Monday, April 27, 2009

Counting malaria out - With preventive, control measures

Article: Salome Donkor
Ghana joins the international community and the rest of the African continent to observe World Malaria Day, today (April 25), on the theme: “Counting Malaria Out”
Commemorative activities to mark the day in the country include countrywide advocacy and educational programmes organised by the National Malaria Control Programme (NMCP), in collaboration with other stakeholders to intensify action aimed at minimising malaria infection, facilitate prompt treatment and prevent unnecessary deaths.
The World Health Organisation (WHO) states that malaria continues to haunt 40 per cent of the world's population and affects more than 500 million people a year, killing more than one million.
The burden of malaria is heaviest in sub-Saharan Africa but the disease also afflicts Asia, Latin America, the Middle East and even parts of Europe.
Malaria is a parasitic infection that can have a serious negative impact on pregnant women and young children in sub-Saharan Africa and other tropical areas. The WHO says the disease is also a major cause of maternal and child mortality and in pregnancy, it leads to low birth weight of babies, premature delivery, untreated low blood glucose and may cause brain damage in babies with low-birth weight.
A woman’s immunity to malaria may be compromised by HIV infection. The prevalence and intensity of malaria infection during pregnancy is higher among HIV-positive women and the risk to the woman and her new-born may be higher.
According to a statement by the Department of Social Affairs of the African Union, African children below five years of age and pregnant women are at highest risk of malaria. As they grow older, childhood malaria infection, including cerebral malaria, can have long-term effects such as delayed physical growth, impaired cognitive development, and persistent neurological damage on them. Malaria during pregnancy can be prevented, reduced and managed with appropriate, low-cost interventions.
Presentations made at a day’s media seminar in Accra to mark this year’s World Malaria Day, indicated that children experience between two and three episodes of malaria each year and the fever reduces their appetite and worsens their malnutrition, while recurrent episodes of malaria in children result in the loss of substantial amounts of time from school. The country records about 1,500 deaths from malaria among children under five years, while 60 pregnant women die every year from malaria.
Realising the devastating impact of the disease, African leaders declared April 25 of each year as Africa Malaria Day in all member states, at the Special Summit on Roll Back Malaria (RBM) held in April 2000 in Abuja Nigeria. Known as the Abuja Declaration on Roll Back Malaria in Africa, the initiative taken in accordance with the Millennium Development Goals, culminated in the celebration of Africa Malaria Day. The leaders committed themselves under the Abuja Declaration, to “halving malaria burden in Africa by 2010.”
During the 3rd Session of the AU Conference of Ministers of Health (Johannesburg, April 2007), the Chairperson of the AU Commission launched the “Malaria Elimination Campaign.”
During the same year, the World Health Assembly at its 60th Session, instituted the World Malaria Day as a day for recognising the global effort at providing effective control of malaria. It is also an opportunity for countries in the affected regions to learn from each other's experiences, support each other's efforts and encourage new donors to join a global partnership against malaria.
Furthermore, on September 25, 2008, the UN Secretary-General’s Special Envoy for Malaria convened the 2008 MDG Malaria Summit on the theme “World Leaders Unite”, at which the Global Action Plan on Malaria was adopted and over US$3 Billion were committed to the fight against the disease.
Delivering a paper on Ghana’s malaria situation and the way forward at an international conference on malaria at Steyning in England recently, the Minister of Health, Dr George Sipa Yankey, was reported to have stated that malaria had been very expensive for Ghana in terms of human and financial losses, explaining for instance that, the disease cost the nation over $760 million in 2006, which was about 10 per cent of Gross Domestic Product (GDP). The minister also outlined possible measures to completely combat the disease, which would include the identification of all malaria endemic areas and mosquito breeding zones and destroying all mosquito lava.
The World Health Organisation (WHO) has adopted a pronged approach to ease the burden of malaria on women and children in endemic areas and that includes intermittent preventive treatment (IPT) for pregnant women, malaria illness management during pregnancy, and the use of insecticide-treated bed nets (ITNs) for the entire population living in malaria affected areas. The WHO approach to malaria prevention and treatment emphasises initiating preventive measures during antenatal care and effective case management for all clinical cases of malaria. As another routine part of focused antenatal care, women should be given information and counselling on the dangers that malaria poses to them and their babies, and the steps they can take to help protect themselves. These messages should address the importance of practices such as continuing antenatal care, receiving the next scheduled dose of IPT and iron/folate, sleeping under an ITN and covering their arms and legs in the evening.
In support of the national malaria prevention programmes, the United States Government announced in December 2006, that Ghana had been selected as one of the eight countries to benefit from an initiative to rapidly scale up malaria prevention and treatment interventions in countries in sub-Saharan Africa, where the disease was most prevalent under a five-year, $1.2 billion project.
The most up-to-date information on nationwide coverage of key malaria prevention and control measures in Ghana comes from a Multiple Indicator Cluster Survey, conducted from August to early October 2006, which indicates that approximately 30 per cent of households reportedly own at least one bed net (of any type) while almost 19 per cent reportedly own one or more insecticide-treated nets (ITN).
A survey conducted by Netmark indicated that the number of people aware of ITNs has increased from 91.1 per cent in 2004 to 99.1 percent in 2008. Also, the proportion of households owning one ITN increased from 10.7 percent in 2004 to 61.6 per cent for the urban communities and from 11.2 per cent in 2004 to 66 per cent in 2008 for the rural communities.
In order to extend the reach of malaria interventions to the community level, the President’s Malaria Initiative (PMI) was instituted to reduce malaria mortality by 50 per cent in vulnerable groups; namely pregnant women, children under five years of age, and people living with HIV/AIDS.
This will be accomplished by achieving 85 per cent coverage of groups at risk with four key interventions which are the use of artemisinin-based combination therapy (ACT), intermittent preventive treatment (IPT) for malaria in pregnancy, use of ITNs, and indoor spraying with residual insecticides (IRS). Another goal of the PMI is to strengthen and improve the capacity of indigenous non-governmental organisations (NGOs) to undertake malaria prevention and control activities under the leadership of the National Malaria Control Programme (NMCP).
It is evident that bringing malaria control to zero would boost socio-economic development of Africa. Because malaria-carrying mosquitoes bite from dusk to dawn, long-lasting insecticide mosquito nets provide the best known means of effective protection. There is growing scientific evidence to demonstrate that combining mosquito net distribution with follow-on "hang up" campaigns carried out by trained volunteers in communities significantly reduces incidences of malaria. Trained volunteers who live in the same community as the beneficiary population and speak the same local language are ideally placed to help families overcome any social or cultural barriers that could prevent the effective use of nets.
Malaria control, elimination and eventual eradication are everyone’s business. “All of us: Children, youth, adults, educated, uneducated, rich and poor, have a role to play because malaria is predictable, preventable and curable, says the AU Social Affairs Department.
The department is of the view that funding for malaria is no longer a major constraint for implementation of programmes. What Africans need now is the unwavering commitment of leadership at all levels to mobilise the whole society by providing an enabling environment at households, community, district, sector and institutional levels for the battle against malaria to be won. Africa could then move nearer to achieving the MDGs by 2015.
The continent has support from the UN Secretary-General, WHO, the Roll Back Malaria Partnership, UNICEF, the World Bank, the Global Fund to Fight AIDS, TB and Malaria, the Gates Foundation and the USA President’s Malaria Initiative and other partners to mobilise capacity, resources and harmonise all existing malaria initiatives in order to finally eliminate malaria from Africa.

Thursday, April 16, 2009

Child prostitution- A threat to development

Article: Salome Donkor
The story narrated by an 11-year-old alleged child prostitute during interrogation at the Greater Accra Regional offices of the Domestic Violence and Victims Support Unit (DOVVSU) of the Ghana Police Service was pathetic and sounded incredible. She described in chilling details how she serviced her clients and charged them various sums of money depending on the size of their male genital organ.
She also said she took alcoholic drinks laced with some drugs to enable her to sleep during the day, to psyche her up for her ‘night duties’
According to Chief Inspector Irene Oppong, Public Relations Officer of the Greater Accra DOVVSU, 13 children, aged between 11 and 15, were arrested by the police in some parts of Accra and brought to the unit for their alleged involvement in child prostitution.
She said they were sent to the Shelter for Abused Children at Osu, but one of the girls aged 11, attempted suicide, for what she termed as deplorable conditions at the shelter.
When the Ghana Police raided Soldier Bar, a brothel near the Kwame Nkrumah Circle in Accra, in May 2008, 160 commercial sex workers were arrested, and out of this, 60 of them confessed to being under 16 years. This confirms the incidence of sex business among children.
It is not surprising that an unconfirmed online report from the Globalmarch website states that there are at least 125 brothels in and around Accra that employ children.
Chief Inspector Oppong said last month, the Nima Police arrested six children suspected to be engaged in prostitution and pointed out that some of the children also operated around the Kwame Nkrumah Circle, Agbogbloshie, Konkomba market and Tema Station, while others travelled from the Eastern and Central regions to and from Accra daily to engage in commercial sex trade.
She said some of the children, who started the practice from the Kumasi Race Course as apprentice, were later lured to Accra after they had been trafficked to the city by women traffickers who are difficult to trace.
She said in the case of those arrested at Agbogbloshie, the children trafficked from Kumasi know the woman who brought them to Accra only as auntie or sister, and that had made it very difficult for the police to trace her. That, she said was in spite of the fact that the woman uses the children to trade in sex and collects GH¢20 from each of them every three days.
Commercial sex trade among children is a form of forced labour whereby children aged below 18 are forced to have sex with adults and juveniles in return for money, part of which is paid to a third party who usually acts as the mediator. Most of the time the mediator tended out to be “madams” who were engaged in child trafficking.
Reports from parts of Accra indicate that the practice, which is a violation of the rights and dignity of victims and tends to have traumatic effects on them, involves children as young as 11 years, despite the health implications and other risks involved.
The United Nations declared 1979 as the International Year of the Child, which was referred to as the 1979 Declaration. The declaration called upon countries, local authorities, civil society organisations and parents to recognise and strive for the protection of the rights of children.
The declaration also influenced the passage of the United Nations Convention on the Rights of the Child (CRC) in November 1989 and Ghana responded positively to the initiatives of the United Nations in being the first country to ratify the convention.
The adoption of the UN Convention on the Rights of the Child in 1989 provides a clear statement prohibiting all forms of violence against children, reaffirming previous human rights instruments.
However, the International Centre for Criminal Law Reform and Criminal Justice Policy asserts that millions of children throughout the world are victims of violence. They continue to be abused, exploited and trafficked under different categories of violence to children, from abuse in the family and institutions, to organised sexual abuse, including child prostitution, sex tourism and child pornography.
In 1998, Parliament passed the Children's Act (ACT 560) which provided a list of enforceable children's rights and obligations of parents towards their wards.
Writing on the topic ‘Child prostitution and the age of sexual responsibility’ Nana Oye Lithur, the Africa Regional Co-ordinator of the Commonwealth Human Rights Initiatives, pointed out that the laws of the country stipulated that children under age 16 may be willing to have sex, but they cannot legally have sex because they do not have the legal capacity to consent to have sex at that age. This is because a person becomes sexually responsible in Ghana at age 16. This means that any child in Ghana who is not 16 cannot give consent to sexual intercourse.
That is why any man or woman who has sex with a girl or boy who is below 16 years commits the offence of defilement. That child who is not yet 16 years cannot agree to have sex with the man or women because the child does not have that legal power or authority to give consent for sex when he or she is not 16 years.
The causes of this form of inhuman form of exploitation against children could be complex. Could it be due to severe poverty, low value attached to education, family dysfunction, a cultural obligation to help support the family or the need to earn money to simply survive that make children vulnerable to commercial sexual exploitation.
Social workers also say there are other non-economic factors that also push children into commercial sexual exploitation. Children who are at the greatest risk of becoming victims of the practice are those that have previously experienced physical or sexual abuse, a family environment of little protection, where caregivers are absent or where there is a high level of violence or alcohol or drug consumption, which induces boys and girls to run away from home making them highly susceptible to abuse.
Chief Inspector Oppong said although the practice was a criminal offence that warranted the prosecution of clients and the mediators since it amounted to defilement, indecent sexual assault and having unnatural carnal knowledge of a child, it was difficult for the police to arrest the perpetrators because they operated under cover.
The child involved is treated as a sexual object and as a commercial object and it involves children in the urban poor, where the victims are most disadvantaged and in some cities in Ghana.
The International Labour Organisation (ILO) Convention 182 classifies commercial sexual exploitation of children as one of the worst forms of child labour in the world. Child prostitution and child pornography are examples of commercial sexual exploitation of children.
This year’s International Women’s Day (IWD) was celebrated on the theme “Women and men united to end violence against women and girls”. The relevance of the theme cannot be overemphasised considering the fact that men and boys in particular, who patronise the services of these child prostitutes need to demonstrate that the practice, which constitutes exploitation against children, is not an acceptable behaviour and they need to speak against it, be role models to younger men and mentor them not to perpetrate domestic violence in any form.
Article 25 (1) of the 1992 Constitution stipulates that “All persons shall have the right to equal educational opportunities and facilities and with a view to achieving the full realisation of the right” 25 (1) (a) states that “basic education shall be free, compulsory and available to all”.
Sections of the Constitution also enjoins Parliament to enact such laws that are necessary to ensure that “parents undertake their natural right and obligation of care, maintenance and upbringing of their children in co-operation with such institutions as Parliament may, by law, prescribe in such manner that in all cases the interest of the children are paramount”.
Apart from these constitutional provisions, Ghana was the first country to ratify the International Convention on the Rights of Children, while at the national level the Children’s Act 1998 (Act 560) was promulgated to protect the welfare and interest of Ghanaian children.
It is however unfortunate that despite all these measures some children continue to suffer negative acts that constitute criminal practices that demean, degrade and threaten the physical and psychological integrity of children and subject them to emotional trauma.
The Executive Director of Challenging Heights, a child-related non-governmental organisation, Mr James Kofi Annan, called for the enforcement of the Children’s Act.
He said said it was necessary for the Department of Social Welfare, Ministry of Women and Children’s Affairs and related agencies to identify the location of homes and centres and shealters for children and ensure that they operate with the necessary permits to protect the rights of the child.
This protection, he explained, should include giving the children food, health facilities, shelter, and education to enhance their integration into society, adding that the peculiar need of the child could also be identified and the necessary counselling services offered to such victims when they are rescued.
Mr Annan urged the government to resource the Department of Social Welfare to enable it to establish more centres in the country to take care of abused children who are rescued.
It is important to understand that proper child care requires that children are taken care of by family members and the society at large to enable them to benefit from the love and warmth of their families.
Parents, governmental and non-governmental organisations and child-related organisations, need to be more responsible and provide the children with the needed care and protection.

Tuesday, April 7, 2009

Making pregnancy safer - Ghana’s initiatives (Daily Graphic, 04/04/09)

Article: Salome Donkor
Pregnancy and childbirth are generally times of happiness and much cherished by families due to the emotional and social joy that it brings to families.
In some cultural settings in the country, elaborate ceremonies are held to ‘outdoor’ new-born children and thank God for seeing the pregnant women through nine months of pregnancy.
Unfortunately, there are occasions that the period of pregnancy and childbirth pose great risk to the health and survival of women and new-borns and these result in maternal and neonatal mortality and mobidity.
When families lose their relations through maternal and neonatal mortality, the joy that motherhood brings to families and relatives turns into agony, suffering, pain and distress.
Pregnancy-related conditions, also known as obstetric complications, include post-partum haemorrhage, infections, eclampsia and prolonged or obstructed labour, as well as complications of abortion, and these are the leading causes of death among women of reproductive age in many developing countries.
Stories of causes of maternal mortality and neonatal (new-born) mortality in Ghana and other developing countries with high rates of maternal mortality, paint a gloomy picture and portray a state of despair as a result of the slow progress being made in saving women’s lives quickly.
The problems cause more anxiety and uneasiness considering the fact that the factors that jeopardise maternal and new-born survival are preventable or treatable with essential services, and the most effective, affordable public health interventions.
One of the Millennium Development Goals is to reduce maternal mortality by three-quarters by 2015 and it is necessary to assess the progress towards the achievement of the goal.
An online report by the World Health Organisation and the United Nations Children’s Fund (WHO/UNICEF, 1999) estimates that there are 585,000 maternal deaths globally each year, resulting from complications of pregnancy and childbirth. The situation in Ghana is equally gloomy with institutional maternal mortality rate of 250 per 100,000 live births.
In 1987, the World Health Organisation (WHO) and other United Nations agencies like UNICEF launched the Safe Motherhood Initiative (SMI). Since then, efforts have been made to raise awareness about safe motherhood, set goals an priorities for the global Safe Motherhood Initiative and also support national safe motherhood programmes through the stimulation of research, mobilisation of resources, provision of technical assistance, and sharing of information to make childbirth and pregnancy safer.
These efforts have rallied interest and commitment from donors, programme planners, researchers and practitioners to reduce the maternal mortality rate, the indicator with the greatest disparity between developed and developing countries.
Ghana adopted the SMI and that led to the initiation and implementation of Safe Motherhood programmes in the country.
In 1998, the government introduced free antenatal care for all pregnant women and in September 2003, a policy of exempting all users from delivery fees in health facilities was introduced.
The exemption policy was given a further boost in 2008 when the British government provided the Ghana Government with £42.5 million to provide free medical care for pregnant women under the National Health Insurance Scheme.
These were done to remove financial barriers to using antenatal and delivery care in public and private health facilities, in order to complement the role of dedicated and skilful health professionals to achieve a reduction in the maternal mortality rate.
This year’s State of the World’s Children Report for 2009 prepared by the UNICEF, which was launched in Accra last Wednesday, called on political leaders, governmental and non-governmental organisations (NGOs) to generate action at all levels to address the problem of maternal and neonatal deaths.
Produced annually, the report is UNICEF’s flagship publication and closely examines a key issue affecting children. The 2009 edition of the report focuses on maternal and new-born health and identifies the intervention and actions that must be scaled up to save millions of lives.
It outlines the direct causes and underlying factors that undermine the health and survival of mothers and new-borns and mentions the causes of obstetric complications, which include post-partum haemorrhage, infections, eclampsia and prolonged or obstructed labour.
It also talks about complications of abortion, which account for most maternal deaths, and anaemia, exacerbated by malaria, HIV and other conditions which heighten the risk of maternal death from haemorrhage (bleeding).
It said for these reasons, around 1,500 women died from complications related to pregnancy and childbirth, adding that since 1990 the estimated annual number of maternal deaths world-wide had exceeded 500,000, amounting to almost 10 million maternal deaths during the past 19 years.
The launch of the report, attended by policy makers, health workers and members of civil society organisations, included an interactive panel discussion, during which members of the panel and the audience deliberated on the issue of maternal mortality in Ghana and the need for stakeholders to implement effective measures for reducing maternal mortality and improving neonatal survival.
The panellists were Dr Opoku Fofie, Gynaecologist at the Wa Hospital; Dr Elias Sory, Director-General of the Ghana Health Service (GHS), and Dr Nelson Damali, Obstetric Gynaecologist at the Korle-Bu Teaching Hospital. The rest were,: Dr Gloria Quansah Asare, Head of Family Health, GHS and Nana Oye Lithur, Africa Regional Co-ordinator of the Commonwealth Human Rights Initiative.
Dr Quansah Asare said Ghana, like other developing countries, does not have the full complement of health care at health facilities to tackle the problem effectively.
She said there was the need to make sure that equipment was available and steps needed to be taken to address the problem of delay in getting to the health facility, adding that the road map to efficient maternal and new-born care was to equip adolescents with knowledge about reproductive health care.
Dr Sory said socio-cultural difficulties encountered by expectant mothers, such as crossing a river to the health facility, and with some perceptions in some traditional setups where women who deliver their babies at the hospitals are laughed at, the problem will still persist.
He also said there was the need to train more midwives to offer comprehensive, emergency obstetric care at the various levels of service delivery.
Nana Oye, who is also a member of the Steering Committee of the Safe Motherhood Initiative, stressed the need for doctors and health service providers to counsel and explain issues to patients and expectant mothers, who must also be given the opportunity to ask questions to know more about pregnancy and the risks associated with it.
She said that was necessary to empower women with knowledge on maternal health and reproductive rights for them to make informed choices on their reproductive health needs.
Dr Fofie spoke about the constraint and challenges confronting health personnel in the rural areas and suggested an incentive package to boost the morale of staff in those areas, as well as encourage others to accept posting to those areas.
Dr Damali called for the provision of basic materials and equipment and the expansion of infrastructure to meet the demands on health facilities, the result of increased hospital attendance due to the provision of free, medical care for pregnant women. He also said non-governmental organisations and individuals and related agencies and organisations should help strengthen the health care system.
The Majority Leader and the Member of Parliament (MP) for Nadowli West, who identified poverty and education as major constraints to maternal health care, called on all stakeholders to come on board to invest in sectors that support essential maternity and basic health-care services to strengthen health systems and improve maternal and new-born care.
He said in addition to enhancing information systems, it was also imperative to expand human resource, foster social mobilisation, establish equitable financing and develop infrastructure, transportation and the referral process.
The UNICEF Ghana Representative, Dr Yasmin A. Haque, asserted that maternal mortality and neonatal deaths were not about statistics, since the loss of the life of one woman through maternal death was painful. For that reason, she said the launch of the report provided an opportunity to count and investigate every life lost as a result of pregnancy and childbirth.
In doing so, we will all recognise the roles we have to play to complement efforts of health professionals, who also need to put in their best including the right attitudes to offer quality care to mothers and enhance safe motherhood in Ghana.