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MALNUTRITION KILLS INFANTS

KOLDA, Senegal
Daddo Sabaly's first four children all died before their first birthday, from either disease or malnutrition.

Ms. Sabaly lives in the Kolda region of Senegal, which historically has had one of the country's highest rates of infant mortality. Her fifth child, a boy named Abdoulaye, is now five. Her sixth is a healthy nine-month-old girl.

Ms. Sabaly credits a community health centre for her children's survival, as well as a community nutrition programme that identifies local food resources such as squash, eggs and milk. Before this programme, feeding children these products was considered taboo.

"At first, Abdoulaye was suffering from malnutrition," she says. "But we went to the community centre, where I learned to properly feed him and he got better."

Issues facing children in Burkina Faso
Only 41 per cent of births are attended by trained medical personnel. The nutritional status of children under age five is deteriorating. Malnutrition is especially concentrated in the northern regions that border Niger. More than 44 per cent of children suffer delayed or stunted growth.

Burkina Faso is one of only 12 countries where guinea worm has not yet been eradicated.
HIV/AIDS continues to spread among young people. An estimated 120,000 children have been orphaned by HIV/AIDS.


School enrollment rates are very low, especially among girls. Almost two thirds of teens and young adults under age 24 are unemployed. Many girls are still subjected to genital mutilation, a practice that causes lifelong damage.
Activities and results for children
HIV/AIDS IN BURKINA FASO

OUAGADOUGOU, Burkina Faso – Until he started receiving life saving antiretroviral (ARV) drugs, 12-year-old Pascal was often too sick to get out of bed. Today he is like any other child, laughing and playing with his younger brother, Bernard.
Pascal has been HIV-positive since birth, infected through his mother, Celine. She gave birth to him not knowing her own positive HIV status, and found out she was infected after Pascal was born, and after her husband had died.

“After my husband died, I was getting sick all the time,” she recalls. “I came to the clinic to find out what was wrong. I was advised to take the test and found out I was HIV-positive. I found out my child was positive in similar circumstances. He was so sick, he nearly died.”

Both mother and son were tested at Ouagadougou’s St. Camille clinic. The clinic has been the pioneering facility in Burkina Faso for HIV and AIDS care since 2001. Through the clinic’s HIV/AIDS programme, both Celine and her son started receiving ARV therapy. The medication saved their lives.

Preventing mother to child transmission

When she became pregnant a second time, Celine once again approached the clinic and enrolled in its prevention of mother-to-child transmission (PMTCT) programme. She was just one of the 1,500 women who enrol each year.
The programme tests for HIV and provides treatment for those who test positive.

At least 10 per cent of the women do turn out to be HIV-positive, but through PMTCT interventions, it’s no longer a given that their babies will become infected.

Dr. Tietra is the head of HIV and AIDS prevention at St. Camille. He credits the clinic’s success to good partnership.
“We were one of the first sites to begin a successful prevention of mother-to-child transmission programme in Burkina,” he says.

“We did it with the support of UNICEF, WHO and the Ministry of Health in Burkina, and we are positive that it is going smoothly in the implementation.

A sign of the success has been the significant reduction in transmission of HIV from HIV-positive pregnant women to their newborn babies.”


CHILDREN AT RISK
Although adult HIV prevalence in Burkina is estimated to be only about 1.6 per cent, children and youth are still at risk of infection. An estimated 10,000 children 14 and under were living with HIV in 2007, and 658 of those under 15 were receiving ARV therapy.

St. Camille’s is taking the lead in providing treatment to infected young people. The UNICEF-supported paediatric section receives referrals from all over the city, and at present is monitoring over 200 children who are either living with HIV or showing signs of having the virus.

Dr. Monica Vilazetti explains how it works: “The monitoring is done monthly of the children. If there’s a problem, we monitor more regularly, and we then decide if the child needs to be admitted or not.


Antiretrovirals are given while monitoring the inpatient children’s condition and we check if there’s an improvement. When they go home we continue to provide anti-retroviral treatment."
“There is no hope if there is no treatment,” she adds. “Their chances of survival would be really, really limited.”
Awareness helps fight the disease
The fight against HIV and AIDS in Burkina Faso extends beyond St. Camille’s walls. A team of peer educators has taken to the streets. They’re part of the Reseau Africain Jeunesse Sante et Development network, which has over 1,500 clubs across the country.

Supported by UNICEF, they encourage their peers to discuss the frequently taboo topics surrounding HIV and Aids. They are just one of many groups who use advocacy and awareness to fight the disease.

Celine herself has joined ‘Help Me to Be a Mother’ – a group that assists and advises HIV-positive pregnant women. She offers them the hope that she herself now feels.

“I just can’t imagine what my life would have been like without the support of the clinic,” says Celine.
CHILD POVERTY IN AFRICA - MARTHA'S STORY - AGE: 15
When things came down a little, the village was occupied by rebels and the situation was tense. Martha's father saw a steep decline in his business and was forced to move to a town deemed safe from rebel attack. There, he was able to rebuild his business and to send money and clothes to his daughter.
With her father gone, Martha moved in with her grandmother, who made a living by selling vegetables in the market. Sometimes, Martha had to help her and missed school as a result. But her situation took a sharp turn for the worse when her grandmother had a severe stroke, which left her unable to walk and almost unable to speak. Martha, by then 13 years old, found herself caring for her bedridden grandmother and with no news from her father. Poverty Sierra Leone
Time went by and, although barely able to keep up with school work, Martha managed to pass the National Primary School Examination, which allowed her to go on to high school. However, with her father gone and her grandmother no longer able to work, there was no money for the necessary school fees. Child poverty Africa

Martha's hopes for continuing her education now depended on her father, and she anxiously waited for him to re-establish contact. One morning, she received devastating news: her father had been murdered by the rebels.
"The whole world stopped for me," says Martha. "For the first time in my life I felt alone. I realised I was an orphan." poverty Africa

Martha is now staying with her stepmother, a woman her father married before his death and who she refers to as 'aunty', and her stepmother's three children. To help her new family, Martha sells biscuits in the street market, but she longs to go back to school. Luckily, her stepmother's new husband has shown sympathy to her plight and is willing to help.

Sierra Leone's decade-long civil war (1991 - 2002) had devastating physical and psychological effects on thousands of children like Martha. Over 10,000 children were directly affected through family separation, random and indiscriminate violence, sexual assault and abduction into the fighting force
CHILD PROSTITUTION IN AFRICA - LOME, TOGO, WEST AFRICA

LOME, TOGO. In downtown Lome there is an area known locally as "The Child Market," where girls as young as nine are offered for sex, sometimes for less than a dollar.

Child welfare groups complain that Togo lacks strong laws to punish the pimps who ruthlessly exploit these children. And the kids themselves complain that the police who patrol the district and are supposed to protect them, "simply demand sex for free." child prostitution Africa

Adjo is 11 years old and tries hard to look sexy in her black mini-skirt and skin-tight blue swimsuit top.
She said over a drink in a bar filled with cigarette smoke and drug dealers lurking in the background that she likes foreign customers best. They pay better and treat her better than Togolese men.

"The Ghanaians, the Ibos from Nigeria, the Senegalese and the other foreigners pay 5,000 CFA (US$10) and sometimes with a bit of luck they'll pay 10,000 CFA (US$20) - and despite that they treat us well," Adjo said.
"The Togolese maybe give us 1000 or 1500 CFA (US$2 or $3) and then want to rape us violently. They often hurt and insult us," the small girl said, visibly upset as she recalled such unpleasant memories. child prostitution Africa

Adjo's 13-year-old friend Amivi meanwhile complained that the security forces did nothing to help the girls by day and simply exploit them sexually at night.

"The soldiers, who are supposed to protect us when they are on patrol want to have sexual relations with us without paying and we are too frightened to say no, so we have to accept without turning a hair," she explained. child prostitution Africa

According to Adjo, she never knew her real parents. But she and Amivi hand over all the money they earn to a woman whom they call "Mama".
If the girls give this woman too little cash at the end of a shift, they run the risk of a severe beating.

"At the end of every day I have to give the money to a woman called Mama. "If I don't have enough money to give her, I get beaten," Adjo said.
Besides Adjo and Amivi, there are several hundred other young girls aged between nine and 15 who can openly be bought for sex in the downtown area of Lome called "Devissime". The name means "Child Market" in the local Mina language.
Many of these girls have been separated from their families.

"I never knew my parents," explained Adjo, "I was abandoned and I've always had to manage on my own."
Sometimes the girls sell themselves for as little as 200 CFA (40 cents). Only the better looking ones such as Adjo, can persuade their Togolese male clients to pay as much as 1500 CFA (US$3).

According to Adjo, " they vary from high school pupils and apprentice mechanics to wealthy members of Togo's ruling elite, who have children of their own back home." " These older men tend to be infatuated with the little girls", she added.

There are no reliable statistics about the sexual abuse of children in Togo, but there is a general perception among social workers and child protection volunteers that the phenomenon has increased alarmingly in recent years.
The issue came up for discussion earlier this week at a seminar in Lome on the trafficking and social exploitation of women and children in Togo.
The meeting was organised by two non-governmental organisations: the Coalition Against Trafficking in Women (CATW) and the Africa branch of the World Association of Orphans (WAO-Africa). child Abuse: child prostitution Africa
Both organisations want to see more research undertaken to evaluate the extent of these problems.
"There is no documentation about this phenomenon that would enable us to gain a better grasp of the situation" said Cleophas Mally from WAO-Africa.
"We have launched an investigation which should give us more reliable figures that would enable us to deal with this scourge more easily," he added.
Mally noted that although many of the exploited children came from very poor backgrounds, some of them had drifted into the life of a child hooker from quite affluent homes.
The seminar brought together journalists, hoteliers, traditional chiefs and religious leaders in a bid to talk openly about the sexual abuse of children, which is still a taboo subject in Togolese society.

Mally said it was still virtually impossible to charge and convict those who fill their pockets from the sexual exploitation of children, because the country's present laws do not provide young people with adequate protection.
However, he noted that a new child protection bill had recently been tabled in parliament.

Investigations carried out by Human Rights Watch (HRW), have shown that many vulnerable children in Togo fall victim to traffickers who supply children as cheap labor or sex slaves throughout West Africa. child Abuse: child prostitution in Africa

The New York-based organization recommended in a report published in March 2003 that Togo revise its laws to provide better protection to the victims of child trafficking and more help for them to be reinstated back into the community.
It accused the government of failing to make any headway in tackling the problem.
Meanwhile, these irresponsible men and women continue roaming about on the streets looking for little girls to devour and little Adjo, frightened of another beating, has to concentrate on earning more money.
She said it was worth spending some of her hard earned cash at the second hand clothes market to buy new outfits as she needs sexy gear to attract new clients.

"With 500 CFA (US$1) I can get two sexy outfits!" she said, bursting into laughter. Help Now! Help save little Adjo, Help fight child prostitution in Africa.

SAVE THE CHILDREN IN AFRICA.. HELP FIGHT CHILD POVERTY .. HELP FIGHT CHILD SLAVERY AND CHILD PROSTITUTION IN AFRICA
THE FIGHT AGAINST MALARIA IN AFRICA - HELP SAVE LIVES
Malaria, one of the world's most important public health concerns, is on the rise again, causing over a million deaths a year, including an estimated 700,000 children.

According to the WHO, in absolute numbers, malaria kills 3,000 children under 5 years old, every day a death toll comparable to that of AIDS. Effective malaria control programs have led to dramatic declines in death in some countries, but obstacles remain in many of the world's poorest countries.

Roll Back Malaria movement has clearly made extraordinary progress in many countries across the world, enabling hundreds of thousands of people living in poor communities to better access prevention and treatment services.

" according to Dr. Gro Harlem Brundtland, Director-General of the World Health Organization. "But there remains much to be done. I hope that international and national agencies, encouraged by the progress, will commit additional resources so that actions to Roll Back Malaria can be scaled up and millions more can benefit." diseases in Africa : malaria

The rising numbers of people affected by Malaria overwhelms national health services, sustains poverty and weakens societies, particularly in sub-Saharan Africa where ninety percent of the cases occur. The cost of prevention and treatment consumes scarce household resources and the disease continues to have a negative impact on the health of children. diseases in Africa: malaria

"Malaria is much more than a health issue. In many countries, it is now endangering development, targeting the poor and especially children who have little or no defense."

according to James Wolfensohn, President of the World Bank Group. "We need to give them those defenses. We have seen in Asia, Latin America and some African countries, that malaria can be controlled with the right tools and resources. We need to work aggressively with local NGOs and with the private sector to fight malaria at the local level, and work with governments to scale up local programs into national strategies."


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EXTREME POVERTY IN NIGERIA

Context and challenge: Poverty, demographic pressures and insufficient investment in public health care inflate levels and ratios of maternal and neonatal mortality

Nigeria is Africa’s most populous country, with 148 million inhabitants in 2007. (source: UNICEF)
There were almost 6 million births there in 2007 – the third highest number in the world, behind India and China – and a total fertility rate of about 5.4. Nigeria is also known for its vast oil wealth. Nonetheless, poverty is widespread; according to the World

Development Indicators 2007, published by the World Bank, more than 70 per cent of Nigerians live on less than US$1 per day, which impairs their ability to afford health care.

Poverty, demographic pressures and insufficient investment in public health care, to name but three factors, inflate levels and ratios of maternal and neonatal mortality.


The latest United Nations inter-agency estimates place the 2005 average national maternal mortality ratio at 1,100 deaths per 100,000 live births, and the lifetime risk of maternal death at 1 in 18.

When viewed in global terms, the burden of maternal death is brought into stark relief: Approximately 1 in every 9 maternal deaths occurs in Nigeria alone.

The women who survive pregnancy and childbirth may face compromised health; studies suggest that between 100,000 and 1 million women in Nigeria may be suffering from obstetric fistula.

Disparities in poverty and health among Nigeria’s numerous ethno-linguistic groups and states are marked.


Poverty rates in rural areas – estimated at 64 per cent in 2004 – are roughly 1.5 times higher than the urban-area rate of 43 per cent.

Low levels of education – especially among women – and discriminatory cultural attitudes and practices are barriers to reducing high maternal mortality rates.

High rates of adolescent births are commonplace across Nigeria, exposing girls and women of reproductive age to numerous health risks.
POOR HEALTHCARE SYSTEM

A national, phased, high-impact strategy to address maternal, neonatal and child health challenges


Given these complex realities, developing strategies to accelerate progress on maternal and newborn health remains a considerable challenge. Nevertheless, the Government of Nigeria, together with international partners, is attempting to meet this challenge.

In 2007, it began implementing a national Integrated Maternal, Newborn and Child Health Strategy to fast-track high-impact intervention packages that include nutritional supplements, immunization, insecticide-treated mosquito nets and the prevention of mother-to-child transmission of HIV.

The strategy is being rolled out in three phases, each lasting three years, and has been designed along the lines of the continuum-of-care model to strengthen Nigeria’s decentralized health system, which operates at the federal, state and local levels.
In the initial phase, covering 2007–2009, the key focus is on identifying and removing bottlenecks, while delivering a basic package of services using community-based and family-care strategies.

A sizeable proportion of expenditure will go towards artemisinin-based combination therapy to combat malaria in women, children, and newly recruited and trained health workers, particularly in rural areas. As basic health care improves, it is anticipated that the demand for clinical services will increase.

The second and third phases of the integrated strategy will place greater emphasis on building health infrastructure.

Throughout nine years, the strategy aims to revitalize existing facilities, construct clinics and hospitals, and create incentives – such as dependable salaries, hardship allowances and performance-based bonuses – that will help retain skilled health professionals in Nigeria’s health system.

THE BIG SICKNESS

“HIV/AIDS is the big sickness,” says Ruth Emmanuel, 15, who is the only female member of the community youth council.
“I know of at least six girls my age who are sick and have been sick for a long time and are not getting better.”

“I think it is our responsibility to spread this information because I don't think they are all aware of it,” Ruth said.

THE FIGHT AGAINST MALARIA

Health-system improvements have the potential to set a new course for meeting Millennium Development Goals 4 and 5

The Integrated Maternal, Newborn and Child Health Strategy – if implemented in full and on time – can markedly improve maternal and newborn health.

Together with this package, the country has recently passed the National Health Insurance Scheme, which integrates the public and private health sectors to make health care more affordable for Nigerians.

If the government passes the National Health Bill – which is currently before the legislature – a direct funding line for primary health care will become available.

These health-system improvements have the potential to set a new course for meeting Millennium Development Goals 4 and 5 in Africa’s most populous nation.


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