Childhood Stunting in Bangladesh
Stunting is the impaired development of children usually due to malnutrition. The People’s Republic of Bangladesh in South East Asia has had one of the highest levels of stunting for children under 5-years-old. It measured at 45% of children under 5 in 2000. A growing national economy has reduced the number of childhood stunting in Bangladesh to 36%. However, this is still a high considering that poor nutrition in the first years of a child’s life can contribute to irreversible damage to health, growth and development.

With the aid of the World Health Organization (WHO), the Bangladesh government’s National Nutrition Council Executive Committee has put forward a Second National Plan of Action for Nutrition targeting improvements in countrywide sustenance. It is the first funded nutrition program of its kind in Bangladesh. Nutrition is an area that requires addressing in the country. As a result, nonprofit organizations including UNICEF, CARE and the World Bank have worked in cooperation with the government’s nutrition program. They developed a collective impact to fight childhood stunting in Bangladesh.

CARE Collective Impact

Nonprofit organization CARE develops disaster response, food and nutrition, health and education for impoverished people globally. The organization’s approach is to link with partners. Together, they execute CARE’s programs as well as support promotions on a national scale. In Bangladesh, CARE has developed the Nutrition at the Center program. It follows the Second National Plan of Action for Nutrition. According to a CARE survey, the program has helped reduce stunting in children less than 2-years-old from 47% to 33%.

UNICEF

Additionally, UNICEF is a nonprofit organization that supports children globally through partnerships. The organization is working in cooperation with the Bangladesh government’s Second National Plan of Action for Nutrition in making a collective impact to fight childhood stunting in Bangladesh. UNICEF has developed research-based programs that reduce stunting within the first 1,000 days of life. This includes counseling on the proper nutrition of pregnant mothers to reduce underweight babies and improve childhood feeding. This highlights the diversity of foods, improves vitamin use and treats infection and severe acute malnutrition (SAM).

The World Bank

Furthermore, the World Bank is a nonprofit organization that invests knowledge and money in developing countries. The organization views investing in Bangladesh’s nutrition as an investment in the future socioeconomic potential of the children. Among children under 5, about 5.5 million are stunted, and out of that number, poorer children bear a disproportionate burden of stunted growth. The World Bank’s plan includes supporting childhood nutrition as well as a conditional cash transfer for 600,000 families.

Bangladesh has made considerable progress but continues to struggle with childhood nutrition. Children born stunted will potentially experience later puberty development and cognitive impairment. This can lead to poor school and later work performance. Stunted women often end up having stunted children, continuing the cycle. Therefore, programs that invest in proper nutrition are vital. The Bangladesh government’s nutrition program seeks to reduce childhood stunting by 25% by 2025. With the collective impact of fighting childhood stunting by nonprofit organizations like CARE, UNICEF and the World Bank, this goal can potentially become a reality.

Joseph Maria
Photo: Flickr

Myanmar's Most Vulnerable PopulationsThe country of Myanmar is facing many difficulties regarding the spread and effects of COVID-19. With a tattered healthcare system, warring states, a fragile economy and thousands of people displaced, Myanmar’s most vulnerable populations are experiencing several risks. Displaced people living in detention camps, Rohingya Muslims and the poor disproportionately face the negative effects of COVID-19 in culmination with a declining economy.

Myanmar

The World Health Organization (WHO) has classified Myanmar’s health system as one of the worst in the world. According to official data, about 40% of Myanmar’s population live below or close to the poverty line.

There is a limited number of doctors, with 6.1 doctors per 10,000 people. Additionally, there are as few as one doctor per 83,000 people in conflict-affected areas according to Human Rights Watch.

Furthermore, there is little healthcare or medical facilities in rural areas, where most of Myanmar’s population lives. That makes it extremely difficult for people to seek medical assistance and testing for COVID-19, and estimate the number of coronavirus cases.

Ethnic Conflict

In addition to a poor healthcare system, Myanmar is also riddled with the conflict between the government and Ethnic Armed Organizations (EAOs). Fighting in areas such as the Rakhine state and Chin state prevents any possible COVID-19 relief and government aid.

Additionally, the government has put mobile internet restrictions in place in response to the armed conflicts. Lack of accessible internet limits information about the virus along with access to medical services, preventing people from knowing the government’s response to COVID-19 and how they can protect themselves.

The Vulnerable

It is at a time like this that minorities and threatened groups are the most vulnerable. Many aid workers fear that on top of inadequate resources and poor living conditions, the virus could exacerbate hostile emotions towards minorities and targeted groups in Myanmar.

Groups such as displaced persons and the Rohingya Muslims face difficult obstacles in receiving medical treatment or preventative measures against the COVID-19 virus.

Displaced People

According to Human Rights Watch, there are about 350,000 displaced people in Myanmar, and 130,000 people living in detention camps in the Rakhine state. Military conflict between the government and ethnic armed groups mainly caused these people’s displacement. Living conditions are dismal in these camps, with little to no resources for treating or preventing COVID-19. There is limited access to clean water, toilets and medical services. Diseases are common and according to a Human Rights Report, “in such camps, one toilet is shared by as many as 40 people, [and] one water access point by as many as 600.”

The Rohingya Muslims

The Rohingya Muslims, a religious minority group, is one of Myanmar’s most vulnerable populations. They have been living in detention camps after experiencing persecution in Myanmar. The Myanmar government has restricted their freedom of movement, and the Rohingya Muslims live in squalid camp conditions. There are only two health centers available, both unequipped to test and treat COVID-19.

Living conditions are extremely cramped. According to a Forbes article, one of the refugee camps, Kutupalong, houses “almost 860,000 refugees. They are more densely populated than New York, with more than 100,000 people living in each square mile.” With people living in such close proximity to one another, the spread of COVID-19 through the Rohingya Muslims is inevitable.

Economic Effects on the Poor

COVID-19 also negatively impacts Myanmar’s economy. As a consequence, it has exacerbated poverty and lowered living conditions. According to the International Growth Centre and World Bank Open Data, Myanmar had the lowest per capita GDP in Southeast Asia in 2018.

Furthermore, because Myanmar’s economy largely relies on international investment and exported goods such as garment products, COVID-19’s disruption on the world economy has caused Myanmar to further suffer.

Especially affected by the economic decline are poor workers and households. Groups such as “street and mobile vendors and various day-rate workers in urban areas, and the landless and day-rate workers in rural areas” experience adverse effects as income, food security and employment decline, according to the International Growth Centre.

In the face of the COVID-19 virus, Myanmar suffers many challenges that make preventing and treating the virus extremely difficult. In all of this, Myanmar’s most vulnerable populations – the displaced, the Rohingya Muslims and Myanmar’s poor – are at the greatest disadvantage. Although there have been efforts by the government to provide financial aid for preventative measures and help from humanitarian organizations, it is not enough. These vulnerable groups are still hugely at risk from COVID-19.

Silvia Huang
Photo: Flickr

American ExportsThroughout the past several decades, nations in Southeast Asia have seen significant declines in extreme poverty rates. As poverty has fallen and these nations have developed economically, the Association of Southeast Asian Nations has become the United States’ fourth-largest trading partner. While the United States does rely heavily on this region for imports, trade with ASEAN also supports American exports and bolsters nearly 346,000 American jobs. The following five countries in Southeast Asia are critical trading partners and demonstrate the economic benefits that can coincide with a decrease in extreme poverty:

1. Malaysia

Malaysia has been extremely successful in reducing poverty throughout the past several decades. According to the United Nations, “… in 1970, 49.3% of Malaysian households were below the poverty line.” As of 2015, the figure had fallen to 0.4%. As poverty has fallen, Malaysia has also grown economically, developing profitable manufacturing, petroleum and natural gas industries.

As the country has reduced poverty and developed economically, it has become an important trading partner to the United States. The United States imports electrical machinery, tropical oils and rubber from Malaysia. It also exports soybeans, cotton and aircraft to the nation. In total, the trade between the two nations totals around $57.8 billion each year and supports nearly 73,000 American jobs.

2. Thailand

Thailand is another country that has seen impressive levels of poverty reduction in recent decades. According to The World Bank, poverty rates fell from around 65% in 1988 to under 10% in 2018. The nation has also evolved economically, developing large automotive and tourism industries as poverty rates have fallen.

Trade between the United States and Thailand has steadily grown, totaling $48.9 billion in 2018. When analyzing imports, the United States relied on Thailand for machinery, rice and precious metals. In terms of exports, the United States provided the nation with electrical machinery, mineral fuels and soybeans. In total, the exports to the nation supported nearly 72,000 American jobs. Additionally, exports to Thailand have been increasing in recent years, growing nearly 14.5% from 2017 to 2018.

3. Vietnam

Vietnam is perhaps one of the most astounding examples of poverty reduction and economic development. The World Bank reports that “the poverty headcount in Vietnam fell from nearly 60% to 20.7% in the past 20 years.” As it has done so, the nation developed one of the most rapidly growing middle classes in Southeast Asia, became a center for foreign investment and developed key industries in electronics, footwear and textiles.

While the United States has come to heavily rely on Vietnamese imports, Vietnam is also a rapidly growing market for American exports. In fact, American exports of goods to Vietnam increased by 246.9%, and American exports of services to the nation increased 110% since 2008. According to the Office of the United States Trade Representative, “U.S. exports of Goods and Services to Vietnam supported an estimated 54,000 American jobs in 2015.”

4. Indonesia

Though the nation still has significant progress to make, Indonesia is another nation that has seen a reduction in extreme poverty rates. Since 1990, the nation has managed to half its poverty rate and make significant economic advancements. Currently the largest economy in Southeast Asia, the nation has developed notable industries in petroleum, natural gas, textiles and mining.

Trade with the nation totaled around $32.9 billion in 2019. While the United States imported apparel and footwear from the nation, it also exported soybeans, aircraft and fuels to Indonesia. In total, American exports to Indonesia are growing, increasing 19.1% from 2017 to 2018 and supporting nearly 56,000 American jobs.

5. Philippines

While poverty is still an issue in the Philippines, it has seen significant declines in recent years. According to the World Bank, poverty fell from 26.6% to 21.6% from 2006 to 2015. The nation has also made significant improvements in developing industries outside of agriculture. While agriculture composed nearly one-third of the nation’s GDP in the 1970s, it currently represents 9.3%, split between an emerging industrial and service sector.

Trade with the nation currently provides $29.6 billion each year, and exports to the Philippines grew 3% from 2017 to 2018. Mainly, the Philippines relies on American exports for electrical machinery, soybean meal, and wheat. Overall, exports to the Philippines support an estimated 58,000 American jobs.

Affecting nearly one in five American jobs, international trade is a critical part of the American economy. As demonstrated by Southeast Asia, a reduction in global poverty rates not only contributes to global economic development but also supports the export industry and American jobs.

– Michael Messina
Photo: Pexels

Facts About Poverty in Thailand
With the second-largest economy in Southeast Asia, Thailand is a relatively wealthy country. Its vibrant culture, delicious food and beautiful scenery attract millions of visitors a year, greatly contributing to its economy. On top of the tourism industry, Thailand exports many commodities like rice, rubber and coconuts. The country also produces goods like textiles, cement and plastics. Though Thailand’s poverty rate has decreased by 65% since 1988, impoverished living conditions are still a pressing issue in the country. The poverty rate fluctuates and currently, it is on the uprise. Here are five facts about poverty in Thailand.

5 Facts About Poverty in Thailand

  1. Poverty is on the rise in Thailand. In 2015, the poverty rate was just 7.2%. This figure has risen to almost 10%. That amounts to 2 million more people living beneath the poverty line, a substantial increase in only a few years. The rise in poverty does not occur in only a few of the country’s regions. Since 61 out of 77 provinces have seen a rise in poverty, one cannot attribute the current situation regarding poverty in Thailand to one specific community or circumstance. It is a widespread problem with profound implications for the livelihood of all Thai people.
  2. The rise in poverty is mainly due to economic reasons. Honing a 4.1% GDP growth rate in 2018 (one of the lowest in the region), the lack of economic progression in Thailand greatly affects its citizens. Additionally, Thailand has the fourth highest wealth inequality rates in the world at 90.2%, meaning there is a huge disparity between the richest and poorest people in the country. Without economic development and wealth equality, cycles of impoverishment will continue to trap the people of the nation.
  3. Environmental disasters have pushed more Thai people into poverty. Agriculturists (who make up 31.8% of the workforce) are already a poor group in the country, but the recent droughts in the past year have impoverished them even more. This combination of economic and environmental factors pushes farmers into even more poverty. Droughts are not the only natural disaster devastating the country. The floods and tsunamis that hit the country throughout the 2000s perpetuated even more poverty in Thailand. These natural disasters are inevitable, yet the lack of safety nets in the country is damaging the livelihoods of farmers.
  4. One of the demographics that poverty affects the most in Thailand is children. As of 2012, 7% of children weighed in as underweight and 16% experience stunting (impaired physical or psychological development due to a lack of nourishment during adolescence). The severe lack of resources could greatly impair future generations in the country. UNICEF is quite active in Thailand, working to alleviate child mortality and malnourishment. Due to its work, the child mortality rate has decreased four-fold; yet, there is still more the country requires.
  5. A solution to the poverty crisis in the country is an increase in social safety nets. Considering that environmental disasters and economic factors contribute to the rise in poverty, government-sanctioned programs to protect the Thai people are one of the easiest solutions to this problem. If Thailand can pinpoint which demographics are most susceptible to poverty, the government can create specific jobs and policies to protect its most vulnerable people.

Despite these five facts about poverty in Thailand, there are still many success stories for the country in terms of poverty alleviation. According to the Asian Development Bank, nobody in Thailand lives in extreme poverty (under $1.90 a day). Everyone in the country has access to electricity, water sanitation is excellent and education rates are high. However, to ensure every single citizen of Thailand is free from poverty, the government must continue to invest in economic development and produce innovative jobs for vulnerable populations. Only then can all be free from the insufferable conditions that poverty produces.

Photo: Pixabay

Female Genital Mutilation
One of the most extreme and dangerous forms of discrimination against women is the practice of Female Genital Mutilation (FGM). Some might not associate the practice with modern, cosmopolitan countries outside of Africa. However, the truth is that it is still quietly happening in a lot of communities in Southeast Asia. In fact, Female Genital Mutilation in Southeast Asia is more common than people previously thought.

What is Female Genital Mutilation?

FGM comprises all procedures that involve the partial or total removal of female genitalia, or other injuries to the female genital organs. FGM usually takes place on religious or cultural grounds and undertaken for non-medical reasons, leaving the girls with long-term health complications. International organizations, such as the U.N. and the WHO, universally consider FGM a violation of human rights and an extreme form of discrimination against women. While it has no health benefits, the practice is prevalent and often performed for cultural and religious reasons. The WHO estimates that more than 200 million women and girls have experienced FGM and that more than 3 million girls are at risk of this painful practice annually.

Female Genital Mutilation in Southeast Asia

While the procedure in many African countries commonly occurs as a ceremony when girls reach adolescence, FGM in Southeast Asia often occurs when the girls are in infancy, which makes it more hidden. Better known as Sunat Perempuan in Malaysia, Singapore and Indonesia, people often quietly carry out the procedure on girls before they turn 2 years old and are aware of what others are deciding for their body. Muslims in Southeast Asia typically observe this practice and reside in countries such as Thailand, Brunei, Indonesia, Singapore and Malaysia.

Singapore

Since FGM occurs quietly, the exact number of women who experienced it is hard to pinpoint. However, experts believe that it is highly prevalent within the Malay community. Based on some anecdotal evidence, some estimate that approximately 80 percent of the 200,000 Malay Muslims were victims of FGM in Singapore. There is no law banning the practice of FGM in Singapore, and the government remains overwhelmingly silent on the issue. Some clinics offer to perform the procedure for around $15 to $26.

Indonesia

Many in Indonesia consider Female Genital Mutilation a rite of passage and people have practiced it for generations in Indonesia, a country containing the largest Muslim population of all countries globally. The government estimates that about 50 percent of the girls aged 11 and under nationwide undergo FGM, while in some more conservative parts of the country such as Gorontalo, the number could be upwards of 80 percent. Local healers say that the practice would prevent the girls’ promiscuity in later life. There is also another widespread belief that God would not accept uncircumcised Muslim women’s prayers. Some hospitals in Indonesia even offered FGM as part of the “birthing packages,” which further legitimizes the procedure and makes it hard to eliminate.

The government has gone back and forth in its decision on the issue. In 2006, the government had banned the practice of FGM, but due to pressure from religious groups, it had moved away from the attempt four years later. Instead, to accommodate the religious and cultural considerations, the government issued regulations allowing for medical staff to carry out less intrusive methods to ensure more safety. In 2016, the women’s minister announced a renewed campaign to end FGM but again met with increased opposition from the religious leaders in the country.

Malaysia

A study in 2012 found that more than 93 percent of the Muslim women that it surveyed in Malaysia have undergone the procedure. In 2009, Malaysia’s Islamic Council issued a fatwa – a legal pronouncement in Islam, allowing FGM and making the practice mandatory unless considered harmful. The call for standardization of procedure by the health ministry in 2012 added more to the problem of FGM in Malaysia as many in the country consider it to be normal and part of the culture.

A New Generation

Despite international condemnation, the practice of Female Genital Mutilation in Southeast Asia is still prevalent and entrenched in traditions in many communities. The practice exists mostly among the Muslim community but is not exclusive to it. It is only until recently that FGM in Southeast Asia has gained more international attention, and more evidence on the prevalence of the practice is necessary to raise awareness on the issue. Across Africa where the practice concentrates, some communities have started to question FGM and abandon the long-standing tradition. Hopefully, with the new awareness of FGM in Southeast Asia, the nations will soon put an end to the practice that has been putting the women in danger for generations.

Minh-Ha La
Photo: Flickr

 

The School Fund: What One Company is doing to tackle the Global Education CrisisOver 115 million school-age children are not able to attend school worldwide, largely due to compulsory school fees that are required for attendance. In Sub-Saharan Africa, about 63 million adolescents are out of school and only 37 percent of children finish secondary school. One company targeting barriers to education is The School Fund (TSF). Through the collaboration of technology and willing donors looking to make a difference, the organization is able to provide low-income students with the opportunity to receive an education.

The Mission

The School Fund is a crowdfunded, nonprofit organization based in California. One hundred percent of donations go directly toward each student’s unique scholarship. Its mission is to tackle the global education crisis by connecting donors to students in developing countries who cannot afford an education. It stands firmly behind the belief that education is the most effective way to successfully eradicate poverty.

Barriers to Education

The reasons children do not receive secondary education are plenty and vary from location to location. Some of these reasons are the cost of supplies, the long distances that need to be traveled to reach school, safety and cultural norms. When it comes to education, poor and rural areas are especially disadvantaged.

How it Works

The School Fund partners with local organizations in Sub-Saharan Africa, Latin America and Southeast Asia. These range from private schools to local public schools, or local scholarship organizations. The Field Partners then select students for the TSF website, including biographies, stories and pictures of the children. Biographies help to keep each donation personal and invested in the growth of each child. Donors then select which student they want to sponsor.

These donors are able to view the breakdown of school costs and receipts on a web platform with complete transparency. Direct journal updates from their sponsored student are available for donors as well, helping to foster the connection between the donor and the student. The School Fund ensures that students are attending school via receipt tracking and field drop-ins.

Outcomes

The School Fund has successfully funded 1,291 students, with many more on the horizon. Since 2009, the organization has raised over $500,000. TSF also found that with just one extra year of secondary education, a student’s lifetime wages have the potential to increase by 10 percent.

TSF has shown a 50 percent growth rate each year in revenue accrued for scholarships. It also connects regularly with its Field Partners to collect updates, including grades and yearly data. This ensures that each student is seeing improvement and growth through their education.

Women in particular benefit from receiving an education. Only one in four girls attend school in many of these developing countries, but of those who do, women have fewer unwanted pregnancies, delay getting married young, have healthier kids and are three times less likely to test positive for HIV. TSF is helping women combat cultural norms and ensuring empowerment for all.

 

Children around the globe continue to face barriers to education. The School Fund is one of many organizations breaking down these obstacles, making sure money is not a deterrent for something that everyone should be entitled to.

Laurel Sonneby
Photo: Pixabay

Drug Reform in Southeast Asia
The United Nations Office on Drugs and Crime (UNODC) has set forth its own sustainable development goals to reduce global poverty systematically. The third objective of its mission is to “ensure healthy lives and promote well-being for all ages,” and Target 3.5 within that states its intent to “strengthen the prevention and treatment of substance abuse, including narcotic drug use such as opium and heroin.” In suit with this target, the UNODC has recently progressed drug reform in Southeast Asia.

Taking Action

In Bangkok on November 19, 2019, the UNODC concluded a two-day meeting with ministers and other government officials from Mekong countries including Cambodia, China, Laos, Myanmar, Thailand and Vietnam. The collaboration between the six states and UNODC produced the establishment named The Mekong Memorandum of Understanding (MOU) on Drug Control. The sole purpose of the November discussion among these states was to confer over the implementation of necessary legislation that focuses on drug reform in Southeast Asia.

The current illicit substance situation in the Mekong countries is primarily the selling and use of methamphetamine in either pill or crystal form. China and Thailand make up significant shares of the global methamphetamine market (a USD $61.4 billion market) with the largest seizures of the illicit substance reported there. Another concern is the trafficking of precursor chemicals necessary to concoct these synthetic drugs and emerging new psychoactive substances (NPS). On a global level, Mekong countries and China, in particular, have become the largest suppliers of NPS as a result of their advanced chemical and pharmaceutical industries. Illegal horticulture for opium also continues at high levels in this subregion of Asia.

Progress Against New Psychoactive Substances

Previously initiated drug policies have kindled substantial efforts to combat the war on drugs in the Mekong. Record high seizures of substances have occurred in most recent years. In 2018, Thailand law enforcement seized 515 million methamphetamine tablets, which is 17 times greater than the amount for the entire Mekong region 10 years ago. Moreover, Thailand authorities captured more than 18 tons of crystal meth, resulting in a larger number than what authorities found in East and Southeast Asia combined five years ago. The Thai government implemented suppression campaigns along the Golden Triangle (Myanmar, Lao PDR, Thailand) borders, forcing the trafficking routes to its western border, by the Andaman Sea through Laos and Vietnam. These areas have had seizure numbers in the first half of 2019 that already surpass the 2018 totals.

While significant headway has occurred, the UNODC and MOU know continued actions need to happen to increase the suppression of narcotics within the region. UNODC Regional Representative for Southeast Asia and the Pacific, Jeremy Douglas, explains, “the epicenter is North Shan in Myanmar, with active supply routes in and out. And the organized crime syndicates behind the trade have demonstrated they can maintain production even if labs are seized, and that new precursors can be used when others are unavailable.” Consideration of all the relevant circumstances for the illicit substances in Mekong countries is essential when countries and organizations formulate further drug reform in Southeast Asia.

The two-day negotiations in Bangkok are proof that the governments of the six states plan to keep moving in a forward direction. Jeremy Douglas added that the consensus from the meeting is to “emphasize dampening market demand through preventive education and addressing health, harms and social consequences, by increasing cross-border operations, joint training and justice cooperation, and continuing to support impoverished opium farmers in Myanmar and Laos to transition away from the drug economy.”

Eyes on Organized Crime

Thailand’s Deputy Prime Minister Wissanu Krea-ngam made a statement in Bangkok addressing organized crime’s hand in its drug problem, “Organized crime takes advantage of gaps and vulnerabilities that result because of uneven law enforcement capacity and coordination problems. The Mekong MOU helps by providing a framework through which we can deliver a more coherent regional approach.”Organized crime in this subregion of Asia is its government’s new primary focus. It is evident that in future years, there will be a global reduction in illicit drugs, specifically in methamphetamine and NPS, due to the continuing drug reform in Southeast Asia.

Ariana Kiessling
Photo: Flickr

 

10 Facts About Sanitation in Southeast Asia
In many developing Southeast Asian countries, governments seldom prioritize sanitation when there is a limited spending budget. However, over the past decade or so, many countries in the area have experienced steady economic growth which has led to gradual improvements in sanitary conditions for the people. Here are 10 facts about sanitation in Southeast Asia.

10 Facts About Sanitation in Southeast Asia

  1. Increased Coverage for Improved Sanitation: As of 2018, 95.5 percent of Southeast Asia’s urban population and 85.6 percent of its rural population had access to improved drinking water. This marked a 2.4 percent increase in access for urban locations and an 8.9 percent increase for rural areas since 2005. Approximately 80.8 percent of people living in urban areas and 64.3 percent living in rural areas had access to improved sanitation such as flush toilets and piped sewer systems in 2018. Access to improved sanitation is also increasing at greater rates than improved water in most countries.
  2. Improved Health Due to Better Conditions: Around 0.71 percent of all deaths in Southeast Asia in 2017 was the result of unsafe sanitation conditions. This percentage has dropped 2.3 percent since 1990 and is lower than the world average of 1.38 percent. Cases of infectious diseases, diarrhea, malnutrition and other negative health effects that open defecation caused have also gone down as the share of the population practicing such actions decreased. As for countries where substantial toilet infrastructure is still lacking, such as Cambodia, Timor, Laos and Indonesia, scientists are working to design and install new flush toilets. One team at the Asian Institute of Technology in Bangkok has received a $5 million grant from the Bill & Melinda Gates Foundation to fund such a project.
  3. Creating Comprehensive National Policies: Certain developing Southeast Asian countries lack comprehensive regulations regarding the design and construction of sewers and other sanitation systems. Existing regulations often fail to take variations in local conditions into consideration and people do not always strictly enforce these regulations. Some also neglect to assign the responsibility of management to an institution.
  4. Establishing Institutional Management: Limited ability to implement sanitary systems and unclear institutional division of responsibility has caused gaps in service provision, resulting in low-quality infrastructure, delayed constructions and miscommunications. Multiple international committees have called for government officials to receive training in all essential aspects of sanitation management.
  5. Raising Awareness Among Policymakers: Internationally, the U.S. Agency for International Development recommended that local policymakers become aware of the benefits improved sanitation systems have regarding health, environment and economy through regional research collaborations and water operator partnerships. The intergovernmental Association of Southeast Asian Nations has also come together to discuss Indonesia’s progress in delivering improved water and sanitation to its people. Locally, increasing media coverage and discussions about sanitation are also helping the subject gain focus.
  6. Raising Awareness Among Local Community: Many locals are unaware of the dangers that lie in unsanitary defecation and do not understand the purposes of an improved sewer system. In Indonesia, Water.org has held media sessions to encourage dialogue and awareness regarding sanitation. Similarly, many community health centers and international organizations are working to educate locals on the benefits of improved sanitation, as well as to inform them of the services and financial support available.
  7. Community-led Sanitation Installations: Community-led total sanitation efforts have drastically improved conditions in many Southeast Asian countries as self-respect became the driving force behind the movement. With help and guidance from local authorities, community households can get the financial and institutional support necessary to connect to the more improved sanitation systems.
  8. Financing On-Site Sanitation Installations: Government sanitation funding often focuses on the large-scale municipal infrastructure like waste treatment plants, tending to overlook the construction of supporting connection infrastructure necessary for on-site household sanitation systems. As a result, people have turned to local banks and other financial institutions for loans that would enable them to build the necessary infrastructure necessary to access improved water on a daily basis.
  9. Local Programs Improve Water Sanitation: There are several local efforts that are working to preserve Southeast Asia’s largest freshwater lake, Tonle Sap, so as to improve the lives of approximately 100,000 locals living in the surrounding area. The Cambodian enterprise Wetlands Work is selling innovative technologies, such as water purifying system HandyPod that uses bacteria to turn raw sewage into grey water. Meanwhile, the NGO Live & Learn Cambodia is in the process of testing new toilet innovations.
  10. Water Privatization Limits Accessibility: The privatization of water is a common phenomenon in Southeast Asia. In Indonesia, for example, European companies Thames Water and Suez have 25-year contracts with the local government in 1997 to provide water for the country’s capital, Jakarta. With the goal of ensuring piped water coverage for 97 percent of the popular by 2017, the actual number came up to only 59.4 percent. However, in Surabaya, another Indonesian city, the government provided water publicly through the government and coverage reached 95.5 percent in 2016. Calculations determine that average water prices in the city are one-third of that in Jakarta.

These 10 facts about sanitation in Southeast Asia show how these countries are making consistent progress in procuring improved sanitation for their population. With the assistance of intergovernmental organizations and nonprofits, more people are now living under safe and sanitary conditions.

– Kiera Yu
Photo: Flickr

Antibiotic Resistance in Southeast Asia
In September 2016, the United Nations General Assembly (UNGA) declared antimicrobial resistance (AMR) a major health threat for nations in every part of the world. AMR comes about when bacteria evolve to resist antibiotics used for the treatment of many infectious diseases such as pneumonia, tuberculosis and salmonellosis. According to the Center for Disease Control and Prevention (CDC), AMR can bring harm to people of all types and agriculture, health care and veterinary industries. Antibiotic resistance in Southeast Asia is of particular concern. 

Antibiotics have been essential to curing infections ever since Alexander Fleming discovered the first form of antibiotics, penicillin, in 1928. In the developing countries of Southeast Asia, antibiotics often do not have regulation and are available for purchase without a prescription from a physician, which exacerbates the phenomenon of AMR and causes major concern. This is an example of how poverty in Southeast Asia contributes to the antibiotic resistance crisis.

Contributions to Antimicrobial Resistance

AMR is a natural process. With or without the use of antibiotics, bacteria will always evolve to fight for survival by strengthening their resistance or by multiplying. Despite this, humans make AMR worse. A plethora of unnatural issues exaggerates AMR, but there are two that are cause for the greatest concern: unregulated sale of antibiotics and the use of antibiotics not as medicine for humans but as growth promoters and disease treatments in livestock. 

Unregulated Antibiotics and Self Medication in Southeast Asia

The World Health Organization Southeast Asia Region (WHO SEAR) includes the countries of Bangladesh, Bhutan, Democratic People’s Republic of Korea, India, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka, Thailand and Timor-Leste. These countries are notorious for selling antibiotics as an unregulated product to the public, a reality of many developing countries around the world. In developing countries, the prevalence of infectious deadly diseases is higher than in more developed nations, making the likelihood of death from these issues higher.

Many consider the countries in Southeast Asia listed above to be hotspots for the spread of AMR. Here, the cost of antibiotics bought over the counter is lower than the cost to visit a physician or health professional. As a result, many self-medicate, making it the leading cause of AMR. Self-medication refers to the use of medication to treat ailments, diseases or infections without the guidance of a medical professional. Without curbing this habit practiced in WHO SEAR, bacteria quickly mutate to resist treatment, leading to more intense illnesses, increased medication prices and death. 

The Use of Antibiotics for Livestock in Southeast Asia

In this region, the use of antibiotics in livestock outweighs the use of antibiotics in humans. To keep livestock in countries around the world healthy, farmers commonly use antimicrobials to treat and prevent diseases and decrease mortality in livestock. Though people widely practice this, the countries of WHO SEAR use this technique excessively due to poverty. With weak regulatory laws to govern or survey the effects this has on the AMR crisis, AMR is aggressively growing. 

Where previously people ignored it when considering the causes of AMR, livestock antibiotic use has recently become a growing concern across the globe. With recognition came complication: in developing countries, farmers rely on the use of antibiotics to prevent illness or death of their animals so they can continue to make a profit. In Southeast Asia especially, the hard reality is that these issues layer and mix with other issues, such as poverty and food security. Policies regarding antimicrobial consumption in livestock that work for developed nations often do not work in underdeveloped nations, due to the complex differences of cultural differences and locations. It is for these reasons that poverty contributes to antibiotic resistance in Southeast Asia.

Efforts to Slow Antibiotic Resistance in Southeast Asia

Given that this crisis is on a global scale and affecting every nation, some are making efforts to control AMR. Unfortunately, there is no way to stop it completely. There are, however, the WHO’s action plans that can bring light to this topic. WHO has laid out five strategic goals: to increase recognition and understanding of AMR, to increase global monitoring and research, to decrease the prevalence of infectious diseases requiring antibiotic treatment, to improve the use of antibiotic treatment and to create a case for sustainable investment that includes all nations, no matter location or level of development

An example of raising awareness is World Antibiotic Awareness Week. Every year brings the annual World Antibiotic Awareness Week, created by the WHO in 2015. This week in November sets goals to increase awareness and encourage health care providers, policymakers and the public to practice healthy and sustainable techniques to slow the spread of antibiotic resistance in Southeast Asia.

– Anna Giffels
Photo: Flickr

Drug Resistant Malaria
A new variation of the parasite causing malaria has captured the attention of medical professionals in South East Asia. They first noticed a strain of drug-resistant malaria in 2013 and it has spread aggressively throughout the region. Medical researchers from the Wellcome Sanger Institute, University of Oxford and Mahidol University noticed that the new strain has replaced local malaria strains in Vietnam, Laos and northeastern Thailand. They have also seen the strain developing new mutations from when they initially identified it in 2013 and this may be enhancing resistance even further.

Resistance Through Time

In 2018, studies showed that the usual first-line drug used for malaria failed to cure the disease at an overall rate of 50 percent, 13 percent in northeastern Thailand, 38 percent in western Cambodia, 73 percent in northeast Cambodia and 47 percent in southwestern Vietnam.

The advancement of the new drug-resistant malaria might stem from the heavy usage of anti-malaria drugs in the region. Medical professionals commonly distribute the drug throughout the area, forcing the parasite to evolve or die out. Patient usage is also giving the parasite a leg up, as often people are taking a weaker dosage or do not finish the treatment but terminate usage when they begin feeling better.

Cause of Malaria

Malaria is the result of the Plasmodium parasite that transmits through a mosquito bite. The drug-resistant malaria strain is called KEL1/PLA1 because of its combination of genetic mutations. A recent study has noted that KEL1/PLA1 has diversified into a subgroup of strains that contain the genetical modifications causing resistance. These parasites are also showing resistance to several classes of anti-malarial drugs. The new adaptations are limiting treatment options and making them increasingly expensive. Currently, clinical trials have begun to test the effectiveness of a triple combination treatment for the new drug-resistant malaria.

The current front-line defense is a two-drug combination of dihydroartemisinin and piperaquine or DHA-PPQ. But a 2018 study showed the resistance to dihydroartemisinin-piperaquine spread undetected for five years in Cambodia, giving the drug time to mutate further and wipe out existing non-resistant strains. One solution is to change the partner drug, piperaquine, to a drug that is currently effective such as mefloquine or pyronaridine. Cambodia and Thailand have implemented this solution but it could be logistically challenging on a large scale.

Consequences of Infection

For now, health officials believe they will be able to manage the situation as malaria rates are lower in Southeast Asia. Officials, however, believe if the drug-resistant malaria parasite spreads to Africa, the consequence could be dire. Sub-Saharan Africa sees the most substantial numbers of malaria and faces the most significant logistical problems when attempting to treat it. In the 1960s, a similar situation occurred where a strain developed in Asia and spread to sub-Saharan Africa, where due to a lack of alternative medications, malaria-related deaths double.

People are currently using rapid test kits to help prevent and treat drug-restraint malaria. The kits can identify which parasite strain is causing malaria, allowing medical professionals to treat malaria accordingly. This tool will be increasingly important if the drug restraint parasite spreads to Africa. Sub-Saharan Africa alone accounted for 66 percent of the 276 million rapid diagnostic test sales worldwide in 2017. The test allows for professionals to best allocate supplies that are scarce in sub-Saharan Africa. As the fight against drug-resistant malaria continues, the rapid test kits are a cost-efficient way to increase their odds of eradicating the parasite.

– Carly Campbell
Photo: Flickr