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Children missing out on HIV drugs

BBC

Only one HIV-positive child in 20 in developing countries receives the treatment they need, a report by children's campaigners has found.

Coming together as the Global Movement for Children, they said the international community must urgently address the problem.

Group chairman Dean Hirsch, said the lack of treatment amounted to a death sentence for millions of children. He warned most of HIV-positive children die before their fifth birthday.

The report has been compiled by Oxfam, Plan International, Save the Children, Unicef, World Vision ENDA Tiers Monde, the Latin America and the Caribbean Network for Children.

It says too few drugs are available in formulations that are affordable and able to be administered to children, while the development of new drugs continues to focus mainly on adults.

More than 90% of children with HIV live in sub-Saharan Africa - they have the least access to treatment, the report said. It continues the "profit-driven climate of drug development" means there is little incentive to develop child-specific formulations of anti-retroviral drugs for children, and that therefore child-appropriate treatment is "practically non-existent".

Mother-to-child transmission
The Global Movement for Children said that, in June 2005, around four million children were in need of cotrimoxazole, an antibiotic costing 3 US cents per day per child, which prevents life-threatening infections in HIV infected children and infants born to HIV-positive mothers.

It can also delay the onset of Aids and the need for anti-retroviral therapy. It adds that 90% of HIV-positive children are infected by a failure to prevent mother-to-child transmission.

The report says providing a mother with comprehensive care can reduce the risk of transmission to less than 2%.

But under 10% of HIV-positive pregnant women currently receive the necessary drugs.
The report makes a series of recommendations including the development of simple and affordable diagnostic tests, more research and development for child specific treatment and improvements to health-care systems in developing countries to make it easier to get medication to children.

Children's worlds 'shattered'
Mr Hirsch said: "These children are missing out on treatment because they are missing from the global Aids agenda."

Ann Veneman, executive director of Unicef, said: "Children are the missing face of HIV and Aids. "Millions have watched their worlds shatter around them because of this disease, losing parents, teachers, a sense of security and hope for the future.

"Children affected by HIV and Aids are often discriminated against and face enormous odds.
"Through strengthened partnerships among governments, donors, international agencies and the private sector, we must do everything possible to ensure that drugs, diagnostic equipment and resources are available to treat children."

Thomas Miller, chief executive officer of Plan International said, "Unless the world takes urgent account of the specific impact Aids has on children we will fail to meet the Millennium Development Goal - to halt and begin to reverse the spread of the disease by 2015."

KENYA BANS SMOKING IN PUBLIC

OUR REPORTER

TEAN congratulates Kenya to have joined the growing number of countries that have banned smoking in public places. On Saturday May. 13, Kenyan Health Minister Charity Ngilu signed a legal notice that entrenches the ban into the country’s laws.

Uganda was a leader in the ban of smoking in public places and gazetted the National Environment (Control of Smoking in Public Places) Regulations 2004 on 12th March 2004 and now form part of the Laws of Uganda.

Uganda having taken bold steps to gazette the above regulations, we are far from seeing these regulations implemented in Uganda.

TEAN calls upon National Environment Management Authority (NEMA), local governments and environmental inspectors to implement the regulations to safeguard the health of non-smokers from second hand smoke.

TEAN Coordinator, Susan Asiimwe said, “I wish to commend the Kenyan Minister of Health highly for taking this bold step to protect the people of Kenya from the health and economic hazards that public smoking causes.”

Saving the newborns from HIV/AIDS

Paul Kimumwe

The absence of healthy bouncing babies implies a bleak future. Yet HIV/AIDS has made it a point that these are as few as possible. Not only has it impaired their capacity to enjoy childhood by killing their parents, but infected them as well, thus, wiping out all hope of having heirs.

In 2005, according to the World Health Organisation (WHO) AIDS epidemic update estimates a total of 3.1 million AIDS related deaths among which included 2.6 million adults and 570,000 children below the age of 15, with new infections being 700,000 children below the age of 15 and 4.2 million adults.

According to Dr. Charles Mugero, the assistant commissioner for Child Health in the Ministry of Health says that HIV/AIDS is one of the five leading causes of infant mortality accounting for over half of all deaths among children below the age of five.

“The major causes of infant mortality include; HIV/AIDS, malaria, diarrhea, pneumonia, diarrhoea, asphyxia (a condition where the baby fails to breathe on its own and commonly results from poorly managed pregnancy, prolonged labour and delivery) and measles,” he says.

While it still baffles many, why newborns, of all people should get infected, yet they are not sexually active, the reluctance to come to terms with this fact has escalated the rate at which these innocent babies are being annihilated.

The sad fact is that, it is the infected mothers, with all their good intentions to subdue the earth, who pass on the virus to their beloved babies, supposedly the future leaders.

The big question is how? “Over 95 per cent of children who are HIV positive got infected through Mother-To-Child Transmission (MTCT),” says Dr Philippa Musoke, the Head of the Department of Paediatrics and Child Health at Makerere University Medical School.

“Mother to child transmission refers to a situation where HIV is passed on from an infected mother to her child and for every 10 women who are infected with HIV, around 3 women will pass the infection to their babies,” she explains.

When does MTCT take place?
“There are basically three instances when the transmission is likely to take place; during pregnancy, childbirth/delivery and breast feeding although the first two are the most risky times,” says Dr. Musoke.

The main factors that increase the chances of transmission during pregnancy include; having unprotected sex especially with multiple partners, having sexually transmitted diseases like syphilis or gonorrhea leading to newly acquired HIV infection and pregnancy when the mother is in advanced stages of AIDS disease. “When the mother is very sick, her immunity is very low,” says Dr. Musoke.

However, it is during child birth when the chances of transmission are highest. “At this stage, the fluids and the blood of the mother come into contact with the baby.

“This is increased if there is premature rupture of membranes, use of un-sterilised materials or instruments during delivery, contamination by infected mother’s blood, or prolonged labour,” she explains.

With the limited number of well equipped health centers and skilled health workers, it is disheartening to think of infected women thinking of having children at all. This is because a needs assessment of Emergency Obstetric Care (EmCO) conducted during 2003 showed that basic EmCO was in only 4% of health centre III and comprehensive EmCO was available in only 6% of the health centre IV while in only 65% of the hospitals.

Worse still, according to the Uganda Demographic and Health Survey (2000/1), the majority of women were delivered by non-skilled attendants, who could not offer appropriate midwifery care including basic care of newborns.

But even with all the health facilities in place, the implications of pregnancy to an HIV positive mother is no cause for celebration.

“The health of the mother is likely to relapse, leading to early opportunistic infections and they (mothers) are susceptible to getting miscarriages and even death,” says Prof. Florence Mirembe, a Gynecologist at Mulago Hospital.

For transmission through breast milk to the baby, the main factors include; when the baby has sores in the mouth, the mother’s breast and nipples are infected or breastfeeding when the mother is already very sickly or if she becomes infected with HIV while breastfeeding.

Dawn of PMTCT
However, all is not lost for infected mothers. With the dawn of PMTCT (Prevention of Mother-To-Child Transmission) initiatives, the chances of giving birth to and raising an HIV negative child are increasingly becoming plausible.

“This initiative is intended to offers services that will prevent mothers from transmitting the HIV virus to their children, and they (services) are made available to all pregnant mothers who have been confirmed to be HIV infected and willing to participate,” explains Dr. Musoke.

She says that it is a full package with a whole range of services from routine counseling and testing for all pregnant women, to provision of anti retroviral drugs (ARVs) to both the mother and the child under the PMTCT program.

However, the main actors in this initiative are the mothers themselves. “It is very important for one (mother) to know her HIV/status because it helps us to identify who needs what and when,” says Dr. Musoke.

What is involved?
Since the transmission can take place either during pregnancy, at childbirth, or during breastfeeding, it becomes prudent that interventions should therefore start as early as possible. For pregnant mothers, it is imperative that they start attending antenatal clinic as early as 3 moths of pregnancy and get care from qualified health workers, seeking early and proper treatment for all sexually transmitted diseases. “They must go with their partners,” Musoke emphasises.

“We encourage them to deliver at a health unit where they can get the best health care, although only just about 30% of mothers deliver in hospitals. It is also important that if the nipples of the HIV infected mother are cracked or injured, the breast milk can be expressed while the breast heals and the baby breastfed again” she adds.

However, to use the old adage, “it takes two to tangle”, the men’s role should not be underestimated since they make most of the reproductive decisions in their homes. While it is more meaningful for partners to test for HIV before marriages, it is important that testing is also done before a couple decides to have a baby. This it the ideal!

“Men need to be aware of all issues regarding the reproductive health of their partners,” says Dr. Musoke.

“Being pregnant alone has a lot of complications that demand delicate handling even for an HIV negative mother, but the situation becomes very fragile if the mother is HIV positive,” she adds.

Symptoms such as lack of enough blood, bleeding during pregnancy, headache, swelling of the feet, and abnormal virginal discharge are just a few of the complications that require immediate medical attention the moment they are identified. Their husbands are not only needed for financial but moral support as well in such circumstances.

“Most women are scared and others refuse to be tested, and this is where we call upon the men to play their roles as men, by encouraging their partners who are HIV positive to take Nevirapine to prevent transmission HIV to the baby. Nevirapine reduces the transmission by just a half. If the mother is sick with HIV then she needs antiretroviral drugs (ARVs) for herself and this would therefore reduce the chances of infecting her baby” says Dr. Musoke.

For an HIV/AIDS free future generation, it is imperative that men’s reproductive role goes beyond the conception level, through pregnancy, childbirth and nurturing of the child to adulthood.

But it is much more fruitful if the spread of the HIV/AIDS virus among young girls, who are the future mothers, is completely done away with to minimise on the incidence levels of HIV/AIDS spread from mother to child, which can overtake the traditionally known mode of transmission of sexual intercourse and blood transfusion.

“As long as young women are infected with the HIV virus some of them are bound to pass it on to their children. We can do something to stop this,” Dr. Musoke concludes.

Environment is key to Sustainable Development

Paul Kimumwe

During the United Nations Millennium Summit in 2000, 189 Heads of State and Governments pledged to work together to make a better world for all by 2015. On our behalf, they signed the Millennium Declaration which promised to free men, women and children from the dehumanizing conditions of extreme poverty and make the right to development a reality for us all!

To this end, Eight Millennium Development Goals were adopted, committing both the rich and poor countries to work together to eradicate extreme poverty and hunger, achieve universal primary education, promote gender equality and empower women, reduce child mortality, improve maternal health, combat HIV/AIDS, malaria and other diseases, Ensure environmental sustainability and develop a global partnership for development – all by the year 2015.

While some progress has been made in the right direction in regards to all eight goals, with less than 10 years left for the deadline, goal number 7, which is, “Ensuring Environmental Sustainability,” still lags behind.

According to the Millennium Developmental Goals Progressive report that was released in May 2005, there should be drastic improvements in our efforts; otherwise, “sustainability will not be achieved with current patterns of resource consumption and use. Land is becoming degraded at an alarming rate. Plant and animal species are being lost in record numbers. The climate is changing, bringing with it threats of rising sea levels and worsening droughts and floods,” is warns.

“Environmental sustainability means using natural resources wisely and protecting the complex ecosystems on which our survival depends,” says the report.

Missing link
Unfortunately, the failure to make a linkage of all these eight goals has left gaps and uncoordinated strategies that have undermined the very essence of working for sustainable development.

“For most people, environmental protection means planting trees. They can not comprehend how their health, farming methods, means of income and feeding habits are important in protecting the environment,” says Mr. Maurice Bafirawala, the District Environment and Forest Officer of Kalangala District.

“If people are poor, then chances are that they will resort to using any means in search for survival, and in a fishing community of ours (Kalangala Island) that is when they start using poor fishing methods like fish poisoning, using small nets, and this has a negative impact on the state of our fish stocks and quality of fish products,” adds Bafirawala.

Dr. Peter Waiswa, the Deputy Director of Iganga District Health Services says that the interrelationship is so great that it becomes prudent to revise our approach to both health and poverty alleviation strategies.

“When people live in a health environment with access to clean water, the chances of suffering from communicable diseases are lessened. In turn, the number of children and women, who are the main victims of these backward diseases, reduces greatly. Besides that, the high rate of school drop outs especially for the girls is highly associated with poor sanitation facilities at their schools,” he says.

Thus, by ensuring a health environment (goal 7), child mortality (goal 4) and maternal mortality (goal 5) would have been cater for, and so is goal 2 (achieving universal primary education) and promoting gender equality and women empowerment (goal 3) by ensuring more girls finish school.

No ones concerned
It is however sad to note that protecting the environment is a duty that no one has been willing to take upon his/her sleeves.

“No body seems to mind about the state of environment, especially in their day-to-day lifestyles,” Says Kayondo Titus, a field officer with Uganda Environmental Education Forum.

“People are so eager to get rid of water bottles, airtime cards, milk pouches, polythene (kaveera) bags and other wastes both at their homes and places of work without regard of where these wastes end up and their impact on the environment. It is frustrating to see grown up people littering everywhere without feeling guilty,” he adds.

The tendency however stems from the deep rooted apathy within the population, and the failure to think beyond the self. There exits wrong thinking that issues to do with environmental protection are a responsibility of the politicians and other authorities.

Bafirawala however says that this apathy can partly be attributed to the too much poverty that has been mistreating our people for so long, with the least opportunity of escape.

“When people are poor and not sure of survival the next day, chances are that he will cut the next tree for charcoal, of clear a forest to get land for cultivation and it is these unsustainable behaviours that have exacerbated the situation,” he says.

Challenges
The biggest challenge however has been the failure on the part of the development oriented activist to include environment concerns in their search for prosperity. Unfortunately, the environmentalists have also been short sighted in their cause to conserve the environment with little or no regard to the prevailing political, social, cultural and economic concerns of the populations.

Secondly, the ever increasing populations has systematically been exerting pressure and overwhelming the capacity of the support systems to recuperate from the shocks that is so often inflicted by natural disasters such as storms, droughts.

This population explosion has also been accompanied with its own evils, yet reversing the situation is more of a myth especially in developing nations, which have very alarming fertility rates. According to the MDG progressive report, by 2007, the number of people living in cities is expected to exceed the rural population in developing regions.

“Nearly one in three city dwellers — almost 1 billion people — lives in slums, in conditions characterized by overcrowding, little employment or security of tenure, poor water, sanitation and health services, and widespread insecurity, including violence against women. Not surprisingly, disease, mortality and unemployment are considerably higher in slums than in planned urban settlements,” says the report.

Yet these are just but two of the environmental issues that need to be addressed.

Word from the Executive Editor

Dear Readers,

Welcome to the first ever blog for environment and health journalists in Uganda. We shall be posting here articles and welcoming your comments.

This development, yet some might say it has been long over due, is all the same significant as we try to bring issues of environment on the web, since they have for along time failed to make it in the mainstream media, because they are not "sexy"

It is therefore our humble appeal, that as we try to bring issues of environment and health to the public, we hear from you by way of comments, on how best we can do it.

Sincerely,
Paul Kimumwe
Executive Editor