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HIV outbreak in Pakistan

When a child has a fever, most parents expect it to be a cold or a mild virus. Many parents in the Sindhi province of Pakistan did not anticipate receiving such a severe diagnosis, but the results from their doctors were alarming: their children tested positive for HIV. On April 24th, 2019, 14 cases of HIV were discovered. Since July, over 894 people tested positive for the disease and almost 750 of them were children. The outbreak in Pakistan has increased the pressure on medical professionals to treat hundreds of new cases and fear among the people of Pakistan is growing. Many are afraid to interact with others for fear of spreading or contracting the disease. Along with a heavy stigma surrounding HIV, growing skepticism around medical facilities in Pakistan has made treating this outbreak even more critical. Here’s what you should know about the HIV outbreak in Pakistan:

Poor sanitation methods contribute to the outbreak

In Pakistan, HIV is not an unfamiliar disease. In the Sindhi province alone, health authorities found around 75,000 HIV positive cases. For the most part, doctors have blamed many failures in the healthcare system to be the reason for this sudden outbreak among children.

This recent outbreak has been credited to the reuse of syringes and failure to follow proper procedures for blood transfusions. Some facilities that disposed of used syringes discovered that people were repackaging and selling them to doctors once again for profit. There have also been reports of reusing dextrose and saline drips in certain treatment facilities. These practices created an easy pathway for the disease to spread to many patients and eventually helped facilitate the HIV outbreak in Pakistan.

“Quack” doctors are popular options for patients, but not necessarily the safest

“Quack” doctors, cheap alternatives to qualified doctors, have grown in popularity in certain regions. Many families living in rural parts of Pakistan cannot travel long distances to cities to see qualified doctors. As populations have grown, governments are struggling to provide sufficient healthcare for all communities in the country. Unqualified quacks have arisen as a result, cashing in on the disparities by treating many patients. Because of a loophole in the system, quack doctors use real doctors’ names and qualifications as a cover for their business and then later pay a fee to the qualified doctors to remain open.

Around 70,000 to 80,000 unqualified practitioners have spread across Punjab province alone. Most quack doctors are either totally unqualified to treat patients, or they are operating beyond their expertise. Most are not allowed to prescribe medicines or use syringes, but it is a common practice for them to do so anyway on multiple patients to save money.

In addition to reusing syringes, these doctors often use veterinarian steroids to treat patients as an alternative to recommended medicines. These steroids mask a patient’s symptoms but do not provide long term solutions to the diseases. Overall, these quack doctors put more and more people at risk of contracting illnesses like HIV with their unsanitary practices.

Many organizations are working to address the outbreak effectively

Since the start of the outbreak in Pakistan, many organizations have been working to provide solutions and treatments. The Sindh Aids Control Program (SACP) began a campaign to treat new HIV patients and provide free tests to the public. They have also curated ways to respond to the outbreak effectively, emphasizing the need for low-cost treatment and prevention services for vulnerable regions, in order to make treatment accessible for all. Currently, roughly 8,866 people are registered with the SACP’s Enhanced HIV AIDS Control Program, and they are expanding their outreach after receiving $6.3 million dollars from the Sindh government to continue their efforts.

Additionally, health officials have begun a crackdown on quack clinics. The Punjab Healthcare Commission is one of the organizations investigating the quacks littered across the Sindh province. Around 47,000 quackery outlets have been visited as of this month, 21,640 have been closed down, 13,637 have been abandoned and 8,757 have been marked for surveillance. The hard work of this commission ensures that the quality of treatment in Pakistan prevents outbreaks similar to the one facing the country now.

While treatment efforts are a major priority for these global organizations, there has also been a major focus on strengthening community education. UNAIDS and other UN organizations are raising awareness about HIV prevention to help tackle the stigma and discrimination that HIV patients face in their communities. Health workers, religious leaders, and even local media personnel are also being invited to health education sessions to address this issue.

The HIV outbreak in Pakistan may have affected the lives of hundreds of children and adults, but the efforts of many organizations have led to a heavy focus on HIV education and treatment in Pakistan. With this influx of assistance from global organizations, thousands of families can be protected from a future epidemic for years to come.

-Sydney Blakeney
Photo: Flickr

How to End the Hygiene Crisis in Ghana
Diarrhea kills 2,195 children each day, more than Acquired Immune Deficiency Syndrome, malaria and measles combined, and n
early 11 percent of Ghana’s population relies on surface water — water that collects on the surface of the ground or top layer of a body of water — for their daily hydration needs. This water is unpurified and unsafe for human consumption, yet Ghanaians lack a safe alternative. Ghanaians who ingest surface water are at risk for water-related diseases, such as ever-deadly diarrhea.  

Risk of Diarrhea

According to the U.S. National Library of Medicine, diarrhea is a global health concern with 1.7 billion cases occurring every year. Although diarrhea can affect any age-group, it is the second leading cause of death in children under the age of five; in fact, 2,195 child fatalities happen every day worldwide. The hygiene crisis in Ghana has escalated with diarrhea as the third leading cause of death for children under five, taking nearly 10,000 lives every year.

How Does Diarrhea Become Fatal?

Diarrhea depletes body fluids, causing dehydration, and children often die when they have lost too much water from their bodies.

Several organizations have implemented health initiatives to combat the hygiene crisis in Ghana. Preventing diarrhea is possible by increasing water availability and quality, distributing oral rehydration salts, breastfeeding infants until six months of age and educating the population on proper sanitization techniques.

UNICEF and IWASH

‘IWASH,’ UNICEF Ghana’s handwashing project, yields extremely promising results in entire villages in Ghana; the program educates schoolchildren on the health effects of not washing their hands. While touring a handwashing facility with 70 schoolchildren, District Resource Coordinator Issah-Bello said that students should share their knowledge in order to be an ambassador for behavior change and end the hygiene crisis in Ghana.

The Rehydration Project

The Rehydration Project cites oral rehydration salts, or ORS, as the most effective and least expensive way to combat diarrhoeal dehydration. ORS is a combination of dry salts mixed with clean water that replaces fluids lost from diarrhea. If ORS is unavailable, a homemade solution may be made with six teaspoons of sugar, one-half teaspoon of salt and one liter of clean water.

Breastfeeding

Breastfeeding infants until six months of age can reduce infants’ likelihood of contracting diarrhea because breastfeeding mothers do not prepare their infant’s formula with contaminated water.

Clean Water

Water.org believes that clean water is the way to end poverty, save lives and prepare for the future. Since 2009, Water.org has worked to increase access to safe drinking water and sanitization facilities in Ghana. The organization’s current project is expected to be completed in late 2017, and is in the process of constructing 61 water facilities.

Water.org has also reached 53,000 Ghanaians through water systems, health and hygiene education and borehole wells. With numerous solutions like these, the hygiene crisis in Ghana is well on its way to resolution.

– Carolyn Gibson

Photo: Flickr

Nile Delta
In rural Egypt, the freshwater of the Nile River is a life-giving resource and the main supplier of drinking water; but, due to pollution from human and animal waste, the river is also deadly.

Annually, 5 percent of Egyptian deaths are the result of water contamination and lack of sanitation, according to the World Health Organization (WHO).

Currently, there are as few as 500 rural waste treatment plants in operation throughout more than 5,500 rural villages, with only 37 percent of rural households being covered by a public sewage line.

This lack of sanitation infrastructure is a serious health risk to rural residents because of water contamination. Diarrhea, typhoid fever and E. coli are just a few of the life-threatening illnesses that result from inadequate waste treatment and storage.

In order to fight back against the mounting problem of untreated wastewater seeping or being dumped into the Nile, the World Bank has pledged $550 million to improve existing sanitation facilities in the rural Delta as well as create new sanitation systems throughout Daqahliya, Sharqiya and Beheira in Lower Egypt.

The Sustainable Rural Sanitation Services Program for Results, approved in July 2015 and set to end in October 2020, is designed to restructure the existing centralized system to create a decentralized system, giving local water and sanitation companies (WSCs) within the Nile Delta the ability to expand and cover larger areas while improving their service.

Through this decentralized approach, WSCs are able to generate more local jobs, improving not only the health of poor rural residents but also their economic standing.

Using a bottom-up business model, WSCs are held responsible through a performance-based capital grant (PBCGs) from the Central Government, ensuring empowered employment and quality service to their communities.

The Sustainable Rural Sanitation Services Program for Results is set to serve 769 villages in seven governorates that have a history of releasing untreated wastewater into tributaries of the Nile.

The program will benefit the health and socio-economic status of rural villages as well as aid in preserving the Nile, the largest source of Egyptian freshwater, constituting 98 percent of drinking water.

The program also protects against untreated human waste seeping into the groundwater, leaving impoverished Egyptians with contaminated drinking water. By the end of the five-year period, an estimated 800,000 poor Egyptians will have benefitted from the program.

Claire Colby

Sources: American Institute of Science, World Bank 1, World Bank 2, WHO, International Water and Technology Conference
Photo: The Chronicle Herald

Ethiopians embrace sanitary improvements
Going to the bathroom: a subject that, as humans, we like to pretend doesn’t even happen most of the time. However, for rural Ethiopians living without the most basic sanitary structures, an initiative to improve latrine use was one which needed to happen.

In the village of Kurt Bahir, local carpenter Kefale Demelash used his skills to build a two-room latrine for public use within the village after becoming inspired to initiate sanitary improvements after a diarrhea outbreak plagued the area.

For this particular latrine, one side was designated for women and the other side for men. Smaller pits were also dug for children which would be safer than customary ones, encouraging the young to start the habit of using them early.

With just the establishment of this one latrine, others were motivated to create their own. Soon, with the help of Demelash, 126 latrines were created within Kurt Bahir, all meeting the international standards for improved sanitation. These new latrines would help reduce the risk of communicable diseases, which are commonly spread by unsafe sanitation practices.

Demelash was able to receive training as a village coordinator through the government’s Health Extension Program (HEP), which trains and deploys members into rural areas of the country to educate and promote sanitary practices.

Further progress in sanitation is also being made through the Water and Sanitation program (WSP), a five-year multi-donor partnership between the World Bank and the government.

The World Bank describes the program goals as “scaling up its capacity, improving sanitation and hygiene services and increasing access by the poor in 104 selected districts in Amhara, Oromia SNNP and Tigray regional states.”

Ethiopia has suffered through many different kinds of communicable diseases attributed to poor hygiene and sanitation. However, with the execution of the government’s Universal Access Plan (UAP), it is hoped that sanitation can be improved by 100 percent.

Currently, more than 7 million people have been educated on healthy sanitation practices by 1,782 trainers and implementers under the program. Prior to the program, open defecation was a recurring problem, but with the organization in full-swing, 52 percent of the kebeles (an administrative unit within Ethiopia) in the woreda (districts) are defecation free.

Taking a creative approach in the program’s expansion strategies, prizes were offered within villages. This was initiated by a local “savings mechanism” through the woreda, where the prize money was given to the best innovator, performer or implementer of an improved sanitation project.

With this strategy in mind, neighbors found inspiration in one another, which ultimately led to improvements across woredas.

The World Bank found “in Mecha and Medebayzana woredas, more than 55,000 households now have improved latrines, and communities have also started applying the sanitation lessons they learned in their daily lives, such as keeping their homes, compounds and communities clean, making themselves safer and healthier.”

Nikki Schaffer

Sources: World Bank, We Are Water
Photo: Flickr

deworming_school_age_children

The World Health Organization estimates that 1.5 billion people, 24% of the world’s population, have a worm infection. Infected people usually have soil-transmitted helminth infections caused by the most prevalent worm species: roundworms, whipworms and hookworms.

These worms are spread through direct contact with contaminated soil caused by open defecation in impoverished, usually tropical, regions. The contact with human feces is a result of poor sanitation, feces contaminating crops and children walking barefoot.

The worm’s eggs can be ingested on food that has not been properly washed or cooked as well as through the consumption of food when people eat with dirty hands. Some worm larvae are also able to work their way through a person’s skin to enter into the body, especially through the soles of children’s bare feet.

When a child has a worm infection, his or her health is compromised. Symptoms are not always pronounced, but rather show up slowly and can sometimes be hard to detect. The worms leech essential nutrients away from a child’s body causing malnutrition, anemia, lethargy and cognitive repression due to lack of nutrients. These issues can cause children to be so physically weakened that school is missed and absenteeism rises.

Thankfully, even though worms are one of the most prevalent infections in poverty stricken areas, it is also has one of the easiest and most cost-effective forms of treatment. Several organizations are working toward deworming children. Innovations for Poverty Action (IPA) and Deworm the World Initiative are two that have teamed up in this effort. Together they were able to deworm over 35 million children in 2012!

Deworming school-age children was possible through school initiatives. They have found that deworming children at school with a pill is highly effective for two reasons.

1. It is so easy that teachers can be trained to administer the medicine, which relieves the costs of needing medical specialists on site.

2. The medicine is safe even if a child is not currently infected. If 20% of the children in a region are known to have worms, then every child can be dewormed safely without the possibility of side effects. This will reduce any possible infections.

The medicine cost is very low as well. The actual medicine only costs a few pennies per child; factoring in all the costs associated with administering the medicine, the cost is still less than 50 cents per child. To be the most effective, the medicine needs to be administered twice a year. Since costs are so low, that goal is financially feasible.

A trial conducted in the early 2000s in Kenya found that by administering the medicine, school absenteeism fell by 25% and younger children were found to have cognitive gains. A separate study found that through deworming children’s bodies were better able to fight off other diseases, such as malaria, because essential nutrients were not being depleted by the worms.

Currently, Deworm the World is working quite intensely in India’s Bihar State, Delhi State and Rajasthan State, as well as in Kenya. The organization is able to work through the schools in those areas, treating millions of children. Those children are now given a much greater chance to excel in school since worms are not stealing their body’s resources.

Deworming children cannot be the sole answer, since the source of the worms needs to be addressed in the regions as well. Proper sanitation, clean water, uncontaminated food and children wearing shoes are still needed to ensure new worm infections do not occur.

But while those issues are being worked on, deworming children is giving infected children a chance to thrive in their education, since they are more energetic and focused during their studies and missing much less school than before.

Megan Ivy

Sources: CDC, Evidence Action, Innovations for Poverty Action, WHO
Photo: What Gives

India's Sanitation Solutions Poor Sanitation
Build toilets, not temples. This is the message from India’s Prime Minister, Narendra Modi, reflecting on India’s sanitation solutions.

 

A Need for Solutions to Poor Sanitation

 

The goal is to end defecation in public places by 2019. About 130 million households do not have toilets – 53 percent of India’s population. The number jumps to 70 percent when villages are singled out, where most people simply relieve themselves in fields, on the side of roads or behind bushes.

The issues that come with this are massive. Health is impacted in numerous ways. The spread of disease is pervasive when open defecation is common: “because India’s population is huge, growing rapidly and densely settled, it is impossible even in rural areas to keep human feces from crops, wells, food and children’s hands. Ingested bacteria and worms spread diseases, especially of the intestine.”

Poor sanitation is the reason for 80 percent of illnesses in India, as well as the leading cause of death for children under 5-years-old. Malnutrition is also a huge problem, despite some children’s diets improving and others getting more than enough to eat. When bacteria gets into children’s intestines, it causes something called enteropathy, which prevents bodies from absorbing nutrients and calories. Because of this, half of India’s children are still considered malnourished.

Hundreds upon hundreds die each year from diseases related to poor sanitation, but politicians have been slow to face up to the problem, and locals have been known to actually prefer “going” in a field instead of a government-built toilet. Culture comes into play here: in the Hindu tradition, it is sometimes encouraged to relieve oneself far away from the home to preserve its purity.

There is a safety aspect to the issue, as well as the issue that people have to leave their homes at night to relieve themselves. There have been instances of young women being raped and murdered while venturing out to take care of business.

 

Innovative Aid at the Heart of India’s Sanitation Solutions

 

What is being done to help solve India’s waste problems? The government’s toilet building campaign is a good start, despite the usage issues that they face. Convincing the public to forget old ways is never easy. Even more worrisome is the fact that while many toilets have been built – around 77 percent of households under the poverty line have toilets – countless numbers of them are out of order.

While toilets are certainly needed, safe water is also key. The Bill and Melinda Gates Foundation is investing in a machine called the Omni Processor which is capable of turning sewage into drinking water while powering itself independently.

Bill Gates even tried out the water it produces. One machine can produce enough clean water for 100,000 people. Construction is already underway for a machine in Senegal, and Gates says that there is one in India’s near future as well.

A simple Google search provides a multitude of water-filtering devices similar to searching for solar-powered flashlights. However, the problem runs deeper than simply purifying water in India. There simply is not enough of it. The country is home to 16 percent of the world’s population, but it only has four percent of the world’s freshwater. The groundwater for many of India’s major cities is quickly disappearing, with levels so low in places like Mumbai and Delhi that they could be depleted entirely within a few years. Machines like the Omni Processor could be the answer to this water depletion catastrophe.

– Greg Baker

Sources: Economist, The Guardian, The Washington Post, Clean Leap, New York Times, India Sanitation Solutions,
Photo: Acumen

india
Poor sanitation can sometimes be the initial domino that starts a cascading wave of other problems. In the case of India, poor sanitation and open defecation have allowed for an overwhelmingly unhygienic environment and a variety of widespread health problems.

In India, there are more people who openly defecate on a regular basis than live in the entirety of Africa. Out of the 1.2 billion inhabitants, 103 million lack safe drinking water and 802 million lack any sanitation services.

For starters, combining an unhygienic environment with a high population density creates a breeding ground for preventable disease epidemics. Two common hygiene-related diseases, typhoid and diarrhea, prevent their victims from absorbing necessary nutrients which leads to malnutrition. India has higher rates of malnutrition in children than Sub-Saharan Africa.

The effect of having proper hygienic practices is shown when comparing the states within India. States where 80 percent or more of the rural population can access toilets have much lower levels of childhood malnutrition than cities where open defecation is commonly practiced.

Not only are there health consequences to open defecation, but social safety consequences as well. When women and children have to relieve themselves, they are forced to venture into the streets rather than using a toilet in the safety of their own home, which compromises their safety. A senior police officer in Bihar stated that about 400 women would have avoided rape last year if they had toilets in their homes.

The root of the problem is the lack of available or accessible toilets to the general population. Unfortunately, use of the toilets found in developed countries would be impractical and nearly impossible to achieve in India. A waste disposal system would need to be put into place, and toilets like these require large amounts of water, which is rarely consistent in developing countries.

While India is not known for being wealthy, the country ranks fourth in the world for manufacturing competitiveness. With many citizens capable of designing and manufacturing innovative solutions, the possibility of a low-cost toilet is promising.

One type of toilet that could potentially work well with India is the composting toilet, which is a toilet that is used for about a year, and subsequently sealed for 6-9 months, where the heat and decomposition of the feces kills off harmful bacteria and creates rich fertilizer that can be used in gardens.

While India’s poor sanitation has deep-rooted negative effects, the country has the innovative capacity to find an efficient and widespread solution.

– Courtney Prentice

 

Sources: Live Mint and The Wall Street Journal, British Broadcasting Corporation, The Child Fund, Water
Photo: OMICK

 

flooding_bolivia
The deluge Bolivia is experiencing since November 2013 has claimed 38 lives from nonstop flooding. Medicine, food and other supplies have recently been delivered. Humanitarian packages are meant to alleviate hunger and provide warmth while combating the disease that floods bring. Malaria and infections that result in diarrhea and topical infections have been reported.

The Ministry of Defense’s aid convoy and evacuation of the local populace in hard-hit regions cannot hinder the continued problems of the flood-filled country. One of South America’s poorest nations, Bolivia has taken a huge hit in infrastructure, roads and most importantly of all, homes. The continuing inundation has disrupted and displaced over 150,000 lives.

Beni, a region taking the brunt of the storm, has over 4,000 displaced families. Livelihoods of farmers have also taken a huge hit. Agricultural products such as corn and wheat are ruined by the torrential season.

Bolivian President Evo Morales has declared a state of emergency for his storm-stricken nation.The charismatic leader has otherwise high hopes and plans for Bolivia. In early January, Morales announced that he plans on building a nuclear reactor, the first in his country.

Before the start of the 2014, Bolivia launched Tupak Katara, its first telecommunications satellite, which was named for a national hero who combated Spaniards during colonial times. The satellite, according to Morales, represented the country’s movement away from foreign assistance regarding communications. Despite such claims, China aided the country in its venture.

Moreover, the coca leaf, the source of cocaine, has been an important platform in Morales’ presidency, particularly its removal from the international list of banned drugs. The coca leaf is a primary product in the livelihood of 40,000 Bolivians—a large part of Morales’ constituency. Since recently assuming the chairman of the Group of 77 nations, Morales vows to reinstate the coca leaf.

Among such accomplishments and claims is the never-ending stream of flooding, with weather reports stating that heavier rainfall will most likely continue for weeks to come. With climate change an ever-present feature in many countries, Bolivia, too, is far from unaffected.

– Miles Abadilla

Sources: BBC, Crossmatch Christian Post, Fox News, Fox News, Reuters, Thomson Reuters Foundation
Photo: The Guardian