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Archive for August 12th, 2009

Uganda is experiencing a nationwide shortage of ARVs

Posted by African Press International on August 12, 2009

Photo: Georgina Cranston/IRIN
Uganda is experiencing a nationwide shortage of ARVs

KAMPALA, HIV activists are demanding that Uganda’s Ministry of Health refund an estimated US$15 million earmarked for purchasing antiretroviral (ARV) drugs, which was instead used to buy shares in a local drug factory and pay health workers.

“For the ministry to divert funds from buying drugs that save lives … is completely unacceptable,” said Stella Kentutsi of Uganda’s National Forum of People Living with AIDS Network.

The diversion of funds comes at a time when the country is experiencing nationwide ARV shortages. Many health centres are unable to enrol new patients and others are only enrolling those with a CD4 count (a measure of immune system strength) of 150 or less. Most low-income countries start treatment at a CD4 count of 200, while others recently raised the threshold to 350.

In its 2008/09 national budget, the government set aside $38 million to buy ARVs from local manufacturer Quality Chemicals Limited – the first ever domestic contribution to the country’s donor-driven ARV programme. However, less than half the allocated funds were actually used to purchase ARVs.

The controversy comes two months after parliament’s budget committee recommended slashing the allocation for ARVs to $20 million in the 2009/10 national budget, on the grounds that money allocated in the previous budget had not been spent on buying the drugs.

“I would request that the ministry refund that money to buy drugs for our people,” said Beatrice Rwakimari, chair of the parliamentary committee on HIV and related matters. “If this money is not committed to buying drugs then … we shall have shortages.”

Health Minister Stephen Mallinga told IRIN/PlusNews that the funds were diverted to pay healthcare workers who had not received salaries; he added that the Ministry of Finance had authorised the diversion of funds and would refund the money.

An estimated 170,000 people are enrolled in Uganda’s ARV programme, which is about 95 percent donor-funded, while another 130,000 need the drugs but are not getting them.


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MOZAMBIQUE: Closing HIV day care centres brings protesters out

Posted by African Press International on August 12, 2009

Photo: Belevncio Nhantumbo/Eu Dream
Activists take to the streets

MAPUTO, – Thousands of people took to the streets of Maputo, capital of Mozambique, and the country’s second city, Beira this week, to protest the government’s closure of day care hospitals for HIV-positive patients.

In Maputo, activists handed Health Minister Paulo Ivo Garrido a memorandum slamming the decision, which they said was a setback in the national response to the epidemic. An estimated 16 percent of Mozambique’s 21 million people are living with the virus.

In March 2008 the state decided to shut down the 23 day care centres for people living with the virus, run by government healthcare facilities across Mozambique, and has been integrating the patients into mainstream institutions, saying the exclusive nature of day centres was harming efforts to eradicate stigma and discrimination.

However, the organizers of the march warned that closing the day centres had led to many people interrupting their antiretroviral (ARV) treatment and could even lead to deaths; HIV-patients were not getting proper care at the main hospitals to which they had been moved, and were sometimes even suffering discrimination.

An HIV-positive domestic worker, Ainda Macamo*, told IRIN/PlusNews she had skipped work to be at the march. “It was an opportunity to join all these people and to meet the minister … We are dying and we cannot keep quiet.”

Csar Mafanequio, national coordinator of the Movement for Access to Treatment in Mozambique (MATRAM in Portuguese), said the government had closed the day care hospitals without consulting civil society or people living with HIV.

Accessing treatment has become even more difficult for those not yet on life-prolonging ARVs, while the quality of patient care had also been affected. “We are asking for the reversal of this situation,” Mafanequio said.

Garrido maintained that despite the shortcomings, “In just four years we have jumped from 6,000 to 140,000 people receiving antiretrovirals; it is … [to be expected] that we will have problems.”


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SOUTH AFRICA: HIV biggest threat to pregnant women

Posted by African Press International on August 12, 2009

Photo: Tiggy Ridley/IRIN
Between 28 percent and 33 percent of women attending antenatal clinics in South Africa are HIV positive

JOHANNESBURG, – HIV is the main cause of death among pregnant women in Johannesburg, South Africa’s most populous city, according to a five-year study of maternal mortality at one of the city’s largest public hospitals.

The study, published in the August 2009 issue of Obstetrics and Gynaecology, found that the maternal mortality ratio was more than six times higher in HIV-positive women (776 deaths per 100,000 births) than in HIV-negative women (124 per 100,000). Nearly half of the 108 women who passed away between 2003 and 2007 died from HIV-related causes, most commonly tuberculosis and pneumonia.

Although most of those who died had a CD4 count (which measures immune system strength) well below 200 – the current threshold for starting treatment – and were eligible for antiretroviral (ARV) drugs, the roll-out of treatment a year into the study period did not reduce maternal deaths among the HIV-infected women because only two had started taking the medication.

“The problem is not that ARVs don’t reduce mortality,” said Dr Vivian Black, of the Reproductive Health and HIV Research Unit (RHRU) at the University of Witwatersrand, Johannesburg, lead of author of the study. Only one maternal death was recorded in about 2,000 HIV-positive women receiving ARVs from an RHRU programme.

The study highlights gaps in the country’s prevention of mother-to-child HIV transmission (PMTCT) programme that are causing HIV-positive women to miss out on testing and treatment.

HIV testing rates increased more than threefold during the study period, yet the authors still identified insufficient HIV testing as “the most important programmatic weakness”.

Between 28 percent and 33 percent of women attending antenatal clinics in South Africa are HIV positive, but many remain unaware of their status and never access the necessary care to prevent transmission to their infants or protect their own health.

The study identified a link between low prenatal clinic attendance and high mortality rates among HIV-positive women, but Black also pointed to the lack of postnatal services for HIV-positive mothers, especially those who are not eligible for ARVs. “Post-partum [after birth] is when we see the bulk of deaths,” she told IRIN/PlusNews.

Black would like to see PMTCT programmes extended to include a greater focus on long-term maternal health. “If you look after the health of the woman she’s less likely to transmit the virus, but securing mum’s health is important because of broader issues,” she said.

The study findings are likely to contribute to the heated debate in South Africa’s HIV/AIDS sector about the need to raise the threshold for starting treatment from a CD4 count of 200 to 350.

The South African National AIDS Council (SANAC) recommended the change after findings from a number of recent studies showed that patients who started treatment earlier developed fewer AIDS-related illnesses and had lower mortality rates, but the National Health Council, an advisory body to the health ministry, has yet to approve raising the threshold to 350.

HIV-positive pregnant women are between 1.5 and five times more at risk of maternal death than HIV-negative women, according to a number of studies cited in the RHRU study, so giving them ARV treatment earlier is particularly important.

The authors conclude that the deaths of most of the HIV-positive women in the study could have been avoided if they had begun ARV treatment, and been given cotrimoxazole prophylaxis [an antibiotic that helps prevent opportunistic infections].

“We’d like to see [a CD4 threshold of] 350 across the board,” said Black, “but if there’s an inability to do that immediately, we would be grateful if they’d prioritize pregnant women, and those with TB.”


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SUDAN: Tensions high, food short in Akobo

Posted by African Press International on August 12, 2009

Photo: Peter Martell/IRIN
A pregnant southern Sudanese woman recovers from gunshot and spear wounds in Akobo hospital

AKOBO, – Tensions have remained high in Akobo County of Jonglei State, Southern Sudan, a week after inter-ethnic clashes left at least 185 people, mainly women and children, dead.

“The Murle have attacked us, and the Jikany [Nuer] are stopping the boats from getting to us,” John Tut, a Lou Nuer in Akobo said.

“We have to act as men to protect our people and fight back or they will continue to crush us.”

Amid warnings of possible retaliatory raids, aid workers are also pointing to rising levels of malnutrition following significant displacement of people and the blocking of river access routes.

Akobo County Commissioner Goi Jooyul Yol said the 2 August dawn attack by the Murle occurred at Geni River in Mareng, 40km southwest of Akobo town. The women and children had camped in the area for three weeks trying to catch fish.

The leader of the Murle community, Chief Ismail Konyi, was quoted by the Sudan Tribune as calling for peace-building between the communities in Jonglei.

“If you ask who recently attacked the other in the area, you will only hear the name of [a community] because nobody is determined to go further and find out who was behind the raid and what actually caused that attack,” he reportedly said in Juba.

“For any incident, there must be a cause and this cause, if not addressed, results into losing either lives of innocent people or properties.”

Following the latest clash, the UN World Food Programme (WFP) warned that its ability to deliver much-needed supplies was being hampered by the violence.

Photo: Peter Martell/IRIN
Women displaced by recent fighting in Jonglei State wait to collect food supplies delivered by a UN helicopter

“WFP and its partners have called on the government to put an end to inter-tribal fighting, which is endangering the delivery of humanitarian aid,” UN spokeswoman Marie Okabe said.

Extra helicopter and airplane flights are bringing in food, but the supplies cannot meet the needs of the community. At least 19,000 people were displaced in April after earlier Murle attacks, while more are reported to have fled the recent attack.

“Food assistance is the number-one humanitarian need in Akobo, besides protection,” said Michelle Iseminger, head of WFP in Southern Sudan.

The roads to Akobo are closed most of the year due to rains, while the main river route has been blocked at Nassir by the Jikany Nuer upstream from Akobo, who have also clashed with the Lou Nuer.

“There is a massive need, there are many people who are hungry and need to be fed,” Yol said.

Feeding programmes

An extra outpatient feeding programme targeting children has been opened by aid agency Medair, which had been providing inpatient paediatric care in Akobo County hospital since June.

“Many children are suffering from malnutrition,” said Eunice Kavoi, team leader for Medair in the area.

The aid agency is also setting up a water treatment centre but it is currently forced to fly in basic materials such as fuel and cement at high cost due to the difficulties of bringing supplies into Akobo by river or road.

“We fear the situation in terms of nutrition will get worse if nothing is done to fly in more food for the community,” Kavoi added.

Photo: Peter Martell/IRIN
Patients recover in a southern Sudanese hospital in Akobo after a massacre at their fishing village

Engage, government urged

On 11 August, the US-based advocacy group Human Rights Watch (HRW) called on the Southern government and the UN to step up their efforts to provide protection.

“To protect civilians, the Southern government needs to engage over a sustained period with state and local authorities from the communities involved, and with youth leaders in the cattle camps who carry out the attacks, to address the root causes of the conflict,” said Georgette Gagnon, HRW’s Africa director.

“They also need to track warning signs of revenge attacks, and deploy security forces accordingly.”

Southern Sudanese officials have promised security will be boosted and the river opened to ship in more supplies. “I am optimistic the river will be opened in the coming days,” said Yol. “I have had fruitful talks and have been assured that the boats will be able to pass along the river soon.”

Some boats with supplies were seen in Akobo on 7 August, coming from Ethiopia on separate river channels from the main route via Nassir.

However, despite official assurances, no boats have been reported to have moved past Nassir. Aid workers stress that more must be done to ensure supplies get through.


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AFGHANISTAN: Midwives defy tradition and save lives

Posted by African Press International on August 12, 2009

Photo: Akmal Dawi/IRIN
Health officials in Bamyan Province say newly trained midwives have increased child delivery rates at health centres and have reduced maternal deaths

BAMYAN, – When the first and only midwifery school was opened in 2004 in Bamyan city, central Afghanistan, not a single application was received for the 18-month course. Today, the school has to turn down dozens of applications from women all over the province because it cannot accommodate more than 25 students at a time.

We have earned the peoples trust in our work, Saleha Hamnavazada, coordinator of Bamyan Midwifery School, told IRIN. We have created a reliable learning environment for women and have assured their men that women are totally safe and protected here.

Conservative traditions in Afghanistan have restricted womens and girls access to education, work, healthcare and other social activities across the country, albeit in varying degrees.

Women and girls are often stopped from going to health centres or schools because of a lack of female health workers and teachers.

The consequences are severe: annually, 24,000 women die before, during or just after childbirth because of a lack of healthcare; and the female illiteracy rate is one of the highest in the world at more than 85 percent, according to UN agencies.

Photo: Masoud Popalzai/IRIN
In addition to providing essential obstetric care, midwives raise awareness of family planning and HIV/AIDS

Breaking down barriers

I want to break superstitious taboos in our society which impede womens education and work, Masooma, a midwifery student from Daikundi Province, told IRIN. I saw the deaths of my two sisters-in-law during childbirth because there was no midwife or doctor to save them.

However, the midwifery profession is starting to be considered both decent and lucrative for women, particularly in rural areas.

A midwife works only for women so it is acceptable, said one man in Bamyan city, who requested anonymity.

The number of midwifery schools in the country has increased from six in 2002 to 31 in 2009, according to Pashtoon Azfar, director of the National Association of Midwives (NAM). Since 2002, more than 2,000 midwives have been trained and employed by the Ministry of Public Health (MoPH) and NGOs in health centres across the country, Azfar told IRIN.

Reducing deaths

Midwives are believed to have improved womens access to essential health services and have reduced maternal mortality in some parts of the country.

Maternal death during child delivery has decreased by about 50 percent, Zainab Rezayee, an obstetrician in Bamyan City Hospital, told IRIN, referring to her hospital.

In 2004, two to four babies were born every month at health centres in rural Bamyan. Today, more than 35 are born in medical centres every month thanks to 41 graduated midwives in the province. Deliveries at Bamyan City Hospital have increased from 30 a month in 2004 to more than 130 in 2009, Rezayee said.

Across the country, the percentage of women receiving antenatal care increased from 4.6 percent in 2002 to 32 percent in 2006, while the rate of child deliveries attended by a skilled health worker increased from 8 percent to over 19 percent in the same period, according to NAM.

In addition to facilitating childbirth, midwives increase womens awareness about family planning, HIV/AIDS and transmittable sexual diseases.

Photo: Akmal Dawi/IRIN
Afghanistan needs up to 8,000 midwives to curb its high infant and maternal mortality ratios

Officials in the health ministry say it is time to re-assess Afghanistans poor maternal mortality record rated the second-worst in the world after Sierra Leone, with 1,600 maternal deaths per 100,000 live births, in a 2006 nationwide assessment.

We need a new assessment to gauge how much the ratio has dropped, said Azfar, who also heads the main midwifery school in Kabul.

No quick fix

Afghanistan has one of the highest fertility rates in Asia and the average Afghan woman gives birth to six to seven children in her life, according to the UN Population Fund.

There are about 2,400 midwives in the country but about 8,000 are required to provide basic obstetric services for all Afghan women, NAM said.

We train 300-400 midwives every year at 31 midwifery schools in the country, said Azfar, adding that one school would be opened by the end of 2009 in the Paktika Province where women have very little access to basic healthcare.

At this rate, it will take at least 14 years to train the needed 5,600 extra midwives. Until then, thousands of women will continue to die from preventable deaths.


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Talks set to boost Kenya electoral reforms – But how fast will the Kenyans move?

Posted by African Press International on August 12, 2009

President Mwai Kibaki and Prime Minister Raila Odinga are expected to use it the meeting to seek public support for the ongoing changes. Photo/FILE

President Mwai Kibaki (right) and Prime Minister Raila Odinga (left) are expected to use it the meeting to seek public support for the ongoing changes. Photo/FILE

ByOLIVER MATHENGEPostedTuesday, August 112009at22:30

A national conference on electoral reforms starts on Tuesday, with President Kibaki and Prime Minister Odinga expected to use it to seek public support for the ongoing changes.

Mr Odinga on Tuesday set the tone for talks when he said tribal politics frustrated efforts to instil democratic practices in most African states.

The three-day meeting, to be held in Nairobi, is aimed at winning greater support for the reforms spearheaded by the Interim Independent Electoral Commission (IIEC) and the Interim Independent Boundaries Review Commission.

The talks are a follow-up to recommendations made by the Kriegler Commission that investigated the 2007 General Election, whose disputed results sparked widespread violence.

The conference is organised by the Ministry of Justice and co-hosted by the two interim organisations formed following the post-election chaos.

The Kriegler Commission had recommended a complete overhaul of the countrys electoral system. It noted that Kenyas constitutional and legal framework on elections was flawed. It also found that the defunct Electoral Commission of Kenyas capacity, independence, composition and management were compromised.

The Kriegler report also said ECKs legitimacy was irreversibly impaired and there were serious defects in the voter register.

It, therefore, recommended that the ECK be reformed or replaced, hence the establishment of the IIEC. The Kriegler team further urged the country to implement measures to inject electoral integrity and empower future poll organisations to carry out their constitutional functions.

Public confidence

This weeks conference seeks to rebuild the publics confidence in the electoral systems. According to the conference concept paper, it will also identify challenges in the electoral system and policy imperatives for reforms. Another objective will be to identify principles and practices to guide electoral reforms.

Speakers include Dr Mrutyunjay Sarangi, a former commissioner of the India Demarcation Board; South Africa Electoral Commission chairperson Brigalia Bam; and Ghana Electoral Commission vice-chairman David Adeenzi.

source.nation .ke

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