http://www.irinnews.org/irin-fp.aspxUpdated everydayen-gbThu, 19 Nov 2009 05:54:01 GMTSIAYA Thursday, November 19, 2009 (IRIN) - When Dorothy*, a single mother of five, told her neighbours in the Kenyan capital, Nairobi, she had tuberculosis (TB), she expected sympathy and maybe even offers of help. Instead, she found herself so severely ostracized, she felt she had to move out.SIAYA Thursday, November 19, 2009 (IRIN) - When Dorothy*, a single mother of five, told her neighbours in the Kenyan capital, Nairobi, she had tuberculosis (TB), she expected sympathy and maybe even offers of help. Instead, she found herself so severely ostracized, she felt she had to move out.

"The kind of discrimination I faced from my neighbours made me regret [sharing] my condition with them; I could not even share the [communal] sink," she told IRIN/PlusNews. "Yes, tuberculosis is very infectious, but those who have it are not death traps."

According to Joseph Sitienei, head of the National Leprosy and TB Control Programme at the Ministry of Health, stigma associated with TB infection is a major impediment in rallying people to seek early diagnosis and treatment for the airborne disease.

"Many people still believe only those with HIV have tuberculosis and therefore they shy away from seeking diagnostic tests for TB, believing if they are found to have it, then it automatically means they are also HIV-positive," he told IRIN/PlusNews. "By those infected not seeking treatment due to stigma, everybody is at great risk."

Dropping out of treatment heightens the risk of multi-drug resistant TB (MDR-TB) developing, "which is very expensive and difficult to treat", Sitienei added. Kenya has 353 people with MDR-TB, of whom about 70 are on treatment.

According to the Kenya AIDS Indicator Survey, 11.4 percent of Kenyans say they would want a family member's TB infection kept secret due to stigma.

Kenya ranks 13th on the UN World Health Organization's list of 22 high-burden TB countries in the world, and is the fifth highest in Africa. In 2008, the country had approximately 132,000 new cases.

Research conducted in Ghana in 2008 found some of the main causes of TB-related stigma were: fear of infection; TB's association with HIV; health staff's own fears; self-stigmatization by TB patients; and the blaming and shaming of TB patients by the public.

While Kenya has successfully integrated HIV and TB services at the testing level, TB counselling still trails behind counselling for HIV.

Education is key

"We have done well in offering HIV testing and counselling and diagnosis of TB, but not much has happened in trying to offer counselling services to people with TB," said Nicholas Muraguri, head of the National AIDS and Sexually Transmitted Infections Control Programme. "This is crucial and possible because it can easily be done within the voluntary testing and counselling facilities."

According to Sitienei, public education about TB is crucial to provide a better understanding of the disease and improve health-seeking behaviour: "With proper counselling, people are better placed to understand their own situation and that of others," he said.

"The truth is, TB spreads very fast, but it is important to help people relate to those with TB without themselves having to fear putting themselves at risk," said Charles Mutua, a former TB patient.

"People must also be made to appreciate that TB infection is not necessarily synonymous with HIV infection. I, for example, had TB but I was never HIV infected," he added.

According to Andrew Suleh, superintendent of Nairobi's Mbagathi District Hospital, communication messages should include debunking popular myths – such as the idea that the disease can be transmitted by sharing utensils.

Ending health worker stigma

Sitienei said it was also important for health workers to understand the disease and treat patients with respect. In 2008, the government launched a communication campaign to reduce discrimination and stigma about HIV and TB among health workers.

"At times even the attitude among healthcare workers determines whether people seek services or not, even though our medical personnel are very conscious about issues of stigma," he said. "Addressing stigma involves fighting it among the public, health workers and those who are infected with TB."

Suleh noted that ensuring health workers were properly equipped to treat TB would help reduce stigmatization of patients.

"[Health worker stigma and discrimination] can arise when healthcare workers feel they are not given the adequate equipment or facilities to handle such cases," he said.

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* Not her real name

http://www.irinnews.org/report.aspx?ReportId=87108KISUMU Tuesday, November 17, 2009 (IRIN) - The Kenyan government is expanding services to meet the growing demand for voluntary medical male circumcision after the launch of a national campaign a year ago.KISUMU Tuesday, November 17, 2009 (IRIN) - The Kenyan government is expanding services to meet the growing demand for voluntary medical male circumcision after the launch of a national campaign a year ago.

"We believe the launch of a rapid results initiative to scale up what we are already offering will help meet the demand; our target is an ambitious one to see to it that at least 1.1 million of the uncircumcised men in this country get the cut by the end of five years," said Jackson Kioko, director of medical services in western Nyanza Province.

Results of three random trials in South Africa, Kenya and Uganda in 2005 and 2006 demonstrated that medical male circumcision http://www.plusnews.org/InDepthMain.aspx?InDepthId=61&ReportId=73184 reduced the risk of HIV infection among men by up to 60 percent.

According to the Kenya AIDS Indicator Survey 2007, 85 percent of Kenyan men are circumcised; HIV prevalence is higher by three-to-five times in uncircumcised men. There are about 1.2 million uncircumcised men between the ages of 15 and 49 in Kenya, most of whom live in Nyanza Province, where fewer than 50 percent of men are circumcised.

Since the launch of the national campaign in November 2008, an estimated 40,000 men have been circumcised and 124 sites opened and equipped with facilities and personnel to offer the service. The government has trained 700 health workers in the province to offer the services in various health facilities.

"The trained health workers will ensure people who demand these services get them in a safe and timely manner and the training of others is ongoing across the various provinces within the country," Kioko added.

The government also plans to roll out mobile medical circumcision. "We do not want people to opt out simply because the services are not near them and we are making arrangements that we go to them rather than them coming to us," Kioko said. "We will, in the near future, offer infant medical circumcision; this has the potential to help people in time before their sexual debut."

Experts remain emphatic, however, that male circumcision must not be viewed as a complete prevention tool. "It is refreshing to see that research is being put to use, but we should take precautions to ensure that we constantly give information that male circumcision must work along with other HIV infection prevention strategies to be effective," said Kawango Agot, head of the Nyanza Reproductive Health Society.

"We have plans to launch a study to look into the sexual behaviours of men who have been circumcised to find out if they are engaging in risky behaviours due to the fact that they have been circumcised," she added. "We hope this will ascertain if indeed people are engaging in [risky sex]."

A 2007 study http://www.plosone.org/article/info:doi%2F10.1371%2Fjournal.pone.0002443 in Kisumu, provincial capital of Nyanza, found that circumcision did not result in increased HIV risky behaviour. It found that as male circumcision became more widely promoted, there would be a need to monitor “risk compensation” associated with the procedure.

ko/kr/mw http://www.irinnews.org/report.aspx?ReportId=87074ISIOLO Tuesday, November 17, 2009 (IRIN) - Hundreds of people have fled their homes in Isiolo, eastern Kenya, following an attack by armed men that left 11 people dead in Kisima locality, the Kenya Red Cross Society (KRCS) said.ISIOLO Tuesday, November 17, 2009 (IRIN) - Hundreds of people have fled their homes in Isiolo, eastern Kenya, following an attack by armed men that left 11 people dead in Kisima locality, the Kenya Red Cross Society (KRCS) said.

"More than 100 Turkana [families] have left their homes since [15 November]," Gitonga Mugambi, the KRCS coordinator in Isiolo, said. "They are moving to the Ngaremara area [about 30km from Isiolo town], which they believe is safe."

Affected communities include the Turkana, who are said to have been behind the attack, the Somali, Borana and Samburu communities. One of those affected, Peter Kalapata, said: "Our women are unable to go to Isiolo town to sell charcoal or buy food; the sick cannot go to the hospital. Things are bad; we need security for all the communities."

The Kisima attack, which occurred about 5km from Isiolo town, also left six people injured, with hundreds of heads of livestock, which were later recovered, stolen, according to the Isiolo divisional police commander, Sammy Kosgey. Tension in Isiolo is still high and has affected learning, Kenya National Union of Teachers Isiolo Secretary, Mohamud Halake, told IRIN on 16 November.

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http://www.irinnews.org/report.aspx?ReportId=87082GARISSA 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=87063WAJIR 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=87025LAMU Thursday, November 12, 2009 (IRIN) - Eight people have died on the Kenyan district 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 district 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=87001DUSHANBE Thursday, November 12, 2009 (IRIN) - Even as world food production grows, hunger is on the rise in many poor countries, according to the Global Crop Prospects and Food Situation report for November, published by the Food and Agriculture Organization (FAO) on 12 November.DUSHANBE Thursday, November 12, 2009 (IRIN) - Even as world food production grows, hunger is on the rise in many poor countries, according to the Global Crop Prospects and Food Situation report for November [http://www.fao.org/docrep/012/ak340e/ak340e00.htm], published by the Food and Agriculture Organization (FAO) on 12 November.

The report highlights a contradiction: world cereal production is at its second-highest level ever, yet food prices remain very high. It identifies 77 countries that are both low-income and food deficit.

In East Africa, cereal prices range from 68 percent to 177 percent over the 2007 numbers. In southern Africa, prices are 58-200 percent higher than in 2007, and in most of Asia prices are up 40-70 percent. Since most low-income food deficit countries are food importers, they lose far more from high prices than they gain from steady crop production.

Hunger, in most cases, is caused by lack of money rather than a shortage of food production, according to the World Food Programme (WFP). [http://www.wfp.org/hunger/causes] In 2008 the number of undernourished people in the world increased by 40 million, despite record harvests. [http://www.fao.org/news/story/en/item/8836/icode/]

The new FAO report suggests that 2009 is likely to see a similar increase in hunger.

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http://www.irinnews.org/report.aspx?ReportId=87006JOHANNESBURG Wednesday, November 11, 2009 (IRIN) - A move by donor countries to provide aid agencies with cash, allowing them the flexibility to source cheaper or more appropriate food in the region or beneficiary country and save on transport and warehousing costs, is not addressing nutritional needs, according to a new report.JOHANNESBURG Wednesday, November 11, 2009 (IRIN) - A move by donor countries to provide aid agencies with cash, allowing them the flexibility to source cheaper or more appropriate food in the region or beneficiary country and save on transport and warehousing costs, is also not addressing nutritional needs, according to a new report.

Food aid should include foodstuffs fortified with micronutrients and animal protein. "The emphasis is more on quantity rather than quality, and rarely does the food aid target the most vulnerable groups: children under five, pregnant women and lactating mothers," said Stéphane Doyon, of the international medical charity, Médecins Sans Frontières (MSF), a co-author of the organization's report, Malnutrition: how much is being spent?

"Barely 1.7 percent of interventions reported as 'development food aid/food security' and 'emergency food aid' between 2004 and 2007 actually address nutrition needs," he said.

The MSF report was published ahead of a new UN Children's Fund (UNICEF) report, which points out that the level of child and maternal undernutrition "remains unacceptable" throughout the world; 90 percent of the developing world's chronically undernourished or stunted children live in Asia and Africa.

jk/he http://www.irinnews.org/report.aspx?ReportId=86993NAIROBI 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 Tuesday, November 10, 2009 (IRIN) - Kenyan officials are protesting as 'unfair' a recommendation by the technical review panel of the Global Fund to reject the country's bid for Round Nine funding.NAIROBI Tuesday, November 10, 2009 (IRIN) - Kenyan officials are protesting as 'unfair' a recommendation by the technical review panel (TRP) of the Global Fund http://www.theglobalfund.org to reject the country's bid for Round Nine funding.

James Ole Kiyapi, permanent secretary in the Ministry of Medical Services and chair of Kenya's country coordinating mechanism http://www.theglobalfund.org/en/ccm/?lang=en, who is responsible for submitting grant proposals to the Fund, said the main reason for the TRP's recommendation was that Kenya's two ministries of health had failed to properly coordinate the management of resources.

In 2008 Kenya split its health ministry into the Ministry of Public Health and Sanitation, and the Ministry of Medical Services. Local media have reported wrangling over roles and access to financing - at one point both ministries appointed someone as head of the National AIDS and Sexually Transmitted Infections Control Programme, a major HIV/AIDS body.

The final decision on the recommendations of the TRP lies with the Global Fund Board http://www.theglobalfund.org/en/board/?lang=en, which is meeting in Addis Ababa, Ethiopia.

A high-powered delegation has been sent to appeal the decision. "We hope our side of the story will be heard," said Ole Kiyapi. The country is requesting US$270 million from the Fund.

Kenya's 2008 proposals http://www.theglobalfund.org/en/fundingdecisions/notapproved for funding for HIV, TB and malaria were also rejected; in 2003 the Global Fund delayed the disbursement of funds over concerns about corruption in the National AIDS Control Council.

Analysts say a recent row http://www.plusnews.org/Report.aspx?ReportId=86496 among HIV/AIDS NGOs over funding could also have played a part in the TRP's decision.

"We as a country have done a shoddy job of managing previous funds. Let this be a wake-up call, and let us learn from our mistakes and tackle the problems that have put us here in the first place," said James Kamau, head of the Kenya Treatment Access Movement, a national advocacy group.

Aidspan, an independent watchdog of the Global Fund, http://www.aidspan.org/index.php?page=gfgrants&menu=globalfundgrants&country=96, gives Kenya a 'D' in terms of grant performance, noting that on average Kenya grants are almost nine months behind schedule.

"If the bid is rejected outright people will die, because the government itself contributes nothing to HIV treatment in this country," Kamau said, adding that the government should start funding its own HIV programmes rather than relying so heavily on donors in order to avoid such uncertainty in the future.

The Global Fund, Kenya's biggest HIV/AIDS donor, has contributed over US$87 million to prevention, treatment and care programmes; more than 200,000 Kenyans are receiving antiretroviral medication.

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http://www.irinnews.org/report.aspx?ReportId=86969NAIROBI 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=86932WAJIR EAST Thursday, November 05, 2009 (IRIN) - The sound of the evening bell at a local boarding high-school in Wajir, in the northeast of Kenya, did not always signal the end of the day's classes. Instead it marked the end of the evening bathroom break as “bucket toilets” were emptied for the day. WAJIR EAST Thursday, November 05, 2009 (IRIN) - The sound of the evening bell at a local boarding high-school in Wajir, in the northeast of Kenya, did not always signal the end of the day's classes. Instead it marked the end of the evening bathroom break as “bucket toilets” were emptied for the day.

Such stories are commonly told with a mixture of humour and concern in the semi-arid region of Wajir, where most residents have little access to improved sanitation - with serious health implications.

"Wajir is prone to diarrhoea outbreaks," Francis Njoroge, Wajir East medical health officer, told IRIN. "Diarrhoeal diseases are [the] third [most] common illness in children below five years.

"Several factors could be contributory: the town lacks a sewerage system [and] uses a bucket system... people depend on boreholes... and many of the community water wells are not protected, exposing them to contamination," Njoroge said.

Outside the town, people use water from open dams, which they share with animals. "During the rainy season, run-off water washes animal waste into the dam, contaminating it," he said.

Wajir residents rely on shallow wells, due to increasing water salinity at depth, which are exposed to contamination during flash floods and from seepage.

The larger Wajir, which borders Somalia, Ethiopia, as well as the Kenyan towns of Mandera, Moyale, Isiolo and Garissa, lies in an area with large aquifers supplied by perennial rivers and dry seasonal river basins - also sources of contamination.

Like most of northern Kenya, Wajir has experienced a prolonged drought and livestock deaths. Animal carcasses litter watering points, posing a further health risk.

Contamination

Wajir South Development Association (WASDA) programme manager, Haretha Bulle, told IRIN of the challenges.

"There are [largely] no flush toilets and no pit latrines," Bulle told IRIN. A few flush toilets can be found in some hotels and in newer settlements but are rare in households.

According to a UN World Health Organization report, latrine coverage in rural Wajir is about 5 percent and just a little higher in the town.

Because of the high water table, pit latrines are not viable, and residents mainly rely on unhygienic bucket toilets - improvised from plastic jerry cans.

"Waste is collected from the bucket latrines by a tractor, which serves the whole town," Bulle noted. The town has a population of about 220,000.

"Households are not able to dispose of waste [and] are forced to dispose it anywhere," she said. "When it rains, the whole town smells. The water gets contaminated more easily and changes colour."

Refuse pit and open pit dumping is prevalent.

El Niño threat

According to Wajir town resident, Khadijah Ibrahim, ongoing El Niño-related rains will only exacerbate the situation. Her family of eight shares one bucket toilet with three other households - about 24 people in total.

"Sometimes the municipal council comes to empty the bucket after a week or 15 days. By the time the waste collectors come, the bucket toilet is already overflowing," Ibrahim said.

Her children, the youngest of whom is three, have been trained to wear shoes before going to the toilet to protect themselves, "but they only use soap to wash their hands before they eat", Ibrahim said.

Eco-toilets

The Arid Lands Development Focus (ALDEF) NGO is piloting eco-toilets, which use heat trapped by solar panels to burn human waste, reducing it to ash.

The toilets do not use water, instead relying on a dehydration/evaporation system. Diyad Hujale, ALDEF programme manager, told IRIN the target was mainly the town centre, which requires about 5,000 toilets.

Hujale recommended that Wajir town’s by-laws should make it compulsory for any upcoming construction to have an eco-toilet facility. The challenge, he said, is "how to get rid of the bucket toilet".

However, the cost of setting up an eco-san unit, about KSh60,000 (US$800), is prohibitive for private households.

Health education

Past recommendations to improve drainage and sanitation in Wajir have not yielded much, according to Bulle of WASDA. "It is one disaster after the other. When the rains come, we think of the drainage but forget about it when the drought comes."

At present, village elders in Wajir are being taught how to chlorinate the community wells, according to health officer Njoroge. Health education on the importance of protecting the wells is also being provided.

He said the construction of more toilets is being encouraged in new settlements, where communities are provided with water treatment chemicals.

"Health education is ongoing. Of importance is that there is continued disease surveillance in the district," he said. The solution lay in "providing clean water to the community and safe disposal of human waste via a sewerage system".

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http://www.irinnews.org/report.aspx?ReportId=86896NAIROBI Wednesday, November 04, 2009 (IRIN) - Encouraging the use of traditional African herbal medicines could prevent some of the one million malarial deaths on the continent, according to specialists attending a conference www.mimalaria.org/pamc in Nairobi. Many poor communities, especially in rural settings, cannot afford modern malarial drugs and many people die due to inaccessibility of treatment.NAIROBI Wednesday, November 04, 2009 (IRIN) - Encouraging the use of traditional African herbal medicines could prevent some of the one million malarial deaths on the continent, according to specialists attending a conference www.mimalaria.org/pamc in Nairobi. Many poor communities, especially in rural settings, cannot afford modern malarial drugs and many people die due to inaccessibility of treatment.

“Malaria kills many people in Africa, both children and adults, despite the availability of free treatment in certain African countries. While it is true many governments in Africa, with development partners, give free pediatric treatment for malaria, many still cannot access this facilities and resort to home treatment,” says Merlin Wilcox of the Research Initiative on Traditional Antimalarial Methods and the University of Oxford.

Some specialists at the ongoing 5th MIM Pan African Malaria Conference in Nairobi said medicines drawn from plants that abound in the continent could be utilized to save many people, especially those in poor settings, from malaria.

BN Prakash, a researcher with the Foundation for the Revitalization of Local Health Traditions, based in Bangalore, said Africa could draw on experiences in India where medicinal plants have been used with great success in the control of malaria-related deaths.

“Research in India has shown a 5-10 times reduction in malaria-related deaths among communities who use traditional medicinal plants like Guduchi [tinospore coeditdia], a local medicinal plant found in India,” said Prakash.

Preserving traditional knowledge

Another speaker, Gemma Burford of the Global Initiative for Traditional Systems of Health, said while there had been increased cases of loss of knowledge about traditional medicinal plants, student-led research could be used to preserve knowledge and create a database on these plants.

“When we carried out research involving school children in rural Tanzania about traditional Maasai medicines, we found out that 48 percent of these children already had knowledge about these plants. We used [this knowledge] to create a database for the purposes of preserving the knowledge and these plants too,” said Burford.

“It is important to note that many malarial drugs are still bought from commercial pharmaceutical shops and not many of them are that cheap. Costs also involve how easy or not it is to access these government facilities, especially in Africa where medical facilities are far-flung,” Burford said.

Educating the youth

Speakers at the conference called on African governments to introduce educational programmes that would teach the younger generations about the traditional methods of treating malaria and other diseases plaguing the continent.

“The biggest obstacle to use of traditional medicines is lack of interest from the youth and teaching them about these medicines would be the best way to let them appreciate their values. Evangelical churches and development agencies must also be persuaded to stop fighting traditional African medicine because modernity and tradition can be married to provide a formidable force against malaria,” added Burford.

Effectiveness and dangers

Doumbo Ogobara, director of the Mali Malaria Research and Training Centre, and a lecturer at the University of Bamako, said there should be more research to ensure the effectiveness of traditional medicinal plants in the treatment and management of malaria.

“More research must be directed towards finding out the effectiveness of these traditional medicinal plants and their safety and efficacy because initiatives on using them could be counter-productive if this is not done. More emphasis therefore must be laid on research for plant-based prophylactics for malaria,” said Ogobara.

Mahamadou Sissoko of the Centre called for caution in taking the traditional medicinal route, arguing that many malaria-related deaths have occurred even among communities that have relied heavily on traditional plants for treatment.

“People are dying even in places where there is still widespread use of traditional medicinal plants and unless the efficacy of a traditional plant on malarial treatment can be ascertained through vigorous research, we could have our backs against the wall. Many traditional healers will abuse this and give anything as medicine so long as it is a plant - we must urge caution,” said Sissoko.

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http://www.irinnews.org/report.aspx?ReportId=86866NAIROBI Wednesday, November 04, 2009 (IRIN) - Authorities in central Kenya have ordered hundreds of people to evacuate after a girl was killed when a mudslide destroyed her home following heavy rains.NAIROBI Wednesday, November 04, 2009 (IRIN) - Authorities in central Kenya have ordered hundreds of people to evacuate after a girl was killed when a mudslide destroyed her home  following heavy rains.

The incident took place in Gathaithi, in Murang’a East district.

“I have ordered all those living near the ill-fated home to vacate immediately and move to safer  ground. The government will provide them with essentials like tents and food,” District Commissioner George Natambeya said.
 
 In the past two weeks, heavy rains have been reported in most parts of the country and the government has ordered some families in landslide-prone areas of the larger Murang’a, Maragwa and Nyeri districts in central Kenya to vacate their homes.  Several deaths have occurred in the area as a result of mudslides because of the area’s topography.

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http://www.irinnews.org/report.aspx?ReportId=86870NANYUKI Wednesday, November 04, 2009 (IRIN) - Two years after violence forced Samuel Mwangi off his farm in the Kiambogo location of Nakuru District in Rift Valley Province, the father of seven is still struggling to rebuild his life and educate his children. Rift Valley, one of Kenya's grain baskets, was the worst-affected by the violence and food security has yet to recover.NANYUKI Wednesday, November 04, 2009 (IRIN) - Two years after violence forced Samuel Mwangi off his farm in the Kiambogo location of Nakuru District in Rift Valley Province, the father of seven is still struggling to rebuild his life and educate his children. Rift Valley, one of Kenya's grain baskets, was the worst-affected by the violence and food security has yet to recover.

Mwangi, who is now living in the central region of Laikipia as an internally displaced person (IDP), spoke to IRIN:

"Before the violence, I had a five-acre farm in Kiambogo where I used to grow maize and beans. I would say that by local standards I was a 'kabudaa' [slang for a rich man]. I also used to buy cereals from neighbouring farms, which I would then re-sell to the National Cereals Board.

"After the violence started [in early 2008], we fled Kiambogo and had to walk many kilometres to Nakuru town [Rift Valley's capital]. I left one of my injured parents behind when we fled as I could do nothing to help.

"Once in Nakuru, we got a lift to Kiganjo [in central Kenya] where we found ourselves stranded for three days. We then found our way to Naromoru [also in central] where we stayed in a makeshift tent by the sewerage area for six months relying on help from well-wishers.

"Then one day, one of the local chiefs asked me to work as a farm caretaker in the neighbouring area of Murero. This is the job I now have. I also work as a casual labourer digging people's farms and helping clean cowsheds to earn some money.

"I have enrolled my children in the local schools although paying school fees is difficult. I go to the schools and explain my situation to the headmaster so that he keeps allowing my children to stay in school even without any money.

"We are still waiting for the promised government compensation money [about US$465] to buy a cow and some goats as the money cannot buy land. In the meantime, we are also relying on relief food.

"I have heard that people have gone back to their former homes but even if I am told to return, I do not think I will. There is nothing left [there] for me; no property, no land and maybe I will be attacked again.

"We have been hearing on the radio that people are getting new land to resettle. If I get new land I will willingly go even if it is not fertile and full of stones. I will go there and develop it the best way I can as I believe in hard work. The most important thing is security.

"Even on the farm where I am a caretaker, I am planting some trees and vegetables to express my gratitude to the [farm] owner for letting my family have a place to live.

"We are facing many challenges two years after we left home but it is often not easy speaking directly to those who should be assisting us. Being an IDP is like being in jail."

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http://www.irinnews.org/report.aspx?ReportId=86871NAIROBI Tuesday, November 03, 2009 (IRIN) - Three years after being diagnosed with HIV, Alice Mworia, 28, went for a routine medical check-up during which she told the nurse she had noticed an unusual vaginal discharge; a test revealed she had pre-cancerous lesions on her cervix that could develop into cancer if untreated.NAIROBI Tuesday, November 03, 2009 (IRIN) - Three years after being diagnosed with HIV, Alice Mworia, 28, went for a routine medical check-up during which she told the nurse she had noticed an unusual vaginal discharge; a test revealed she had pre-cancerous lesions on her cervix that could develop into cancer if untreated.

"I was experiencing a bad smell from my private parts and I wondered whether it was because I was HIV-positive; I could not keep quiet any more and I shared with one of the nurses and she referred me to the doctor," Mworia told IRIN/PlusNews. "I did not even know there was anything called cervical cancer, which I was informed can kill very easily."

According to the UN World Health Organization (WHO) [http://apps.who.int/hpvcentre/statistics/dynamic/ico/country_pdf/KEN.pdf], some 2,635 Kenyan women are diagnosed with cervical cancer every year, with 2,111 dying from the disease, making it the most prevalent cancer among women in the country. About 38.8 percent of women in the general population are estimated to harbour cervical human papillomavirus (HPV) infection [http://www.cancer.gov/cancertopics/factsheet/Risk/HPV] - a leading cause of cervical cancer - at any given time.

High risk, low knowledge

For cervical HPV infection to progress to cancer, certain co-factors must be in place, including smoking, long-term hormonal contraceptive use and co-infection with HIV.

"Women who are HIV-positive have weak immune systems and this makes them very susceptible to persistent human papillomavirus that develops into cancer of cervix," said Lucy Muchiri, a senior lecturer in human pathology at the University of Nairobi's College of Health Sciences and a member of the sub-Saharan Africa Cervical Cancer Working Group.

"It takes a relatively shorter time for the HPV virus to develop into full-blown cancer of the cervix for women who have the HIV infection … It would take relatively longer in women who are not infected with HIV."

Pap smear tests - which check for changes in the cells of the cervix - are available at most district health facilities in Kenya, but according to WHO, fewer than 6 percent of women access them.

"I think many women die from the disease for a number of reasons - one is ignorance because knowledge about the disease among women and in the general population is very low and it is mistaken for other diseases," she said. "It is appalling that despite most cancer-related deaths in women happening because of cervical cancer, it is the least talked about or even known by people, including women."

According to Francis Kimani, director of medical services at the Ministry of Health, Kenya is planning a screening programme for early detection and treatment of cervical cancer as well as a widespread education campaign.

Education gap

"I think our best bet is to carry out education to let people know about the disease and that early detection of it can be very helpful," Kimani told IRIN/PlusNews. "It is true that not many people - especially in rural areas - know about the disease."

Studies [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2631263] have shown that HPV is higher among women who have multiple sexual partners and unprotected sex.

"Maybe to prevent it in the first place, the same methods used in combating HIV, like condom use, abstinence and keeping to one faithful partner, should be encouraged in this case too," Muchiri suggested.

She noted that the government also needed to invest in making the HPV vaccine - which protects against four major types of HPV, including two types that are responsible for 70 percent of cervical cancers - widely available in public hospitals.

Vaccine availability

The Kenya Pharmacy and Poisons Board approved the sale of an HPV vaccine in the country in 2007, but its availability is extremely limited and it is still prohibitively expensive for most Kenyans.

"HPV is a sexually transmitted virus and with the vaccine in place, it is important to encourage parents to take their young girls between the ages of nine and 15 to be vaccinated before they debut into sex," she said.

A recent study by the local NGO, Centre for the Study of Adolescence, found that four in 10 Kenyan girls had sex before the age of 19, many of them as early as 12.

"Once they [women] become sexually active, it is important to encourage [them] to go for Pap smear tests or visual detection of the pre-cancerous lesions but even vaccination at this stage is still feasible so long as one has not contracted the virus," Muchiri added.

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http://www.irinnews.org/report.aspx?ReportId=86853MOMBASA Thursday, October 29, 2009 (IRIN) - After days of heavy rain, flash floods in Kenya's coastal Magarini district have displaced at least 500 families, sweeping away houses and livestock, officials said.MOMBASA Thursday, October 29, 2009 (IRIN) - After days of heavy rain, flash floods in Kenya's coastal Magarini district have displaced at least 500 families, sweeping away houses and livestock, officials said.

Most of the affected families were from Kurawa and Kanagoni villages in Magarini. Many have already sought alternative shelter, with some heading to a camp for the displaced along the Malindi-Garissa highway.

John Manasseh, a local leader, told IRIN on 28 October: "We had assumed that since the rains were delayed at the beginning of the year, we would not experience any flooding. We even started cultivating our farms in readiness for the rain, but it seems we were all wrong."

Most of the coastal region has been dry, having not had rains since early 2009. In August, the Kenya Meteorological Department warned that the country could soon experience El Niño-related enhanced rainfall. Already, heavy rains have been reported in many parts of the country, with Coast Province being the latest to experience flooding.

The Magarini flash floods occurred a day after two people reportedly died in Kolongoni village in neighbouring Kilifi district, after a house in which they were sleeping collapsed after a downpour, crushing them.

Jillo Galgalo, one of those displaced by the floods in Magarini, said they lacked clean water for domestic use and were at risk of infection from waterborne diseases.

"Most pit latrines have been washed away because nobody expected any floods to occur this soon," Galgalo said. "We are in dire need of clean water because most water points are now filled with all sorts of waste, including human waste and cow dung."

Along with the neighbouring Tana River district - where roads connecting the towns of Mombasa, Garissa and Lamu have been cut off due to the rains - roads in Kilifi have not been spared, with most roads connecting local trading centres impassable.

Security issues

At least 100 trucks and passenger vehicles plying several routes along the north coast region have either become stuck in mud or were parked by the roadside. Most of the drivers, especially those on the Malindi-Garissa route, have expressed concern over possible bandit attacks.

"Our main concern is security, keeping in mind the number of times we've had cases of fellow drivers being attacked by armed bandits in recent times," Abdalla Musa, a truck driver, said.

However, the Tana Delta district commissioner, Ireri Ngatia, said the government would provide security for all drivers using the route.

Ngatia and his Magarini counterpart, Richard Kananu, have also appealed to residents living in low-lying areas to move to higher ground.

Meanwhile, the Kenya Red Cross Society and other humanitarian organizations are assessing the situation and preparing to start providing the necessary assistance.

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http://www.irinnews.org/report.aspx?ReportId=86793JOHANNESBURG Thursday, October 29, 2009 (IRIN) - An African international agreement has opened the door to a debate on the rights and protection of people displaced by natural disasters, with a nod to migration as a result of climate change. JOHANNESBURG Thursday, October 29, 2009 (IRIN) - An African international agreement has opened the door to a debate on the rights and protection of people displaced by natural disasters, with a nod to migration as a result of climate change.

The Kampala Convention, a ground-breaking treaty adopted by the African Union (AU), promises to protect and assist millions of Africans displaced within their own countries. Significantly, the treaty recognized natural disasters as well as conflict and generalized violence as key factors in uprooting people.

Jean Ping, chairperson of the Commission of the African Union, told IRIN that "more and more people are likely to be displaced" as Africa experiences more frequent droughts and floods brought about by climate change.

He said the inclusion of displacement by natural disasters was informed by the global debate on the need to develop a framework for the rights of "climate refugees" - people uprooted from their homes and crossing international borders - because the changing climate threatened their survival.

The treaty also calls on governments to set up laws and find solutions to prevent displacement caused by natural disasters, with compensation for those who were displaced. Migration expert Etienne Piguet said with the Kampala Convention the AU had "once again" tried to push the envelope.

In 1969 the Convention Governing the Specific Aspects of Refugee Problems in Africa, adopted by the then Organization of African Unity, had gone a step further than the 1951 UN Refugee Convention by using a definition of "refugee" that included not only people fleeing persecution but also those fleeing war or events seriously disturbing public order.

Piguet described the reference to people displaced by natural disasters as an "interesting attempt" to find "adequate answers to the new concern about migration linked to environmental degradation".

In 2008 climate-related natural disasters like droughts, hurricanes and floods forced 20 million people out of their homes, while 4.6 million people were internally displaced by conflicts, according to a recent joint study by the UN Office for the Coordination of Humanitarian Affairs (OCHA) and the Geneva-based Internal Displacement Monitoring Centre.

The Representative of the UN Secretary-General (RSG) on the Human Rights of the Internally Displaced Persons in a submission to the UN Framework Convention on Climate Change noted that people uprooted from their homes by natural disasters enjoyed protection under the existing human rights law and the guiding principles on internal displacement.

However, the Kampala Convention also calls on governments to "prevent or mitigate, prohibit and eliminate root causes" of displacement, and find "durable solutions" to them.

Moussa Idriss Ndele, President of the Pan-African Parliament, the legislative body of the AU, said the debate in Kampala on the rights of people displaced by natural disasters did not "quite evolve properly - we did not address the issue of climate change" because most people still believed conflict was the biggest trigger of displacement.

Can of worms

However, it was unclear which events could be linked to climate change. "More and more people are being displaced by floods, which are becoming more and more frequent and intense," said Rachel Shebesh, chair of the African Parliamentarian Initiative for Climate Risk Reduction.

The RSG said there was a need to clarify or even develop a legal framework to help people who moved inside or outside the country because environmental degradation and slow-onset disasters - like desertification, salination of soil and groundwater - made areas uninhabitable, and if displaced persons could not return to their homes they should be considered forcibly displaced.

The Intergovernmental Panel on Climate Change (IPCC) has projected more frequent and intense floods and droughts in Africa during the next few decades, and the debate is not only set to continue, but to intensify.

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http://www.irinnews.org/report.aspx?ReportId=86805KAMPALA Tuesday, October 27, 2009 (IRIN) - The African Union Convention for the Protection and Assistance of Internally Displaced Persons in Africa is a comprehensive document that will, if ratified, fill a void in international humanitarian law, say experts. KAMPALA Tuesday, October 27, 2009 (IRIN) - The African Union Convention for the Protection and Assistance of Internally Displaced Persons in Africa is a comprehensive document that will, if ratified, fill a void in international humanitarian law, say experts.

Whereas the rights of people who flee across national boundaries are protected under the 1951 Convention Relating to the Status of Refugees and a similar instrument introduced 18 years later by the Organization of African Unity (now the African Union), there has been no international legislation catering specifically for people displaced within their own country (IDPs).

IDPs vastly outnumber refugees in Africa. In just 10 of the 18 countries in east and central Africa, there are more than 10 million IDPs, according to the UN Office for the Coordination of Humanitarian Affairs (OCHA), with Sudan (four million), the Democratic Republic of Congo (2.12 million) and Somalia (1.55 million) heading the list.

In the same region, there are refugees in 16 countries, totalling just less than two million, according to OCHA.

This latest instrument, also known as the Kampala Convention because it was signed in the Ugandan capital, "obliges governments to recognize that IDPs have specific vulnerabilities and must be supported", said Walter Kälin, Representative of the UN Secretary-General on the Human Rights of Internally Displaced Persons.

"It covers all causes of displacement, is forceful in terms of responsibility and goes beyond addressing the roles of states to those of others like the AU and non-state actors."

Signed by 17 African states at the end of summit on 23 October, the convention defines IDPs broadly, irrespective of who is displacing them.

According to the International Committee of the Red Cross (ICRC), the convention provides a solid framework for enhancing the protection and assistance of IDPs in Africa. The ICRC is the custodian of international humanitarian law.

"The crucial challenge now is the same one facing international humanitarian law in general – ensuring that once the convention is signed and ratified by as many states as possible, it is actually implemented and respected," ICRC president Jakob Kellenberger said.

"States must now take concrete steps to implement the convention into their own national legislation and regulation systems, and develop plans of action to address issues of displacement.

"The convention goes further than international humanitarian law treaties in some aspects, for example, in the rules it contains on safe and voluntary return, and on access to compensation or other forms of reparation," Kellenberger added.

Next steps

To become a binding document, the convention has to be ratified by 15 of the AU's 53 member states.

"No international treaty is perfect, and the AU IDP Convention does have a few weaknesses. Concerns over the lack of effective enforcement mechanisms and insufficient guarantees for equality and non-discrimination have been raised," the Brookings-Bern Project on Internal Displacement noted in a statement.

"There is some question regarding the extent to which non-state actors and armed groups called upon by the convention to protect IDPs can be bound by its provisions. Nevertheless, the convention, which has benefited from the input of international experts, is considered to be generally consistent with international standards such as the Guiding Principles on Internal Displacement."

AU officials in Kampala were cautiously upbeat, urging member states to remain engaged. "It is the responsibility of member states that the convention becomes a binding instrument," Jean Ping, AU Commission President, said. "At this point, it is an achievement, but not an end in itself."

Zambian president Rupiah Banda also chose his words carefully. "We have given legal force to the task ahead and Zambia is ready to sign," he said. "Those who are displaced should not be forgotten."

An observer who requested anonymity said progress would require member states to demonstrate greater political will to implement the convention and address concerns about sovereignty and enforcement.

"It is a question of a progressive [AU] Commission versus [conservative] member states," he told IRIN in Kampala. "For example, the inclusion of armed groups in the draft was interpreted by some member states as lending legitimacy to such groups."

The convention emphasizes the sovereignty of member states but spells out the obligations and responsibilities of armed groups. Among others, it prohibits armed groups from carrying our arbitrary displacement, recruiting children and impeding humanitarian assistance.

"Overall, though, the convention has a good chance of getting the necessary signatures rather quickly," the observer added. "In April, SADC’s [Southern African Development Community] 11 members committed to speedy signature."

Political will

Civil society leaders, attending a parallel event, insisted political will and demonstrated commitment were key to progress. The fact that only five presidents came to Kampala, they said, called for an urgent strategy to bring on board more states.

Present were Banda, Ugandan President and host, Yoweri Museveni, Zimbabwe's Robert Mugabe, Somalia's Sheikh Sharif Sheikh Ahmed and Mohamed Abdelaziz of Saharawi, along with high-level UN, INGO and AU delegations.

"It is one thing to have a good convention and another to implement it," Dismas Nkunda of the New York-based International Refugee Rights Initiative told IRIN.

In 2007, the AU adopted the African Charter on democracy, elections and governance, but it has so far been ratified by only two member states.

The basic question of impunity also needed to be addressed. Until African countries learn to respect the law, participants said, the continent would "remain at rock bottom" in its attempts to address the problems of the displaced.

AU officials seemed conscious of these sentiments. "We have come a long way, but a plan of action is now envisaged," Jolly Joiner, AU commissioner for political affairs, told IRIN. "Once member states are on board, we will take this convention forward."

Antonio Guterres, head of the UN Refugee Agency (UNHCR) and representative of the UN Secretary-General at the summit, said solving the question of displacement in Africa required political solutions.

"There is no humanitarian solution to conflict," he explained. "The solution is always political."

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http://www.irinnews.org/report.aspx?ReportId=86762NAIROBI Tuesday, October 27, 2009 (IRIN) - Before 15 January 2008, Erick Kioko was a typical ghetto youth - juggling several petty jobs to survive, but mostly, he liked working as a part-time disc-jockey for local entertainment outfits operating from Mathare slums in the Kenyan capital, Nairobi.NAIROBI Tuesday, October 27, 2009 (IRIN) - Before 15 January 2008, Erick Kioko was a typical ghetto youth - juggling several petty jobs to survive, but mostly, he liked working as a part-time disc-jockey for local entertainment outfits operating from Mathare slums in the Kenyan capital, Nairobi. Other times he served as a tout on city minibus routes, earning KSh50 (US66 cents) per trip. Sometimes he was a porter at a taxi rank. He did all these jobs to support his wife and child, mother and three siblings. Then the country went to the polls in December 2007 and the ensuing violence changed Kioko's life for ever.

Kioko found himself trapped in Kisumu, in the west, where he had gone for a DJ gig. Somehow he made it to Nairobi after two days to find Mathare engulfed in chaos. Kioko, now aged 26, spoke to IRIN about how he lost his arm:

"When I realized that the violence was getting worse, all I wanted to do was check that my family was safe; I arrived in Mathare on 15 January 2008 to find that youths had formed groups to guard their homes from being burnt by rival groups. I found my mother at the gate of the [Moi] Air Force Base where many people had sought refuge.

"In the evening we heard that one of the groups had ordered everyone to remain indoors. I decided to make my way home but I found a group of men - I think they were more than 15 - raping a woman. They were armed with many weapons, including machetes. The woman's screams were so painful, I decided to pick up a few stones and start stoning the mob in the hope that they would leave her alone.

"I continued throwing stones at the group without realizing that three of them had detached themselves and surrounded me. I realized too late that they wanted to cut me up. One of them was so close to me, he aimed his machete at my head. Instinctively, I put my left hand up to shield myself. The next thing I knew my hand was on the ground, he had cut it off! I was in shock.

"I saw the others move closer to me and somehow an inner voice told me to run. I took off with all my strength, heading for the air force base; I just wanted to be near my mother. There I was quickly helped into an ambulance and rushed to Kenyatta National Hospital.

"I stayed in hospital for a month, sleeping on the floor and sometimes going without food as the place was very congested. All they did was dress the wound, I was promised surgery but I was only operated on towards the end of February. Later, Blue House [a charity operating in Mathare] helped me with two other operations in another hospital where the stump was further reduced.

"Now I have healed and I am trying to get on with life, but how can I be a DJ with only one arm? I can no longer be a tout because you need both hands; I can't be a porter either. I dropped out of school in Class Three due to lack of fees so I can't get less-tiring jobs easily. My wife and I live with my mother because I can no longer afford to rent our own place. I spend the nights with friends because I cannot sleep in the same room as my mother.

"All I have right now are questions. Why me? Why has the government forgotten those like me yet it is compensating IDPs [internally displaced persons] who lost property? What of us who lost limbs? I have not even paid the debt I owe Kenyatta National Hospital. I have written to the district commissioner … telling him about my plight but I have not had a response. I plan to go back to his office soon.

"I just need to find a way of supporting myself again. Most of all, I wish I could leave this slum; it is a constant reminder of my lost arm. Friends have even shown me where they found the hand. I wish I had a prosthetic hand so I could resume being a DJ, I wish I could start a small business and be able to rent a house but all these remain just that - wishes - for now.”

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http://www.irinnews.org/report.aspx?ReportId=86763NAIROBI Tuesday, October 27, 2009 (IRIN) - Replacing manual data with electronic health records would significantly improve the quality of care and enable African HIV treatment programmes to be scaled up more efficiently, say the authors of a new article on the subject. NAIROBI Tuesday, October 27, 2009 (IRIN) - Replacing manual data with electronic health records would significantly improve the quality of care and enable African HIV treatment programmes to be scaled up more efficiently, say the authors of a new article on the subject.

"Talkin' About a Revolution", published in the latest edition of the Journal of Acquired Immune Deficiency Syndromes, looked at the Academic Model for Providing Access to Healthcare (AMPATH), a programme that uses electronic health records in care and treatment services for around 100,000 HIV-positive patients at sites across western Kenya.

"Scaling up treatment programmes requires timely data on the type, quantity and quality of care being provided," the authors said. "Health care is an information business; managing patient care requires managing patients' data at many levels ... health care systems the size of AMPATH (or larger) cannot effectively be managed without ... [electronic] data."

More efficient care

The health data system can help programme managers avoid medical errors and stock-outs of key medicines, while enabling clinicians to monitor and care for their patients more effectively.

"Electronic records help us store data efficiently, retrieve it when we need it, and monitor and evaluate the progress of our programmes much more easily than if we were using manual systems," said Erica Kigothe, AMPATH's programme manager in charge of data management.

"When a patient comes to a clinic for a visit, instead of poring over large files, the clinician has one summary sheet that contains all the vital patient information and should he or she need more information, they can always go back to the patient's computerized file," she told IRIN/PlusNews.

A previous study comparing an AMPATH clinic before and after the adoption of electronic health records found that patient visits were 22 percent shorter, provider time per patient was reduced by 58 percent, and patients spent 38 percent less time waiting.

Kigothe noted that assessing disease trends was also easier with electronic records, as was collating data for the purposes of research and new directions in programme development.

Electronic health systems have been successfully used in the care and treatment of HIV in Lesotho, Malawi, Rwanda, South Africa and Uganda, but few African countries have adopted the systems on a large scale.

"Programme implementers in low-income countries sometimes see clinicians' recording of patient data and the management of those data as secondary to providing good care, or even a distraction," the article's authors commented.

Not all smooth sailing

The programme has not been without its difficulties. "In one of our sites in Busia [town on the Kenya-Uganda border] they have very frequent power outages, so they have had to find ways to work around it, inputting data when power is on, even if that is at night," Kigothe said.

Finding people with computer skills is not always easy in the developing world, particularly in rural areas, and "like any equipment, computers break down from time to time and require repair or replacement, which can cause some problems" and incur additional expenses, she said. "In addition, the data collectors are human, and therefore prone to the occasional error."

Electronic systems are not cheap; they require considerable investment in computers, training data collectors and hiring information technology experts. However, according to the study, AMPATH's total cost of care is under US$100 per patient per year, making the system financially feasible even in resource-poor settings.

"You're going to have to spend quite a lot of money to set up the system," Kigothe said. "But looking at the big picture, it saves so much in the long run - for example, each of our data collectors manages 2,000 patients' information, something that would be impossible using manual data collection."

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http://www.irinnews.org/report.aspx?ReportId=86768MIDRAND Tuesday, October 27, 2009 (IRIN) - Disaster risk reduction as a tool for climate change adaptation is a "technical mouthful" said Rachel Shebesh, chair of the African Parliamentarian Initiative for Climate Risk Reduction. MIDRAND Tuesday, October 27, 2009 (IRIN) - Disaster risk reduction as a tool for climate change adaptation is a "technical mouthful" said Rachel Shebesh, chair of the African Parliamentarian Initiative for Climate Risk Reduction.

Members of the Pan-African Parliament thought so too. The legislative body of the African Union met in Midrand, halfway between Johannesburg and Pretoria in South Africa, for a parliamentary debate on climate change in Africa.

Shebesh, the new champion of disaster risk reduction (DRR) in Africa for the UN International Strategy for Disaster Reduction (UN-ISDR) has been given the job of making the subject accessible.

Why?

The UN Special Representative of the Secretary-General for Disaster Risk Reduction, Margareta Wahlström, said DRR was "the first line of defence" against climate risks. Many countries did not have a plan that covered what to do to adapt to the impact of climate change, but drawing up a disaster risk reduction plan was a starting point.

DRR deals with the short-term changes in climate variables, such as temperature; adaptation to climate change is about long-term changes to climate. It is now widely acknowledged that reducing vulnerability to climatic variables could improve resilience to the increased hazards associated with climate change.

What does it mean?

Wahlström acknowledged that trying to explain to countries what this meant, and how to take DRR into account, could sometimes be problematic. Essentially, it is about "disaster-proofing" any plan or programme.

"You take into account the current and future disaster risks. If you are building a bridge in an area, you study the soil, ask the people who live in the area about what they know about the conditions in the area: do they build in the area? What precautions do they take? The easiest thing to do is draw up a check list."

Wahlström said she had come across several cities and towns in developing countries who had already been doing this, and "we are now busy putting all this information together for our next report."

She also said she would not be surprised if "disaster-proofing" became a pre-requisite for sourcing money for any climate change adaptation project, "but I would rather countries took up the initiative on their own." India, she said has made it mandatory for projects costing a certain amount to be disaster-proof so as to qualify for funds.

jk/he http://www.irinnews.org/report.aspx?ReportId=86774KAMPALA Monday, October 26, 2009 (IRIN) - Seventeen countries signed the African Union convention on internally displaced persons (IDPs) after years of preparation culminated in a week of meetings in the Ugandan capital but a lot more hard work remains before it becomes effective, according to observers.KAMPALA Monday, October 26, 2009 (IRIN) - Seventeen countries signed the African Union convention on internally displaced persons (IDPs) after years of preparation culminated in a week of meetings in the Ugandan capital but a lot more hard work remains before it becomes effective, according to observers.

"The most important step now is implementation," Julia Dolly Joiner, AU commissioner for political affairs, said. "We need to move from intentions to actions."

For the Brookings-Bern Project on Internal Displacement,  it is crucial that implementation is carried out "in a timely fashion and in a manner that makes a real difference to the lives of persons affected by internal displacement in the region, including host communities.
 
"The first step forward should involve a process of national dialogue and civic education aimed at securing the Convention's ratification and implementation by the State parties," according to a statement by the project, which monitors displacement issues worldwide to promote best practice among governments and other actors.

Fifteen countries must ratify the convention before it enters into effect.

Organizers of the 19-23 October meetings  insisted that the fact that only 17 signed did not represent a lack of political will and commitment on the part of the African states.

"We debated together and we agreed but when it comes to signing, the person has to have been given the authority by his government to sign," one AU official told IRIN. "Only 17 had such authorization."

Ugandan President Yoweri Museveni, who chaired the summit, praised it as "a very important milestone [that] has gone beyond conflicts to address issues of development.

"We have at least agreed in words, we now have to put our words [into] action," he told a news conference. "The solace for the women in Darfur may not be very immediate, but the fact is that people have come together to discuss the matter."

Partnerships urged

Joiner called for international support. "Africa cannot do it alone; that is why we are calling for partnerships," she told IRIN. "We are optimistic that countries will be faithful to their commitments under the convention.”

The AU will now try to get more signatures, and lobby 15 countries to ratify the convention so it can become a binding document. Observers, however, say much more work needs to be done to generate political will, given that most presidents stayed away from the summit.

The convention addresses the root causes of displacement in Africa, where at least 11 million people are displaced by conflict and climate change-related natural disasters, among other reasons.

According to the Brookings-Bern Project, three of the world's top five countries with the largest populations of conflict-induced IDPs are in Africa.

These include Sudan, with an estimated 4.9 million IDPs, the Democratic Republic of Congo, with at least one million, and Somalia, where the UN estimates 1.5 million are displaced. Hundreds of thousands more are displaced in Cote d'Ivoire, Ethiopia, Kenya, Uganda, and Zimbabwe.

Overall, citizens in at least 20 African states are experiencing internal displacement.

The convention aims to promote regional and national measures to prevent, mitigate, prohibit and eliminate the root causes of internal displacement as well as provide durable solutions.

"People who flee persecution or conflict and cross into another country are categorized as refugees and, as such, benefit from a long-standing and well-oiled international legal protection system, including the 1951 Refugee Convention," the UN High Commissioner for Human Rights, Navi Pillay, said.

"Until now [IDPs] have been more or less excluded from the system of international legal protection, even though they are often displaced in exactly the same way, and for exactly the same reasons, as refugees. At least in Africa, that should no longer be the case."

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The IDP convention obliges states to:

- Prohibit and prevent arbitrary population displacements, respect the principles of humanity and human dignity, as well as aspects of international humanitarian law concerning the protection of IDPs;

- Ensure assistance to IDPs, incorporate obligations under the convention into domestic law and designate a body to coordinate IDP protection and assistance;

- Devise early warning systems on potential displacement and establish disaster risk reduction strategies, protect communities and respect individual rights on protection against arbitrary displacement;

- Respect the mandates of the AU and UN, and the roles of international humanitarian organizations; and

- Take necessary action to effectively organize humanitarian relief and guarantee security; respect, protect and not attack humanitarian personnel or resources, and ensure armed groups conform with their obligations.

It prohibits armed groups from:

- Carrying out arbitrary displacement, hampering the provision of protection and assistance to IDPs and restricting the movement of IDPs;

- Forcibly recruiting, kidnapping or engaging in sexual slavery and trafficking; or

- Attacking humanitarian personnel or resources.


It obliges the AU:

- To intervene in respect of grave circumstances such as war crimes and crimes against humanity;

- To respect the right of members to request such an intervention and support efforts to support IDPs; and

- Strengthen capacity and coordinate the mobilization of resources for protection and assistance to IDPs.

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http://www.irinnews.org/report.aspx?ReportId=86746NAIROBI Friday, October 23, 2009 (IRIN) - The Inter-Agency Standing Committee (IASC), a grouping of UN and non-UN organizations that since 1992 has worked to harmonize humanitarian best practice, is conducting a review of its various policy statements, guidelines and manuals.NAIROBI Friday, October 23, 2009 (IRIN) - The Inter-Agency Standing Committee (IASC), [http://www.humanitarianinfo.org/iasc/pageloader.aspx] a grouping of UN and non-UN organizations that since 1992 has worked to harmonize humanitarian best practice, is conducting a review of its various policy statements, guidelines and manuals.

Until the end of October, anybody involved in the humanitarian world is invited to take part in brief surveys [http://tinyurl.com/iascreview] designed to gauge the overall familiarity, accessibility and utility of selected IASC products.

These include policy documents on civilian-military partnerships, assisting the elderly in humanitarian crises, and mental health and psycho-social support in emergency settings.

The surveys take 5-7 minutes to complete.

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