Proper Handwashing Facilities Still a Rarity in Poorer Countries

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Oct. 15, 2015 –  Diarrheal diseases are one of the leading causes of child deaths globally, responsible for an estimated 2.2. million deaths annually, more than from Malaria, HIV and Aids, and measles combined yet most homes in poorer countries lack handwashing facilities with soap and water.

Proper handwashing is key to reducing diarrheal diseases but according to a joint report from the World Health Organization and UNICEF less than 10 percent of homes in many low-income countries do not have soap and water.

The report, released ahead of World Handwashing Day, which is marked on Oct. 15th, showed that 1 percent of the population in Liberia, 2 percent in Rwanda and 3 percent in Malawi have a facility at home with soap and water.

The report was compiled from household surveys and analyzed results from 54 low and middle-income countries, mostly in Asia and Africa.

In Afghanistan, 39 percent of homes have a facility with soap and water while in Pakistan, the figure is 54 percent.

Of the African countries surveyed, Tunisia, 78 percent, and Namibia, 47 percent, had the highest rates of homes with soap and water facilities.

Other countries with low rates include Haiti, 22 percent, Central African Republic, 14 percent, Uganda, 8 percent and Sierra Leone, 7 percent.

Were the MDGs Successful?

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September 23, 2015 - The Millennium Development Goals expire at the end of this year and will be replaced by the Sustainable Development Goals that will be adopted by UN member states on Friday.

But as advocates have pointed out, particularly those from the least developed countries, the MDG agenda is still unfinished business and will be incorporated into the new, and expanded, global goals that will run until 2030.

Here we take stock of what has been achieved since 2000 when the eight Millennium Development Goals were adopted, and the gaps that remain.

Goal 1 – Eradicate extreme poverty and hunger

The number of people living in extreme poverty has fallen from 1.75 billion in 1999 to 836 million in 2015 but about 800 million people still live in extreme poverty and suffer from hunger. Over 160 million children under the age of five have inadequate height for their age due to malnutrition.

Goal 2 – Achieve universal primary education

The number of out-of-school children of primary school age worldwide fell by almost half, to an estimated 57 million in 2015, down from 100 million in 2000. Primary school net enrollment rate in the developing regions has reached 91 percent in 2015 from 83 percent in 2000. Further efforts needed to achieve universal primary education.

Goal 3 – Promote gender equality and empower women

The average proportion of women in parliament has increased from 14 percent to 22 percent since 2000, but remains low in absolute terms. Globally, about three-quarters of working-age men participate in the labor force, compared to only half of working-age women. Women earn 24 percent less than men globally.

Goal 4 – Reduce child mortality

The global under-five mortality rate has declined by more than half, dropping from 90 to 43 deaths per 1,000 live births between 1990 and 2015. More work is needed to improve child survival rates. Every minute around the world, 11 children die before their fifth birthday, mostly from preventable causes.

Goal 5 – Improve maternal health

The global maternal mortality ratio has fallen from 330 to 210 deaths per 100,000 live births between 2000 and 2013. Only half of pregnant women receive the recommended amount of antenatal care.

Goal 6 – Combat HIV/AIDS, malaria and other diseases

New HIV infections fell by 40 percent between 2000 and 2013, from an estimated 3.5 million cases to 2.1 million. In sub-Saharan Africa, still less than 40 percent of youth aged 15 to 24 years had correct knowledge of HIV transmission in 2014. Over 6.2 million malaria deaths have been averted between 2000 and 2015

Goal 7 – Ensure environmental sustainability

Between 1990 and 2015, the proportion of the global population using an improved sanitation facility has risen from 54 percent to 68 percent, and those using an improved drinking water source increased from 76 percent to 91 percent. Globally, 147 countries have met the MDG drinking water target, 95 countries have met the MDG sanitation target and 77 countries have met both. Emissions of carbon dioxide rose from 23.8 to 33.0 billion metric tons from 2000 to 2012.

Goal 8 –  Develop a global partnership for development

Official development assistance from developed countries rose 66 percent in real terms between 2000 and 2014, to USD 135.2bn. Funding will remain a critical factor for the post-2015 development agenda.

Related Story: Understanding the Sustainable Development Goals – Five Key Questions

Risk of Polio Spread in Europe After Ukraine Cases

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Sept. 8, 2015 - While the UN has set 2018 as its target for the global eradication of polio the confirmation last week of cases in Ukraine – which left two children aged four years and ten months paralyzed for life – is worrying proof that if vaccination rates slip then the virus will reemerge.

Ukraine had only a 50 percent polio vaccination coverage rate in 2014 but that had reportedly slipped to 14 percent this year due to low or no availability of vaccine doses and strong anti-vaccine sentiment.

The Global Polio Eradication’s International Monitoring Board (IMB) issued a warning less than a year ago that “the risk in Ukraine is of deep concern.”

The Oct. 2014 warning added that, “The last thing the global polio eradication program now needs is the re-emergence of polio in a place distant from its two epicentres and threatening to reverse the certified polio-free status of a whole region (in this case Europe).”

Polio incidence has been reduced by 99.9 percent since 1988 when there was an estimated 350,000 cases to just 37 cases in 2015 as of Sept. 2.

The two Ukraine cases occurred in the southwest of the country which shares borders with Hungary, Poland, Romania and Slovakia. To contain the spread, the World Health Organization says two million children in Ukraine under the age of five must begin to get vaccinated within two weeks of the confirmed cases.

Children typically get four doses of the polio vaccine, at ages two months, four months, 6-18 months and a booster does at 4-6 years.

The children in Ukraine were infected with a vaccine-derived type of polio. Such cases are rare – there have only been only 500 cases of paralysis from circulating vaccine-derived polio virus type 1 (cVDPV1) from 2001-2011 while the oral polio vaccine has prevented some 3.5 million cases of paralysis – but the most important risk factor for emergence and spread of cVDPV1 is immunity gaps resulting from low immunization coverage.

The European Center for Disease Control (ECDC) in a bulletin last week said, “It is likely that the cVDPV1 strain has been circulating for many months in Ukraine and that the virus could be found in other parts of the country.”

“Based on experiences from other similar events in the past, we can assume that the risk of more children presenting with paralytic poliomyelitis in Ukraine is high and that it will remain high until large-scale supplementary immunisations have been implemented, in accordance with WHO recommendations for the control of polio outbreaks,” the bulletin added.

It said there is risk of the virus being imported into EU countries from border areas but the risk of it resulting in paralysis is low given widespread vaccine coverage. However, the ECDC warned that there are pockets of under-immunized or unimmunized people in the European region, and said Bosnia and Herzegovina, Romania and Ukraine are at high risk for further polio spread.

- Denis Fitzgerald @denisfitz

Cuba First Country to Eliminate Mother to Child HIV Transmission

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June 30, 2015 – The Caribbean region has the second highest incidence of HIV after sub-Saharan African but has made steady progress over the past decade in reducing new infections and on Tuesday Cuba achieved a feat that has so far evaded the rest of the world.

The World Health Organization announced that the island nation has become the first country to eliminate mother-to-child transmission of HIV. The most recent figures from WHO show that 240,000 children globally were born with HIV in 2013, down from 400,000 in 2009.

“Eliminating transmission of the virus is one of the greatest public health achievements possible,” WHO Executive-Director Margaret Chan said in a statement. “This is a celebration for Cuba and a celebration for children and families everywhere.”

An estimated 1.4 million women living with HIV become pregnant annually and, unless treated with anti-retrovirals, have a 15-45 percent chance of transmitting the virus during pregnancy, labor or through breastfeeding. If both mother and child receive antiretroviral treatment during these crucial stages then the risk of transmission is lowered to about 1 percent, according to WHO.

The Caribbean nation has also eliminated mother-to-child transmission of syphilis. Some 1 million pregnant women are infected with the disease annually and it results in early miscarriage and stillbirth, newborn death, low-birth-weight and other serious infection in newborns.

The WHO guidelines for validating elimination of mother-to-child transmission of HIV and syphilis notes that as treatment is not 100 percent effective, elimination is defined as a reduction to such a low-level that it no longer constitutes a public health concern. Among the indicators are new HIV infections among infants are less than 50 cases per 100,000 live births or less than 5 percent for women living with HIV who are breastfeeding. These targets must be met for two consecutive years.

In 2013, only two babies in Cuba were born with HIV and only five with syphilis.

- Denis Fitzgerald 
On Twitter @denisfitz

UN Investigators Find Numerous Flaws With WHO’s Ebola Response

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May 11, 2015 – The World Health Organization is ill prepared to respond to international health emergencies and poorly managed the initial response to last year’s Ebola outbreak in West Africa, an independent team of investigators appointed by the UN has concluded.

The esteemed panel of investigators, in an interim report, said the WHO did not seek support early enough from other United Nations agencies that have experience in emergency response, did not engage with local communities early enough on changing behaviors that spread the disease, and its authoritative status was undermined by a combination of the above as well as fluffed communications including belatedly declaring Ebola a Public Health Emergency of International Concern.

“At present, WHO does not have the operational capacity or culture to deliver a full emergency public health response,” the investigators concluded. Among their recommendations are establishing a new agency for emergency health response or reforming WHO.

The latter is preferable, the investigators said, because “establishing a new agency would take time to put in place and substantial new resources would be required to establish its basic administrative systems, and operational response capacity.”

“A new agency would, in any case, have to rely on and coordinate with WHO for public health and technical resources, creating an unnecessary interface,” the report says. “A WHO that is capable of adequately responding to public health emergencies requires deep and substantial organizational change.”

Although WHO leads the health response cluster during humanitarian emergencies, the investigators write that “it is unclear…how a public health emergency fits into the wider humanitarian system and at what point an outbreak becomes a humanitarian emergency that requires a broader United Nations-wide response.”

They add that “one of the difficulties is that the risk assessment of public health emergencies and so-called humanitarian emergencies differs, because of uncertainty in assessing the likelihood of disease spread.”

Among other recommendations are that WHO should have used medical anthropologists for developing communications strategies for changing traditional burial and funeral practices that contributed to the spread of Ebola and that UN member states should increase their contributions to WHO so that it can effectively respond to public health emergencies.

“Now is the historic political moment for world leaders to give WHO new relevance and empower it to lead in global health,” the report concludes. “In response, the (WHO) Secretariat needs to take serious steps to earn this leadership role in relation to outbreaks and emergency response and to regain the trust of the international community.”

Full report is below.

Denis Fitzgerald
On Twitter @denisfitz

 

Ebola Interim Report on WHO Response

Post-2015 Must Address Plight of Poor Urban Mothers and their Children

Child in slum in Kampala, Uganda next to open sewage -  Licensed under CC BY 2.0 via Wikimedia Commons

Child in slum in Kampala, Uganda next to open sewage – Licensed under CC BY 2.0 via Wikimedia Commons

May 8, 2015 – Save the Children says UN member states must make a commitment to tackling inequality in the post-2015 development agenda and in particular the disparities in urban settings where the poorest kids are twice as likely to die before their fifth birthday as the richest.

The organization’s annual State of the World’s Mothers report examined child death rates in cities. And from Delhi to Washington DC, the data showed that the poorest lack access to pre-natal care, skilled birth attendance and proper nutrition resulting in “alarmingly high risks of death,” according to the report released this week.

“We specifically looked at the urban inequities because more and more families are going to cities to have a better life for their families,” Save the Children CEO Carolyn Miles told UN Tribune. But the poor are often confined to slums without access to proper sanitation and clean water supply.

“It really is about inequity and for us it’s about how do you reach those poorest children and more and more of those children are in urban slums,” Miles said.

The report says the post-2015 agenda must set specific targets for improving the wellbeing of urban mothers and children. While generally there has been good progress in reducing child and maternal mortality globally, this is not the case for the urban poor.

Specifically, Save the Children says the post-2015 framework should:

Ensure that all mothers, newborns and children have access to quality essential health services and other basic resources no matter where they live, how wealthy they are, or on the basis of their ethnic identity.

Include an explicit commitment that no target will be considered to have been met unless it has been met for all social and economic groups. This means that the proposed targets for child and newborn mortality should be achieved by all sectors of society within a country, not just at the national level.

Asked what low-cost high-impact interventions work best for tackling hight rates of child mortality in urban settings, Miles explained the work her organization does in community healthcare.

“A big part of what we do in urban settings are these community healthcare programs. They are local people – they could be women or men – who live in those communities and we train them on basic healthcare and we train them on working with mothers during pregnancy and making sure they’re eating the right things as much as possible, they’re going to the clinics for regular checkups, they have a plan for when they give birth for where they’re going to go – they’re not going to have their baby at home – they’re actually going to go to a hospital,” Miles explained.

“Those community health workers are really important and they look after that baby in that first really critical month for newborns,” she added. “You can implement that program for not a lot of money and you can do it in large numbers in urban slums, it’s very effective.”

Besides economic inequities, there are gender inequalities too with more girls than boys dying in their first five years. This is often a result of the prioritizing of boys over girls when it comes to health and nutrition, Miles said.

There are also more poorer women than men living in urban areas due to a number of factors including employment and wage discrimination and an increase in lone-mother households.

It is no surprise then that the report found that countries that come tops for gender equality – the Nordic states – are also the best places to be a mother while countries that rank low on gender equality indexes are at the bottom.

Top Five Countries
1 Norway
2 Finland
3 Iceland
4 Denmark
5 Sweden

Bottom Five Countries
175 Niger
176 Mali
177 Central African Republic
178 Democratic Republic of the Congo
179 Somalia

Source: Save the Children 2015 Mothers’ Index  Rankings

- Denis Fitzgerald
On Twitter @denisfitz

UN Urges Action on Prison Overcrowding

San Quentin prison in California. source: creative commons/California Dept. of Corrections

San Quentin prison in California. source: creative commons/California Dept. of Corrections

April 22, 2015 - The prisoner population exceeds prison capacity in 77 countries by at least twenty percent and the United Nations is asking member states to examine sentencing laws as a means to reducing the number of inmates.

Some 10 million people are behind bars globally, ranging from a high of 2.2 million in the United States to just two in San Marino, according to the International Center for Prison Studies.

The declaration adopted last week at the UN Congress on Crime Prevention and Criminal Justice calls on states to examine “penal policies” and “to enhance the use of non-custodial sanctions” to reduce prison overcrowding, which leads to increased violence, suicide and the spread of infectious disease.

The highest rates of overcrowding regionally are in Benin (363%), El Salvador (320%), Philippines (316%) and Serbia (158%).

By far, the single biggest cause of prison overcrowding are custodial sentences for people convicted of low-level drug offenses. About 25 percent of all prisoners worldwide have been convicted of the sale or possession of drugs, says a new study from the Penal Reform Institute. In US federal prisons, that rate rises to 49 percent.

The call from the UN crime congress is timely as delegates will gather next month at UN headquarters to discuss plans for the 2016 UN General Assembly special session on the World Drug Problem.

The meeting was called for by the presidents of Colombia, Guatemala and Mexico in 2012, countries at the forefront of the drugs problem that has lead to spiraling rates of violence.

Advocacy groups are hoping that the meeting will lead to a re-examination of policies that are causing overcrowding of prisons and a rethink on the criminalization of drugs. The facts support such calls. For example, while women globally represent about ten percent of all prisoners, most are imprisoned for minor drug offences and many of these have existing addiction issues, which are not treated in prisons.

The General Assembly session in preparation of the 2016 high-level meeting will take place on May 7th.

Top Ten Prison Populations Globally

1 United States of America 2 217 000
2 China 1 657 812
3 Russian Federation 673 818
4 Brazil 581 507
5 India 411 992
6 Thailand 330 923
7 Mexico 255 638
8 Iran 225 624
9 Indonesia 167 163
10 Turkey 165 033

Top Ten Countries Where Prison Population Exceeds 100 Percent of Prison Capacity

1 Benin 363.6
2 Comoros 343.3
3 El Salvador 325.3
4 Philippines 316.0
5 Zambia 279.3
6 Guatemala 270.6
7 Venezuela 269.8
8 Bolivia 256.9
9 Sudan 255.3
10 Uganda 254.6

Source: International Center for Prison Studies

- Denis Fitzgerald
On Twitter @denisfitz

US Senators Urge Funding for UNFPA as Republicans Hold Purse Strings

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Feb. 6, 2015 – A group of US senators is urging President Obama to continue funding the UN Population Fund (UNFPA) as the threat of Republican-controlled legislatures pulling funds for the agency looms.

The Republican Party won significant gains in the house and senate in the midterm elections and US funding for UN climate and population programs are under threat. Under President George W. Bush, the US withheld funds for the UNFPA claiming in part that the agency supported Chinese government programs which include forced abortions and coercive sterilizations.

The 22 senators, including Barbara Boxer, Dianne Feinstein and Kirsten Gillibrand, in a Jan. 27 letter, wrote that “U.S. funding for UNFPA supports a range of global activities including the provision of voluntary family planning information, education and services, training and deployment of skilled birth attendants and midwives, and work to help end the harmful practices of female genital mutilation and child marriage.”

We are disappointed that despite UNFPA’s critical work around the world, a number of misperceptions about the organization persist,” the letter added.

On its website, the UNFPA says it “does not promote abortion as a family planning method.”

The US has contributed some $30 million annually to the agency under the Obama administration. From 2001-2008, a total of $244 million in Congressionally approved funding was blocked by the Executive Branch.

The UNFPA receives some $450 million yearly with Sweden ($66M), Norway ($59M), the Netherlands ($49M) and Denmark ($44M) the top donors.

Since the Helms amendment to the foreign aid package in 1973, US foreign aid is prohibited from being used to pay for abortion as a method of family planning “or to motivate or coerce any person to practice abortions.”

The senators conclude their letter by saying, “support for UNFPA is cost-effective, saves lives and supports our broader diplomatic, development and national security priorities.”

- Denis Fitzgerald
On Twitter @denisfitz

Slowdown in Ebola Cases as Funding Increases

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Nov. 5, 2014 – The World Health Organization on Wednesday said that incidences of the Ebola virus appear to be on the decline in Liberia, stabilizing in Guinea but increasing in Sierra Leone, particularly in the capital Freetown.

The latest WHO situation report shows 398 new cases in Liberia in the past 21 days out of a total of 6,525 cases that have resulted in 2,697 deaths so far.  In Guinea, 256 new cases have been recorded in the past three weeks bringing the total to 1,731 cases with 1,041 deaths.

However, Sierra Leone has reported 435 cases in the past week alone. “Much of this was driven by intense transmission in the capital of Freetown, which reported 115 new confirmed cases and remains one of the worst affected cities in this outbreak.”

Sierra Leone has the second highest incidence of Ebola, after Liberia, with 4759 cases resulting in 1,070 deaths. More than a quarter of the country’s Ebola cases have been recorded in the past three weeks.

The WHO also said that the number of beds in Ebola Treatment Centers (ETCs) has increased from 284 at the beginning of August to 1,047 at the end of October with 593 in Liberia, 294 in Sierra Leone and 160 in Guinea.

“The establishment of more beds is in part held back by challenges in finding sufficient numbers of foreign medical teams to operate ETCs,” the WHO said.

The outbreak of Ebola in the Democratic Republic of the Congo, which is separate and unrelated to the outbreak in West Africa, is almost under control. There have been no new cases in the past 24 days, WHO said, and if no other cases are reported in the next 18 days the country can be declared Ebola-free.

Meanwhile, funding to combat Ebola is increasing with more than $1 billion committed so far according to UN figures. The top five contributors are the United States, which has given $313 million; the UK, $95 million; Canada, $51 million; China, $41 million; and Sweden $34 million.

Russia is the only permanent member of the Security Council that has not yet donated funds to combat Ebola.

A list of all contributions and pledges made so far is here and includes funds given directly to the UN appeal as well as money donated bi-laterally to an affected country.

- Denis Fitzgerald
On Twitter @denisfitz

France Absent From Donors to UN Fund for Combatting Ebola

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Oct. 8, 2014 – France has yet to contribute to the UN fund to combat the Ebola virus outbreak in West Africa.

The most recent list of contributions to the fund, which is seeking $988 million, shows that the US has contributed $113 million of the $391 million so far committed, making it, by some distance, the biggest country donor.

The UK is next with $7.8 million contributed, then Australia at $7 million, followed by Kuwait, $5 million, Canada, $4.2 million, and Germany $3.2 million.

Twenty-two countries in total have contributed to the fund. Besides the six above, the others are:

Switzerland $3 million
Japan $3 million
Norway $2.2 million
China $2.2 million
Denmark $2.2 million
Italy $2.1 million
Ireland $1.2 million
Netherlands $1.2 million
Finland $1 million
South Korea $600,000
Spain $540,468
India $500,000
Luxembourg $269,054
Austria $263,505
Estonia $80,600
Andorra $20,053

Russia is the only other permanent member of the Security Council besides France to not yet contribute.

A list of all contributions and pledges to the United Nations Ebola Response Fund, as compiled by the UN Office for the Coordination of Humanitarian Affairs, is here.

France is the former ruler of Guinea, which is the epicenter of the Ebola virus outbreak. The first case in the current outbreak, the biggest ever, was diagnosed there in March 2014. The country has registered 1,298 cases, resulting in 587 deaths, according to the World Health Organization. Twenty-five percent of the cases in Guinea have been diagnosed in the past three weeks.

The total number of cases for Liberia, Sierra Leone and Guinea has topped 8,000 resulting in 3,800 deaths.

The US, Spain, Senegal and Nigeria have also recored cases while a recent study suggests there is a 75 percent probability of the virus spreading to France in the next twenty days. The UK and Belgium are also at high risk of the virus spreading there at 50 percent and 40 percent respectively, according to the study.

The study, by researchers from Boston University, also found that a travel ban on flights from affected countries would delay international spread of Ebola by three weeks and concluded that the best intervention is on the ground assistance in the affected countries.

- Denis Fitzgerald
On Twitter @denisfitz

Image: US CDC