even if small are worth being conducted and published. It may then be further researched and adapted as necessary in different settings but that should not be a condition for funding or publishing.
Third, knowledge transfer should be bi-directional and not unidirectional as is currently done. Therefore, countries in the Global North should be open to learning from solutions found in the Global South (what are also termed as “resource-limited or resource-poor” countries).
There are many lessons in this regard: African Union’s coordination of country COVID-19 responses through the Africa Centre for Disease Control, and diverse experiences on managing epidemics in the Global South.
Finally, researchers must tap into the power of local knowledge. This means including Ministries of Health and local investigators to identify the main problems that need studying and finding solutions to mitigate them – another step towards creating equity.
Having countries from the Global South involved with setting study priorities and also funding portions of studies will ensure that they are vested in the process and are equal partners in studies that impact their own populations. Indeed, no country has infinite resources as was seen during the recent COVID-19 pandemic and any solution that uses the available resources efficiently should be welcomed.
LMICs and HICs are vestiges of colonialism. They divide instead of unite by making the most populous parts of the global community inferior to the least populous. Most importantly, they perpetuate inequities which pose serious consequences for global solidarity.
Using ‘Global South’ versus ‘Global North’ to refer to LMICs and HICs respectively in global research vocabulary is the most equitable thing to do.
Dr. Ifeanyi M. Nsofor, MBBS, MCommH (Liverpool) is Senior New Voices Fellow at the Aspen Institute, Senior Atlantic Fellow for Health Equity at George Washington University, 2006 Ford Foundation International Fellow.
Dr. Sowmya R Rao is a Senior Research Scientist with the Department of Global Health at Boston University School of Public Health (BUSPH), a Fellow of the American Statistical Association and a biostatistician primarily interested in global health disparities.
The outbreak, which escalated rapidly since late June, has seen a total of 69,483 confirmed cases and 327 related deaths between 1 January and 7 August, with a case fatality rate of 0.47 per cent, according to the UN health agency. The cases were reported from all 64 districts in the country.
In July alone, 43,854 cases and 204 deaths were reported, accounting for 63 per cent of the total cases and 62 per cent of the deaths. The sharp increase in numbers is unprecedented compared to the past five years, emphasizing the gravity of the ongoing outbreak.
“The higher incidence of dengue is taking place in the context of an unusual episodic amount of rainfall, combined with high temperatures and high humidity, which have resulted in an increased mosquito population throughout Bangladesh,” WHOsaid.
Symptoms of dengue
Most people with dengue have mild or no symptoms and get better within two weeks. Rarely, dengue can be severe and lead to death. If symptoms occur, they usually begin four to 10 days after infection and last for two to seven days.
Symptoms may include high fever (40°C, or 104°F), severe headache, pain behind the eyes, muscle and joint pains, nausea, vomiting, swollen glands, and rash.
Severe dengue symptoms often come after the fever has gone away and may include severe abdominal pain, persistent vomiting, rapid breathing, bleeding gums or nose, fatigue, restlessness, blood in vomit or stool, being very thirsty, pale and cold skin, and feeling weak.
People with these severe symptoms should seek medical care right away.
Transmitted through mosquito bites
Dengue, a viral infection that transmits through mosquito bites, has long plagued tropical and sub-tropical regions. Aedes aegypti and Aedes albopictus mosquitoes serve as the primary vectors for the disease. An infected mosquito can transmit the virus for the rest of its life.
While there is currently no specific treatment for dengue, early detection and appropriate healthcare for case management can significantly reduce mortality.
According to WHO, the focus is on treating pain symptoms. Acetaminophen (paracetamol) is often used to control pain. Non-steroidal anti-inflammatory drugs like ibuprofen and aspirin should be avoided as they can increase the risk of bleeding.
Health authorities’ efforts to control the outbreak
Bangladesh’s health authorities have established a dedicated dengue control room to collect data and coordinate at the national level, with additional control rooms in all districts and medical college hospitals.
Six hospitals assigned for the management of COVID-19 patients in the capital, Dhaka, have been repurposed for dengue case management, and dedicated dengue wards and dengue corners have been established in medical college hospitals.
In addition, authorities are providing training to healthcare staff, supplying intravenous saline and other supportive medicines to health facilities, and stepping up surveillance, risk communication, community engagement and laboratory testing.
WHO
Controlling mosquito populations is an effective prevention against dengue.
WHO risk assessment and advice
WHO assessed the dengue risk at the national level as “High”, primarily due to the escalating case numbers, high case fatality rate, and the extensive geographical distribution of cases.
The UN health agency called for integrated vector management (IVM) to control mosquito populations and reduce human-vector contact, including removal of potential breeding sites, reducing vector populations, and minimizing individual exposure.
Specific actions involve vector control strategies for larvae and adult mosquitoes and source reduction, especially of water storage practices, and include covering, draining and cleaning household water storage containers on a weekly basis, using insecticide-treated nets and indoor space spraying (fogging).
At an individual level, protective measures include topical application of repellents to exposed skin or treatment of clothing, and the use of long sleeves shirts and pants; use of household insecticide aerosol products or mosquito coils, as well as window and door screens, which can reduce the probability of mosquitoes entering the house.
A young mother sits on a low wooden stool above burning embers from a piece of bark placed in a small earthenware pot. A bright purple and white cloth covers her legs and keeps the smoke from escaping.
This is part of a lower-body treatment process for mothers who have given birth as teenagers. She will soon lie down on a mat on the floor and receive a soothing and warming massage as her six-year-old son draws with crayons right next to her.
Aorn is now 21 years old, but looks a lot younger. She’s one of an estimated 47,400 teenagers between the ages of 15 and 19 who give birth each year in Thailand and one of many who have faced discrimination and stigmatization.
UN News/Daniel Dickinson
Aorn plays with her six-year-old son at the Khon Wai Sai centre.
She was just 14 years old when she became pregnant after she and her boyfriend failed to use any contraception. The boy’s parents were supportive and both families met to decide how to manage the pregnancy.
Although Aorn felt positive about giving birth, her mother felt that she would be stigmatized for being a young parent and that she was likely to drop out of school.
Her mother persuaded her to take a herbal drink that would abort the foetus, which ultimately did not work. Despite this failed attempt to terminate the pregnancy, her son, One, was born fit and healthy.
“I was so relieved when he was born healthy, and I have no regrets,” Aorn told UN News. “I’m so happy to have him in my life.”
While his mother receives care, energetic and inquisitive One patiently makes crayon drawings.
Aorn’s mother was right in her prediction that her daughter would stop going to school, as is the case among many young mothers from disadvantaged backgrounds.
Eventually, she was put in touch with a small non-governmental organization (NGO) Khon Wai Sai in her hometown just outside the regional capital of Chiang Mai in the north of Thailand. Supported by the UN Population Fund (UNFPA), the organisation provides services, guidance, and small financial grants for small start-up businesses to teen mothers. It was one of those grants that helped Aorn to realize her dream of opening a coffee shop.
She now provides advice, as a peer educator at regular meetings at Khon Wai Sai, to other young women who could benefit from her experience.
“I tell young women, especially those from the countryside who do not have access to information about their options for example birth control,” she said.
“Many don’t have that information. I knew about birth control, but decided not to use it, so what I needed most from Khon Wai Sai was financial support to start a small business,” she explained.
The woman who is massaging Aorn is herself a teenage mother. Nan gave birth at age 16, and now, her daughter is now almost four years old.
UN News/Daniel Dickinson
Nan fries traditional Thai snacks to generate income.
She too came to Khon Wai Sai for advice and support and ultimately was promoted as a staff member.
“At my school, they didn’t talk about sexual activity,” she said. “Teachers told us that we were too young to know about reproductive health. And when I went to the health centre to get a condom, they said the same. People just wanted to gossip about me.”
Nan is now involved in small income-generating activities. She makes compost from food scraps and is an expert at raising earthworms. She also makes traditional snacks at the Khon Wai Sai centre called Dok Jok, a deep-fried bread product in the shape of a flower “which is mainly popular with older people”, she said.
Despite the challenges faced by these two women in accessing good advice, Thailand has worked hard to ensure all Thais, including young people, have the right and access to sexual and reproductive health services.
The universal health coverage system, which is available to all citizens, provides family planning services and access to a range of birth control options, including contraceptive pills, long-acting contraception implants, and up to 10 free condoms a week to every young Thai person.
UN News/Daniel Dickinson
Aemmy is the coordinator of Khon Wai Sai based in northern Thailand.
Legislation introduced in 2016 to ensure the right to appropriate services and to ultimately reduce adolescent pregnancy has also proved successful. Five years after the law’s implementation, the pregnancy rate of 15 to 19-year-olds was halved from a record high in 2011 of 53.4 births per 1,000 to 24.4 births. The aim is now to go beyond the original target to less than 15 births per 1,000 women.
While the progressive legal framework and commitment to provide care makes Thailand a leader in the region for sexual and reproductive health, the letter of the law is not always adhered to by healthcare providers, and many teen mothers are still struggling to access the care they need, according to Aemmy, the Khon Wai Sai coordinator.
The legislation is relatively new, so many healthcare providers, especially in government facilities, “still have a negative perspective or attitude towards teenage parents despite the law stipulating that denying their rights is illegal,” she said.
Speaking ahead of International Youth Day, marked annually on 12 August she said more work needs to be done to ensure that young women are not denied services.
“It is the responsibility of the government to enforce the law and also to make sure health providers are properly trained.”
Discrimination and the resulting stigmatization of pregnant teens remains one of the key social barriers to them accessing care, but according to Asa Torkelsson, the UNFPA Country Director for Thailand, there are other factors.
Among them are gender inequality, poverty, sexual violence and coercion, social pressures, exclusion from educational and job opportunities, and negative attitudes about girls, she said.
Working with the Government, UNFPA has developed new partnerships, including with the corporate sector, to promote what Ms. Torkelsson calls “a more holistic approach to support girls’ rights and to empower them to avoid adolescent pregnancy”.
That approach includes age-appropriate comprehensive sexuality education for all young people, the building of “gender-equitable societies by empowering girls and engaging men and boys,”, and “measures to ensure adolescents’ access to sexual and reproductive health information as well as services that welcome them and facilitate their choices”, she explained.
Back at the Khon Wai Sai centre, One has finished his drawing and is ready to eat lunch with his mother, while Nan fries up a new batch of Dok Jok.
Both young women have ultimately accessed the services they needed and are committed to ensuring that those who follow behind them can do so as well.
*some names have been changed to protect identities
This project with Khon Wai Sai is supported by UNFPA Thailand in partnership with Reckitt through the multi-year ‘Empowering our Youth Project’, 2022 – 2026. It aims at ending unmet needs for family planning and promoting access to sexual and reproductive health services and rights among vulnerable and young ethnic populations in the north of Thailand.
“The risk remains of a more dangerous variant emerging that could cause a sudden increase in cases and deaths,” he said.
EG.5 is a sublineage of the omicron variant and has been detected in 51 countries, including the United States, China, South Korea and Japan, according to an initial risk evaluation.
While overall risk is low, “based on its genetic features, immune escape characteristics, and growth rate estimates, EG.5 may spread globally and contribute to a surge in case incidence.”
COVID-19 reporting declines
Tedros recalled that three months have passed since he declared the end of COVID-19 as a global health emergency, though at the time he cautioned that it remains a threat.
Since then, the number of reported cases, hospitalizations and deaths globally has continued to decline.
Meanwhile, the number of countries reporting data to WHO also significantly declined. In the past month, only 25 per cent reported their COVID-19 deaths and only 11 per cent reported their hospitalizations and intensive care unit admissions.
Tedros said the risk of severe disease and death is vastly lower than it was a year ago, due to increasing population immunity – whether from vaccination, infection or both – and from early diagnosis with better clinical care.
“Despite these improvements, WHO continues to assess the risk of COVID-19 to global public health as high. The virus continues to circulate in all countries, it continues to kill and it continues to change,” he added.
Recommendations for countries
In response, WHO has published recommendations for countries, which include updating their national COVID-19 programmes to move towards longer term sustained management of the disease.
They are also urged to continue collaborative surveillance to detect significant changes in the virus, as well as trends in disease severity and population immunity.
Tedros called for all countries to report COVID-19 data, especially on death and severe disease, genetic sequences, and vaccine effectiveness.
Governments should continue to offer vaccination against the disease, especially for the most at-risk groups, and ensure equitable access to vaccines, tests and treatment.
Nearly seven million people have died from COVID-19, and there have been more than 769 million confirmed cases worldwide.
The virus first emerged in Wuhan, China, in late 2019 and WHO declared the global pandemic the following March.
Every hour, 11 children die of AIDS, so finding them and offering treatment is as critical as ever, according to the UN entity UNAIDS, which released a new report about how imams, pastors, and priests are reaching those most in need. While three quarters of adults living with HIV are on treatment, only half of children are, the agency reported.
There are still 1.7 million children around the world living with HIV, and they are particularly vulnerable, said Stuart Kean, author of the Compendium of Promising Practices on the Role of African Faith Community Interventions to End Paediatric and Adolescent HIV, co-published by UNAIDS and the US President’s Emergency Plan for AIDS Relief (PEPFAR).
“If they’re born with HIV, then 50 per cent of them will die by the age of two,” he told UN News. “If they don’t and if they are not found and put on treatment, 80 per cent of them will die by the age of five, so there’s much greater urgency to find these hidden children.”
Promising practices
The new compendium documents 41 promising practices that provide evidence of the core roles that faith communities have played. This includes significant strides in identifying undiagnosed children living with HIV, improving continuity of treatment, supporting adolescents to access psychosocial support, care, and treatment, and enabling peer support groups to empower children and adolescents living with HIV.
“This report shows how vital is the role of faith-based organisations in helping children living with HIV to access life-saving treatment, in advocating in support of their needs, and in tackling stigma,” Jacek Tyszko, Senior Programme Advisor at UNAIDS told UN News. “It demonstrates too the approaches that have been most effective, so that they can be scaled up. It’s a report that will help save lives.”
Zambian influencers
“If you want to find women, go to their places of worship,” said Gibstar Makangila, head of a Zambia-based non-governmental organisation, Circle of Hope.
Since a new community-outreach model unrolled across Zambia’s capital city, Lusaka, in 2018, faith leaders have helped to reach 60,000 people across the country who were not receiving antiretroviral treatment, or ART, he said.
“As a faith community, we are the bridge between the community and health services,” he told UN News. “It is the most influential group in sub-Saharan Africa.”
When social media spread mis- and disinformation about the COVID-19 vaccine, Circle of Hope consulted faith leaders, the “real influencers”, he said. After convincing their congregants of the benefits, vaccination rates in Zambia soared, to 75 per cent from 34 per cent within six months.
Now, these imams, pastors, and priests are now playing a key role in making sure no one is left behind in the global bid to rid the world of HIV/AIDS, according to UNAIDS.
Abstinence and condoms
Contrary to anti-condom or anti-gay myths about religions, faith leaders are driving advocacy efforts to tackle the stigma and discrimination of those living with HIV and advocating for abstinence or at least prevention, including condom use, Mr. Makangila said.
They also readily direct congregants to projects for adolescents and to community health posts, set up as discreet unbranded stalls in markets. Now, 130 community health posts across the country, offer, with Ministry of Health and PEPFAR support, free services, from condoms to on-site treatment. Targeted programmes are also reaching teenagers, he said.
“I’ve seen this result thousands of times in people who would be dead without treatment,” Mr. Makangila said, adding that “the best is yet to come”, with health posts being planned for Côte d’Ivoire, Kenya, Nigeria, South Sudan, and Zimbabwe.
Baby baskets in Nigeria
A new baby is a celebration, commonly in marked in Nigeria in places of worship, where a pregnant congregant typically receives a baby shower basket chock full of goodies, from blankets to diapers.
Now, these welcome baskets include information on HIV testing and support services from local health-care providers, Mr. Kean explained.
Building on a successful trial, the Catholic Caritas Foundation implemented this “congregational approach” in Benue state demonstrating the effectiveness of using on-site confidential testing in such congregational settings as churches.
United Nations
SDG 3
Across Nigeria, this approach has already reached thousands. From April 2018 to March 2019 alone, 22,197 children under age 15 were referred for HIV testing, 21,142 of them were tested, and 106 new HIV-positive children were identified and linked to treatment.
Eswatini: Community action
The faith-based organisation Shiselweni Home Based Care in Eswatini launched an intervention involving community members visiting people who may be living with HIV, referring them to testing facilities and, if testing positive, supporting them to start and adhere to ART medication.
The latest trend indicates a dramatic 71.4 per cent decline in overall client mortality, from approximately one in three clients in 2007 and one in 10 in 2011.
Religious leaders and faith-based organisations like Circle of Hope in Zambia have also enrolled as “Faith Paediatric Champions”, who advocate to governments and community members for all children and adolescents to be supported to access HIV care and treatment.
Race to end AIDS
However, the global response to end AIDS in children continues to be inadequate, UNAIDS Executive Director Winnie Byanyima and John Nkengasong, US Global AIDS Coordinator and Special Representative for Global Health Diplomacy, said in the new report.
“The work of faith communities in addressing the challenge of HIV in children has been highly effective,” they wrote. “In that work of practical delivery, faith communities, and faith-based organisations have also reminded the world of a deeper lesson: to truly embrace those who are most vulnerable and excluded, caring, compassion, and love are essential.”
On the occasion of World Breastfeeding Week, Christine explained how she is helping other nursing mothers through a UN-supported programme in the Rhino Camp.
“I feel like the proudest mother in the world when I breastfeed him,” said Christine, from South Sudan. “I know that breastfeeding him will help him grow into a strong and healthy and intelligent boy. He is my future.”
Each morning, inside her small house, she gets herself and young son ready for the day. With 12-month-old Alvin snuggled into a wrap tied across her back, she makes her way to the local health centre just a few minutes’ walk from her house. There she is greeted by a small group of women, most of whom have tiny babies in their arms or on their backs.
Christine comes here each day, where she earns a small income as a community worker, mentoring other breastfeeding mothers. She is here to help give her son the best start at life and to help other women do the same.
Lifeline in fragile settings
World Breastfeeding Week 2023
Breastfeeding is always important, but in fragile settings like this, it’s a lifeline. It not only provides all the nutrients a baby needs for the first six months of life, it’s also free of charge and almost always available.
In 2016, when Christine was a 25-year-old college student and aspiring teacher, rebels attacked her hometown of Yei, in South Sudan. She and her family fled into the bush, but shortly afterwards, her father was killed while looking for medicine for a sick family member. Fearing for their lives, Christine and her family fled to Uganda, eventually settling in Rhino Camp.
Her husband has since returned to South Sudan, but Christine has stayed on. In South Sudan, two thirds of the population are facing crisis levels of hunger, the highest number ever, and there is no sign of the situation improving soon.
She has found some stability in Uganda, for herself and her son. She said she was happy with the life she is building there.
Cash for breastfeeding mothers
Ⓒ WFP/Arete/Siegfried Modola
WFP’s nutrition programme supports breastfeeding mothers through cash assistance and nutrition counselling.
Last year, while heavily pregnant, Christine became one of 13,000 pregnant and breastfeeding women from both refugee and host communities to receive Nutricash.
Part of the Swedish-funded Child Sensitive Social Protection Programme, under which the World Food Programme (WFP) collaborates with the UN Children’s Fund (UNICEF) and the Government of Uganda, the project provides each woman with $13 to help meet food and nutrition needs and $4 that is put into savings.
Christine has used some of her savings to plant avocado trees and cassava. She plans to go back to school one day and become a teacher. She hopes her savings will make this a reality. Other women use the money to buy goats and pay for school fees.
Breaking cycles of poverty
Ⓒ WFP/Arete/Siegfried Modola
Every week, Christine meets with her Joy Care Group, where mothers offer each other support and comfort in addition to sharing experiences about breastfeeding.
“By supporting breastfeeding mothers, through cash and nutrition assistance and counselling, we are breaking a vicious poverty cycle and giving the opportunity to these mothers to send their kids to school, to invest in their small business and in the near future, to become fully self-reliant,” said Abdirahman Meygag, WFP’s country director in Uganda.
After receiving nutrition training from WFP’s partner, Save the Children, Christine started supporting women to breastfeed.
“Some women, especially younger mothers, are often scared to breastfeed,” she explained. “Often, they don’t know how to place their babies, and they want to give up because it’s too painful. They have a lot of chores that cause stress, and they don’t produce enough breastmilk.”
Knowledge is power
Ⓒ WFP/Arete/Siegfried Modola
WFP supports women to breastfeed so that children can have the healthiest start in life.
Breastfeeding is one of the simplest, smartest, and most cost-effective ways of ensuring that children survive and thrive. Breastfeeding has broad benefits, and can help to prevent infant death and childhood illness.
Each week, Christine and members of the Joy Care Group come together for friendship, to share information on breastfeeding and to support and comfort each other.
The women gather under the shade of a tree, holding their babies in their laps as they share their struggles, worries and fears. From time to time, they breastfeed their young babies.
Group member Jemma said knowledge is key.
“I know my child is going to be well and not only my child, but everyone’s child in the group,” she said. “Because we have the knowledge and since we are coming together, every week we learn more.”
Learn more about how the UN supports women and their children during World Breastfeeding Week and throughout the year here.
World Breastfeeding Week
Marked annually from 1 to 7 August, World Breastfeeding Week focuses on the invaluable benefits of nursing. The World Health Organization (WHO) and UNICEF recommend: early initiation of breastfeeding within one hour of birth; exclusive breastfeeding for the first six months of life; and the introduction of nutritionally-adequate and safe complementary, solid foods at six months together with continued breastfeeding up to two years of age or beyond. This year’s theme is on working and nursing.
Here are some quick facts:
More than half a billion working women are not given essential maternity protections in national laws.
Just 20 per cent of countries require employers to provide employees with paid breaks and facilities for breastfeeding or expressing milk.
Fewer than half of infants under six months of age are exclusively breastfed.
Over 820 000 children’s lives could be saved every year among those under age five if they were optimally breastfed from birth to 23 months.
Breastfeeding improves IQ, school attendance and is associated with higher income in adult life.
Improving child development and reducing health costs through breastfeeding results in economic gains for individual families and at the national level.
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