Archive for category: Global Poverty

Key articles and information on global poverty.

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5 Things Being Done to Prevent Cholera Outbreaks in Africa

Cholera Outbreaks in AfricaDue to the use and ingestion of contaminated water, cholera has become one of the most common waterborne diseases in the world. Cholera is a bacterial disease that causes such symptoms as diarrhea, dehydration, and, if not treated quickly, even death. Lack of availability to drinking water and sanitation facilities in Africa allows cholera to spread easily and quickly. However, many organizations have come up with different ways over time to help reduce the spread of cholera. Here are five things being done to prevent cholera outbreaks in Africa.

5 Things Being Done to Prevent Cholera Outbreaks in Africa

  1. Access to Clean Water: Being a waterborne disease, cholera can be prevented most effectively with access to clean drinking water. CDC has created a program called The Safe Water System Project, which brings usable water to areas with contaminated water. The Project also treats water with a diluted chlorine solution, making it safe to drink. CDC was able to use this program to bring safe water to more than 40 schools in Kenya, providing clean water to the students, staff and their families.
  2. Oral Vaccination: The FDA approved an oral cholera vaccine called Vaxchora. Due to the spread of cholera cases in Africa, in 2017 and 2018, the World Health Organization (WHO) distributed Vaxchora to five different countries in Africa to prevent further cholera outbreaks. By distributing this vaccine, WHO is giving relief and medical treatment to millions of individuals who previously may not have had access to any medical care.
  3. Proper Sanitation Facilities: Cholera can spread very easily if proper sewage and sanitation facilities are not in place or contain defecation. An organization called Amref Health Africa has made it their goal to supply communities in Ethiopia with clean toilets, sinks and other sanitation facilities. Amref Health Africa also sends teams to help train the community on how to maintain the facilities and educate them on other hygiene practices.
  4. Establishing Treatment Centers: According to the United Nations Office for the Coordination of Humanitarian Affairs, 11 treatment centers have been established in Africa with the specific purpose to prevent cholera outbreaks. In addition, an organization called Medecins Sans Frontieres (MSF) has created mobile clinics to meet the needs of those in more rural areas who may have contracted cholera. MSF has also established the Cholera Treatment Centre (CTC), which is a facility where individuals can visit and be treated for cholera.
  5. Hygiene Practices: UNICEF has launched a campaign to help spread hygiene awareness. The campaign is called My School Without cholera and is brought to more than 3,000 schools in Cameroon. Along with this campaign, UNICEF is urging Cameroon’s government to act and address the impact cholera has had on its community.

 

While as of 2018, cholera hotspots around the world have seen a decline of 60% since 2013, thousands of individuals are still susceptible to cholera in Africa. The WHO has estimated that Cameroon, Kenya, Somalia, Sudan and the Democratic Republic of the Congo have had more thna 45,000 confirmed cases and close to 700 deaths just in the time span of 2017 to 2020. The call to educate others on and how to prevent cholera outbreaks is imperative to the health of those who face cholera as an everyday battle.

– Olivia Eaker
Photo: Flickr

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The State of Hunger in Indonesia

Hunger in Indonesia
With the population estimated at over 250 million people, Indonesia is the fourth most populous country in the world. It has been enjoying strong economic growth in the past decades and it is the largest economy in the Association of Southeast Asian Nations (ASEAN). Despite the impressive economic growth, however, it is still a lower middle-income country. Hunger in Indonesia continues to be a significant issue.

Poverty and Hunger in Indonesia

Poverty is still concentrated in rural areas, with 14.3% of the rural population living in poverty in 2014, accounting for more than 60% of the total poor. Additionally, challenges of high food prices and unequal access to food remain unresolved, despite increasing trends in food production and availability. As a consequence of poverty and food scarcity, 19.4 million Indonesians are unable to meet their dietary needs.

A 2019 report by the Asian Development Bank (ADB) and the International Food Research Institute (IFPRI) found that about 22 million people suffered from chronic hunger in Indonesia between 2016 and 2018. Despite the strong growth that Indonesia has made in the agricultural sector, many families across the country still engage in traditional agricultural activities that are low-paid. This leads to hunger and stunting in children.

The Double Burden of Malnutrition

The impressive economic growth has brought about substantial improvements in many aspects of human development in Indonesia. The mortality rate of children under five has dropped from 85 out of 1000 births in 1990 to 31 in 2012. The prevalence of underweight children is also low at 5.4%.

However, the stunting rate in Indonesian children remains widespread. Approximately 37.4% of children under five in 2013 suffered from stunted growth. Stunting in children, a sign of chronic malnutrition, comes with lifelong consequences. It interferes with other development processes of the body, including brain development, which has damaging effects on intelligence, performance in school and productivity at work later in life.

Malnutrition can have detrimental effects very early on in life. When children receive inadequate nutrition in the womb, they become more prone to obesity when their body consumes more food. This in turn leaves them vulnerable to other non-communicable diseases such as diabetes and heart disease. This is the double burden of malnutrition that Indonesia faces. It is estimated that 8.9% of adult women and 4.8% of men are obese, while 8% of the women and 7.4% of men in Indonesia have diabetes. Additionally, more than 1 in 4 women of reproductive age suffer from anemia.

The negative effects of malnutrition are not only felt by the individuals suffering from them but also by society as a whole. It is estimated that losses due to stunting and malnutrition account for 2-3% of Indonesia’s gross domestic product (GDP).

Efforts to Decrease Hunger

In an effort to secure food for low-income households, the government of Indonesia set up a program called Raskin to deliver subsidized rice monthly to the most vulnerable households. Under this program, the eligible households could purchase 15kg of rice each month for a fifth of the market price. Each year, the government distributes 3.4 million tons of rice to a target population of 17.5 million people. With the annual budget of $1.5 billion, Raskin is Indonesia’s largest social support program.

The government also coordinates with nonprofit organizations globally to help combat hunger in Indonesia. Due to its size and geography, Indonesia is particularly vulnerable to natural disasters, which cause food security in many communities. The World Food Program (WFP) is working closely with the Indonesian government to improve nutrition and the quality of food. It also helps mitigate the effects of natural disasters on food security by providing policy advice and technical assistance.

Moving forward, it is essential that the government and other humanitarian organizations continue to make hunger in Indonesia a priority. With continued efforts, hopefully the nation will be successful in achieving Sustainable Development Goal 2: zero hunger in Indonesia.

– Minh-Ha La
Photo: Flickr

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Food Systems and COVID-19

Food Systems and COVID-19
The Borgen Project has published this article and podcast episode, “Food Tank, Food Systems and COVID-19: A Conversation with Dani Nierenberg,” with permission from The World Food Program (WFP) USA. “Hacking Hunger” is the organization’s podcast that features stories of people around the world who are struggling with hunger and thought-provoking conversations with humanitarians who are working to solve it.

 

To say Danielle Nierenberg is passionate about food is an understatement. A world-renowned researcher, speaker and advocate, she’s spent her career fighting for food-systems change and is an expert on all things food and ag.

In 2013, Danielle co-founded Food Tank, a global community pushing for food systems change. Food Tank aims to educate and inspire and highlight solutions that will create change.

We’ve been curious to learn more about Danielle and her work for a while. And during this unprecedented time, we wanted to get her expert insight into how coronavirus will affect food systems as well. So, we dialed Danielle up to talk about her career, Food Tank and COVID-19.

Click below to listen to Danielle Nierenberg’s conversation about food systems and COVID-19.

 

 

Photo: Flickr

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Renewable Energy in Nicaragua

renewable energy in NicaraguaLocated in Central America, between Honduras to the north, and Costa Rica to the south lies Nicaragua. Over the past few years, the country has taken steps to further its already growing renewable energy sector. In 2015 alone, the country was able to produce 54% of its electricity from renewable energy sources. Growth in this sector is notable and is expected to continue.

The Emergence of Renewable Energy in Nicaragua

Nicaragua’s government has turned to renewable energy for a few key reasons. One is the country’s natural abundance of renewable resources. Nicaragua experiences powerful winds and large amounts of sunlight on a regular basis. The country is also home to 19 volcanoes—a reliable source of geothermic heat.

The second reason for turning to renewable energy resources is to become energy independent. Nicaragua itself does not produce oil. As a result, Nicaragua has historically relied on imports of fossil fuel resources. While the country still imports foreign oil, the increased production of renewable energy, like geothermal energy from Nicaragua’s volcanoes, has reduced that dependency.

These two reasons have led Nicaragua to increase its consumption of renewable resources over the past few years. Much of the renewable energy that is produced in Nicaragua is sugarcane biofuel, which accounts for 33.2% of the renewable energy sector. The second most used form of renewable energy is geothermal, which comes in at 24.6%, followed by wind energy at 22.5%. The least used forms of renewable energy are solar energy at 0.5% and hydroelectric energy at 0.25%. As the percentages show, Nicaragua is using more renewable energy leading to a diversification of its energy sector. Nicaragua also has the potential to expand the amount of renewable energy produced, particularly from wind. Wind alone produces over 1,000 megawatts.

Benefits of Renewable Energy in Nicaragua

Nicaragua is an extremely poor country with high poverty rates, especially in rural areas. Fortunately, renewable energy has the potential to help the impoverished people of Nicaragua and provide a model for other impoverished nations.

People who live in poverty tend to have a harder time gaining access to electricity because of their inability to afford it. Some forms of renewable energy are becoming more affordable than fossil fuels. Take geothermal energy for example—the second largest form of renewable energy in Nicaragua. This form of energy is 80% cheaper than fossil fuels. Solar energy is on its way to becoming cheaper than fossil fuels as well. While installation of the technology needed to produce renewable energy is initially expensive, once installed, it lowers the cost and increases the accessibility of electricity for impoverished people.

Nicaragua is continuing to develop its renewable energy sector. The reward of this action will be a cleaner environment and cheaper electricity for its impoverished citizens.

– Jacob E. Lee 
Photo: Wikimedia

5 Facts about Poverty in El Salvador

Facts About Poverty in El Salvador
El Salvador is the smallest country located in the Southern part of Central America. With a population of almost 6.5 million people, the country has the largest population density for its size in the region. The country is famous for its exports, primarily coffee and sugar, which are ideal crops for a tropical climate. The gorgeous weather also makes it an alluring vacation spot and draws tourists seeking sweeping palm trees, breathtaking views and glistening beaches from across the globe. However, just outside the paradise of the resorts is a much different world. Here are five facts about poverty in El Salvador.

5 Facts About Poverty in El Salvador

  1. The poverty rate was improving. From 2007 to 2019, El Salvador experienced some economic progress, with its poverty rate dropping from 39% to 22.3%. However, it will be a challenge for the country to maintain those numbers considering how the COVID-19 pandemic is impacting the economy and the exports the country relies on.
  2. The impoverished often live in overcrowded areas. Poorer neighborhoods, referred to as slums, tend to be located in undesirable areas that have a landscape more susceptible to danger. Many families live in small, overcrowded quarters, which can pose a major public health risk. Houses are usually built very close to each other and are sometimes adjoined in order to share materials. For many, the only choice for housing is makeshift structures that do not protect from the elements and cannot withstand the force of natural disasters such as hurricanes, earthquakes or even heavy rainfall. These communities often lack basic services such as electricity, plumbing and sanitation sewer plants. This makes for unsanitary conditions and very limited access to clean water.
  3.  Schools often have a lot of empty desks. The country struggles to maintain a sufficient education system, which one can largely attribute to a high rate of dropouts. Of all the children nationwide, around 34% do not attend the elementary grade levels. Furthermore, more than 60% of children do not finish high school. As a result, around 20% of the population above the age of 10 are illiterate. The education deficit perpetuates the cycle of unskilled laborers joining the workforce as minors, which hinders the economy’s growth.
  4. Good job opportunities are not widely available. Much of the country’s poor population work in the manufacturing, agriculture and tourism industries. These jobs traditionally do not pay a living wage, have unsafe conditions and require long hours due to flimsy work laws and standards that are relatively unregulated by the government. Child labor is prevalent within poorer communities, with a staggering 1.8 million children currently employed. The lack of a welfare program and the government’s failure to enforce child labor laws enable this practice. For many families living below the poverty line, this is the only way they can afford to get by.
  5.  Violence and crime plague communities. El Salvador has one of the highest crime rates worldwide, directly endangering many of its citizens. Most of the crime committed is gang-related and, with the involvement of an estimated 60,000 members, gangs run rampant in practically every community. Feeling they have no other option than to flee, those vulnerable to gang activity migrate to other countries in order to find refuge and employment in a safer area. One of the gangs’ main targets is business owners, as they look to get a cut of their revenue. The loss of income severely impacts job creation and business survival.

Looking Ahead

These five facts about poverty in El Salvador are grim, but also solvable. Fortunately, Habitat for Humanity, an organization that strives to improve living conditions for the impoverished, has committed to helping. The organization has built homes for around 25,000 Salvadorans. To support the community, the volunteers also build public structures such as new schools, health centers, business suites and much more. In addition, the volunteers teach citizens job skills, money management and disaster preparation in order to give them the tools needed to thrive. With continued relief efforts by humanitarian organizations, a better future can emerge for current generations and generations to come.

– Samantha Decker
Photo: Flickr

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10 Facts About Sanitation in Mauritania

Forbes ranked Nouakchott, the capital of Mauritania, the 20th dirtiest city as it lacks proper water management, which leads to famine and disease. Here are 10 facts about sanitation in Mauritania. 
Mauritania is the geographic and cultural bridge between North African Maghreb and Sub-Saharan Africa. The Islamic nation has a population of around 4 million people. Located in northwest Africa, the coastal country includes 90% desert land. Mauritania is infamous for being the last country to abolish slavery — in 1981 — and slaves still make up 4% to 10% of the population. Meanwhile, Forbes ranked Nouakchott, the capital of Mauritania, the 20th dirtiest city as it lacks proper water management, which leads to famine and disease. Here are 10 facts about sanitation in Mauritania. 

10 Facts About Sanitation in Mauritania

  1. According to WHO, the lack of water sanitation causes nearly 90% of the 2,150 deaths from diarrheal diseases in Mauritania each year. Stagnant water breeds malaria mosquitos, parasites and other contaminants. With over 16.6% of the population below the extreme poverty line, many Mauritanians cannot afford to acquire clean water or proper healthcare.
  2. According to the Africa Development Bank Group, 68% of Mauritanians have access to potable water. In 2008, only 49% of the population had access to potable water. In isolated desert villages, citizens must trek miles to reach the closest water source. Meanwhile, in the capital city of Nouakchott, people in poverty often purchase water from vendors who hauled the barrels from a water supply several kilometers away.
  3. WaterAid determined that in 2017, 1,048,500 Mauritanian children under the age of 17 lacked a proper household toilet. Because people cannot afford toilets and lack access to running water, Mauritanians rely on latrines. In 2010, the government of Mauritania halted funding towards latrines, further stalling progress toward sanitation. However, UNICEF’s Community-Led Total Sanitation (CLTS) initiative has improved 67% of latrines since 2009.
  4. As of June 12th, 2020, Mauritania logged 1,439 cases of the novel COVID-19. Although many facilities lack proper sanitation to handle the virus, the Mauritanian government enforced curfews, travel bans and shop closures. In hopes of preventing potential economic damage, the government also distributed food and exempted 174,707 households from paying electricity bills. Organizations like WHO and UNICEF responded to the situation by treating coronavirus patients and implementing sanitation facilities to contain the virus.
  5. In 2018, the Chinese company CTE subsidized $40.3 million toward a rainwater collection system for a new sanitary sewerage network in Nouakchott. Prior to the project, Nouakchott’s sewerage network served only 5% of the city’s households. Building better sewerage networks will allow Mauritania to bring running water to rural areas. Since the country is below sea level, sewerage networks can also help limit floods and stagnant water.
  6. The African Development Bank funded the National Integrated Rural Water Sector Project (PNISER) to install drinking water supply networks and solar pumping stations in rural Mauritania. The Ministry of Hydraulics and Sanitation is implementing the new networks in rural communities that lack water systems. Around 400,000 square meters of irrigated land will receive water availability, generating additional income for women and youth.
  7. World Vision initiated the WASH Mauritania program in 2016. It has provided three local villages with access to water, hygiene and sanitation resources. With funding from the U.S. and Germany, World Vision Mauritania “[rehabilitated] boreholes, water towers, water retention points, fountains and water network extension.” In the village of Maghtaa Sfeira, WASH benefited over 900 people and sponsored more than 200 children. As a result of this program, many women and children no longer have to seek unsanitary water holes or trek miles for water supplies.
  8. According to WaterAid, 60% of Mauritania’s schools lacked sanitation in 2016. When schools offer sanitation, not only can children practice good hygiene, but their school attendance increases.
  9. Because Mauritania is vulnerable to desertification, WHO partnered with the Mauritanian government in 2013 to ensure that schools, healthcare facilities and villages have proper water, sanitation and hygiene. WHO provided water basins, installed toilets and insured higher quality of food for schools. In addition, WHO equipped the country with six biomedical waste incinerators to dispose of hazardous substances. In one instance, transforming a Land Rover into a mobile water laboratory has enabled WHO to monitor the water quality of different villages.
  10. In 2020, the World Bank secured funding for the Water and Sanitation Sectoral project and the Mauritania Health System Support project. The Water and Sanitation Sectoral Project received an International Development Association (IDA) grant of $44 million to improve latrines, add hand-washing facilities and rehabilitate water systems. In the Hodh el Chargui region in eastern Mauritania, an additional $23 million IDA grant will increase the quality of reproductive, maternal, neonatal and child health and nutrition services. Together, these projects will benefit more than 473,000 people.

Improving sanitation in Mauritania can potentially have wide-reaching benefits — from raising incomes and boosting the national economy, to improving education and lowering mortality rates. It is imperative that the government and other organizations focus on providing sanitation resources to the people of Mauritania.

– Zoe Chao
Photo: Flickr

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The War Against Tuberculosis in Lesotho

Tuberculosis in Lesotho
On May 13, 2020, Lesotho confirmed its first case of COVID-19, making it the last country in Africa to contract the virus. The country now has to make a difficult decision on how to take charge of the situation. In short, the government has its work cut out for it.

But COVID-19 is not the first disease that the country has had to fight off. For years, Lesotho has been at war with tuberculosis, an incredibly infectious disease that acts similarly to COVID-19. Although Lesotho’s fight with TB may not be over, it has certainly made great strides towards ending the epidemic its citizens are living in.

Tuberculosis in Lesotho

Lesotho is a country in Africa that South Africa surrounds on all sides. It is a developing country home to approximately 2.11 million people. Currently, Lesotho ranks second in the world for people with tuberculosis, with an estimated 724 cases per 100,000 people—about 15,276 people in total. In Lesotho, tuberculosis is particularly harmful to those with HIV, as 73% of people who contract tuberculosis also have HIV.

Tuberculosis is the leading fatal infectious disease in the world, and it kills more than 1.6 million people worldwide each year. TB is an airborne disease: it transfers when a person breathes contaminated air droplets from an actively sick person. If untreated, active TB can be lethal. However, 90-95% of infected people do not actually show symptoms. Most tuberculosis is treatable, as the success rate of treatment in Lesotho is around 77%, but the country has seen a rise in MDR-TB or multidrug-resistant tuberculosis. As the name suggests, multidrug-resistant tuberculosis is immune to the common medications for TB. According to the National Center for Infectious Diseases, MDR-TB affects about 10% of people with smear-positive TB or around 1,000 people. The stronger strain of the bacteria requires that doctors develop more creative treatment options.

Treating Tuberculosis

Although the tuberculosis epidemic has significantly impacted life in Lesotho, the country has not stopped its ongoing war with it. Trained community health workers treat and supervise several patients from the patients’ homes. These workers give injections as well as monitor the side effects of treatments. Patients who become dangerously ill go to Botshabelo Hospital, a place that specializes in MDR-TB in the capital of Maseru.

The CDC also partnered with Lesotho in 2007 to help fight the infection. Since then, it has been working diligently to bring peace. The CDC helps the Ministry of Health and Social Welfare’s efforts towards HIV and TB treatment by improving health information systems, preventing transmission of HIV between mother and child, increasing the capacity in laboratories and giving counseling and testing for those HIV has affected. It also works with the ministry on diagnosis and treatment of the many variations of TB infecting the country. Altogether, the CDC has lowered the TB mortality rate to just 46 deaths per 100,000 infected.

Global Resilience

As a whole, the world has made phenomenal progress in its fight against tuberculosis. Global efforts have saved more than 50 million lives since 2000. Furthermore, global aid is actually is one of the best investments in the public health industry, as each dollar that goes towards TB relief yields $43 back.

Even though Lesotho is facing much loss, including those from its new COVID-19 cases, the country has stayed resilient amid hardship. Lesotho continues its ongoing war with TB, and it will not stop until there is no disease left to fight. The people of Lesotho show the world each day what true bravery looks like as they work towards a new, tuberculosis-free era.

– John Pacheco
Photo: Flickr

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7 Facts About Poverty in Cyprus

Poverty in Cyprus
Cyprus is an island country in the Mediterranean Sea, just south of Turkey, with a population of 1.2 million. The Republic of Cyprus, the country’s only internationally recognized government and part of the European Union, controls 60% of the southern region of the island. The Turkish Republic of Northern Cyprus controls 36% of land in the north region of the island. The division between the North and South republics of Cyprus has created a power struggle of high tension, leaving the island politically unstable. Despite this instability, Cyprus has seen an improvement in decreasing poverty rates, as well as an expanding economy. Here are seven facts about poverty in Cyprus.

7 Facts About Poverty in Cyprus

  1. Cyprus’s economy is growing and expanding. Its tourism sector saw a significant boost in 2018 when more than 4 million travelers visited the island, a 7.8% increase from 2017. This increase in tourism correlates to its increase in GDP per capita, rising from $25,957.85 to $28,341.05 in 2018. Experts expect Cyprus’s GDP per capita to increase even more in 2020, with models estimating a 1.03% increase.
  2. When Cyprus gained independence in 1960, it began transitioning to a service economy. Cyprus’s economy started focusing more on its tourism and service sectors instead of agriculture. This allowed the GDP to rise. As of 2020, Cyprus’s GDP was $34.5 billion, a 3.9% growth since 2019.
  3. Cyprus’s unemployment rate has decreased. With the expansion of Cyprus’s economy came more jobs in the tourism and service sectors. As a result, unemployment rates have decreased. Since 2015, the country has cut its unemployment rate almost in half, from 14.91% in 2015 to 7.92% in 2019.
  4. Education in Cyprus is growing. Today, Cyprus has five private universities and three public ones. Both are rapidly expanding and connecting with other institutions across the globe. These schools continuously put millions of dollars back into the local economy, thus, providing thousands of jobs for the community.
  5. Life expectancy is increasing in Cyprus. As of 2020, the island’s life expectancy is 81.05 years, a 0.19% increase from 2019. Future projections from U.N. data predict a continuous upward trend.
  6. Cyprus does not have a standard minimum wage law for all workers. However, some occupations do have certain wage requirements. These requirements undergo review and revision annually in an effort to be fair to citizens. Since there is no countrywide minimum wage, however, this leaves room for many disparities in poverty and wealth.
  7. The Economic Interdependence Project is a partnership between the Republic of Cyprus and the Turkish Republic of Cyprus Chambers of Commerce. Created in 2009, the project’s goal is to intervene and encourage partnerships between businesses of both parties. The project hopes to reveal the benefits of the two communities working together to improve Cyprus’s economic stability and growth. They have been able to open the first island-wide business directory with more than 200 businesses. Additionally, the project also gave Market Research Grants to some businesses. 

Concluding Thoughts

Despite Cyprus’s political tensions between the southern and northern regions, the country has expanded its economy, increased tourism and implemented programs that encourage business relationships. These factors have allowed for an overall decrease in poverty in Cyprus. Hopefully, this progress will continue in the coming years.

– George Hashemi 
Photo: Wikimedia Commons

Tuberculosis in the Marshall Islands: A public health emergency

TB in the Marshall Islands

Tuberculosis in the Marshall Islands is one of many health issues decimating the Central Pacific civilization. The country, which encompasses around 1,200 islands, struggles with high poverty rates and little access to sustainable health care and medicine.

General Facts about TB

Tuberculosis is one of the longest-lasting pandemics in modern history. As the deadliest infectious disease in the world, it kills approximately 4,000 people a day and most commonly affects the lungs. Colloquially termed “consumption” in the 1800s, tuberculosis, if untreated, overwhelmingly consumes an individual’s body. The World Health Organization (WHO) estimates the disease affects around one-quarter of the world’s population with latent tuberculosis, but only a small percentage of those cases become active.

Tuberculosis becomes active due to public health issues that accompany poverty, such as malnutrition, overcrowding and lack of accessible healthcare. In the Marshall Islands, 30% of the population lives under “the basic-needs income line,” and more than 75% of the population resides on its two main islands: Ebeye and Majuro. This population density places the country’s population at severe risk for tuberculosis.

Marshall Islands Risk Factors

The PBS documentary, “Unnatural Causes: Is Inequality Making us Sick?” explores the tuberculosis crisis in The Marshall Islands. The sixth episode of the series on the Marshallese explains that the rate of tuberculosis is 23 times higher than in the United States, partially due to overcrowding. Ebeye Island is more densely populated than Manhattan, with Majuro trailing close behind.

In the Marshall Islands, most people cannot afford to go to the hospital. Instead, they rely on public health outreach to hand-deliver tuberculosis medication to them on a daily basis. Although tuberculosis is highly treatable, the cost and strict daily medication regimen lasting from six months to two years also contribute to the Marshallese becoming increasingly susceptible to tuberculosis.

“What tuberculosis needs to flourish in a person’s body is a broken down immune system,” said Jim Yong Kim, MD, a doctor from Harvard University. “The stress itself of poverty can contribute to the likelihood of developing active tuberculosis.”

Multidrug-Resistant TB

Furthermore, if someone stops taking their medication when they have not finished the full course, they are at risk of developing multidrug-resistant tuberculosis. Antibiotics do not affect this strain of the disease and therefore are virtually impossible to treat.

In 2010, the Marshall Islands declared “a public health emergency” due to a sudden rise in multidrug-resistant tuberculosis. While the country made the effort to quarantine the infected, most Marshallese do not have the economic option to quarantine and stay home from work.

Treatment Rate and Projects

Yet, among these harrowing tales of tuberculosis, the global rate of the disease is decreasing at approximately 2% per year, according to the World Health Organization. In addition, the Marshall Islands, as of 2017, has an 83% treatment success rate.

While tuberculosis in the Marshall Islands presents a scary feat, some outside groups are also working in the country to combat the disease.

Notably, a group from the Migrant Clinicians Network (MCN) embarked on an ambitious 24-week project in 2018 to screen every person on Ebeye island for tuberculosis. The group managed to screen 70% of the population, making the project hugely successful considering the amount of time and manpower it takes to test an entire densely populated island.

MCN identified more than 250 cases of active tuberculosis and set all cases into a strict treatment regimen. Dr. Zuroweste, MD, one of the doctors who worked on the project, also noted the extreme need for widespread testing not only for health but for economic reasons. “Anytime you have TB incidence that’s over 1%, it’s been shown to be cost-effective to screen the population for the disease,” said Zuroweste, noting the 1.5% incidence in the Marshall Islands.

In addition, MCN noted that testing and treating the Marshallese would have “downstream effects.” Most active tuberculosis cases in Arkansas, U.S., are from Marshallese immigrants, so identifying the problem at the source can prevent its spread to other nations.

While tuberculosis poses a significant threat to the Marshall Islands, medical missions to the islands and concentrated efforts to reduce dangerous strains of the disease are already underway. Building awareness of the disease and its harmful complications can also encourage more efforts to help the public health issue worldwide.

– Grace Ganz
Photo: Flickr

5 Facts About Tuberculosis in Mozambique

Tuberculosis in MozambiqueMozambique continues to struggle with the political and economic effects of a civil war that ended in 1992. More than half the country’s population lives below the poverty line and suffers disproportionately from HIV and tuberculosis (TB). Here are 5 facts about tuberculosis in Mozambique.

5 Facts About Tuberculosis in Mozambique

  1. Detection Rates – The TB detection rate in Mozambique is relatively low, however, many people who suffer or die from tuberculosis in Mozambique go undiagnosed and untreated. Despite its prevalence in Mozambique, the country rates among the lowest in the world for TB, with a 57% detection rate. In comparison, its neighbors Zimbabwe and South Africa report  83% and 76% detection rates respectively. With a population of 29.5 million people, an estimated TB incidence of 551/100,000 and an under 5 mortality rate of 73 per 1,000 live births, Mozambique’s current status demands better diagnostic and treatment tools. Organizations like Health Alliance International (HAI), a nonprofit organization based in Seattle, Washington, identified detection and diagnosis as a major obstacle for Mozambique and provided necessary diagnostic technology to aid the country’s underfunded medical facilities. The organization’s work has helped to improve TB detection across the nation. In addition, Apopo, another U.S. nonprofit enterprise that fights TB, trains rats to detect the disease in sputum, with the goal of increasing testing rates.
  2. Healthcare – Half the nation lives without accessible healthcare — an estimated 50% of the population of Mozambique live at least 20 kilometers from the nearest healthcare facility, likely contributing to the nation’s disproportionately low detection and treatment rates of TB. In fact, an HAI study revealed that 65-80% of people diagnosed with TB in Mozambique do not receive treatment. In response to this deficit, HAI created an online network of test results and TB personnel called GxAlert that allows patients to receive the care they need. Since its implementation in 2014, the program has successfully linked 52 facilities nationally and now accounts for 80% of all people diagnosed and treated for drug-resistant TB in Mozambique. This development promises to lower TB-related deaths, as Mozambique boasts a TB treatment success rate of 90%.
  3. Tuberculosis and HIV – While people diagnosed with HIV are the most vulnerable to TB, it is the leading cause of death among people diagnosed with HIV in Mozambique. HIV has a prevalence of 12.6% in people from ages 15 to 49, and 56% of TB patients in Mozambique also carry HIV. Consequently, groups like the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) do crucial work for the elimination of tuberculosis in Mozambique. EGPAF has deployed “cough officers” to healthcare facilities across the nation to ensure that people co-infected with HIV and TB receive proper care. In 2018, EGPAF’s efforts helped to treat 8,249 TB patients in the province of Gaza.
  4. Economic Instability – Mozambique’s problems run deeper than healthcare — efforts made to improve the diagnosis and treatment of HIV and TB patients in Mozambique have brought technology and healthcare providers to the nation, but economic instability threatens healthcare progress. Mozambique also suffers from poverty, malnutrition and mental health crises brought about by civil war and political unrest. For these reasons, the CDC, WHO and HAI have worked with the government of Mozambique for years to establish essential infrastructure and provide financial resources. For example, the CDC has worked with the National TB Program in Mozambique for nearly 10 years. Early diagnosis, integrating TB and HIV services and diagnosis and treatment of drug-resistant TB are the main areas of focus.
  5. Anyone Can Help – Anyone can help eliminate TB by contacting their representatives in Congress and advocating on behalf of those suffering from the disease. Organizations like HAI and The Borgen Project provide crucial educational information for those who want to make an impact. Help support the End Tuberculosis Now Act by emailing Congress (it only takes 25 seconds) or by adopting a HeroRAT with Apopo.

– Will Sikich
Photo: Flickr