http://www.irinnews.org/irin-fp.aspxUpdated everydayen-gbMon, 16 Nov 2009 21:14:06 GMTKABUL Monday, November 16, 2009 (IRIN) - For Kabul’s estimated population of 4-5 million there are only 35 public toilets, according to the municipal authorities.KABUL Monday, November 16, 2009 (IRIN) - For Kabul’s estimated population of 4-5 million there are only 35 public toilets, according to the municipal authorities.

“We need at least 65 extra public latrines in Kabul immediately,” Nesar Ahmad Habibi, head of Kabul’s waste management authority, told IRIN, adding that the lack of government action and limited resources had prevented the construction of sufficient public toilets in the city.

"We have even sent proposals to the president's office but to no avail," he said.

Many people are forced to defecate and urinate in the open: "It's not that we don't want to use a latrine, it's because there is no latrine," said Arifullah, a local man.

"If you have a pain in your stomach and there is no toilet how long can you wait?" asked another man.

Only five of the 35 public toilets have facilities for the disabled - well below what is needed given the large number of disabled people resulting from three decades of turmoil.

People who use the latrines have to pay a small fee to cover maintenance and cleaning - 5-10 Afghanis [10-20 US cents], a sum that the large number of extremely poor people in the city would prefer to avoid paying.

No soap

"I don't use the latrines because they are extremely dirty," said Abdul Jamil, a young man. "There is also no soap to wash your hands."

None of Kabul's public toilets provide soap or hand-drying facilities.

Whilst hand-washing is crucial for disease prevention, soap is also not available in toilets in most Kabul schools, officials in the Ministry of Education said.

"Inappropriate latrines, open defecation and poor waste management cause serious diseases and damage the environment," Hassan al-Sayed, country director of the French NGO Solidarités, [http://www.solidarites.org/defaulteng.shtml] told IRIN.

Waste management

In September 2008 Kabul Municipality told IRIN [http://www.irinnews.org/Report.aspx?ReportId=80641] that up to 90 percent of the 3,000 tons of solid waste produced in the capital every day was managed and dealt with.

However, officials say waste management capacities have deteriorated sharply in the past year: "Now we collect only about 50 percent of the solid waste produced in Kabul on a daily basis," said Habibi, citing dwindling resources, staff reductions and broken-down trucks as major problems.

"For waste management in Kabul we need 17,500 staff but we have only 3,000; and we need 2,500 trucks but we only have 119."

Rapid population growth and unregulated housing developments have created serious social and environmental challenges in Kabul [http://www.irinnews.org/Report.aspx?ReportId=75508], according to government officials.

Al-Sayed, whose organization has been helping households in Kabul to build hygienic latrines, emphasized the importance of public awareness about sanitation and hygiene.

"What if there are hundreds of safe latrines but people don't use them," he said, adding that people should know the risks of open defecation and unsafe latrines.

Only 12 percent of Afghans have access to improved sanitation and less than 25 percent have access to safe drinking water, according to the UN Children's Fund (UNICEF).

Most Afghans use the traditional dry vault toilet systems [http://www.irinnews.org/Report.aspx?ReportId=73691] which were ranked the worst toilets in the world by The State of the World's Toilets 2007 [http://www.wateraid.org/documents/the_state_of_the_worlds_toilets_2007_1.pdf] report.

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http://www.irinnews.org/report.aspx?ReportId=87052NAIROBI Monday, November 16, 2009 (IRIN) - The first cases of pandemic influenza H1N1 2009 have been confirmed in Somalia, according to the UN World Health Organization (WHO).NAIROBI Monday, November 16, 2009 (IRIN) - The first cases of pandemic influenza H1N1 2009 have been confirmed in Somalia, according to the UN World Health Organization (WHO).

"Two out of 10 samples tested positive for novel H1N1 [pandemic strain] on 3 November 2009 in KEMRI [Kenya Medical Research Institute] referral laboratory in Nairobi," Mohamed Mahamud Fuje, WHO's H1N1 focal point for Somalia, told IRIN.

On 9 November, WHO issued a statement saying Somalia was the last country in the Eastern Mediterranean region to report confirmed cases of H1N1.

2009 H1N1 (also known as “swine flu”) was first detected among human beings in Mexico, spreading worldwide in much the same way as regular seasonal influenza.

On 11 June 2009, WHO signalled that a pandemic of 2009 H1N1 flu was under way.

Awareness building

WHO said it had conducted training for 70 health workers from the self-declared republic of Somaliland and the self-declared autonomous region of Puntland "on case management, surveillance, outbreak communication and social mobilization, infection control, and vaccination".

Fuje added that this would be extended to south-central Somalia very soon to strengthen WHO’s surveillance. He said the aim was to train enough people and "if we do that I am confident we would be able to deal with any outbreak".

Bahsir Ali Bihi, the Puntland Minister of Health, told IRIN on 16 November that the region had started vaccinating people going to the Haj against H1N1.

"We have started with the pilgrims and we are also conducting prevention campaigns," Bihi said. "We are gearing up for a major campaign to sensitize people to the danger and how to prevent it."

Messages will be disseminated to the population by radio, pamphlets and billboards, he said.

WHO said personal protection equipment and laboratory diagnostic kits had been pre-positioned in Somalia for infection control and rapid diagnosis.

The biggest constraints are the lack of an effective and sensitive disease surveillance system which would enable early detection of cases of influenza-like illnesses, WHO noted.

The absence of appropriate laboratory facilities in Somalia had led to delays in the identification and confirmation of the H1N1 virus and further delays in response, WHO said. The agency recommends a national influenza centre be established.

Fuje said lack of sufficient funds was "severely hampering efforts to increase social mobilization and community awareness on prevention and case management".

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http://www.irinnews.org/report.aspx?ReportId=87055POCHALLA Monday, November 16, 2009 (IRIN) - An increasing number of people in Southern Sudan cannot find enough to eat or adequate pasture and water for their livestock, raising fears of conflict between communities over grazing lands, local leaders warned.POCHALLA Monday, November 16, 2009 (IRIN) - An increasing number of people in Southern Sudan cannot find enough to eat or adequate pasture and water for their livestock, raising fears of conflict between communities over grazing lands, local leaders warned.

"Where there was peace, there was no rain and then where there were good rains, there was insecurity," Kuol Manyang, governor of Jonglei State, said.

His counterpart from Upper Nile State, Gutlauk Deng Garang, warned that hunger would force pastoralist cattle herders to move their animals, sharply increasing the likelihood of clashes with rival ethnic groups.

"We expect the cattle herders to start moving soon, and then it is expected [that there will] be conflict between the Lou and the Jikany Nuer," Garang told IRIN recently. Conflict between the Shilluk and Dinka communities had added to food insecurity, he said.

More than 2,000 people have died and about 350,000 have been displaced by violence across Southern Sudan since January, according to the UN Office for the Coordination of Humanitarian Affairs.

The World Food Programme (WFP), which began airdropping food in the area on 4 November, estimates that 1.2 million people are already facing serious food insecurity in Southern Sudan.

"Air drops are a last resort to get food into these inaccessible places during this time of hunger," Michelle Iseminger, head of WFP in Southern Sudan, told reporters at Pochalla, a remote settlement on Sudan’s border with Ethiopia.

Wider problem

According to the UN Food and Agriculture Organization, the food insecurity in the region is part of the wider threat facing eastern Africa and the Horn, where prolonged drought and mounting conflict have left an estimated 20 million people needing food aid.

The warning came at a tense time for Southern Sudan, which is struggling to recover from a 22-year civil war that ended less than five years ago. Elections are due in April, followed by a referendum on the south's potential full independence in 2011.

"If we are not able to handle the situation well... repairing adequate supplies... we can expect very, very significant levels [of hunger] which can border on the red flag emergency, which becomes a famine," Hilde Johnson, the UN Children’s Fund (UNICEF) deputy executive director, said during an 8 November visit to Jonglei's capital, Bor.

"When natural resources are being diminished on a daily basis, you will see hard pressure coming in on already meagre resources," Johnson added. "This will exacerbate conflict, there is absolutely no doubt."

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http://www.irinnews.org/report.aspx?ReportId=87057HANOI Monday, November 16, 2009 (IRIN) - The birth rate in rapidly developing Vietnam has dropped in recent years while maternal health and antenatal standards have risen – albeit only for the dominant ethnic groups. Ethnic minorities mostly still give birth at home, without a healthcare worker or midwife, specialists say.HANOI Monday, November 16, 2009 (IRIN) - The birth rate in rapidly developing Vietnam has dropped in recent years while maternal health and antenatal standards have risen – albeit only for the dominant ethnic groups. Ethnic minorities mostly still give birth at home, without a healthcare worker or midwife, specialists say.

Vietnam has 54 ethnic groups, with the Kinh comprising more than 80 percent of the population of 85.8 million, according to government figures. They are the dominant ethnic group. A few others, such as the Tay and Hoa (ethnic Chinese), have similar standards of living and education.

But most other ethnic minorities - more than eight million people - live mostly in the mountainous and remote areas, and are economically disadvantaged. The poverty rate is 69.3 percent, compared with 23.11 percent for the majority Kinh and Chinese ethnic groups, according to the UN Children’s Fund (UNICEF). [http://www.unicef.org/vietnam/overview.html]

Maternal mortality rates vary widely across the country. In Cao Bang province, with a 98 percent ethnic minority population, there are 411 maternal deaths for every 100,000 live births, according to UNICEF. In Binh Duong province, near Ho Chi Minh City, the rate is less than one-tenth of that.

H’Mong struggles

Minorities such as the H’Mong mostly still give birth at home, and are far less likely to access healthcare, especially antenatal care, health specialists say.

The H’Mong, who make up less than 1 percent of the population, have much lower standards of living, and are often confined to remote areas, in the mountains.

Women “don’t know how to recognize problems and this may lead to obstetric emergencies”, said Nguyen Van Hai, manager of the Save Newborn Lives project at Save the Children.

Barriers to care cited by experts include a lack of confidence when it comes to accessing and dealing with the healthcare system and health workers, and poor fluency in Vietnamese.

In addition, H’Mong women traditionally give birth at home with their husbands or with traditional birth assistants (TBAs), who lack formal training.

The cost of healthcare is also prohibitive, including the US$10 to give birth at a health centre. “For ethnic minority groups, it's too much,” said Hai.

Hoa Binh leads the way

Since 2001, the UN Population Fund (UNFPA) has been working with local government in Hoa Binh province, 80km south of Hanoi, to improve the use of antenatal services among H’Mong communities.

UNFPA officials say visits by H’Mong women to two commune-level health centres have increased since 2001, and there has not been a maternal death since 2003.

Tran Thi Tuyet Minh, a government doctor who works with UNFPA, said 65 percent of her patients now are H’Mong or another minority, against 8-10 percent in 2001.

“Hoa Binh province achieved some results. However, we must try more,” she told IRIN.

The rise in attendance of H’Mong women at one commune-level health centre is partly thanks to one of the midwives being ethnic H’Mong. Patients are more apt to trust her as they share a culture and, more importantly, language. Many H’Mong girls do not complete middle school, or even attend primary school for more than a year or two. Poor education and lack of fluency in Vietnamese keep them confined to the house and fields.

“If it [the commune-level health centre] is run in a city way, rural people won’t go,” said Duong Van Dat, national programme officer with UNFPA’s reproductive health unit in Hanoi. “It must be culturally adapted to needs.”

The Hoa Binh programme is still something of a pilot project, but Dat said there were hopes the lessons learned could be replicated and applied to other areas, even though it is near the capital and far northern mountainous areas, such as Ha Giang and Cao Bang province, might provide different challenges.

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http://www.irinnews.org/report.aspx?ReportId=87061HARADH Monday, November 16, 2009 (IRIN) - Aid workers at al-Mazraq camp for internally displaced persons (IDPs) in Haradh District, Hajjah Governorate, northernYemen, say more and more children are arriving at the camp in a state of moderate or severe malnourishment.HARADH Monday, November 16, 2009 (IRIN) - Aid workers at al-Mazraq camp [http://www.irinnews.org/Report.aspx?ReportId=87005] for internally displaced persons (IDPs) in Haradh District, Hajjah Governorate, northernYemen, say more and more children are arriving at the camp in a state of moderate or severe malnourishment.

"During our tent visits, we found that an average family has a severely or moderately malnourished child," said Sarah Yahya, a volunteer working with the UN Children’s Fund (UNICEF) on identifying malnourished children.

Khalid Shaibani from the UNICEF-run therapeutic feeding centre (TFC) at the camp told IRIN the number of malnourished children was increasing by the day as new IDP families arrived.

"Two babies died from malnutrition complications just a few days after their families secured shelter in the camp. Another 10 were referred to a hospital in Haradh town, 40km west of the camp," he said.

Of the 3,000 under fives targeted by a recent screening in the camp, 667 cases (22 percent) were severely malnourished and 200 (6.67 percent) moderately malnourished, according to Shaibani.

In September UNICEF screened about 1,200 under-five IDP children in the camp and found 7 percent severely malnourished. [http://www.irinnews.org/Report.aspx?ReportId=86423]

Ali Mahdi is one of the parents who brought his two young children to the TFC.

"Faris's arms and legs are getting thinner and thinner by the day. No food remains in his stomach for more than 10 minutes due to very bad diarrhoea and vomiting. He hardly stands up or sits down and spends most of the time lying on his back," said the father of the four-year-old boy.

Mahdi, his wife and their six children fled their home in the Dhafir District, Saada Governorate, to the Saudi border in mid-August because of fighting between government troops and Houthi-led insurgents. Whilst taking refuge there, they had very limited access to food, Mahdi’s wife, Khudhra, told IRIN.

After a Saudi army operation against Houthi insurgents in the border area in early November, the family was forced, along with hundreds of others, to flee again. [http://www.irinnews.org/Report.aspx?ReportId=86977]

Chronic malnourishment

Rajia Ahmed Sharhan, a nutrition officer with UNICEF in Sanaa, said moderate malnourishment is not very visible.

“Probably malnourishment was there among some children before the displacement occurred, but was not very visible. When the families had to flee and had problems with accessing proper and nutritious food for weeks, those moderate cases became severe,” she said.

"We cannot say that the war situation is the only source of the problem because mothers neglect their babies and don't know how to feed them. Several cases had shown chronic malnutrition," said UNICEF volunteer Yahya.

Tent visits to increase mothers' awareness on how to care for their babies, as well as to promote breastfeeding, revealed that many mothers often gave their babies tea with bread in the morning and at night, which can lead to anaemia and malnutrition, Yahya said, adding: "If water is given in lieu of tea, symptoms will be milder.”

"Even worse, mothers with newborns come to us and ask for milk powder, preferring it to breastfeeding. They aren't aware of the benefits of breastfeeding for their babies," Yahya said.

According to the World Health Organization, only 11.5 percent of mothers in Yemen exclusively breastfeed their babies until they are six months old. [http://www.who.int/nutrition/databases/infantfeeding/countries/yem.pdf]

Plumpy’Nut treatment

TFC provides different types of therapeutic formula to affected children, depending on how serious the case is, TFC's Shaibani said. "Acute moderate cases get two sacks of Plumpy’Nut [http://www.irinnews.org/report.aspx?ReportId=72897] a day while severe cases with serious complications are given concentrated proteins and vitamins through nasogastric tubes in the camp's clinic."

He said 75-percent fat milk is given to infants with oedema (an abnormal accumulation of fluid beneath the skin or in one or more cavities of the body), usually caused by malnourishment complications. "If no improvement is noticed, the centre refers critical cases to the Haradh-based hospital or to Sabin Hospital in Sanaa."

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http://www.irinnews.org/report.aspx?ReportId=87062GARISSA Monday, November 16, 2009 (IRIN) - Armed with a university certificate, Hubbie Hussein Al-Haji returned to her pastoralist community in Garissa, northeastern Kenya, expecting to serve as a veterinary health assistant. But she was refused the job.GARISSA Monday, November 16, 2009 (IRIN) - Armed with a university certificate, Hubbie Hussein Al-Haji returned to her pastoralist community in Garissa, northeastern Kenya, expecting to serve as a veterinary health assistant.

But she was refused the job. "When I came back to Garissa [Northeastern Province capital], I was told you [a woman] cannot treat our animals because you menstruate - it will make our cows perish," she told IRIN.

Al-Haji and a colleague then started a local NGO, WOMANKIND Kenya (WOKIKE) to provide leadership training to women. They also set up a sanctuary for girls at risk of female genital mutilation/cutting (FGM/C).

"Girls are often seen as an object for the pleasure of men," Al-Haji said. In her community, FGM is a highly valued ritual, marking the transition from childhood to womanhood.

At present, the centre is supporting 120 girls aged around six years old because they are at risk of FGM/C from age eight. The girls, most of whom have escaped FGM/C, are enrolled on the recommendation of the government children's department and the community.

"When we started the campaign against FGM, the community turned against us; it was a taboo subject," Al-Haji explained. "The most difficult men to work with were the educated ones who see you [an educated woman] as a challenge."

With time, WOKIKE received the support of local religious leaders, most of whom are Muslim. "[Now] the religious leaders are telling the community that FGM is not a religious obligation," she said.

One success story has strengthened Al-Haji’s resolve to support disadvantaged women in northeastern Kenya. Hafsa, who has been supported by the centre for 14 years, is about to join the University of Nairobi to study pharmacy.

"I was rescued from traditional practices like FGM and early marriage," Hafsa told IRIN, adding that she came to the centre from Ijara [a district south of Garissa] at four.

"You are discriminated against either way by the community if you have not been circumcised and by friends in schools outside northeastern if you have been circumcised," Hafsa, who went to a high school in eastern Kenya, said.

At least 32 percent of Kenyan women have undergone FGM/C, according to a report by the Population Council. Among communities such as the Somali, Abagusii, Kuria, Maasai and Samburu, more than 90 percent of women undergo it.

Women’s work

The situation of girls and women in neighbouring Wajir is no better, said Haretha Bulle, a programme manager with the Wajir South Development Association (WASDA).

"In a typical Somali household, the woman's labour is needed for cooking, taking care of small babies, and it is for this [reason] that girls are often pulled out of school," Bulle told IRIN.

A lack of awareness of the value of education and no boarding-school facilities for girls has had adverse effects.

"There is no man who will trust his daughter to go to school [alone] in town without her mother," she noted. "Yet for you to go to high school you have to go to primary [school]."

Many of the girls suffer FGM/C and cannot report the practitioners. "In April, a girl who underwent FGM bled to death. The circumciser was arrested, and then released," she said.

"They are often very old women who sometimes cannot even see," Bulle added. "FGM/C cannot go away overnight. You cannot tell the Somali not to circumcise - though they don't like the Pharaonic type."

The Pharaonic form of FGM, also known as infibulation, involves the total removal of all external sex organs before the vagina is sewn up, leaving a small opening for the passing of menstrual blood.

At home, the girls too are exposed to gender-based violence, but the communities do not see it as a problem, Bulle added.

"If you try to intervene, you end up being accused by the woman herself of interfering," she explained. "[However], I cannot say that the [reported] cases of rape here are alarming."

The bigger problem was lack of support systems. "Care services for abused women in this part of the country are almost non-existent," she said. For instance, if a woman has been raped, "PEP [post-exposure prophylaxis] ... [is] only in the books in this part of the world". PEP services within 72 hours of HIV exposure help to prevent infection.

High divorce rates

In the town of Moyale, along the border with Ethiopia, women and girls were seen as "inferior" to men, assistant chief for Odda location, Rashid Osman, said.

"A woman can get married but at the end when there is a divorce, she does not get her rights," he said. "Here, people seem to marry and divorce anyhow. Consequently, there are many divorcees and neglected children."

Despite awareness-raising, traditional perceptions are hard to change. "You hear men saying that by the end of the next rains, I must marry a fourth wife then I will go for Hajj. You would expect Hajj to be more of a priority," he said.

"Sometimes people marry for very strange reasons... like to take care of the cows since the town is growing and herders have to go further out to the fields."

Across northeastern Kenya, said Rashid Karayu, chairman of the Global Integrated Development Programme, a local NGO, women were more disempowered than in other areas.

"The perception from the people and even the women themselves is that they are inferior," he told IRIN. "Even in school committees, women who are best placed to speak for their children often shy away."

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http://www.irinnews.org/report.aspx?ReportId=87063DAKAR Monday, November 16, 2009 (IRIN) - Health officials have confirmed three cases of yellow fever in Côte d’Ivoire’s northwest Denguélé region, of 10 suspected cases. DAKAR Monday, November 16, 2009 (IRIN) - Health officials have confirmed three cases of yellow fever in Côte d’Ivoire’s northwest Denguélé region.

"We have 10 suspected cases, with three confirmed," Siméon N’da, Health Ministry head of communications, told IRIN on 16 November. Health workers vaccinated people in and around affected villages at the weekend, according to N'da. He did not specify how many people were vaccinated and in what localities.

N'da said there had been no deaths from the mosquito-borne viral infection. Local taxi drivers told IRIN they transported the bodies of four teenagers from the village of Tron Touba to the region’s main city Odienné during the week of 9 November. Villagers said they had died of an unknown illness.

Local health officials in Odienné would not comment.

Some 30,000 people worldwide die of yellow fever each year, of about 200,000 cases, according to the World Health Organization (WHO). No cure exists and 50 percent of infected people who cannot access treatment will die, according to WHO, which says vaccination is “the single most important preventive measure”.

np/ajhttp://www.irinnews.org/report.aspx?ReportId=87068DUBAI Friday, November 13, 2009 (IRIN) - An estimated 200 million children aged under five in the developing world suffer from stunted growth due to maternal and childhood undernutrition, according to a new UNICEF report. DUBAI Friday, November 13, 2009 (IRIN) - An estimated 200 million children aged under five in the developing world suffer from stunted growth due to maternal and childhood undernutrition, according to a new UNICEF report. http://www.unicef.org/publications/index_51656.html

“Stunting is associated with developmental problems and is often impossible to correct. A child who is stunted is likely to experience a lifetime of poor health and underachievement,” a UNICEF statement on 11 November said.

In the Middle East, the Occupied Palestinian Territories have a stunting prevalence of 10 percent, a surprisingly better result than other, far wealthier neighbours, which have the following scores:

Lebanon - 11
Jordan - 12
Oman - 13
UAE - 17
Saudi Arabia - 20
Kuwait - 24
Iraq - 26
Syria - 28
Egypt - 29
Yemen – 58

at/oa/cbhttp://www.irinnews.org/report.aspx?ReportId=87018BANGKOK Friday, November 13, 2009 (IRIN) - A recent spate of natural disasters in Asia has further underscored the importance of breastfeeding during emergencies, with a need for additional policies to support this.BANGKOK Friday, November 13, 2009 (IRIN) -  A recent spate of natural disasters in Asia has further underscored the importance of breastfeeding during emergencies, with a need for additional policies to support this.
 
Hundreds of thousands were displaced and forced into evacuation shelters following a series of deadly typhoons in the Philippines, Cambodia, Vietnam and Laos, and an earthquake in Indonesia in the past two months.
 
But according to experts, during such disasters, support for mothers to breastfeed is often overlooked and not given the priority it needs, despite its life-saving function.
 
Besides raising awareness of the importance of breastfeeding, aid organizations need to have policies on infant feeding, they say.

“You have to have a strong policy in place, and make sure all the actors and all the staff in that organization know about this policy,” Anna Winoto, a nutrition specialist with the UN Children’s Fund (UNICEF) in Indonesia, told IRIN.
 
In emergency situations, poor water and sanitation and security situations contribute to a heightened risk of disease among children, who are vulnerable to diarrhoea, malnutrition and pneumonia.
 
Practices such as using infant formula milk, when water may be contaminated and feeding bottles cannot be sterilized, contributes to the risk and has been shown to lead to an increase in diarrhoeal disease in infants.
 
“Breastfeeding is actually even more crucial under emergency conditions because children under five, and infants in particular, are at an increased risk of infection, disease and malnutrition,” Winoto said.
 
“Breastfeeding should be seen as a life-saving intervention,” she said.
 
In an emergency situation, establishing private spaces for mothers and infants, one-to-one counselling and mother-to-mother support is needed to encourage breastfeeding, say UNICEF and the World Health Organization (WHO).
 
“As part of emergency preparedness, hospitals and other healthcare services should have trained health workers who can help mothers establish breastfeeding and overcome difficulties,” said WHO Director-General Margaret Chan in a statement to mark World Breastfeeding Week in August.
 
Both UNICEF and WHO advocate exclusive breastfeeding for children up to six months of age, and continued breastfeeding and complementary feeding until age two.
 
Dangerous donations
 
But one obstacle to breastfeeding during emergencies is unsolicited or uncontrolled donations of breast-milk substitutes, which undermine breastfeeding, according to UNICEF and WHO.

Following a 7.9 magnitude earthquake in West Sumatra on 30 September, UNICEF Indonesia, worked with the country’s Health Ministry, and contacted local and national radio stations to broadcast requests to stop milk-substitute donations.
 
“It’s a huge problem, and the problem lies in the lack of knowledge among the donors on the potential harm,” said Winoto.
 
Meanwhile, coordination in emergencies also remains a challenge, with little capacity to locate only those children who truly need infant formula and not disrupt breastfeeding practices, she said.
 
“In our experience, it’s gotten better but it’s still a huge challenge because there are so many actors when an emergency comes, and so many donations,” she said.
 
Helping with trauma
 
Besides the health benefits, breastfeeding advocates underline the psycho-social benefit of maintaining the activity during an emergency, which is traumatic for babies and young children, experts say.
 
“In an emergency, keeping the baby on the breast is not only about nutrition, it is giving the child that security and closeness when it is scared,” Elvira Henares-Esguerra, director of the Philippine NGO Children for Breastfeeding, [http://breastfeedingphilippines.com/cfb.html] told IRIN.
 
In the aftermath of Typhoon Ketsana, which caused massive flooding in the Philippines in September, Henares-Esguerra and a handful of breastfeeding mothers with their children visited an evacuation centre.
 
They demonstrated breastfeeding practices, and encouraged displaced mothers to do the same.
 
“We discovered that infant formula was being given out by the government at evacuation centres,” said Henares-Esguerra.
 
“We wanted to encourage the mothers to breastfeed,” she said.

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http://www.irinnews.org/report.aspx?ReportId=87020WAJIR Friday, November 13, 2009 (IRIN) - Khadijah Ibrahim is a mother of six in the northeastern Kenyan district of Wajir East. The area has suffered recurrent droughts and is now facing the risk of flooding from El-Nino rains. For now, however, the effects of the drought continue to be felt, as Khadijah told IRIN: WAJIR Friday, November 13, 2009 (IRIN) - Khadijah Ibrahim is a mother of six in the northeastern Kenyan district of Wajir East. The area has suffered recurrent droughts and is now facing the risk of flooding from El-Nino rains. For now, however, the effects of the drought continue to be felt, as Khadijah told IRIN:

"My husband, who is a nomadic pastoralist, moved away with the livestock when the drought became very serious and some of the animals started dying, but we are hopeful that he will return now that the rains have started.

"When he left, my children and I were left behind as usual. We could not go with him as the children were already enrolled in school here.

"Sometimes my husband is gone for long but he always sends back some money from the grazing fields for the upkeep of the family. He sends the money with the drivers along the highway.

"But the money has been reducing as some of the livestock died along the way. Now my husband has been sending me less money yet the prices of food have gone up because of the drought.

"The children are not able to get milk since all the cows have moved away. With the drought, the price of milk from goats, cows and camels has all gone up. We are now buying a litre of goat’s milk at 120 shillings [US$1.6]. Camel milk, which used to be the cheapest, is now selling at about 70 shillings [90 US cents].

"But we are expecting the price of milk to go down, as with the rains, the animals will return.

"The price of food is still high with a kilogram of maize flour now selling at 80 shillings [$1.06] - up from 60 [80 US cents] in September. The price of meat, milk and vegetables has also gone up.

"Getting food is hard for most families here in Wajir but I would say that I am a little luckier as I live closer to the town [Wajir]."

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http://www.irinnews.org/report.aspx?ReportId=87025JUBA Friday, November 13, 2009 (IRIN) - Reported cases of kala azar infection, a deadly disease also known as visceral leishmaniasis, have continued to rise in Southern Sudan, according to medical workers.JUBA Friday, November 13, 2009 (IRIN) - Reported cases of kala azar infection, a deadly disease also known as visceral leishmaniasis, have continued to rise in Southern Sudan, according to medical workers.

"We are clearly in the midst of a kala azar epidemic," Jill Seaman, working in the Old Fangak clinic in Jonglei State, run by the Sudan Medical Relief organization, said.

"Our numbers are remaining high - with 80 admissions in the past week and patients coming daily," Seaman, an infectious disease expert, said in a 12 November email to IRIN.

The outbreak, which is transmitted by the sand fly, has hit some of the most remote and difficult-to-access regions of Upper Nile and Jonglei states, areas also suffering from recent inter-ethnic clashes.

The disease is almost always fatal within one to four months unless treatment is given, but some 95 percent recover if treated in time.

However, many patients were arriving too late at health centres, Seaman said. "Some people come to die the same day," Seaman said. "There is so much anaemic heart failure in the early months of an outbreak, requiring blood transfusion - if at all possible."

MSF teams

Médecins Sans Frontières (MSF - Doctors Without Borders) has sent emergency teams into Upper Nile and Jonglei to try to treat those they can reach.

"Numbers continue to increase in terms of admissions and those being treated, but the main concern is that there are many still in remote areas who are not receiving treatment," said Ross Duffy, who heads MSF Holland in Southern Sudan.

The disease suppresses the immune system, leaving victims open to other infections such as malaria or pneumonia. Symptoms include fever, diarrhoea, vomiting, nosebleeds, a swollen spleen and jaundice.

"The symptoms can appear like malaria, and there is not a huge awareness of kala azar in many communities, but we are working to get the message out," Duffy added.

With poor or badly timed rains meaning failed harvests, coupled with months of insecurity caused by inter-ethnic clashes, many people are already weakened.

"Other NGOs are now looking for spots not well covered - there are surely people dying in their villages without coming for care," Seaman added.

Many of those received by clinics are children, according to the World Health Organization (WHO), which is supporting efforts to treat those affected.

"Children account for a significant proportion of the outbreak: admission figures over the past two months show that 42 percent of patients were children under five, and 47 percent aged 5-17," a 9 November WHO health situation report said.

Kala azar is endemic in some parts of Southern Sudan and outbreaks occur every 5-10 years. Treatment involves an injection every day for a month - requiring patients to stay near health facilities, which can put enormous pressure on those caring for them.

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http://www.irinnews.org/report.aspx?ReportId=87027KABUL Thursday, November 12, 2009 (IRIN) - The sixth and last polio immunization campaign in 2009 begins on 15 November across Afghanistan: Up to eight million under-five children are expected to receive the oral vaccine, according to the Ministry of Public Health (MoPH).KABUL Thursday, November 12, 2009 (IRIN) - The sixth and last polio immunization campaign in 2009 begins on 15 November across Afghanistan: Up to eight million under-five children are expected to receive the oral vaccine, according to the Ministry of Public Health (MoPH).

About 54,000 volunteers and health workers will conduct the exercise, despite insecurity which is increasingly impeding humanitarian access.

"The MoPH has not engaged in direct talks with the armed opposition for access but through tribal elders we have tried to raise awareness about the importance of polio vaccination for all children," Farid Raaid, MoPH's spokesman, told IRIN.

In September Taliban insurgents reportedly endorsed a three-day polio immunization [http://www.irinnews.org/Report.aspx?ReportId=86136] in areas under their influence.

Five polio immunization campaigns have been carried out so far in 2009: Some threats and attacks by armed groups were reported, particularly in insecure southern provinces.

About 15 percent of Afghan children miss out on different immunizations, according to the country's latest National Risk and Vulnerability Assessment. [http://www.nrva.cso.gov.af/]

The 15 November drive will cost US$4 million - funded by UN agencies, Rotary International and other donors, Raaid said.

Most polio cases in south

Poliomyelitis has been virtually eradicated in the relatively secure north and central parts of Afghanistan but the virus has remained endemic in the insecure south and southeast, according to the UN World Health Organization (WHO).

Of the total 25 polio cases confirmed so far this year, 22 were reported in the two southern provinces of Kandahar and Helmand and one each in Nooristan, Ghor and Kapisa provinces, the MoPH said. Last year 31 polio cases were reported country-wide.

Lack of awareness, and population movements, and the return of refugees from Pakistan, are other factors militating against effective anti-polio coverage.

Afghanistan and Pakistan are two of the four countries in the world where wild poliovirus transmission has never been interrupted. In Pakistan 118 polio cases were reported in 2008 and 32 in 2007, according to WHO.

Vitamin A drops

During the immunization period about 6.8 million children aged 6-56 months will receive oral drops of Vitamin A which, MoPH officials said, enhances body resistance against flu, pneumonia and other cold-related diseases.

Afghanistan has one of the highest infant morality rates in the world and global and severe acute malnutrition are at 19.7 percent and 6.7 percent respectively among under-five children, according to WHO.

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http://www.irinnews.org/report.aspx?ReportId=86995PHANOP Thursday, November 12, 2009 (IRIN) - A close look at this river bank village on the Ho Chi Minh trail bordering Vietnam reveals details which belie its tranquility.PHANOP Thursday, November 12, 2009 (IRIN) - A close look at this river bank village on the Ho Chi Minh trail bordering Vietnam reveals details which belie its tranquility.

Cluster munitions containers are used as planter boxes for flowers and herbs. Decorative pedestals at the local temple are old bomb shells, and a discarded spare fuel tank from a US plane downed during the Vietnam war serves as a boat.

The remnants of old ordnance from heavy US bombing from 1966 to 1975 are everywhere in this village in the eastern province of Khammouane and are part of daily life.

Janthan, 38, is hoarding two 500 pound bombs - the explosives have been removed - which lie by her front gate.

“I bought them from the bomb hunter for 200,000 kip (US$24) each,” she told IRIN, clutching her seven-month-old grandson.

“I’ll sell them when the price of scrap metal goes up,” she said.

For Phanop village, where people are mostly subsistence farmers, selling old metal and unexploded ordnance (UXO) littered on their land helps to eke out a living.

“It’s their main activity,” said Sivilay Chanthaphoumy, the Mines Advisory Group’s (MAG’s) provincial programme manager for Khammouane Province.

“Some families lack food about four or five months a year, so during that time they go to the forest or jungle and look for leftovers from the war,” he said.

Choosing risk

Laos is the most heavily bombed nation in the world per capita because of the war, and is strewn with metal from the conflict, including UXO such as bombs, grenades, bullets, mortar shells and cluster munitions. [http://www.irinnews.org/Report.aspx?ReportId=78463]

Collecting scrap metal is a deadly economic activity borne of the need by many of the nation’s poorest to make a living.

“Some people are completely reliant on it, but most people supplement their incomes with it,” said Tom Morgan, the regional information officer for MAG [see: http://www.maginternational.org/] Southeast Asia.

A 2006 UXO risk education needs assessment written by MAG found there was generally a high level of awareness about the danger of UXO in three contaminated provinces surveyed in the north, east and south of Laos.

However, both adults and children voluntarily came into contact with UXO for a number of reasons, including economic ones. Among those identified at high risk were scrap metal dealers, and adults and children who collect scrap metal.

In Langkang, a town near the Vietnam border, would-be collectors from Phanop or other villages can purchase cheap Vietnamese metal detectors at the local market for $12-15.

Scrap metal, in fragments or as part of UXO, is usually good quality steel, aluminium and copper. It is sold by scrap dealers to a few foundries in Laos, but most of it goes to private foundries in Vietnam and China, where it is used in construction.

Maligna Saignavongs, the director of the government's National Regulatory Authority for UXO/Mine Action Sector in Lao PDR (NRA), said 36 of the country’s 47 poorest districts were located in UXO-contaminated areas.

Scrap metal can sell to dealers for up to 35 US cents per kilogram, making it tempting for those in the very poorest districts who make less than $4-5 per month, he said.

“If the government would like to prevent the search for scrap metal, it’s difficult because we have no substitute for them for how to alleviate poverty,” Maligna told IRIN.

“The scrap metal is no problem, but if you take the metal from an UXO, it can lead to accidents. So we are trying with mine risk education, especially with the high risk group like scrap metal dealers,” he added.

The NRA is drafting a prime ministerial decree expected to be approved next year which will ban children from collecting scrap metal and regulate collection by adults, Maligna said.

Alternative incomes

To provide an alternative source of income, Handicap International (HI) Belgium [see: http://en.handicapinternational.be/] has started a pilot project, funded by the UN Children’s Fund (UNICEF), that gives families the inputs for a home garden in return for a written commitment not to collect scrap metal.

“We want to see how best we can support these families, and in turn raise their income levels to the point where they no longer need to send their kids to collect scrap metal,” said Simon Ingram, UNICEF’s communication chief in Laos.

Kim Warren, HI’s UXO programme coordinator in Laos, said there had been an overwhelming response, with 60 families in three districts of southern Savannakhet Province signing up for the project, where it is hoped they can sell their excess produce.

“We are insisting - and we are very strict about this - that they are willing to stop doing this and will get rid of their metal detectors,” Warren said.

“Unless you’re replacing people’s livelihoods and giving them something else, to stop them from collecting or using a metal detector, it’s tricky,” she said.

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http://www.irinnews.org/report.aspx?ReportId=86998LAHORE Thursday, November 12, 2009 (IRIN) - People living along the busy Temple Road in Lahore, the capital of the eastern Punjab Province, are accustomed to some unusual sights.LAHORE Thursday, November 12, 2009 (IRIN) - People living along the busy Temple Road in Lahore, the capital of the eastern Punjab Province, are accustomed to some unusual sights.

“Every now and then we see blood or parts of an aborted foetus floating in the drain that runs past the houses and shops,” said Rubina Bibi, a housewife.

The street in Lahore is home to a dozen or more illegal “abortion clinics”, known as ‘Safia clinics’. Run in most cases by midwives, the clinics are visited by a large number of women seeking an abortion but having difficulty getting one in a society where the practice is highly stigmatized - and legal only under extremely limited circumstances.

“The [abortion] rate is rising because in these times of high inflation fewer families can afford many children,” Uzma Parveen (not her real name), who runs one of the clinics, told IRIN. She said that until two or three years ago around 10 women visited her clinic each month seeking an abortion, whereas “there are now 15 or 20.”

According to a May 2009 report [http://www.guttmacher.org/pubs/IB_Abortion-in-Pakistan.pdf] by the government’s National Committee for Maternal and Neonatal Health (NCMNH) and the New York-based Guttmacher Institute, which works worldwide to advance sexual and reproductive health, “a nationwide study estimated that 890,000 abortions took place in 2002. This amounts to 29 abortions per 1,000 women.”

About 30 percent of married women use contraception, although a quarter of them, an estimated 6.6 million women in 2007, have an unmet need for contraception, the NCMNH-Guttmacher study found. Opposition from husbands, a belief that God alone should decide if a child is to be conceived or not, and a lack of awareness are all factors in the low levels of contraception use.

The report noted that abortion rates were substantially higher in the North West Frontier Province (NWFP) and Balochistan, the most rural of Pakistan’s four provinces. In NWFP an estimated 37 abortions take place per 1,000 women aged 15-49 and in Balochistan the rate was 38 per 1,000. The lower rates of 25 per 1,000 women in the Punjab and 31 in Sindh were linked to higher contraception use in urban areas.

Research by the US-based Population Council [http://www.popcouncil.org/projects/RH_PakPilotStudyContrAbort.html] in rural Punjab found women resorted to abortion when contraception was unavailable. It stated: “Women attempt to abort pregnancies that are unwanted by all means even if their husbands are not supportive.”

Most women seek abortions to avoid surpassing a desired family size, on average around three children: poverty is another factor.

Poverty link

“I am coming here for the second time, to have an abortion. I know it’s a bad thing, but what can I do? I already have four children and we simply cannot manage to care for more,” said Amna Bibi (not her real name), outside a clandestine abortion clinic. The clinic is based in a dingy room; the equipment used by the `dai’ (traditional midwife) looks primitive; there are no facilities for sterilization and the sheet on the bed is badly stained.

“What choice do I have but to come here? No one else will help me though I am terrified about going through this, and all the pain it will cause,” said Amna, who estimated that she was about three months pregnant. She said she expected to pay around Rs 2,500 (about US$30) for the abortion. Prices for abortions run from around Rs 1,700 (US$21) to Rs 4,150 (US$50)

Amna’s sister Naseem Bibi (not her real name), who accompanied her, said: “I use birth control pills given to me by a nurse secretly, because my husband would be angry if he knew. Men think pills could encourage us to have intercourse with other men, as there would be no fear of pregnancy.” Naseem has two young sons, and does not want more children for now.

“Many practitioners know abortions are illegal, and refuse to perform them. Therefore women turn to quacks who perform abortions in unsafe conditions. This can lead to complications and many women end up in hospitals. Some of them even die due to these complications,” Marium Waqas of NCMNH told IRIN. “Abortions in unsafe circumstances do affect the health of women.”

Post-abortion care

According to the NCMNH-Guttmacher report, the 2002 national study estimated that 197,000 Pakistani women were hospitalized for complications after unsafe abortions. Only about 50 percent of poor women who need treatment for severe abortion complications receive hospital-based care. A study in a large Karachi hospital over a 21-month period reported that 10 percent of women admitted for post-abortion care died of serious complications.

“We see women regularly who have suffered acute post-abortion complications. Many are brought in very late because their families are scared. Few admit they have had an abortion. Infection and heavy bleeding are the most common problems,” Rubina Ahmed, a gynaecologist at a community clinic, told IRIN.

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http://www.irinnews.org/report.aspx?ReportId=86999LAMU Thursday, November 12, 2009 (IRIN) - Eight people have died on the Kenyan island of Lamu and others have been hospitalized following a suspected outbreak of acute watery diarrhoea (AWD), an official said.LAMU Thursday, November 12, 2009 (IRIN) - Eight people have died on the Kenyan island of Lamu and others have been hospitalized following a suspected outbreak of acute watery diarrhoea (AWD), an official said.

The spread of AWD could be attributed to recent floods in the area which have seen people displaced, said Lamu District Medical Officer Mitwani Bijuma.

The most affected areas were Langoni, Mkomani, Kandahar and Kijitoni.

Lamu principal chief Jamal Mzee Fangupi told IRIN street food vendors and social gatherings had been banned, and hygiene awareness programmes were in place, to curb the spread of the disease.

Recent floods have left thousands homeless in Lamu and the neighbouring districts of Malindi and Magarini.

jk/aw/cbhttp://www.irinnews.org/report.aspx?ReportId=87001NIAMEY Thursday, November 12, 2009 (IRIN) - High school students in the Niger capital, Niamey, learned to put HIV/AIDS and reproductive health in a broader context during a recent essay contest.NIAMEY Thursday, November 12, 2009 (IRIN) - High school students in the Niger capital, Niamey, learned to put HIV/AIDS and reproductive health in a broader context during a recent essay contest.

"In preparing my essay I learned that AIDS is not a death sentence," said one female student who requested anonymity. "This kind of exercise should be encouraged because it allows students to increase their knowledge of AIDS and its consequences."

Nearly 500 students in Niamey participated in the recent contest, an initiative of the Réseau National des adolescents et jeunes en population et développement (RENAJEN/POPDEV).

Students were asked to cover one of two themes: what kind of moral support to offer to a friend who learns he/she is HIV-positive, or what advice to give to someone who does not practice birth spacing, said Hinsa Garba of RENAJEN.

The contest aimed to bring home the concept of responsible sex to students, Ousseini Boubacar, the head of RENAJEN, told IRIN. "At the same time, by participating in this contest the young people give us the opportunity to gauge their knowledge of reproductive health and HIV/AIDS."

Niger authorities welcomed the exercise. "It's a good strategy, not only for educating youths about sexually transmitted diseases, but also to call parents' attention to the necessity to facilitate openness and debate about these subjects," Mallam Issa Mallam Souley, national population director, told IRIN.

Abdoul-Kader Moussa, one of the contest winners, told IRIN: "I said in my paper that I would tell a friend not to be discouraged, and to follow the treatment as prescribed by a doctor." He said this was based on things he had learned in radio and television education programmes about HIV.

Cultural factors sometimes trump education – about 40 percent of adolescents in Niger have sexual relations before age 15, according to the Joint UN Programme on HIV/AIDS (UNAIDS); 97 percent of women have never had an HIV test. UNAIDS said the determining factors included low education, economic dependence, and early sexual relations and marriage.

Niger has an HIV infection rate of 0.7 percent. In its 2008-2012 poverty reduction strategy the country aims to keep the rate below that.

bb/np/hehttp://www.irinnews.org/report.aspx?ReportId=87013JOHANNESBURG Thursday, November 12, 2009 (IRIN) - Did you know that agriculture contributed 42 percent of Nigeria's gross domestic product (GDP) in 2008, more than double the 20 percent of revenue that oil brought into the national coffers? JOHANNESBURG Thursday, November 12, 2009 (IRIN) - Did you know that agriculture contributed 42 percent of Nigeria's gross domestic product (GDP) in 2008, more than double the 20 percent of revenue that oil brought into the national coffers?

A programme to boost food security, launched in 2001, helped Nigeria's rain-dependant small-scale farmers with irrigation and access to credit and marketing services, said a new UN Food and Agriculture Organization (FAO) report taking an in-depth look at 16 countries that have made some headway in reducing the number of hungry people.

Barbara Huddleston, an FAO food security expert, said the study was produced as part of the effort to "stimulate interest in investing in smallholders, asking countries and donors to make a commitment in real people" ahead of the World Food security Summit in Rome, Italy, next week.

Two reports published this week draw attention to agriculture with a caseload of good news stories on improving food security. The FAO report, Pathways to Success, looks at policy initiatives that have improved food security, and new measures taken in the wake of last year's global recession.

The US-based International Food Policy Research Institute (IFPRI) uses its book, MillionsFed, to look at a mix of food security success stories over a period of years, many of which were driven by NGOs and communities.

In 1990 an initiative driven by Helen Keller International, which works to prevent blindness and reduce malnutrition, and local organizations in Bangladesh encouraged 1,000 households to plant vegetables rich in vitamin A to address a deficiency in this micronutrient, which can cause night blindness: at that time 30,000 children in the South Asian country were going blind each year.

The programme, eventually driven by 70 local NGOs and the government, grew to cover 870,000 households across the country by 2003, and helped improve the food security of nearly five million people - almost four percent of the population.

There is also the IFPRI story of farmers on Burkina Faso's central plateau who have been sowing crops in planting pits and built contour bunds - rows of stones piled up along the contours of the land to capture rainwater runoff and prevent soil erosion - and have produced an additional 80,000 tonnes of food per year.

"These are examples of people choosing to step out of their comfort zones and risk innovation; these people did not wait for external agencies to step in," said Rajul Pandya-Lorch, co-editor of MillionsFed. "We want to highlight the importance of creating the space to allow people to take risks and experiment."

The case studies underline that there is "no single, simple solution to helping farmers be more productive", said Prabhu Pingali, deputy director of the Bill and Melinda Gates Foundation, which commissioned MillionsFed.

"A comprehensive approach is needed - from investing in improved seeds and healthy soil to supporting effective farm management practices and expanding small farmers' access to markets," he said.

Such efforts pay off with investment in science and technology - improved seeds, fertilizers and pesticides - hallmarks of the "green revolution" that turned around food production in Asia from 1965 to 1990.

Policy decisions like liberalizing agricultural markets, giving land-rights to farmers, investing in rural infrastructure and agricultural extension services also help. The FAO report points out that 84 percent of Vietnam's paddy fields are irrigated, so rice farmers no longer have to depend on the rain.

"In just five years, from 1993 to 1998, the share of people living in poverty fell by 21 percent [in Vietnam]," noted IFPRI, which has also devoted a chapter to land reforms in Vietnam.

The IFPRI and FAO initiatives have many examples of useful ideas to inspire communities and governments. And there is hope - at least 31 out of 79 countries monitored by FAO have registered a significant decline in the number of undernourished people since the early 1990s.

jk/he http://www.irinnews.org/report.aspx?ReportId=87014NAIROBI Wednesday, November 11, 2009 (IRIN) - Programmes supported by the Global Fund to Fight AIDS, Tuberculosis and Malaria reported 2.3 million people on life-prolonging antiretroviral (ARV) drugs in June 2009. Funding to beneficiary countries is based on performance, and failure to meet targets can lead to delays, suspension, discontinuation or termination of grants.NAIROBI Wednesday, November 11, 2009 (IRIN) - Programmes supported by the Global Fund to Fight AIDS, Tuberculosis and Malaria reported 2.3 million people on life-prolonging antiretroviral (ARV) drugs in June 2009. Funding to beneficiary countries is based on performance, and failure to meet targets can lead to delays, suspension, discontinuation or termination of grants.

In November 2008, IRIN/PlusNews brought you a list of some of the countries that have fallen foul of the Fund's strict accounting procedures; here is an updated version.

Kenya - In November 2009 the Global fund's technical review panel - an independent team of health and development experts - recommended that the Global Fund Board reject a bid for $270 million in Round 9 of funding. The chair of Kenya's CCM said the main reason given was poor coordination between the country's two health ministries.

The government has experienced difficulties with its Global Fund proposals in the past. In 2008 the Global Fund rejected Kenya's application for $300 million in Round 8, and $37 million was delayed in 2003 after claims of corruption in the National AIDS Control Council.

Mauritania - In September 2009 the Global Fund suspended support to the Executive Secretariat of the National AIDS Committee after finding evidence of fraudulent and unjustified expenditures. The Fund demanded the reimbursement of US$1.7 million within three months, and immediate removal of the people identified as responsible.

The new government, named in September after presidential elections in June, began proceedings against four National AIDS Committee members suspected of embezzlement. The State has promised to return the $1.7 million and account for a further $2 million whose use was questioned, and has committed to re-structuring the Country Coordinating Mechanism (CCM), Mauritania's funding management body; CCM weakness is seen as contributing to the problems.

Philippines - In September 2009 the Global Fund suspended all five of its grants to the Tropical Disease Foundation (TDF) - the principal recipient - after an investigation by the Office of the Inspector General found that around $1 million of $85 million in total disbursements were unauthorized expenditure. The Global Fund has demanded repayment and will transfer the TDF's grants to a new principal recipient.

Zimbabwe - in 2009 the Global Fund decided to bypass the National AIDS Council as the principal recipient of existing and future grants, choosing to channel money through the United Nations Development Programme and paving the way for the country to receive a grant of $37.9 million in August.

Zimbabwe has had a turbulent relationship with the Global Fund; several proposals have been rejected and the government has frequently accused the Geneva-based agency of political bias, which the Fund denies.

Chad - In 2006 the Global Fund suspended support after an audit uncovered misuse of funds and a lack of satisfactory capacity in the principal recipient and sub-recipients to manage the Fund's resources. The suspension was lifted in 2007 after a series of investigations and commitments from stakeholders to put better systems in place.

Nigeria - In 2006 the Fund decided to discontinue its Round 1 support for HIV/AIDS programmes, but awarded other HIV/AIDS grants in Round 5.

Myanmar - In 2005 the global Fund terminated grants worth $98.4 million [http://www.theglobalfund.org/en/pressreleases/?pr=pr_050819] after the government imposed temporary restrictions on travel and new procedures for reviewing the procurement of medical and other supplies. The Fund said at the time that the restrictions "prevented implementation of performance-based and time-bound programs in the country".

Senegal - In 2005 the Fund cut malaria grants worth $7.1 million [http://www.theglobalfund.org/en/pressreleases/?pr=pr_050301] over systemic issues that resulted in poor performance. A grant proposal for malaria projects submitted in Round 4 was later approved.

South Africa - In 2005 the Global Fund Board stopped funding for an HIV prevention programme [http://www.plusnews.org/Report.aspx?ReportId=39240]. The Board decided that the grant, received by an NGO named loveLife, had failed to "sufficiently address weaknesses in its implementation".

Uganda - In 2005 the Global Fund temporarily suspended all five of its grants after a review by accounting firm PricewaterhouseCoopers found "serious mismanagement" of one of the grants by the Project Management Unit in the Ministry of Health.

The grants were worth $201 million over two years, of which $45.4 million had been disbursed. The health minister and his two deputies lost their positions and are standing trial with several other government officials for the misuse of Global Fund money.
Ukraine - In 2004 the Global Fund temporarily withdrew grants worth $92 million [http://www.theglobalfund.org/en/pressreleases/?pr=pr_040130] citing "management issues". The grants were reinstated six weeks later, when a new principal recipient, the International HIV/AIDS Alliance, was put in place.

Pakistan - In 2002 the Fund discontinued support for Pakistan's malaria projects because of weak project implementation, slow procurement of health products, poor data quality, and slow spending of project funds; according to reports, only 15 percent of insecticide treated bed nets were distributed during the grant period.

Several other countries, including Bolivia, East Timor, Namibia, Sierra Leone, Tanzania and Togo, have also had funding proposals rejected, or have had funding withdrawn. Countries can appeal a grant decision when a proposal has been rejected in two consecutive rounds.

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http://www.irinnews.org/report.aspx?ReportId=86972JOHANNESBURG Wednesday, November 11, 2009 (IRIN) - Plumpy'nut, a widely distributed ready-to-use therapeutic food (RUTF), has revolutionized the treatment of acute malnutrition, but its 12-year dominance is being challenged by a newcomer. JOHANNESBURG Wednesday, November 11, 2009 (IRIN) - Plumpy'nut, a widely distributed ready-to-use therapeutic food (RUTF), has revolutionized the treatment of acute malnutrition, but its 12-year dominance is being challenged by a newcomer.

The patents for Plumpy'nut - a blend of peanuts, sugar, milk powder, oil, vitamins and minerals - are owned by Nutriset, a French family-run business, and the Institute of Research for Development, a French public research institute.

Now an American family-owned company, Tabatchnick Fine Foods, is turning the heat up in the blended food kitchen by applying for a patent for their RUTF in the US - where the Plumpy'nut patent is registered - to treat malnutrition in children and boost women's immune systems.

Tabatchnick hopes to open up the market with his patent challenge and has started manufacturing an RUTF that is being evaluated by the UN Children's Fund (UNICEF), the world's largest buyer of RUTF and Plumpy'nut.

Manufacturers of similar pastes have been wary of challenging Nutriset. "The patents are so broad that if you add one micronutrient into a jar of Nutella [a widely distributed brand of nut pastes] it will fall within the patent," said Stéphane Doyon, leader of the Nutrition Team at Médecins Sans Frontières (MSF), the international medical charity.

The US patent describes Nutriset's RUTF as a "complete food or nutritional supplement" comprising "a mixture of food-grade products, said mixture being coated with at least one lipid-rich substance optionally derived partly from oleaginous seeds".

The mixture could be in the form of "powder, particles or granules", the seeds could be "peanuts, cocoa beans, almonds, coconuts or pistachio nuts, or they can consist of a mixture of various fats of vegetable origin".

The protein source in the RUTF could be skimmed milk, powdered yoghurt or whey, and/or at least one product which provides carbohydrates, particularly carbohydrate bulking agents, sucrose, glucose, fructose, skimmed milk, whey, or flour made of maize, wheat, millet, oats, rice, cassava or potato starch", according to the patent documents.

Plumpy'nut was the first RUTF to be developed and is regarded as the industry standard. Several similar pastes have been developed but can only be sold in countries where the Plumpy'nut patents are not registered.

"Because Plumpy'nut is a brand name, it is the most popular," said an aid agency worker. "It is like Coke - people still prefer it, even if you have other similar drinks."

Two is a crowd too

Nutriset has attempted to broaden the scope of its two patents claim industry insiders, who also say the company has been "very vigilant" in ensuring that its patents are respected; manufacturers of peanut-based RUTFs have received legal letters.

"You have to keep reminding people [by sending letters]," said Nutriset spokesman Remi Vallet. "We are not trying to protect any monopoly - there is no monopoly there are other RUTF manufacturers in the market."

In Kenya, where the Plumpy'nut patents are registered, Nutriset has threatened legal action against Compact, an Indian and Norwegian manufacturer, for storing 25 metric tons of its RUTF, eeZeePaste, which it intended to supply to Somalia and the Democratic Republic of Congo.

"Our patent lawyers are studying the letter [from Nutriset] at the moment. I think they are stretching the interpretation of their patents," said Arne Andreassen, managing director of Compact, who pointed out that conflict-torn Somalia does not have adequate storage facilities.

Vallet said Nutriset was flexible where products were for humanitarian interventions. "We are willing to talk to Compact if they can show the supply was meant for Somalia. We allowed Diva [a South African RUTF manufacturer] to supply a UNICEF programme in Kenya, and are now in talks with them to enter into an arrangement with us."

Nutriset patents are registered in the European Union, the US and Canada, as well as in 16 francophone members of the African Intellectual Property Organization and 16 members of the African Regional Intellectual Property Organization in Eastern and Southern Africa.

In countries where Nutriset patents are registered, companies granted a manufacturing license are allowed to make, store, sell or use products similar to Plumpy'nut, but may not use the brand name. A network of Nutriset franchise-holders covers Niger, Ethiopia, Democratic Republic of Congo, Ghana, Tanzania Madagascar, Malawi, Mozambique, Dominican Republic, India and USA.

Nutriset patents are not registered in India, South Africa and Haiti, which have large numbers of malnourished children, and the company said competitors were free to invest in research and development of other RUTF products that would not fall within the scope of its patents.

Ben Tabatchnick, head of the family business, said his product was still in the development phase, but the patent would be "open-source", which would allow other producers to replicate his recipe.

His company "was trying to take the fear out of other producers from producing RUTF and keeping up with demand; no one producer can supply (even with licensed franchises) the world demand for RUTF and RUSF [ready-to-use supplementary foods]", he commented. "By allowing others free access (with proper oversight by UNICEF and MSF), this can and will be accomplished."

MSF's Doyon said patents for humanitarian products should be "filed only on an exceptional basis and ... licensing agreements should be offered to third parties on flexible terms and conditions, so as to ensure the widest possible availability of nutritional products of a humanitarian nature. We have been saying [this] to Nutriset ... [but] their reaction to Compact seems to say that they do not agree."

All the nuts in one jar

According to a study commissioned by UNICEF, Nutriset supplies the bulk of its product from France and the UN agency is the world's largest buyer of Plumpy'nut, which accounts for 89 percent of its RUTF procurement every year.

The cost and difficulty of exporting Plumpy'nut from France could be significant. In 2008 most of UNICEF's emergency supplies to Ethiopia had been air-freighted - 39 percent of the cost - whereas a local supplier in Kenya could have decreased transportation costs by around $80,000 per year and reduced overall supply-chain delay from eight weeks to one week.

[However] "It does not always work out cheaper to buy in the south," than to ship RUTF from Europe said Steve Jarrett, principal advisor in UNICEF's supply division. The study noted that there were "considerable risks in having a vital product like RUTF produced only by one dominant world supplier".

Nutriset has taken a number of precautions to protect the production process, including security staff, and the ability to rapidly shift staff and equipment to scale up production outside of France, including in the US.

But if Nutriset's manufacturing facility were to "go off-line for any reason — be it mechanical failure, worker strike, natural disaster, or a host of other reasons — the ramifications could effectively halt the entire RUTF supply chain for all of Nutriset's customers", the study commented.

A single global producer "limits the extent to which the supply chain includes surge capacity"; in the face of a complex emergency Nutriset would be forced to prioritize orders and reduce its ability to meet needs elsewhere. The study also suggested that multi-sourcing could bring down costs.

Jarrett said UNICEF was in favour of encouraging the production of RUTFs in beneficiary countries because this would help to "advocate its use - it is easier to get a buy-in from countries."

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http://www.irinnews.org/report.aspx?ReportId=86979NAIROBI Wednesday, November 11, 2009 (IRIN) - When the working members of a household die from HIV-related illnesses in northern Tanzania, older dependants have to work longer hours to cope financially, according to recently published World Bank study.NAIROBI Wednesday, November 11, 2009 (IRIN) - When the working members of a household die from HIV-related illnesses in northern Tanzania, older dependants have to work longer hours to cope financially, according to recently published World Bank study.

"Adult death is associated with increased farm hours ... Older women who suffer the loss of a co-resident member among their baseline household are working five hours more each week," the study found.

More than 1,000 men and women older than 50 were surveyed over a 13-year period between 1991 and 2004 in the Kagera region. http://www-wds.worldbank.org/external/default/WDSContentServer/IW3P/IB/2009/09/02/000158349_20090902155306/Rendered/PDF/WPS5037.pdf.

Older adults who had relied on remittances and other in-kind support from their adult children were left with the burden of caring not only for themselves but also their orphaned grandchildren.

"Grandparents who should be in retirement are forced to start working and parenting again, often when they are not in the best physical condition," said Wamuyu Manyara, portfolio manager at the Africa Regional Development Centre of HelpAge International http://www.helpage.org. "An older woman with thinning bones should really not be forced to return to the field and farm."

The study noted that the shocks caused by the death of adult children were primarily felt by older people living with the children when they died. Women had less secure access to land and assets than men, but shouldered most of the labour after their children died, and also felt the shocks more than men. Owning more assets, such as land and animals, could act as a buffer.

"Policies which help ensure complete markets for livestock and other forms of assets, provide asset accumulation, and preserve women's rights to property may help mitigate the long-run negative impact of prime-age [15-50 years] deaths," the report said.

Little support

The elderly were often marginalised by state welfare programmes. "Older people are not organised enough to advocate for their needs, and they wind up being grouped in government departments with either children or people with disabilities - both these groups have powerful lobbies that drown out the needs of older people," said HelpAge's Manyara.

"In Kenya we are currently in the process of identifying community spokespeople to give them a public voice, but because many of them can't speak English or are illiterate, they are not always willing to take on the challenge."

Several African governments were doing more to include older people in social welfare programmes, particularly older carers. "There is now an appreciation of the magnitude of the problem, and there are some programmes catering for older people's economic needs," Manyara noted.

"Old-age pensions and child-care grants provided to older South Africans, and cash transfer programmes for older Kenyans, are practical examples of the types of programmes that need to be rolled out across the region ... [but the need] is still much higher than the numbers being catered for."

Research by the UN Children's Fund, UNICEF, in five African countries found that between 40 percent and 60 percent of all orphans in Kenya, Namibia, Tanzania, Uganda and Zimbabwe were being cared for by grandparents, particularly grandmothers.

Need for targeted programming

"Some of these older people can still work - they have energy and should be supported in their work with income-generating projects," Manyara suggested. "The conditions for accessing microfinance are usually so rigid that older people do not qualify; something should be done to encourage older people still able to work to access these funds."

Kavutha Mutuvi, HelpAge International's regional advocacy coordinator, said older people needed secure incomes. "There should be social pensions ... especially for those who are caring for households in their old age," she said.

Yet the bureaucratic hurdles in accessing support were considerable. "When a grandmother wants to claim a foster care grant, she may be asked for death certificates for her children or birth certificates of the grandchildren," Mutuvi pointed out.

"She may not have or have access to this documentation, but the fact that she is their grandmother can easily be verified by consulting community leaders - there should be a way to do away with much of the red tape they go through to claim support."

Older people also needed psychosocial assistance when their children died and they were left to raise the grandchildren. "We have tried to form support groups, which are more successful among women than men, but when it comes to helping grandparents with parenting skills, there is a definite need ... because they do come to us with questions when kids, for instance, want to know about sexuality," Mutuvi said.

The role of older people should be acknowledged when drawing up national home-based care policies and programmes, she said, by providing meaningful support such as physical help from community workers.

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http://www.irinnews.org/report.aspx?ReportId=86984NAIROBI Tuesday, November 10, 2009 (IRIN) - Three years after the Kenyan government began to promote emergency contraception as part of its family planning strategy, the “morning-after pill” remains as controversial as ever: critics argue that unless the public is better educated about its purpose, it risks undermining the messages of abstinence and protected sex, putting impressionable young people at risk of HIV.NAIROBI Tuesday, November 10, 2009 (IRIN) - Three years after the Kenyan government began to promote emergency contraception [http://www.who.int/mediacentre/factsheets/fs244/en] as part of its family planning strategy, the “morning-after pill” remains as controversial as ever: critics argue that unless the public is better educated about its purpose, it risks undermining the messages of abstinence and protected sex, putting impressionable young people at risk of HIV.

"When you speak to young girls and the youth, they confide that unwanted pregnancy rings more in their minds than the possibility of contracting venereal diseases or HIV," said Anne Muisyo, coordinator of the Abstinence and Worth the Wait programme at Crisis Pregnancy Ministries. "It is the very reason I have qualms about a campaign telling people to relax because there is a pill they can run to after engaging in unprotected sex."

Muisyo's fears seemed borne out by students IRIN/PlusNews spoke to in the Kenyan capital, Nairobi. Jack*, a student at the Kenya Polytechnic University, says even though he fears HIV, he finds some reassurance in the existence of the pill.

"You know for us young people, we engage in quick and unplanned sex, for example at a party... You get a girl and you do not have a condom, what do you do? Let the opportunity pass by? No," he said. "Do it and give her some small money for a pill tomorrow."

Molly*, a student at the same university, said: "It's not that I do not use condoms at all with my partner, but the comfort you get when you realize there is a pill which is available cheaply is very tempting."

"You give yourself the belief that just once will not bring damage," she added.

The government is keen to stress that emergency contraception must not replace the condom.

Not a replacement for condoms

"I think it is important to note that we have been very consistent in our condom use promotion campaigns and we are not ready to change course because it prevents both pregnancies and HIV," said Shahnaaz Sharif, the director of public health at the Ministry of Public Health. "We have also been very consistent in saying that these pills do not in any way prevent one from contracting HIV."

Experts warn that unless the messages about emergency contraception are accompanied by further education on family planning and warnings about the dangers of unprotected sex, the government's campaign could backfire.

A study published in a recent edition of the East African Medical Journal found that just 15.8 percent of sexually active students said they used condoms every time they had sex, compared to 22.5 percent who reported never having used a condom.
Need for more education

"Various studies have shown that the sexual debut amongst the youth is happening very early," said Marsden Solomon, regional medical adviser for reproductive health NGO Family Health International. "Because a pregnancy has an immediate effect on them both psychosocially and economically, they would jump into anything that presents an opportunity to prevent it, and an emergency pill provides that opportunity for them."

"What they forget is that while they might have prevented an unwanted pregnancy, they have not done anything to protect themselves from HIV and any other sexually transmitted disease," he added. "I think the message to the youth should be abstinence, and for those who cannot, then dual protection methods like other long-term contraceptives together with a condom should be the most appropriate."

Solomon noted, however, that the emergency pill should not be dismissed altogether, noting that with proper education, it could form a useful tool in a much-needed national family planning push. According to the 2003 Kenya Demographic and Health Survey (KDHS), nearly 20 percent of births in Kenya are unwanted and a further 25 percent happen at an unwanted time.

A study by social marketing group Population Services International - the government's partner in the national emergency contraception campaign - reported that the average age of women who use emergency pills regularly is 24.

(* not their real names)

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http://www.irinnews.org/report.aspx?ReportId=86953LESIDAI Tuesday, November 10, 2009 (IRIN) - Many Kenyan children are in school, but enrolment in the north has been adversely affected by insecurity, food scarcity and traditional attitudes, residents and teachers said.LESIDAI Tuesday, November 10, 2009 (IRIN) - Many Kenyan children are in school, but enrolment in the north has been adversely affected by insecurity, food scarcity and traditional attitudes, residents and teachers said.

"I just joined a new school a few weeks ago [20 October]," 14-year-old Kelly Lanyasunya said at Lesidai primary school in Samburu Central District (central-northwestern Kenya). "I got a new uniform and I am making friends but if this area gets insecure, I will have to move to another school."

Like her classmate, Nabik Kekichorumongi, is forced to change schools whenever bandits attack the surrounding villages.

Stephen Leparachwo, head teacher at Lolkunono primary school in Samburu Central, said Lesidai primary school often receives parents bringing their children from Pura, a neighbouring area affected by banditry.

"When they come, some are even without food… The bandits follow the fleeing residents [and their cattle], not giving the children a chance to read," he said.

Cattle-rustling

Much of the insecurity is due to cattle-rustling between the Samburu, Pokot, Turkana and Borana communities, according to local residents. In September, for example, Pokot cattle raiders killed 32 people in Samburu Central.

Rustling has also affected food production, especially in fertile areas like Ngano on the Kirisia ranges, where bandits lurk in the beautiful landscape.

In 2008, insecurity worsened in Ngano, according to the headmaster of a local school, Simon Lenolkulal. "We could hear gunshots, so we were seeking cover on the ground with the children," he said, recalling a recent incident.

"There is a high rate of transition even of school teachers here… Teachers are reluctant to work here because of the insecurity. One week there is peace, the next week we are moving... Every week we enrol new children, then when there is tension they leave."

The school relies on food aid from agencies like the UN World Food Programme (WFP). According to Lenolkulal, however, people could farm the land and eliminate food aid, if there were more security.

At neighbouring Lgoss primary school, deputy head teacher Bernadeta Lesuruan told IRIN: "When there is conflict and the parents flee, we have more children coming to the classes."

Hunger

Food scarcity tends to drive up school attendance, local residents said.

When there is a general food distribution, enrolment in school goes down, while in more difficult times the number of children increases, Lesuruan said.

"During such times you see young children carrying toddlers to school for the food… During the drought, the children were entirely relying on food in school. Some were fainting after coming from home hungry. When there is no food [at all], school attendance is very low."

In August, WFP was feeding at least 900,000 children in schools to help drought-affected families in Kenya's arid and semi-arid regions.

"Food is an issue," said Peter Emanman, the school feeding programme officer in Samburu Central.

Recent rain has brought hope of an improved food situation. "People are starting to plant but the food crops will not be ready by December [the next school holiday month]. What will happen then?" Emanman asked.

Few girls at school

There are few school teachers and hardly any female teachers. At Lgoss, Lesuruan was the only female member of staff.

"Since I came here [in 2008] more girls are staying in school especially those who would run away for the period of their menstruation," said Lesuruan. "I bring pads to the school for the girls."

Apart from the location of the school, 12km from the nearest shopping centre, the high cost of sanitary pads also feeds absenteeism.

Early marriages also affect girls’ attendance at school: Most drop out in the middle primary school classes. In 2008, some Samburu schools had no girl candidate sitting the national primary school leaving exam.

"There is a mentality that if girls are educated and get jobs, the earnings will not return home but go to the husband," said another teacher.

Most of the boys in school are late entrants; some of the girls stay at home to work. "In this community people are not fond of keeping children in schools," the teacher added.

Night school

However, some communities are trying to educate residents about the value of education: Currently under way in Baragoi District, the pastoralist night school initiative targets cattle herder children who are unable to attend day school.

"The children leave the fields at 4pm and then attend class," said Emanman. "The students get `uji’ (maize meal porridge) in the evening and are taught until 10pm."

Some children from these schools have progressed to the formal education system, but the night school initiative is largely designed to teach basic literacy to herders and others, he added.

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http://www.irinnews.org/report.aspx?ReportId=86968NAIROBI Monday, November 09, 2009 (IRIN) - A planned national survey of men who have sex with men (MSM) will be the first step in the government's plan to incorporate this high-risk group into the country's HIV programme, a senior government official has said.NAIROBI Monday, November 09, 2009 (IRIN) - A planned national survey of men who have sex with men (MSM) will be the first step in the government's plan to incorporate this high-risk group into the country's HIV programme, a senior government official has said.

"We have continued to ignore this group of people yet they are responsible for a big chunk of new HIV infections; we have resolved as a government that we cannot sit back and wait for things to get out of hand," said Nicholas Muraguri, head of the National AIDS and Sexually transmitted infections Control Programme (NASCOP).

There have been few studies on HIV among MSM in Kenya; a survey of 285 men in Mombasa in 2007 found an HIV prevalence of 43 percent among men who had sex with men exclusively, compared with 12.3 percent among men who had sex with both men and women. Kenya's national HIV prevalence is 7.4 percent.

HIV programming for MSM is extremely limited despite the country's national strategic plan for HIV/AIDS classing them as a “most at-risk population”.

"We cannot do this [provide HIV programmes for MSM] without knowing roughly how many they are and what special needs they require; I hope the survey that we will embark on will help us answer some of these questions," Muraguri said.

He noted that the survey - due to start in December and last six months - will attempt to discover information such as the specific sexual health risks and needs of MSM, MSM “hot spots” around the country, and the number of MSM-friendly health facilities available.

It will use respondent-driven sampling, recruiting openly gay men to reach out to other MSM who may not be out of the closet, and using existing MSM-friendly facilities to help conduct the research.

High hopes for better services

Joshua* is a male commercial sex worker in Nairobi who recently received training from NASCOP on reaching out to his peers with HIV/AIDS messages.

"Today I talked to 75 male commercial sex workers - 40 of them are HIV-positive but they do not know what to do," he told IRIN/PlusNews. "Many are homeless after being kicked out of their homes due to stigma."

Joshua hopes the survey will enable the government and NGOs to provide more services to MSM.

"Currently at a clinic in Nairobi, we are given one bottle of [water-based] lubricant to last three months but you know as a commercial sex worker, you finish it in a week," he added. "So it means for the remaining time, you engage in sex without the lubricant, putting yourself at great risk."

He noted that there was also a lack of sufficient knowledge about the risks associated with HIV and anal sex in the general population. "Many women [clients] approach us for anal sex wrongly believing that it lowers their chances of getting infected," he said. "Everybody should be educated on the dangers of this kind of sex because it seems people have the wrong perception."

However, not all MSM are as enthusiastic about the prospect of being counted and questioned by a government that has thus far shown little support for the rights of MSM.

Not everyone on board

"People in this country are still very homophobic and we are stigmatized a lot; who will want to come out to agree that he is a homosexual? Let them address issues of stigma first," said Donald*, who has not come out of the closet. "How do you convince me to come out and say I am a homosexual yet the same government that is asking me to do this criminalizes what I am engaged in?"

"I would rather they offered the services without going into the business of knowing who we are and trying to count us," he added.

Proof that homosexuality remains taboo in Kenya was not hard to come by on the streets of Nairobi: "To say they want to offer services to people who are engaged in acts that do not conform to the law is taking this issue of human rights too far," said Lynette Moseti. "That money can be used to help children who are living with HIV."

Homosexuality remains illegal in Kenya, punishable by up to 14 years in prison. According to Muraguri, however, the urgency of the problem necessitated ignoring the law. "Rigidity will only make our situation worse," he said.

Muraguri stressed that the government's survey did not intend to stigmatize MSM.

"We appreciate the stigma these people face and that would be [the] last thing we would want to do; even in other mainstream HIV services that the government offers we use data to offer services, so I do not think there is anything unusual about the survey," he said.

Lorna Dias, MSM coordinator at Liverpool VCT (voluntary counselling and testing), Care and Treatment, one of the only organizations in the country that provides services to MSM, says the planned survey shows that the government is serious about tackling the epidemic among most at-risk populations.

"It is a positive step and a clear indication that the government is ready to open up to the reality that men who have sex with men pose a great risk to the war against HIV unless they are integrated within mainstream HIV and AIDS programmes," she said. "The next step should be to de-stigmatize them and see them as normal people who need services like everybody else."

*(not their real names)

ko/kr/cbhttp://www.irinnews.org/report.aspx?ReportId=86932CAIRO Monday, November 09, 2009 (IRIN) - The conversion of excess rice straw into fertilizer, rather than simply burning it off could be the solution to a problem that has plagued Cairo residents for the last 10 years: the “black cloud” that decends on the city every October and November.CAIRO Monday, November 09, 2009 (IRIN) -  The conversion of excess rice straw into fertilizer, rather than simply burning it off could be the solution to a problem that has plagued Cairo residents for the last 10 tears: the “black cloud” that decends on the city every October and November.

Hundreds of thousands of rice-growing farmers burn their excess rice straw after harvest to prepare for a new farming season, but the government is making efforts - some say insufficient efforts - to tackle the problem.

“This is how we turn hay [rice straw] into useful fertilizer that farmers can use to enrich their land with natural nutrients,“ Sayed Eissa, a 25-year-old agricultural engineer, told IRIN, as he sprayed mounds of dried hay with a special liquid formula and then mixed the grass thoroughly to ensure it was fully moist.

With the help of an assistant in the small factory in Qalyubia Governorate - in Egypt’s Nile Delta, about 120km north of Cairo - he put the hay in a machine that minced it. It was then taken out and left in the open air to give the bacteria a chance to become active. “This way, we can benefit from the tons of hay that accumulate here without causing any harm to the environment,” he said.

Eissa and others who staff the scores of agricultural waste recycling factories are part of Egyptian government efforts to limit the smoke pollution.

Rice, a staple of the Egyptian diet, is normally grown on some 486,000 hectares of Egypt’s 3.2 million hectares of agricultural land. This year, farmers grew rice on an additional 162,000 hectares of land. Agriculture experts say that 0.404 hectares (one acre) of rice produces two tons of hay, meaning the country accumulated 3.2 million tons of hay this year.
 
Some of the hay is used as feed for livestock but experts say more than 60 percent is burned before the new planting season.

Respiratory problems

“The black cloud is behind most of the severe respiratory problems affecting thousands of Egyptians every year,” said Ahmed Abdel Wahab, an independent pollution consultant. “This problem is so persistent that no end appears to be in sight.”

“To get rid of the hay, I must burn it,” said Abdel Hamid Said, a farmer from the Nile Delta governorate of Sharqia, about 90km north of Cairo.

Farmers like Said say the mounds of hay that accumulate on their land become home to rats and snakes that eat their crops and can even destroy their harvest. “We also feel afraid that snakes might attack our children,” he added.

But this is not without cost to Egyptians who either live in the capital or around the farms. When rice straw burning occurs, millions of residents must travel in poor visibility on the roads and many use masks to reduce the effect of the smog.

A few kilometres from where Eissa was making rice hay fertilizer, specialists at the Benha General Hospital were counting the numbers of people being admitted with respiratory problems. Officials at the hospital said respiratory diseases increase by 150 percent in October and November because of the black cloud.

“My son fell ill a few days ago because of this massive burning of agricultural waste,” said Hesham Mashhour, a 40-year-old civil servant. “Farmers continue to burn the straw, while the government is silent.”

Complacent?

The Ministry of Environment said it has made progress in curbing the black cloud. “The cloud appeared only 40 hours this year instead of 190 hours last year,” Ahmed Abul Soud, chairman of the Air Quality Unit in the ministry, said. “We’re trying to end it, but it will take some time.”

Sceptics say the smog will never disappear if the government’s focus is only on limiting rice-straw burning and not on tackling other causes of pollution in the city, such as that from vehicles.

According to the UN Environment Programme, in normal times the average Cairo resident ingests more than 20 times the acceptable level of air pollution, and this year the problem is also being exacerbated by the incineration of mounds of rubbish abandoned in the streets - an indirect consequence of the May 2009 pig cull. http://www.irinnews.org/Report.aspx?ReportId=86742

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http://www.irinnews.org/report.aspx?ReportId=86933PESHAWAR Monday, November 09, 2009 (IRIN) - The huge bomb blast in the western Pakistani city of Peshawar on 29 October which left 117 people dead, many more injured and an unknown number of trauma victims was the most deadly this year.PESHAWAR Monday, November 09, 2009 (IRIN) - The huge bomb blast in the western Pakistani city of Peshawar on 29 October which left 117 people dead, many more injured and an unknown number of trauma victims was the most deadly this year.

According to the New Delhi-based Institute of Conflict Management, the blast was the latest in violence that claimed 6,715 lives in Pakistan in 2008 (2,155 civilians, 3,906 “terrorists” and 654 security forces personnel) and at least 650 so far in 2009.

“I fell to the ground with the impact, and could not see anything for some minutes. All I heard were screams and cries for help,” said Muhammad Idrees, 40, who sells bracelets at the market. Many of those who died were women and children out shopping.

Most of the dead and injured were taken to the government-run Lady Reading Hospital, the largest public-sector medical facility in Peshawar. Doctors at the hospital said they struggled to cope.

“The thing is no hospital in the world is equipped to deal with the kind of situation you see when over 300 seriously injured people are suddenly brought to a hospital. Naturally problems occur,” Hamid Afridi, head of Lady Reading Hospital, told IRIN.

With 86 consultants and over 800 other doctors available, Afridi said they were not lacking staff and that support from nurses and medical students living on the premises was at hand, but there was a need for “more formalized trauma care”.

While the hospital has a large accident and emergency care department, staffed by 62 doctors and headed by a trauma care specialist, “we need even more expertise given the situation we now face”, Afridi said.

Panic attacks

Hundreds of people who were not injured are psychologically affected. “I suffered panic attacks for days, even though I was not injured in the blast but just heard the enormous boom some distance away,” said Azhar Khan, 30.

Adnan Hussain, 14, lost all his immediate family members in the blast - including his parents, four sisters and a three-year-old brother. He suffers a far deeper sense of loss. “He weeps when he is alone, so we try to keep him busy,” Adnan’s paternal uncle, Ayaz Khan, said. The family - from the town of Rawalpindi in Punjab Province - were shopping in Peshawar when the bomb struck.

Others suffer in different ways: “My son was a shopkeeper at a stall selling clothes in this market. I know he is dead, but it would give me some sense of mental peace if I could see his body,” Ameera Bibi, 60, told IRIN. Accompanied by her daughters, Bibi still regularly visits the site of her only son’s death.

“The survivors of such incidents need counselling, but there is not much awareness of the need. More and more victims of terrorism are, however, now seeking help and that is a good sign,” said psychologist Asif Khan.

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