http://www.irinnews.org/irin-fp.aspxUpdated everydayen-gbWed, 17 Mar 2010 18:54:08 GMTJOHANNESBURG Wednesday, March 17, 2010 (IRIN) - Ethembeni Enrichment Centre, a school in a run-down part of Port Elizabeth, the largest city in Eastern Cape, South Africa's poorest province, has achieved a remarkable 100 percent pass rate for a dozen years. But officials from the education department, sent on a fact-finding mission to learn from the school's success, are running more than two hours late.JOHANNESBURG Wednesday, March 17, 2010 (IRIN) - Ethembeni Enrichment Centre, a school in a run-down part of Port Elizabeth, the largest city in Eastern Cape, South Africa's poorest province, has achieved a remarkable 100 percent pass rate for a dozen years. But officials from the education department, sent on a fact-finding mission to learn from the school's success, are running more than two hours late.

Irritation is discernible in the voice of school principal Elbe Malherbe - punctuality is one of the few rules that must be abided by teachers and pupils alike. "When ... [it's time to] start, you start," Malherbe told IRIN in clipped replies during a telephone interview. Then, in a sudden change of tone, she said: "I wish you could see through the phone what I am seeing."

It is the first day of applications for the 2011 school year and a woman in traditional Xhosa attire is filling out a form for her child. Ethembeni only accepts pupils whose mother tongue is Xhosa, which generally translates into poor and black. The annual school fees are R3,800 (US$506), excluding stationery.

Many poor parents make sacrifices to keep their children in school, but Malherbe believes in affordable - not free - education, because it is an "investment by pupils, parents and teachers [that] everyone must buy into".

The language of instruction is English. Apart from not brooking tardiness, the school's other non-negotiables are that class attendance is compulsory, home work must be completed, pupils must clean the classrooms and grounds every day, and parents must be involved in their child's education.

"The classrooms were barely furnished. The driveway to the school was a rocky, narrow passage ... The school hall was packed with a few hundred eager faces, the children virtually sitting on top of one another on the floor ... I saw struggle, hunger and poverty etched into each child's countenance," educationist and vice-chancellor of the University of the Free State, Jonathan Jansen, recounted after a recent visit.

"For any child to pass under these difficult circumstances, it would take a miracle," he wrote. Yet nearly two-thirds of the 70 pupils in Ethembeni's 2009 matric, or final year, class achieved a university-entrance pass, while other financially comparable schools hung on at the bottom of the academic achievement ladder.

The school has no library, no science laboratory, although there is a computer that gives the 400 pupils internet access. The government pays for 11 of the 17 teachers; the salary shortfall of the six other teachers has to come out of the school fees.

The compactness of the school is part of its success. "In schools of a thousand [students], how can you know all the parents? If I have a problem with a child, or they have not done their homework, I phone their parents and they are here in five minutes," Malherbe said.

"We're not Einsteins here - we teach. It's nice to be part of a winning team. With nothing, you can still be successful if the heart is right and the spirit is right."

Ethembeni, which means "place of hope", swims against the prevailing national current in education, where standards have been steadily declining - in contrast to school fees.

More money, less education

The government's answer to the malaise is to throw more money into the education system; in the 2010/11 financial year it budgeted R165 billion (US$8.6 billion) for the sector, a 17 percent above inflation increase from the previous year.

The matric, or final high school exam, is used as a benchmark for the state of education in South Africa. Of the 550,227 pupils who wrote their final examinations in 2009, 61 percent passed, and 19.9 percent of those achieved the required marks to qualify for tertiary education.

Marius Roodt, an education analyst at the South African Institute of Race Relations, a policy and research organization, told IRIN the current teaching standard was akin to Bantu education - the system imposed by apartheid prime minister Hendrik Verwoerd, who said blacks should only be educated to be "hewers of wood and drawers of water".

"It is very unlikely that there will be an increase in matric pass rates. In 2004 the pass rate was 71 percent, and it has been on a steady downward trend since then, with each year reflecting a decrease. This is a trend that is likely to continue into the future, at least in terms of the quality of the qualification," Roodt said.

He attributed the decline to the political influence of the 240,000-member South African Democratic Teachers Union (SADTU), the country's largest teacher union and an affiliate of the Congress of South African Trade Unions (COSATU), which is an alliance partner of the ruling African National Congress.

"An example was when the union encouraged members to campaign for President Jacob Zuma prior to last year's general election, instead of teaching," he said.

"Although teachers should be allowed to be unionized - like any profession in any democracy - the influence of SADTU is malignant and not benign. It is possible that SADTU has the interest of only its members at heart, and not that of the pupils in South Africa's schools," Roodt commented.

"The reintroduction of the 'school inspectors' system, which would greatly improve the quality of the country's teaching, has been resisted by SADTU for some time. The union has also opposed systems to monitor teacher performance," he said.

Zuma announced in his 2010 State of the Nation address that a system of oversight would be instituted to monitor schools and ensure that teachers were in class to teach.

SADTU spokesperson Nomusa Cembi told IRIN that the union objected to the reintroduction of school inspectors, and did "not know where the president got the information that teachers are only in class for three hours, or so, a day."

Zuma first made the claim in a speech to school principals in KwaZulu-Natal Province, who gathered at the Durban International Convention Centre in August 2009. "We need to confront certain realities. For example, teachers in former whites-only schools teach in class for an average of 6.5 hours a day, while teachers in schools in disadvantaged communities teach for around 3.5 hours a day. The result is that the outcomes are unequal."

A recent survey published by Tokiso, an independent labour dispute resolution body, found that the teachers' union was responsible for 42 percent of all work days lost through industrial action between 1995 and 2009. Cembi said this gave the impression that SADTU members "strike at the drop of a hat".

Tanya Venter, CEO of Tokiso, told a local newspaper, Business Day, that SADTU's participation in the 2007 public sector strike was the main reason for the union recording such a high rate of absenteeism.

A recent World Bank working paper: No More Cutting Class? Reducing Teacher Absence and Providing Incentives for Performance, found "each additional 5 percent increase in teacher absence reduces learning by 4 to 8 percent of a year’s learning for the typical student."

Cembi said responsibility for the deterioration of education should be shared among learners, teachers, the education department and the government. She was unable to provide any data on whether or not a SADTU teacher had ever been dismissed for poor performance.

Zimbabwe's loss, South Africa's gain

Government has been widely blamed for creating a critical shortage of teachers trained in science and mathematics after it closed teacher training colleges in 2000 and put the onus on universities to produce educators. The government is now considering re-opening the teacher training colleges.

One solution has been to recruit teachers from Zimbabwe. Dickson Masemola, head of education in Limpopo Province, which borders Zimbabwe, said his department had hired 600 Zimbabwean educators to teach maths, science and commercial subjects, resulting in a turnaround in academic performance.

Mbali Thusi, a spokesman for the education department of KwaZulu-Natal, said a number of foreign teachers, especially in maths and science, were working in the province, and more would be hired because of the shortage of qualified teachers in these fields.

"The problem is more severe in rural schools - most maths and science teachers prefer to work in urban areas," Thusi said. "But we are eager to recruit more foreign teachers because of the shortages ... We have sent requesting documents to the national department to give us a go-ahead. We want to recruit hundreds of these teachers to plug the holes in our system."

The head of the KwaZulu-Natal School Governing Bodies Association, Reginald Cheliza, told IRIN: "We would like our children to succeed in school, but it is clear that this is not happening. Some of the problems start at school level, others at provincial or even national level."

cm/go/he http://www.irinnews.org/report.aspx?ReportId=88452KATHMANDU Tuesday, March 16, 2010 (IRIN) - Nepal is boosting efforts to tackle child malnutrition, which is so widespread that every other child under five has been found to be malnourished.KATHMANDU Tuesday, March 16, 2010 (IRIN) - Nepal is boosting efforts to tackle child malnutrition, which is so widespread that every other child under five has been found to be malnourished.

Alarmed by the situation, officials say plans are afoot which will see combined action across a range of ministries in addition to activities by the Health Ministry, traditionally responsible for the issue.

“Multi-sectoral nutrition action has been planned. This was endorsed by several ministries recently, and for the first time they will be working together actively,” Rajkumar Pokhrel, a nutritionist and head of the government’s nutrition programme at the Department of Health Services, told IRIN.

The plans, which will include the ministries for women, local development, agriculture and education, will be scaled up this year amid an increase in support from aid agencies, according to department officials.

An expansion of feeding programmes for infants, young children and women in food-deficit areas is envisaged.

There will also be increased coverage of the government’s micronutrient programme aimed at pregnant women, mothers and their infants, which will include more dosing with Vitamin A and iron to prevent anaemia.

Iron deficiency anaemia is a major public health issue in Nepal, where 36 percent of women aged 15-49, and nearly half (48 percent) of children aged 6-59 months, are anaemic, according to the Health Ministry.

"This will drastically reduce anaemia among women and children," said Pokhrel.

Malnutrition widespread

A report from the Department of Health and the UN Children’s Fund (UNICEF) released earlier this month found that 50 percent of Nepali children under five are malnourished, 49 percent are stunted and nearly 2 percent are severely malnourished.

The problem is particularly pronounced in underdeveloped food-deficit areas of the far- and mid-west regions where more than 27 percent of children are acutely malnourished, Pokhrel said.

“In such areas, there is a need to provide food rations which include fortified super flour also for the mothers,” he said.

Health experts say poor maternal health among Nepali women is directly contributing to child malnutrition; nearly a quarter of the country’s estimated 14.5 million women are malnourished, afflicted particularly by a low body mass index.

Meanwhile, nutrition workers from NGOs say the government has not done enough to educate women and health workers about nutrition at a local level, especially in the most remote areas.

“The government has not done anything vital. It has even failed to raise awareness about basic education about nutrition,” Som Paneru, a nutrition expert and executive director of health and education NGO, the Nepalese Youth Opportunity Foundation (NYOF), [http://www.nyof.org/] told IRIN.

Agency support

Officials say the World Bank, UNICEF and the United States Agency for International Development (USAID) recently completed a nutritional gap analysis to assess child and maternal nutrition needs.

The findings are to be integrated into the Nepal Health Sector Programme, which aims to expand access to and the use of essential health care services, and is supported by the World Bank and the UK Department for International Development (DFID).

The first phase of the programme will expire in July this year and the Ministry of Health and Population is drawing up plans for its implementation over the next five years.

“The World Bank now is bringing significant funding which hasn’t been previously specifically for nutrition within the national health sector plan. So we know the interventions that will work,” Gillian Mellsop, UNICEF country representative in Nepal, told IRIN.

However, officials say they have yet to sort out how efforts will be coordinated across the relevant ministries, while challenges lie ahead in implementing programmes at the local level.

“We still do not have specific planning for community-level programmes and we have not been able to make targeted area-focused programmes,” said Pokhrel.

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http://www.irinnews.org/report.aspx?ReportId=88442AWKA Monday, March 15, 2010 (IRIN) - Interceptions and convictions of human traffickers and smugglers have risen year-on-year in Nigeria since the government passed legislation to ban the trade in 2005, but the volume of trafficking is still high and progress on convictions needs to speed up, say government officials.AWKA Monday, March 15, 2010 (IRIN) - Interceptions and convictions of human traffickers and smugglers have risen year-on-year in Nigeria since the government passed legislation to ban the trade in 2005, but the volume of trafficking is still high and progress on convictions needs to speed up, say government officials.

"Trafficking rates have come down,,,and convictions are up," Ego Uzoezie, Commissioner of Women Affairs in Anambra State Ministry told IRIN, "but the progress is not as high as we'd like when we compare it to the efforts the government has put in."

Nigeria uses the UN definition of trafficking, which includes recruiting, transporting, harbouring or receiving people through use of force or coercion, abduction, or fraud; and exploiting a person in a position of vulnerability for forced labour or servitude.

How many men, women and children are trafficked each year in Nigeria is unknown – the only figures on record are the number of people law enforcement officers have intercepted since the National Agency Prohibiting Trafficking in Persons (NAPTIP) was set up in 2004.

Over 4,000 victims were intercepted between 2004 and the end of 2009, with the number rising each year to reach 1,000 in 2007 and 1,269 in 2008, according to NAPTIP.

Most children trafficked and smuggled in Nigeria are sent by families to work as domestic labourers, with a minority used as street beggars, or sold into marriage or to illegal orphanages, according to NAPTIP. Families pay middlemen to take children across the borders to West African destinations like Togo and Cameroon, or north to Saudi Arabia, said Simon Chuzie Egede, the head of NAPTIP.

The UN Children's Fund (UNICEF) child protection specialist in Abuja, Sharon Oladiji, said poverty was still the main reason families pushed children to leave home to find work.

"I was sold by my mother because of a 20,000 naira [US$137] debt she owed a yam-seller. Later I was forced into early marriage by him [the seller]," said Grace Ikede (not her real name), from Rivers State. She was lucky - the man she married helped her trace her family when he heard her story. "We are on the look-out for the seller, but he is on the run," she told IRIN.

Convictions up

The government has been making progress in the fight against traffickers and smugglers, partly because the Ministry of Women's Affairs, NAPTIP, the police, immigration services, and child protection agencies such as UNICEF, have started working closely together, Egede told IRIN. Prosecutions have steadily risen since 2006, with 67 traffickers convicted between 2004 and the end of 2009, UNICEF said.

On the US State Department list rating countries' efforts to eliminate the worst forms of trafficking, Nigeria rose from tier-two to tier-one status

"This is a clear sign Nigeria has made progress in preventing trafficking, punishing traffickers and protecting children," UNICEF's Oladiji told IRIN.

In 2009 the government also set up a Victims Trust Fund, through which assets confiscated from traffickers are transferred to victims. NAPTIP said so far the assets of two traffickers in Sokoto State had been seized.

But prosecuting traffickers was still "achingly slow", Oladiji said, with dozens of cases awaiting trial. A 2009 report on Nigeria's justice system noted that detainees could wait up to nine years for conviction. NAPTIP's southern zonal coordinator, Ijeoma Okoronkwo, said it would take state-by-state reform of the prosecution system to speed up the rate.

Next steps

Oladiji told IRIN that preventing trafficking would have to be stepped up in view of the sluggish prosecution service, and stressed that this must be a community effort, not a family-by-family attempt. UNICEF has been working with communities in at-risk border areas to encourage them to protect vulnerable families from turning to child smugglers.

A human rights lawyer in Anambra State, Ben Nwosu, told IRIN that punishments should be made more severe to deter traffickers. "The fines and jail terms given to those convicted and sentenced are still not enough compared to the inhumane treatment that the traffickers subject their victims to."

NAPTIP is evaluating the impact of its recent efforts – including the Victims Trust Fund, among other tools – to better prioritize its funding, Egede told IRIN.

To attract more funding for the fight, NAPTIP and all other agencies involved should develop clear action plans on prevention and prosecution, so that donors could peg funding to the initiative, UNICEF's Oladiji told IRIN.

The governments of Italy, Switzerland, Finland and the United States have recently supported anti-trafficking activities in Nigeria.

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http://www.irinnews.org/report.aspx?ReportId=88424DAKAR Monday, March 15, 2010 (IRIN) - IRIN has asked a range of experts over the past year why malnutrition is recurrent in Niger even after decades of donor support and government programmes. Two of the hardest-hit regions were focused on - Diffa, which has borders Chad, and Zinder, which borders Nigeria.DAKAR Monday, March 15, 2010 (IRIN) - IRIN has asked a range of experts over the past year why malnutrition is recurrent in Niger even after decades of donor support and government programmes. Two of the hardest-hit regions were focused on - Diffa, which has borders Chad, and Zinder, which borders Nigeria.

Hassane Doudou Boukary, Zinder regional director of the UN Population Fund:

"Demography is at the heart of [efforts to reduce the malnutrition rate in Zinder below the 15 percent emergency threshold]. In Niger, each woman has on average 7.1 children; in Zinder it is 7.4. Unless we can resolve the issue of family planning, there will be an open door for more malnourished children. Contraception needs to be one of the strategies to fight malnutrition."

Patrick Barbier, head of the Niger mission of Médecins Sans Frontières (MSF):

“Even though there is a law that guarantees no-fee care for under-five children, it is not enforced. Access to care would give a child the resilience to withstand [food security] shocks better.”

Amadou Harouna, Zinder regional director of the Health Ministry:

"You can heal people, [but] they will always fall sick: we must educate them. But there is not enough action at the community level. There is a lack of awareness and education on nutrition issues. When there is a food distribution, people come, we distribute the food quickly because they are so rushed, but we do not know what happens when they get home. There is also the fact that [those trying to combat malnutrition] focus too much on the child, forgetting that there is a family around [that child]."

Aboubacar Mahamadou, deputy director of the Health Ministry’s office of nutrition services:

“It is a vicious circle of constant crises and international actors responding to them. There is no exit strategy for these groups. Their goal should be to prepare a government to face crises. Dependency [on these NGOs] is not good because the state does not stand on its own. It is like these emergency NGOs put out the fire, but the gas is still on. The government [until now] has not capitalized on crises to draw lessons so donors can see we have learned… There is lack of government financing on nutrition. We [office of nutrition services] want the nutrition problem recognized not only as a food security and malnutrition issue, but as something needing to be tackled in a continuum from prevention to treatment. Costs can be hard to quantify, but this a critical activity.”

Yacouba Adjahararou, Tanout regional director in the Agriculture Ministry:

“The population eats cereals [millet, sorghum] of little nutritional value. There is no off-season cultivation. However, where vegetable gardening has been developed [using drip irrigation], people eat what they produce [cabbage, lettuce, carrots, tomatoes, onions] and they like it.”

Animal malnutrition

Kosso Matta Kellou, Diffa regional director in the Livestock Ministry:

“In a pastoral region like Diffa, international agencies focus on under-five children in their fight against malnutrition, but the problem starts with animals. Animals represent a family’s savings, their income, their food source, their lives and livelihoods. With dwindling water resources, animal illnesses, the shortage of pasture and fodder, herders and breeders are losing dozens of animals at a time. You can go a long way to preventing human malnutrition if you can prevent animal malnutrition. The two are linked. There is not enough investment in livestock - 90 percent of the population is made up of herders and livestock brings in most of the region’s income, and investment is not proportionate.”

Mamane El Hadj Omar, Diffa director of the NGO Helen Keller International:

“There needs to be economic development. Without that, there will always be malnutrition. It is not only a question of treating the malnourished, but also investing in education. A mother’s level of education determines how receptive she is to [nutrition education] outreach… We need to harmonize our interventions. A village has one person coming through and telling them what to do; that person leaves and the next [person] says ‘no, don’t do that, this is what you should do.’”

El Hadji Abdou Salissou, president and deputy secretary-general of the committee of nutritional crises in the Diffa governor’s office:

“Water is a huge problem here. The growing cycle keeps getting shorter. The water basin [used for growing] is increasingly covered in sand. It is not that people do not want to work, but there is no water. There have been attempts to bring in motor pumps, but that did not work. There is not enough funding for electricity [to power the pumps]. This region has the country’s fastest growing population, along with extreme poverty, water shortages, rain problems and few international actors here.”

Jenny C. Akers, economist at US-based Tufts University and fellow, Center for Global Development:

"Niger is a highly risky agro-climatic environment, with 300-500mm of rainfall per year, poor soil quality and subject to periodic droughts and pest infestations. All of these factors, but especially the periodic shocks, reduce agricultural production on a regular basis and discourage investment in agricultural production – as it is a highly risky venture. The frequency of shocks… can either be exacerbated or mitigated by agricultural markets.

"If fuel prices are low, if only a few areas were affected by drought and prices in northern Nigeria, and if surrounding countries’ prices were lower than those in Niger,  then traders could import grains from surrounding countries to make up the local deficit and keep prices fairly stable in the country. If, however, multiple markets – especially those in the breadbasket regions of Niger, Maradi and Zinder – are affected by drought, and neighbouring countries also are affected by shocks, then Niger can’t import. This is what happened in 2005 - prices soared partially because of a combination of droughts but also because of fewer imports from neighbouring countries.”

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http://www.irinnews.org/report.aspx?ReportId=88425ADDIS ABABA Monday, March 15, 2010 (IRIN) - Ethiopia has made some headway towards improving maternal and child health, but more needs to be done to reduce the high number of preventable deaths, says an official. "I know that we have gaps in effectively addressing maternal health, but previous assessments are showing us that if we [make a] concerted effort, we can achieve goal number five of the MDGs [Millennium Development Goals]," Kebede Worku, State Minister for Health, said.ADDIS ABABA Monday, March 15, 2010 (IRIN) - Ethiopia has made some headway towards improving maternal and child health, but more needs to be done to reduce the high number of preventable deaths, says an official.

“I know that we have gaps in effectively addressing maternal health, but previous assessments are showing us that if we [make a] concerted effort, we can achieve goal number five of the MDGs [Millennium Development Goals],” Kebede Worku, State Minister for Health, said.

The ministry has just concluded a two-month campaign to promote safe motherhood but public relations officer Ahmed Emano said the campaign would continue in various forms in upcoming months.

“We are not only working to achieve the MDGs, but to have even more ambitious targets to improve maternal health in the country,” the minister told IRIN at the end of the first phase of the campaign, No woman should die while giving life.

The campaign, according to the health ministry, is being positioned as the start of a long-term mobilization initiative - ultimately to be extended through 2015 in line with the MDGs.

It aims to raise public awareness, facilitate dialogue on the importance of improving maternal health and secure commitments for accelerating reduction of maternal and neonatal mortality.

Dire situation

Ethiopia’s 2009 demographic and health survey showed that 25,000 women died every year giving birth, while 300,000 babies died annually across the country. In terms of personnel, the country had only one midwife and three doctors for every 100,000 citizens. Only 6 percent of births occurred in a health facility attended by skilled health personnel, a report by the UN Population Fund stated. As a result, many women deliver under the care of traditional birth attendants – which can be risky.

Amina Nuri, 32, for example, lost two of her children due to complications. “The traditional birth attendant was very much respected in my area,” she told IRIN in Hawassa Referral Hospital in the Southern Region. “I don’t know what went wrong with my delivery twice.”

Eventually, Amina undertook a difficult three-hour journey to the hospital to deliver another child. “I had to walk some three hours to reach here [Hawassa Referral Hospital],” she said. “I am bleeding now; the nearby [medical centre] could not stop it. I am afraid that I might lose this one as well.”

Million Getachew, a gynaecologist at the hospital, however, said Amina’s case was not common because there were relatively better facilities in the Southern Region. “We are trying our level best to address maternal health,” he said. “The hospital is equipped with all the necessary equipments and the regional government has also given attention to address maternal health. We are providing the best treatment in the country.”

Improvements

Earlier this year, the Minister of Finance and Economic Development, Sofian Ahmed, told parliament that out of eight MDGs, improving maternal health was a big challenge for the government.

“We need to be able to provide modern health facilities to every district in the country,” he said. “This requires a lot of focused effort and development partners’ support.”

Despite the challenges, international partners say Ethiopia will achieve this goal. “I am confident that Ethiopia is on the right track towards achieving the Millennium Development Goals to reduce maternal and child mortality,” Ted Chaiban, representative of the UN Children’s Fund (UNICEF), said.

The MDGs are eight international development goals that all 192 UN member states and at least 23 international organizations have agreed to achieve by the year 2015. They include reducing extreme poverty, reducing child mortality rates, fighting disease epidemics such as HIV/AIDS, and developing a global partnership for development.

According to Ethiopia’s ministry of finance and economic development, the country has made “astounding” progress on the goals. In the early 1990s, indicators of poverty, malnutrition, and basic health were among the worst in the world, with widespread hunger and food insecurity, a literacy rate of only 26 percent, and an infant mortality rate of 123 per 1,000. Fewer than a third of children were in school.

By 2008, primary school enrolment had topped 91 percent, infant mortality fell to 77 per 1,000, while the proportion of the population with access to clean water increased to 52.4 percent, according to a government report.

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http://www.irinnews.org/report.aspx?ReportId=88428DAKAR Friday, March 12, 2010 (IRIN) - This year there are less than half the reported meningitis infections than in the same period in 2009, but more patients are dying - 13 percent in 2010 versus 8 percent in 2009 - according to the World Health Organization (WHO) Multi-Disease Surveillance Centre in Ouagadougou, Burkina Faso, which tracks 14 countries prone to meningitis outbreaks between Senegal and Ethiopia.DAKAR Friday, March 12, 2010 (IRIN) - This year there are less than half the reported meningitis infections than in the same period in 2009, but more patients are dying - 13 percent in 2010 versus 8 percent in 2009 - according to the World Health Organization (WHO) Multi-Disease Surveillance Centre in Ouagadougou, Burkina Faso, which tracks 14 countries prone to meningitis outbreaks between Senegal and Ethiopia.

Infections typically "peak" at the end of March or early April, when the disease is most widespread. "This year pales compared to last year's outbreak," the West Africa medical expert at the European Commission Humanitarian Aid (ECHO), Amparo Laiseca, told IRIN.

In response to the 2009 outbreak, ECHO provided more than US$6 million to support meningitis vaccinations in the region. Based on the current threat, ECHO will spend about $400,000 at most this year, she said.

Below is a snapshot of the epidemic across the region.

Ghana

More than 100 people have been hospitalized with meningitis complications and another 27 have died, according to the Ministry of Health. WHO delivered 100,000 doses of meningitis vaccines on 2 March, the second delivery this year from its emergency stock of meningitis vaccine.

Prisons received 200 doses and another 300 went to security agency personnel on a peacekeeping mission in Bawku in Ghana's upper east region, a flashpoint of electoral rows, land disputes and ethnic violence.

The north, upper east and upper west of Ghana, 12 hours by car from Accra, the capital, have all reported cases.

W135

At $1.37 per dose, the vaccine for preventing the spread of W135 costs one-third more than the vaccine used to treat the more widespread A and C strains.

Because W135 is rarer, there is only one manufacturer and fewer doses are required, according to the multi-agency International Coordinating Group (ICG), which manages an emergency stock of meningitis vaccines. ICG has 2.7 million doses of the W135 vaccine, but 6.3 million of the meningitis A and C vaccines.

After a seven-year absence, W135 reappeared in the region in 2009, contributing to one of the largest epidemics in the past decade.
Ghana's Health Minister, Benjamin Kumbuor, told IRIN on 4 March: "I just returned from a tour of the affected areas. It was a new strain [W135] ... happily, the cases are dropping. We have not had any more casualties."

Burkina Faso

On 12 March the Ministry of Health said there had been 2,188 reported cases and 336 deaths, and the 15-percent fatality rate had not changed in the past month. Health Minister Seydou Bouda said the situation was "under control", and after vaccination campaigns the five most recently affected of the country’s 65 districts were no longer in epidemic phase (10 infections per 100,000 residents).

Benin

WHO representative Léon Kohossi told IRIN that in the central Benin towns of Tanguiéta and Bassila the pneumococcal meningitis bacteria had led to a number of deaths. Overall, the country has had 104 reported infections and 16 deaths - mostly from the more common "A" meningitis strain - as of 28 February. Benin has not yet introduced the pneumococcal vaccine.

Subsidized mass roll-outs of pneumococcal vaccine have taken place only in Rwanda and the Gambia, starting in 2009. The Global Alliance for Vaccines and Immunisation (GAVI) has estimated that this vaccine could save the lives of seven million children globally over the next two decades.

To qualify for GAVI support for this vaccine – which brings down the price from the retail cost for low-income countries of $7 to just $0.15 per dose - income-eligible countries must give at least half of all newborns the third dose of the diphtheria, pertussis (whooping cough) and tetanus (DTP3) vaccine.

Niger

The recently formed post-coup government is drafting a response plan. As of 28 February, 425 infections and 34 deaths have been reported.

Nigeria

Alejandro Javier Costa, of ICG, said Nigeria's request for vaccines from the emergency meningitis vaccine stock was being reviewed. As of 21 February, 565 infections and 55 deaths have been reported.

Togo

The country has experienced one of the region's highest fatality rates - as of 28 February there have been 188 infections and 49 deaths - but the data is hard to interpret as it may be incomplete, according to ECHO's Laiseca. "Health workers often do not have any means to communicate the information to a central level. It is possible not all infections were recorded [which would decrease the fatality rate.] "

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http://www.irinnews.org/report.aspx?ReportId=88414NIAMEY/ZINDER Thursday, March 11, 2010 (IRIN) - A severe food and malnutrition crisis is looming in Niger, according to aid agencies. More than 20,000 under-five children are being treated for malnutrition nationwide and at least another 200,000 are at risk of severe malnutrition, according to the Office for the Coordination of Humanitarian Affairs (OCHA).NIAMEY/ZINDER Thursday, March 11, 2010 (IRIN) - A severe food and malnutrition crisis is looming in Niger, according to aid agencies.

More than 20,000 under-five children are being treated for malnutrition nationwide and at least another 200,000 are at risk of severe malnutrition, according to the Office for the Coordination of Humanitarian Affairs (OCHA).

“You need to go to the field to realize that we need to act now,” said Kalil Hamadoun, Médecins Sans Frontières (MSF) field director for Zinder region in southern Niger, which had the country’s second highest percentage of children underweight for their height, according to a December 2009 government study.

Selling prized cattle, cutting meals, eating food intended for animals and scrounging for anything to sell as firewood or animal feed have become increasingly common, according to local officials and the national information system for livestock sales.

Access to food, rather than its availability, is turning out to be the main problem in 2010, according to the US famine monitoring group, FEWS NET.

The needs are urgent and the response must be immediate, UN Office of Coordination for Humanitarian Affairs (OCHA) head of mission Modibo Traoré told IRIN. “Everything takes time. [Aid delivery] is long and difficult and it can take weeks before it makes it to its destination.”

Food prices up, incomes down

Food and fodder prices in parts of the south are up around 30 percent on 2009, according to FAO and Belgian NGO Aquadev.

But March incomes have dropped to half of what they were last September due to more agriculture workers competing for dwindling jobs, according to the US famine monitoring group FEWS NET.

“We need to ensure people have access to food… We are not even in the hungry season yet,” Aboubacar Mahamadou, the Health Ministry’s deputy director of nutrition services, told IRIN, referring to the June-September planting season when most families have finished eating their previous harvests and are waiting for the next one in October.

Interventions

The World Food Programme (WFP) is planning "blanket" food distributions - months earlier than usual if needed - to 500,000 children aged 6-23 months in 20 of the neediest communities.

“If we look at a map of interventions at the moment, we see they are drops of water in the ocean [of need],” WFP regional director in Zinder, Doumbaye Djimadoumngar, told IRIN.

OCHA has estimated it will cost more than US$200 million to cover 60 percent of Zinder’s food needs before the next harvest, and to continue nutrition activities.

The European Commission for Humanitarian Aid (ECHO) has pledged an additional US$27 million to fight malnutrition in Niger and neighbouring Sahelian countries. The exact amount for Niger will be decided in the coming months. Last year, Niger received $17.7 million from ECHO.

The UK government has recently announced additional emergency funding for Niger. This comes on top of $81 million emergency aid from the European Commission, Islamic Development Bank, and the governments of Japan, Spain and the USA.

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http://www.irinnews.org/report.aspx?ReportId=88402GAZA CITY Wednesday, March 10, 2010 (IRIN) - A half-finished two-story building in central Gaza City is one of the few places providing support to amputees, most of them civilian victims of the Israel-Palestinian conflict, as they try and come to terms with their injuries. GAZA CITY Wednesday, March 10, 2010 (IRIN) - A half-finished two-story building in central Gaza City is one of the few places providing support to amputees, most of them civilian victims of the Israel-Palestinian conflict, as they try and come to terms with their injuries.

Ten patients were waiting to see Dr Hazem al-Shawwa, the director of the Artificial Limb and Polio Centre, when IRIN visited. Mostly young, they had been caught in the violence of Israel’s 23-day assault on Gaza at the end of 2008 and beginning of 2009, and were still learning to use their new prosthetic limbs.

“We have 250 new amputees following the Israeli war to add to the 5,000 cases we had before the war,” said al-Shawwa. “Some of the injured from the Gaza war are still having problems with their amputated limbs as they were not treated properly at the time due to the hectic situation; initial treatments focused on saving lives.”

A new upper floor extension to the centre is under construction, reflecting the demand for its services, but a lack of funds has delayed work.

In the centre’s ground-floor training room, 15-year-old Jamila al-Habbash took a firm grip on the parallel bars and shuffled forward. She lost both her legs in a missile strike by an unmanned Israeli drone as she played on the roof of her home in eastern Gaza city: her sister and cousin were killed in the blast.

Mohamed Ziada, one of five specialists at the centre, said Jamila was making good progress since her artificial legs were fitted in December, and may soon not need her crutches. He pointed out that treating teenagers was expensive as they quickly outgrow their prosthetics and need numerous re-fittings.

“Worse than a nightmare”

Fifteen-year-old Ghassan Mattar also lost his legs when an Israeli missile hit his home in eastern Gaza City on 5 January 2009, an incident documented by the Palestinian Centre for Human Rights (PCHR). “I still can’t believe I’ve lost my legs. It’s worse than a nightmare,” he told IRIN.

The only rehabilitation hospital with the capacity to treat amputee patients effectively is the al-Wafaa Rehabilitation Centre in northern Gaza. Ghassan should have been sent there directly but the hospital was hit by artillery fire during Israel’s Gaza incursion, and its wards were evacuated, according to PCHR.

Ghassan was able to leave Gaza for Egypt and received six months of treatment at the Palestine Hospital in Cairo. However, back in Gaza he found his artificial legs were giving him problems as they did not fit properly so he visited the artificial limb centre and got a better fitting pair.

A below-the-knee prosthetic costs about US$800 at the centre. An above-the-knee limb is twice as much, and an arm costs $1,200. Although seemingly expensive, Ziada told IRIN it was a fraction of the cost charged in other countries.

Imports interrupted

The problem facing the centre is that a blockade of the Gaza Strip by Israel since June 2007 has interrupted imports of both prosthetic limbs - mainly from Germany - and the raw materials with which to make them.

“We use hundreds of different parts, plastics and materials to make prosthetic arms and legs. Without even just one of the materials, the limb cannot be made,” said Ziada.

It takes about 30 hours to manufacture a limb when all the parts are available. “The Red Cross helps the centre to mediate between us and the Israelis to let materials cross, which takes about three months,” Ziada added.

Prosthetics specialists from other countries who had tried to come and train Gazan doctors had been denied entry into Gaza, according to Ziada. “We need at least another five specialists because of the large number of amputees from the Gaza war.”

The centre is assisted by the UN agency for Palestinian refugees (UNRWA) and NGOs Handicap International and Islamic Relief.

Israel says the aim of its 27 December 2008-18 January 2009 incursion was to destroy the military infrastructure of Hamas, the ruling party in Gaza, and to prevent the firing of rockets into Israel. According to the PCHR, 5,303 Palestinians were injured in the conflict.

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http://www.irinnews.org/report.aspx?ReportId=88378DAKAR Wednesday, March 10, 2010 (IRIN) - It costs more to vaccinate a child in Chad against polio - almost 70 US cents per child - than in any other country in the world at risk of polio outbreaks, according to the World Health Organization (WHO).DAKAR Wednesday, March 10, 2010 (IRIN) - It costs more to vaccinate a child in Chad against polio - almost 70 US cents per child - than in any other country in the world at risk of polio outbreaks, according to the World Health Organization (WHO).

It costs half as much to vaccinate a child in violence-wracked Afghanistan, Sudan or Somalia.

WHO polio coordinator Mohammed Mohammedi, who was kidnapped in Somalia in 2001 by militias and held hostage for four days, is now working in Chari Baguirmi, the Chad region with the second highest number of reported polio cases in 2009 after the capital, N'Djamena.

He told IRIN the main reason Chad had not been able to wipe out an outbreak after almost two years was lack of money and poor management. "Not enough of the money intended for polio campaigns makes it to the population in Chad." He reckoned only 60 percent of the funds for polio vaccination campaigns were used to fight polio.

In 2010 donors have been called on to raise US$10 million for polio eradication in Chad.

Corruption

Speaking to IRIN last December, Oliver Rosenbauer, spokesman for the multi-agency Global Polio Eradication Initiative (GPEI), said corruption boosts polio costs in Chad. "Less than half the children who need vaccinations are being reached in the capital, the most affected area. Campaigns have been poorly run and managed. There is poor financial tracking and almost non-existent management. "

The government's coordinator for polio vaccinations, Sylvain Djimrangar, told IRIN it had been a "challenge" to trace polio spending from the national level to health centres.

Chad's WHO representative Youssouf Gamatié told IRIN that while it is difficult to know how much money is misdirected, his team frequently reports that during campaigns there are no cars to transport vaccines - sometimes even no vaccinators. The government receives money for car rentals and US$10 per vaccination team of two people per day. A typical campaign lasts three days.

While GPEI's Rosenbauer pointed out the lack of political will and buy-in as longstanding impediments to eradicating polio in Chad, Gamatié told IRIN President Idriss Deby Itno is steadfast in cracking down on corruption. "[The president] explicitly said [in a recent meeting]: 'We have seen behaviour of local health staff that goes contrary to government action... It is the responsibility of the minister of health to take charge so that there is no longer this type of behaviour.'"

Role for regional governors

As of February, polio vaccination funds are sent to regional governors to increase their involvement - and oversight - of polio activities. No more costly trips for supervisors from the capital into the field, said Gamatié.

"Progress is being made," he told IRIN. "More and more, [decentralized] financial oversight committees are becoming operational; more and more authorities are involved, [and] national staff are sacked for mismanagement."

Government coordinator Djimrangar told IRIN regional financial committees should improve oversight. Starting in 2010, the government has started investing more money in health education for all vaccination campaigns.

There were 66 reported cases of polio in Chad in 2009, 15 of which were in the N'Djamena region. The virus causing polio is highly infectious; once it invades the nervous system, it can cause total paralysis in a matter of hours. WHO considers even one reported case an outbreak.

The health district reporting the most cases was in the Chari Baguirmi region, which has a population of 621,000, according to the latest census. It is suspected of being the origin of the latest polio outbreak, in April 2008.

WHO's Gamatié said polio vaccinations in Chari Baguirmi started one week earlier than the nationwide campaign - to allow enough time to reach all the children, some of whom have not been vaccinated in years. Vaccination plans and maps were drawn up for the first time.

One village vaccinator per village

The cases reported here in 2009 were "just the tip of the iceberg", WHO polio coordinator Mohammedi told IRIN. "Those cases were accidental discoveries. During vaccinations, we saw children who were paralyzed who may have been infected with polio." Twenty of 59 WHO designated health "catchments" do not have functioning health centres, he said.

WHO is piloting the recruitment of one village vaccinator per village - about 3,000 for Chari Baguirmi - rather than using roving vaccination teams that were required to be literate.

"What is important for a vaccinator is not so much that this person can read and write, but rather that the community respects them. Ideally, we can get the village chief. There is no missing children this way because the vaccinator lives right there," Mohammedi said.

The government receives 10 US cents per child vaccinated (proved by finger markings) rather than getting money upfront per vaccination team.

Once a village completes it vaccinations, a supervisor reviews progress. If a village vaccinated at least 90 percent of its under-five children, the vaccinators are paid.

"There is no reason we cannot wipe this virus out in the next six months," Mohammedi told IRIN. "Or even sooner."

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http://www.irinnews.org/report.aspx?ReportId=88381TANOUT Wednesday, March 10, 2010 (IRIN) - "Empty" increasingly describes villages around the southern Niger town of Tanout in Zinder Region: Water wells and pastures, fields and food banks - and slowly - entire villages, are emptying.TANOUT Wednesday, March 10, 2010 (IRIN) - “Empty” increasingly describes the southern Niger town of Tanout in Zinder Region: Water wells and pastures, fields and food banks - and slowly - entire villages, are emptying.

Of the 42 families in the village of Garin Dagabi, 13 have left in search of food and water, along with the heads of 20 other families.

During a typically four-month rainy season, the village had two good rains, said its leader, Issouf Boukary. “During the first rain, we planted millet, which started to grow… but then the entire harvest dried up.”

Insufficient rains nationwide [http://www.irinnews.org/report.aspx?ReportId=85296] led to a 31 percent slump in crop production compared to last year - 410,000 tons less - according to the government’s latest estimates.

Per-capita gross cereal production for Niger’s 15 million people is likely to be the lowest in 20 years, with more than half the country facing production deficits similar to those in 2004 that contributed to the country’s 2005 food crisis, according to the US famine monitoring group, FEWS NET.

The government has estimated that poor rains have forced some two million people to finish off their food reserves seven months before the next harvest. Another five million may soon follow.

A cereal bank set up three years ago in Garin Dagabi with 10 tons of cereal now has only three tons remaining. “We have a little money in the bank to buy other sacks [of millet], but at current [elevated] prices [in Zinder], we would have to go far to be able to afford it,” Boukary told IRIN.

Gouragass

It is not much better in the nearby village of Gouragass where farmers harvested about 10 percent of the millet, sorghum and beans they typically grow. “In a normal [rain] year, we can cover 9-10 months of our [food] needs, but this year was really bad: We did not get even one month of food after the harvest [October 2009],” said village chief Alhadji Idi.

A government distribution of 140 tons of millet in October 2009 to nine villages in the region is long gone. Remittances have done little to cover the gap, as in the past, both village chiefs told IRIN.

“The village has not known a situation this difficult since [the 1984 food crisis]. Even [2005] was not this bad. And the hardest part is only beginning,” Idi told IRIN. Villagers have cut in half how much they eat, he added.

Nigerien sociologist Issouf Bayard, originally from Zinder, told IRIN that 1984 was a pastoral and agricultural crisis, whereas 2005 was primarily agricultural.

“Now in 2010 we have agricultural and pastoral problems, plus a population that has doubled in size and health epidemics we did not have two decades ago.”

It will take some US$166 million to avoid a food crisis in Zinder, according to the UN Office for the Coordination of Humanitarian Affairs (OCHA).

Famine food

With food prices on average 30 percent higher in December in Zinder than in previous years, according to Belgian NGO Aquadev, households are turning to a wild weed known locally as ‘jiga’ - normally the fare of camels and locusts.

“Jiga is a famine food,” the local Agriculture Ministry director, Yacouba Adjaharou, told IRIN. “People normally eat it in small quantities. When they start eating more of it so early [in the season], it is a sign of hard times.”

Cattle sell-off

Families are selling their cows - including pregnant ones and calves - to afford food, according to the Food and Agriculture Organization (FAO). “This phenomenon is a sign of crisis, as a breeder would never sell his cow that recently gave birth if he were not in serious difficulty,” FAO emergency programme officer, Nourou Tall, told IRIN.

Malnourished animals and weak demand from Niger’s biggest customer, Nigeria, whose currency is worth less this year against the French franc (CFA), have reduced asking prices by up to half.

“Before, we could sell a ewe for at least US$42 and now we only get half as much,” said Gouragass chief Idi.

Digging deeper

Poor rains have worsened the shortage of hay - estimated at five million tons in 2008 by FAO - used as animal feed. This year, there is only enough for one-third of Niger’s cattle.

Even that will last at most another two months, according to a recent discussion hosted by FAO for groups working on food security. “The situation will be very critical starting in April,” FAO’s Tall told IRIN.

The government estimates an additional shortage of 32,000 tons of animal food, such as corn, of which FAO will provide 8,450 tons. Most will go to the most easterly region of Niger, Diffa, followed by Zinder.

Meanwhile, residents with no cattle are digging deeper - literally - to find cash, by selling anything that can be transformed into animal feed or firewood. “Because so many trees have been cut down, people are digging two to three metres to unearth the roots of large trees,” said Tanout Department’s agriculture director, Souleymane Roufaï Kane.

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http://www.irinnews.org/report.aspx?ReportId=88385BOSASSO Monday, March 08, 2010 (IRIN) - A long civil war, frequent droughts, unemployment and high food prices have led to an increase in the number of street children in Bosasso, the commercial capital of Somalia’s self-declared autonomous region of Puntland, with NGOs and government officials calling for urgent steps to resolve the problem. BOSASSO Monday, March 08, 2010 (IRIN) - A long civil war, frequent droughts, unemployment and high food prices have led to an increase in the number of street children in Bosasso, the commercial capital of Somalia’s self-declared autonomous region of Puntland, with NGOs and government officials calling for urgent steps to resolve the problem.

"In the past, most of the children on the streets of Bosasso were from south-central Somalia," said Muse Ghele, governor of Bari region. "Now we are noticing more and more locals both from urban and rural areas.”

Between 4,500 and 5,500 children are on Bosasso's streets, according to the governor.

Abdulaziz Mohamed Hamud, child protection consultant with OxfamNovib, told IRIN: “You have to understand that numbers of street children are estimates and could be even higher... There are no exact figures but the numbers seem to be increasing daily."

Young providers

The children, according to Abdihakim Farah Arush, chairman of the Bari Child Protection Network (BCPN), fall into two categories: those who work to help their families, mostly local and internally displaced (IDPs) who go home at night; as well as those who sleep on the street, mostly substance abusers.

The reasons for the children being on the street vary, he said. Many of those from south-central Somalia were separated from their families on their way north while others end up on the streets to help their families, or fend for themselves.

Shoe-shining and car-washing, serving as porters or washing sacks in the market are the jobs of most of the street boys in Bosasso.

Arush said while most street children were boys, more and more girls were joining them, cleaning business premises or people’s homes. Some children as young as two or three were put on the streets to beg by desperate families.

Hamud of OxfamNovib said most of the children suffered abuse and physical violence. "Many of them have the scars as proof. On the street at night they are easy prey with no one to protect them."

Risks

Many have been infected with "all sort of diseases, such as TB, skin diseases; while many others suffer from malnutrition. Most don’t know what they suffer from," Hamud added.

Abdullahi Said, 12, is on the street because he has to help his mother with his three younger siblings. He collects garabo (leftover khat) and sells it to those who cannot afford the good khat or he shines shoes. On average, he takes home 30,000 Somali shillings (about US$1) a day.

"What I make from garabo and shining shoes is what I take home to help my mother feed us,” he told IRIN. Said’s father died in 2009 so the responsibility of helping his mother care for the family fell on him.

“My mother used to go to the market and do any job she could find but now she cannot even do that. She just had the baby,” he said.

There are no agencies that help the street children directly, said Hamud.

Arush’s agency is part of a child protection network in Puntland. "Unfortunately we cannot provide material support but we advocate for them and when we get information that they are in trouble we try to intervene,” Arush said.

Hamud said a lot more was needed to help the children. "First, serious assessments need to be carried out to determine the extent of the problem,” he said. Many of the older children were turning to crime. “They not only pose a security, but also a social, risk. We need to address their needs as a matter of great urgency.”

Legal intervention needed

He said Puntland should have a separate juvenile justice system to deal with child offenders. “Now, children arrested by the police end up in the same cells as adults, where they are vulnerable to abuse.”

He said those involved in child protection were trying to lobby the legislature for a Juvenile Justice Law, aimed at guaranteeing children's rights, so that children would no longer be kept in jail with adults or tried in adult courts.

“Agencies and local authorities should do everything possible to provide them with an alternative to the streets.”

Governor Ghele said the authorities had identified a site to build a home for the children but did not have the financial resources to build and operate it. "We need a lot of support if we are going to put them in safe homes," he said.

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http://www.irinnews.org/report.aspx?ReportId=88351DAKAR Tuesday, March 02, 2010 (IRIN) - The government of Sierra Leone has announced that from Independence Day (27 April) it will abolish user fees for pregnant women, lactating mothers and children under five, but will this, on its own, improve their lot? DAKAR Tuesday, March 02, 2010 (IRIN) - The government of Sierra Leone has announced that from Independence Day (27 April) it will abolish user fees for pregnant women, lactating mothers and children under five, but will this, on its own, improve their lot?

IRIN looks at Sierra Leone for the third part of its series on maternal and child health.

Sierra Leone has the world’s highest maternal mortality rate - 1,800 women die per 100,000 live births, according to UN Children’s Fund (UNICEF).

C.T.H. Bell, a gynaecologist with the privately owned New Life hospital in Sierra Leone’s capital, Freetown, says that more critical than free treatment is speed of decision-making in the home, an efficient transport infrastructure, and prompt treatment on arrival at a health centre.

He suggested that the expansion of free health required more preparation, and should not be seen as a cure-all. “Have we put our house in order before inviting the guests? Women will go for free treatment - where? You are inviting people to your house, but do you have the drugs? Do you have the IV [intravenous] fluids you need? Do you have blood? Are your staff motivated?”

Abolishing user fees will not address life-threatening delays in delivering maternal care - even in the woman’s own community, he said.

“At times, the husband - who has to decide - is not there. Or maybe the mother will say: ‘No, let’s wait. Or maybe there is an old woman in the community who will say: ‘Wait, wait, wait’ - until it is too late,” Bell told IRIN.

Monir Islam, head of WHO’s Making Pregnancies Safer Programme, told IRIN poor roads and a lack of ambulances made it hard for people from rural areas to get to a city for emergency care. “Free care means little on its own. If women cannot make it to a centre, what good is free care?”

Traffic jams further slow down those trying to reach Sierra Leone’s only hospital handling obstetric and gynaecological emergencies, in east Freetown, said Bell. “If somebody has an emergency in the west, that person has to drive through the city to the east… By the time the person gets to the hospital, maybe [the woman or baby] is dead.”

Prompt treatment

Bell said there were often delays at clinics. “The patient… gets to the facility - no doctor, no nurse, no medicine, no blood and the patient has to wait until a doctor is called on duty.”

He said poorly paid public servants - the average monthly doctor’s salary is around US$100, while a 50kg sack of rice costs $34 - are worn out because they do multiple jobs to survive.

In June 2008 NGOs operated more than half the country’s health facilities, according to the Health Ministry. There are almost as many international doctors employed by NGOs (50) as there are local doctors (60). Nursing graduates are only able to find temporary work, when someone resigns or dies, according to the UN Population Fund. Many emigrate to foreign countries in search of better jobs.

Lack of trained government healthcare workers is all too often an excuse by governments to delay improving maternal health care, WHO’s Islam told IRIN.

In addition to training more health workers, governments should provide existing workers with the equipment and power supplies they need to do their jobs, he said. “If a woman makes it to the clinic, will there be trained midwives, an electricity generator?”

“Unless there is a comprehensive overhaul and improvement of maternal health care, poor people will continue to get only poor options, whether user fees exist or not.”

No-cost medical care will do little to make pregnancies safer unless health centres are better equipped to serve expectant mothers, according to WHO.

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http://www.irinnews.org/report.aspx?ReportId=88280DAR ES SALAAM Monday, March 01, 2010 (IRIN) - A Tanzanian project is integrating family planning and HIV messages via community health workers who teach HIV-positive couples how to avoid unwanted pregnancies or infecting their unborn children.DAR ES SALAAM Monday, March 01, 2010 (IRIN) - A Tanzanian project is integrating family planning and HIV messages via community health workers who teach HIV-positive couples how to avoid unwanted pregnancies or infecting their unborn children.

“I talk to them and they tell me they are afraid,” Margaret Mapunda, a trained community health worker in Tanzania’s commercial capital, Dar es Salaam, told IRIN/PlusNews. “Some want [children] but they don’t know what to do and just conceive and go to traditional birth attendants to deliver.

“Many are taking antiretrovirals and they don’t even know which contraceptives are good and bad,” she added. “They do not ask because of stigma. Some say they are abused at health facilities.”

Since 2008, more than 3,000 couples have received family planning services from home-based care service providers in the areas of Dar es Salaam, Arusha and Kilimanjaro under the Tutunzane – Swahili for “let’s care for each other” - project, run by reproductive health NGO, Pathfinder International [http://www.pathfind.org/site/PageServer?pagename=Programs_Tanzania_Projects_Tutunzane].

Family planning needs

A 2009 study [http://journals.lww.com/aidsonline/pages/articleviewer.aspx?year=2009&issue=11001&article=00004&type=abstract] conducted in the northern Tanzanian region of Mwanza and published in the journal, AIDS, found numerous potential benefits of offering family planning counselling as a part of antenatal services, particularly in clinics offering HIV testing.

According to Children and AIDS, Fourth Stock Taking Report 2009 [http://www.unicef.org/aids/files/B230stocktaking_06Nov09_FINAL_loRes.pdf], by the UN Children’s Fund, as many as 130,000 HIV-positive Tanzanian women become pregnant every year; 53 percent of these have access to prevention of mother-to-child transmission services.

A study carried out by Pathfinder International in 2008 found that 90 percent of home-based care providers were willing to add family planning services to their activities but lacked adequate training. So far the project has trained about 250 community health workers to integrate family planning messages into their HIV counselling.

“Community home-based care service providers are very low cost and they interact more with people living with HIV than anybody else; they therefore provide a perfect opportunity to reach out to them, including with family planning services,” said Judith Rwakyendela, reproductive health and family planning programme officer at Pathfinder International.

“When you give people antiretrovirals, the objective is to make them live longer, yet many of them become strong, active and engage in sex without necessarily aiming at having a baby,” she added. “It is important that they are given the opportunity to prevent unwanted pregnancies, which plays the twin role of improving their health and preventing mother to child transmission.”

Johannes and Vivian Murliryianga*, from the Dar es Salaam suburb of Sinza, have five children; they are now receiving counselling from a community health worker as they try to prevent more pregnancies. Unfortunately, they learned about prevention of mother-to-child transmission too late to stop their youngest child from contracting HIV.

“I normally did not go to a government hospital, I just had my babies at a clinic run by some lady to whom we give small money and she allows you to give birth at her place. We just call her shangazi [auntie],” Vivian said. “I was surprised when my child tested positive; I didn’t even know children could get HIV.”

Under the Pathfinder programme, couples like Vivian and Johannes are given family planning advice according to their situation and needs.

“As you know family planning methods are many - we just give them choices depending on what they prefer and the situation,” Mapunda said. “You will get some married couples telling you they prefer condoms, especially among discordant ones; some want pills. We counsel them on the merits and demerits of each.”

Involving men

She noted that while counselling had been largely successful, encouraging men to participate had been a challenge. “We have seen more success where fathers agree to join the programme but not all are willing and it becomes very difficult because it means the mother does many of the things secretly,” she said.

“Imagine trying to give these services to a woman who fears disclosing her status or whose husband’s status is unknown; it is a challenge but we try what we can,” she added.

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http://www.irinnews.org/report.aspx?ReportId=88263SANAA Sunday, February 28, 2010 (IRIN) - Hundreds of schools in the northern Yemeni province of Saada have reopened after five months of closure following an 11 February ceasefire between Yemen's army and Houthi-led Shia rebels, according to local officials. SANAA Sunday, February 28, 2010 (IRIN) - Hundreds of schools in the northern Yemeni province of Saada have reopened after five months of closure following an 11 February ceasefire between Yemen's army and Houthi-led Shia rebels, according to local officials.

More than half the 121,000 students in grades 1-12 who were due to start the current semester last October were invited to return to school on 27 February, Mohammed al-Shamiri, head of the Saada education office, told IRIN.

"We issued a circular calling on all teachers of these schools to come back to their work and resume classes," he said. "We reopened only those schools we can supervise, but not those in districts that are still controlled by Houthis."

During a meeting chaired by Saada governor Taha Abdullah Hajer, provincial education officials agreed that the revised date for the start of the first semester be 27 February and that it should end on 18 May. The second semester is scheduled to run from 23 May to 15 August 2010. The school year usually begins in October and ends in June.

School tents

According to al-Shamiri, some 220 of the governorate’s 725 schools, which were all closed during the war, were completely or partially destroyed or looted.

"The Saada governorate leadership and education ministry are contacting donor organizations on the issue of providing tents to be used as classrooms in locations where schools were destroyed," al-Shamiri told IRIN.

As part of its planned humanitarian response, the UN Children's Fund (UNICEF) has requested funds from donors to support the resumption of education in Saada through the provision of temporary learning spaces such as school tents, teaching kits and basic educational items for children, Aboudou K Adjibadé, UNICEF representative in Yemen, told IRIN.

"Funding is also sought for rehabilitating schools, deploying teachers, including female teachers in order to promote girls attendance, and offering capacity development to the Ministry of Education and local education offices to resume schooling in the wake of the ceasefire," he said.

According to Adjibadé, school tents were provided to relevant bodies in the neighbouring governorate of Hajja, where an estimated 120,000 displaced people live.

IDP returns

Abdullah Dhahban, a local council member in Saada, said the government and humanitarian organizations should accelerate the return of thousands of displaced children who cannot access education where they are.

"Very few students had access to education in their areas of displacement,” he said. "After the fighting broke out on 11 August, children who fled with their families couldn't get their files and documents from schools in their home districts so that they could enroll in new schools after displacement."

According to a 22 February report by local NGO Seyaj Organization for Childhood Protection (SOCP), some 383,332 children in Saada (about 97 percent of the governorate's school-age children) have been unable to go to school over the past five months. The figure includes those 121,000 children who were due to start this semester in October and those who had never enrolled in schools.

ay/at/edhttp://www.irinnews.org/report.aspx?ReportId=88255YANGON Friday, February 26, 2010 (IRIN) - The government of Myanmar and the International Labour Organization (ILO) have for the third time renewed an agreement aimed at tackling forced labour.YANGON Friday, February 26, 2010 (IRIN) - The government of Myanmar and the International Labour Organization (ILO) have for the third time renewed an agreement aimed at tackling forced labour.

“Neither party sought any changes and there were absolutely no issues in terms of its renewal,” Steve Marshall, liaison officer for the ILO in Myanmar, told IRIN in an interview.

The agreement will come into effect on 26 February for another year.

However, Marshall said much work was still required to ensure the proper application of the agreement.

Recently, 17 people - mostly farmers who complained about forced labour, or people helping them to lodge their complaints - were imprisoned because of their involvement in ILO cases, breaching the agreement.

While 13 were subsequently released, four are still in detention.

Under the agreement, first signed in February 2007 [http://www.ilo.org/yangon/info/lang--en/docName--WCMS_106131/index.htm], anyone who complains about forced labour or facilitates a complaint is protected by law.

Marshall said arrests of this kind raised “serious credibility issues” as far as the implementation of the pact was concerned.

“Although harassment of this nature is reported only in respect of a minority of cases, they of course impact on the confidence of people to complain,” he said.

The agreement will examined by the ILO governing body in Geneva in March, where it will be fully reviewed, he said.

Fears of retaliation

The Myanmar government passed a law in 1999 forbidding the use of forced labour but the phenomenon is still documented in various forms by the UN and international human rights groups.

In a farming village in Kunchangone Township in the southern Ayeyarwady Delta, men are forced to work as night guards at a nearby army post, or hand over the equivalent of US$2 to the military unit.

“We don’t want to do this job, but we can’t refuse,” one angry farmer told IRIN. “If we are unlucky, we can be put on the list,” he said, referring to retaliation by the military.

Despite joint awareness-raising by the ILO and the government about the law, most perpetrators are from the military or local authorities.

Under the agreement, the agency assesses complaints directly from victims, or through a nationwide network of volunteers who act as facilitators for complainants.

The ILO compiles evidence and hands over the cases to the government for investigation, which can result in compensation to victims and prosecution of perpetrators.

Since 2007, the ILO has submitted more than 200 cases - about half concerning underage recruitment to the military.

Child soldiers

Government law states that no one younger than 18 should be in the army, but military units are under pressure to maintain their strength.

“While some kids volunteer to join up, many of the cases we get are not voluntary,” said Marshall. “In either case it is against the law.”

“A kid is walking home from the market, or home from school or at the bus stop or at the railway station, and he is approached by a broker … and either tricked or straight out abducted into the army,” he said.

The average age of child soldiers seen in cases submitted to the ILO is about 15 or 16, but there have been cases of children as young as 11.

Of all the types of forced labour, Marshall said the government was the most responsive in this area, locating the child, returning him to his family and prosecuting perpetrators.

Since 2007, the ILO has helped with the release of more than 80 children from the military, while about 30 cases are still under negotiation, he said.

Despite this, Marshall said a lot more had to be done to disseminate information about the law. “There is a large proportion of people out there who don’t know what their rights are,” he said.

“Also, in the country you have to be quite brave to exercise your rights. So the number of complaints in no way can be seen to be reflecting the size of the problems.”

Blame economics

According to the ILO and rights groups, the military regularly uses forced labour for its activities, such as sentry duty, or when camps are shifted and porters are needed to carry supplies, or in construction.

Military units are also under-funded and rely on farming to survive, and villagers are often compelled to work for them.

The practice is also used by civilian authorities, who cannot afford the labour to build roads, for example.

“A lot of forced labour is driven by a very bad economic structure. The local authorities have no money, they’ve got no resources,” said Marshall. “It’s not just a social issue; it’s an economic policy management issue as well.”

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http://www.irinnews.org/report.aspx?ReportId=88240PRETORIA Friday, February 26, 2010 (IRIN) - Zimbabwe's still-limping economy can provide few essential services, so children living along the border cross into South Africa to attend school during the day or even to see a doctor, often at great risk to their personal safety.PRETORIA Friday, February 26, 2010 (IRIN) - Zimbabwe's still-limping economy can provide few essential services, so children living along the border cross into South Africa to attend school during the day or even to see a doctor, often at great risk to their personal safety.

The UN Children's Fund (UNICEF) regional child protection advisor for East and Southern Africa, Cornelius Williams, said the movement of unaccompanied child migrants from Zimbabwe was one of the biggest problems confronting humanitarian agencies in the region. Between 3,000 and 15,000 Zimbabwean children are known to move into and out of their country every month.

"Unfortunately, governments continue to devote most of their resources to child trafficking, where much smaller numbers of children are involved," Williams told IRIN at a meeting of officials from 15 countries in Pretoria from 23 to 25 February to discuss ways of strengthening cross-border co-operation to protect children at risk.

William Duncan, deputy secretary-general of the Hague Conference on Private International Law, the Netherlands-based world organization for cross-border cooperation in civil and commercial matters, said an even bigger issue was that "There is no central authority in Zimbabwe to contact to help repatriate the child."

The Chief Family Advocate in South Africa's Department of justice and Constitutional Development, Petunia Seabi, said a solution to the problem was being worked out. "We are in talks with the Zimbabwean authorities to set up protocols to protect these children."

She said neither of the governments would prevent children from accessing services across the border, but would rather try addressing the risks the children took while crossing the border unaccompanied.

Duncan pointed out that the numbers of Zimbabwean children moving around the region only underlined the need for close cooperation between child protection agencies and "between judges in different countries, and the Hague Children's conventions make this possible."

Many African countries have yet to ratify the Hague Conventions pertaining to children, which seek to standardize international legislation and provide a comprehensive legal framework to for the cross-border movement of children; more governments have ratified the African Charter on the Rights and Welfare of the Child and the UN Convention on the Rights of the Child.

Duncan acknowledged that most countries did not have the resources or the capacity to ratify the Hague Conventions, which include treaties on child abduction, inter-country adoption, protection of children and the international recovery of child support. He said the Hague Conference was trying to build capacity.

Delegates at the meeting said the discussion on the need for better cooperation between governments couldn't have come at a better time than on the eve of the FIFA World Cup, which kicks off in South Africa in June.

"We will probably see a flood of child migrants to South Africa, not only attracted by economic benefits but a chance to spot their football hero," said Williams.

The South African government was gearing up for the challenge, he said. They were planning safe areas for unaccompanied child migrants around the various stadia, and an advertising campaign aimed at visitors, which, they hoped, would deter child prostitution.

jk/he http://www.irinnews.org/report.aspx?ReportId=88249DAKAR Thursday, February 25, 2010 (IRIN) - Nutrition experts in Guinea are studying options for treating moderately malnourished children, as funding shortages disrupt normal programmes using fortified flour.DAKAR Thursday, February 25, 2010 (IRIN) - Nutrition experts in Guinea are studying options for treating moderately malnourished children, as funding shortages disrupt normal programmes using fortified flour.

In recent months local health centres ran out of supplies and had to refer families to remote facilities for corn-soya blend (CSB), used for the treatment of moderate acute malnutrition and provided by donors through the UN World Food Programme (WFP).

WFP is seeking funds to maintain CSB stocks in Guinea. “We recently received some CSB but needs still outweigh supply,” WFP-Guinea head of programme Foday Turay told IRIN. While recent unrest in the country led some donors to pull back, a lack of funding for WFP nutritional programmes pre-dates the latest instability.

Humanitarian workers told IRIN the current situation reflects the overall difficulty of attracting aid funding for Guinea and underlines the need to find alternative and long-term solutions.

“The break in WFP’s pipeline is representative of the problem everyone has finding [aid] funding for Guinea,” Reza Kasraï, head of Action contre la Faim (ACF) in Guinea, told IRIN.

“We’re in a no-man’s land between a politically stable country where donors would like to give development funds and a full-on emergency where humanitarian donors contribute regardless of the political situation.”

Stop-gap measures

The funding and supply breaks are forcing aid agencies and the Health Ministry to turn to temporary solutions – like using therapeutic foods designed for severe acute malnutrition – but a more sustainable strategy is needed, nutrition experts say.

When CSB stocks ran out, ACF used Plumpy’nut for some moderate malnutrition cases, Kasraï said.

“These are stop-gap measures… Using Plumpy’nut for moderate acute malnutrition is not in the national [malnutrition treatment] protocol, and just because the product is on hand does not mean it’s a long-term solution.” The product is more expensive than foods used to treat moderate acute malnutrition (MAM), he said.

Nutrition workers in Guinea are debating the viability of using Plumpy'nut for moderate cases if the need arises; another option being discussed is using local foods, prepared specially for children’s nutritional needs.

“Stop-gap measures may be better than nothing but a plan is needed to assure adequate funding for the CSB supply and access to contingency funds to mitigate the impact of CSB shortages,” Sheryl Martin of Helen Keller International in Guinea told IRIN.

“We are all frustrated by the lack of funding and are doing the best we can in the short term.”

Integrated

ACF’s Kasraï said it is important to use an integrated approach – not only therapeutic feeding but also programmes to address the principal causes of undernutrition in Guinea, by boosting people’s livelihoods, ensuring proper breastfeeding and weaning practices and improving home hygiene and access to health services, sanitation and safe water.

He said there is a growing movement towards community- and even household-based management of MAM, which would also reduce the strain on health centres. "The challenge is in finding a reliable way of ensuring that moderately malnourished children receive fortified [with vitamins and other micronutrients] and high-caloric diets in the home."

A January 2010 ACF nutritional survey in Conakry’s Matoto commune shows a global acute malnutrition rate of 7.3 percent, with 1.6 percent severe acute malnutrition, he said.

“While these percentages are not alarming, if you look at absolute numbers you’re talking about some 10,000 children suffering acute malnutrition – and that is in just one of five Conakry communes.”

Mamady Daffé, Health Ministry head of nutrition, said the combination of poverty and a lack of knowledge of children’s nutritional needs contributes to child malnutrition. He said even if families understand children’s nutritional needs, many do not have the means to meet them.

“People’s living conditions must improve. Without this we will not be able to tackle malnutrition," he told IRIN. "The cost of living is up; people cannot buy what they need to eat properly.”

In the Dixinn commune of Conakry, health workers conducting a nutritional survey in January saw a malnourished four-year-old girl. Her father is unemployed and her mother barely makes ends meet doing petty commerce.

“Sometimes I go for days without preparing a proper meal,” the mother, Fatoumata Keita, told IRIN. She said she often gives her daughter quinine to ease stomach pain.

The latest monthly nutritional survey in Conakry – carried out by HKI and the Health Ministry – showed a rise in moderate acute malnutrition among under-five children from 3.8 percent in January to 5.5 percent in February.

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http://www.irinnews.org/report.aspx?ReportId=88233JAFFNA Wednesday, February 24, 2010 (IRIN) - Thousands of children have returned to school in northern Sri Lanka, where efforts are under way to restore the area’s battered education infrastructure. The Government of Sri Lanka aims to have all children from the five districts of Jaffna, Kilinochchi, Mannar, Vavuniya and Mullaitivu back in school by the end of April. JAFFNA Wednesday, February 24, 2010 (IRIN) - Thousands of children have returned to school in northern Sri Lanka, where efforts are under way to restore the area’s battered education infrastructure.

The Government of Sri Lanka aims to have all children from the five districts of Jaffna, Kilinochchi, Mannar, Vavuniya and Mullaitivu back in school by the end of April.

At the same time, authorities are working to address the infrastructure needs of schools damaged in the decades-long civil war.

“Assessments have been done and schools will be completely rehabilitated by mid-[2010],” Susil Premajayanth, Minister of Education, told IRIN.

Thousands return

According to the UN Children’s Fund (UNICEF), more than 48,000 children of school-going age, most of whom were in camps for displaced people (IDPs), have returned to their districts in the Northern Province.

The school year started on 5 January and so far, 43,469 students between the ages of five and 18 have registered. However, thousands more are still out of school, the agency says, although no firm figures are available.

“Restoring full access to education remains a key priority for children,” UNICEF Sri Lanka Representative, Philippe Duamelle, told IRIN.

In the Vanni region, which comprises the districts of Kilinochchi, Mannar, Vavuniya and Mullaitivu, 94 schools have re-opened, with 14 in Jaffna District.

Before 2008, when major displacements began, there were 1,014 schools in the Northern Province, some of which were damaged by the conflict or gradually shut down, says UNICEF.

As part of the efforts to restore education, the education ministry and the National Institute of Education (NIE), with support from UNICEF, are developing an accelerated learning programme.

The programme targets about 100,000 students in resettlement areas in the northern and eastern provinces who lost up to two years of education due to multiple displacements, where teachers will be helped to condense two years of curricula into one.

Damaged schools, missing teachers

“Schools need to be renovated and furniture and supplies delivered. The quality of education is also critical - both teacher training and the lack of teachers also need to be addressed,” said Duamelle.

Some US$24 million is needed to repair or rehabilitate more than 300 schools in the north, many of which lack essential materials such as furniture, and teaching and learning aids, according to provincial education authorities.

Most of these schools were looted for materials such as wood and roof tiles, or were damaged by fighting, while a small number have been neglected over the years.

A major challenge in restoring education is the lack of teachers in the Vanni, especially in key subjects such as English, mathematics and science.

“There is instability and deprivation of all kinds and all levels. The same applies to schools,” said Kumuduni Padmasekeran, a voluntary teacher at a school in Kilinochchi, which lacks teachers.

Outside the system

Although many children are now back at school, there are still thousands in the IDP camps in the north, where there is a serious shortage of teachers.

In Menik Farm alone, the largest IDP camp, there are 25,539 registered students.

"All children within IDP camps will be shifted to newly constructed or rehabilitated schools or host schools elsewhere within three months,” said education minister Premajayanth.

The government is also trying to cater for internally displaced children living outside the camps, said GA Chandrasiri, governor of the Northern Province.

“We believe in offering equal access to education for children. Those with relatives outside the camps were deprived for a while but soon things will improve,” Chandrasiri said.

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http://www.irinnews.org/report.aspx?ReportId=88218CAIRO Tuesday, February 23, 2010 (IRIN) - A new report by the UN Children’s Fund (UNICEF) and the Egyptian government says the number of children living in income-poor households is increasing, causing poorer living conditions and a greater deprivation of their rights as children. CAIRO Tuesday, February 23, 2010 (IRIN) - A new report by the UN Children’s Fund (UNICEF) and the Egyptian government says the number of children living in income-poor households is increasing, causing poorer living conditions and a greater deprivation of their rights as children.

Entitled Child Poverty and Disparities in Egypt, and released on 16 February in Cairo, the report said Egypt’s economic growth in the years leading up to the 2009 financial crisis had not adequately benefited the nation’s estimated 28 million children.

“This growth has not led to a proportionate reduction in income poverty or deprivation,” said the study, which is part of a global series of UNICEF studies on child poverty and disparities.

Economic growth is often seen by commentators as failing to keep up with Egypt’s rapidly rising population.

The report said 23 percent of children under 15 were living in poverty (on less than US$1 a day) and that income poverty was highly correlated with shelter deprivation.

It said more than a quarter of Egyptian children (seven million) were deprived of one or more of their rights under the 1989 Convention on the Rights of the Child, ratified by Egypt. Around five million children were deprived of appropriate housing, including shelter, water and sanitation standards; and 1.6 million under fives experienced health and food deprivation.

“It’s important to look at how poverty affects children’s lives and how we can address it,” Sigrid Kaag, UNICEF regional director for the Middle East and North Africa, said at a gathering to discuss the new study. “A child who lives in poverty rarely gets a second chance at education or a healthy start in life.”

Mushira Khatab, Egypt’s family and population state minister, said at the gathering: “The government must take children into consideration when it comes to formulating policies aimed at ending poverty. Investing in the nation’s children can produce good results. Education will get these children out of poverty.”

She called on the government to introduce special laws for the protection of children.

Rural areas worse

The poverty rate among children in rural areas was more than double that in urban areas, and much higher in the south than in the north, according to the study. The south, known as Upper Egypt, had the highest incidence of poverty among children - 45.3 percent.

Girls and boys were equally vulnerable to poverty and deprivation of rights, but girls in rural areas were the least likely to attend school or complete their education, thus increasing the likelihood of them being poor in adulthood.

The study recommended that policies be directly aimed at children to alleviate their poverty.

“If we’re to break the cycle of poverty, it’s key that children are at the heart of development policies,” Kaag said.

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http://www.irinnews.org/report.aspx?ReportId=88203SANAA Tuesday, February 23, 2010 (IRIN) - Hundreds of children have either been killed or used as child soldiers in fighting between Yemeni government forces and Houthi-led Shia rebels in the north of the country since August 2009, according to a new report by Seyaj Organization for Child Protection (SOCP), a local child rights NGO.SANAA Tuesday, February 23, 2010 (IRIN) - Hundreds of children have either been killed or used as child soldiers in fighting between Yemeni government forces and Houthi-led Shia rebels in the north of the country since August 2009, according to a new report by Seyaj Organization for Child Protection (SOCP), a local child rights NGO.

The 22 February report said some 89,000 children were forced to flee their homes with their families, whilst "187 children were killed, 402 exploited as soldiers by Houthis, and another 282 recruited by pro-government local militias."

The findings are based on an SOCP survey in December 2009 - with support from the UN Children’s Fund (UNICEF) - of children in internally displaced persons (IDP) camps in Hajja, Saada and Amran governorates, as well as in some of Saada's conflict-ridden districts: Saada city, Razeh, Alb, Baqem, Ghamr and Qataber.

According to the report, 42 percent of children in camps (estimated at 35,000) are affected by malnutrition, 19 percent have diarrhoea, 25 percent have respiratory infections, and 3 percent malaria.

SOCP conducted interviews with 684 former child soldiers and collected information on a total of 73,926 children for the survey.

Aid agencies say more than 70 percent of the estimated 250,000 people displaced by the conflict since 2004 live outside IDP camps, with children making up over half of the displaced population.

On 11 February the two sides agreed on a ceasefire, which is fragile, with reports of sporadic clashes.

The SOCP report said 383,332 children in Saada (about 97 percent of the governorate's school-age children) had been unable to go to school in this period.

Displacement, insecurity, and the destruction of schools, or their utilization for military operations, were the main reasons, Ahmad al-Qurashi, head of SOCP, told IRIN.

Of the 701 schools in Saada Governorate, 17 were destroyed in the fighting and another16 had been taken over by one or other of the warring parties. Most of the remaining schools were deserted, he said.

Child soldiers

"The number of children exploited as soldiers could be much higher than the figure indicated by the report because we had difficulty detecting who is still under 18 due to lack of birth documents," SOCP lead researcher Fahd al-Sabri told IRIN. He said only 8 percent Yemeni citizens have birth certificates.

"The number of children killed during the fighting could also be much higher than the figure in the report because many areas hit by fighter jets of the Saudi and Yemeni armies remained inaccessible," al-Sabri said.

Since August 2009, aid agencies have had difficulty getting comprehensive information about the war’s impact on children, according to UNICEF child protection specialist George Abu al-Zulof, but, he told IRIN, most of the laws regarding child rights appeared not to have been respected during the fighting.

We urge parties to the conflict to release child soldiers so they can get back to school, Abu al-Zulof said, and he called for "an impartial investigation" into the impact of the war on children.

SOCP chairperson al-Qurashi urged Yemen to update Child Rights Law No. 45 of 2002 to make provision for clear penalties against individuals who exploit children in armed conflict.



ay/at/cbhttp://www.irinnews.org/report.aspx?ReportId=88208DAKAR Tuesday, February 23, 2010 (IRIN) - US researchers have begun collecting tissue samples from thousands of pregnant women in an effort to learn what causes stillbirths – babies born dead – and preterm deliveries. This is the second of a three-part series on maternal and child health, and the seldom mentioned babies who are born after they have died. DAKAR Tuesday, February 23, 2010 (IRIN) - US researchers have begun collecting tissue samples from thousands of pregnant women in an effort to learn what causes stillbirths – babies born dead – and preterm deliveries. This is the second of a three-part series on maternal and child health, and the seldom mentioned babies who are born after they have died.

Data is scarce on the more than 13 million babies born before 37 weeks of pregnancy every year – of which one million die – and the 3.2 million that the World Health Organization (WHO) estimates are stillbirths, according to recent a report based on collaborative research led by the US-based Global Alliance to Prevent Prematurity and Stillbirth (GAPPS).

Lack of equipment and technicians to interpret ultrasound scans of the baby in the womb have made it difficult to gather information in sub-Saharan Africa and Asia, where most these deaths occur, GAPPS said. Stillbirths were "neither recorded nor discussed in health policies, making them effectively "invisible", the report commented.

"Stillbirth is largely ignored globally," Craig Rubens, executive director of GAPPS and a paediatrician, told IRIN. "Most stillbirths do not receive an autopsy and parents are left with more questions than answers."

Aminata Ndiaye, 24, from Senegal told IRIN it was God's will that her baby was born dead in November 2009. "We do not have control over these matters - He who gives can also take away, and we must accept the good lord's will."

Interventions

Participants at an international conference on premature births and stillbirths, organized by GAPPS in May 2009, drafted an agenda to reduce stillbirths and preterm births by promoting low-cost proven interventions.

Based on a review of 2,000 studies of interventions conducted up to 31 December 2008, GAPPS looked at the success rate of more than 82 interventions and compiled a list of 21 that were proven to keep preterm newborns alive.

These measures include early breastfeeding, carrying a child against the mother's chest - "kangaroo" mother care - providing Vitamin K at delivery, and using ordinary air rather than oxygen to resuscitate babies not breathing at delivery.

Proven methods to prevent stillbirth include presumptive malaria treatments during pregnancy, syphilis screenings, boosting protein during pregnancy, and emergency obstetric care.

Unfortunately, these life-saving measures are not widely adopted due to lack of awareness about what causes preterm births and stillbirths, cultural barriers, poorly functioning health systems, lack of political will and resources, and corruption, according to GAPPS.

Lack of research

Researchers launched tissue-collection for the study in the US in November 2009, and plan to expand it to India and Africa. The goal is to collect samples of maternal blood, urine, vaginal and amniotic fluid, which surrounds the foetus during pregnancy, umbilical cord blood, and placental tissue from 6,000 pregnant women.

"The challenge with understanding preterm birth is that it has been looked at as an 'event' rather than a complex syndrome," Rubens told IRIN.

Unlike cancer researchers, who for years have had access to extensive tissue samples from patients with the illness, maternal and child health researchers have had little to consult.

There have been no standard operating procedures for collecting tissue specimens from pregnant women, which meant there was no tissue bank that researchers around the world could access, and therefore no large-scale scientific studies could be conducted.

High-quality specimens would speed up research into preventing newborn deaths and stillbirth rather than just reacting to it. "There is very little that can be done ... [without specimens], which is why most of the research focus for preterm birth has been on keeping the preterm neonate [baby] alive," Rubens told IRIN.

"The cost of prospective research is much more significant – you have to enrol a large cohort of pregnant women and follow them throughout their pregnancy," said Rubens.

A co-author of the study, Joy Lawn, of Save the Children, a UK-based NGO, noted that "Preterm births and stillbirths are ... a private loss to many families that should be on the public's priority list."

pt/he http://www.irinnews.org/report.aspx?ReportId=88216DAKAR Monday, February 22, 2010 (IRIN) - Saving a newborn’s life could be as simple as tapping the bottom of its foot, rubbing its back or helping pregnant women in rural communities get to a clinic. In this first part of a three-part series on initiatives to reduce maternal and newborn deaths, IRIN reports on a US-funded study that tracked 120,000 births in rural communities over two years to learn the impact of birth-attendant training on newborn survival.DAKAR Monday, February 22, 2010 (IRIN) - Saving a newborn’s life could be as simple as tapping the bottom of its foot, rubbing its back or helping pregnant women in rural communities get to a clinic. In this first part of a three-part series on initiatives to reduce maternal and newborn deaths, IRIN reports on a US-funded study that tracked 120,000 births in rural communities over two years to learn the impact of birth-attendant training on newborn survival.

An estimated 3.2 million foetuses die annually, according to World Health Organization (WHO); an additional 3.7 million babies die in their first month, mostly in rural communities with little or no health services.

But what is classified as a stillborn may actually not be, US-based University of North Carolina neonatologist Cyril Engmann, one of the researchers in the Democratic Republic of Congo (DRC), told IRIN.

“When birth attendants see a newborn who is not breathing, they think the baby is dead. But that baby may be alive but did not take a breath yet,” Engmann said.

Traditional birth attendants with no formal training, nurses, midwives and doctors learned how to jumpstart breathing through hand-pumped ventilation, touching the child’s skin or tapping its foot. The training taught rural health workers in Argentina, DRC, Guatemala, India, Pakistan and Zambia WHO’s Essential Newborn Care course and for a smaller group, an American neonatal resuscitation programme.

Stillborns declined by 30 percent among babies delivered by birth attendants who participated in the three-day training, which took place between 2005 and 2007.

Trainer Engmann estimated that up to one million babies’ lives could be saved annually with proper newborn care training, which includes regularizing the baby’s body temperature at birth and exclusive breastfeeding for the baby’s first months.

Following the training more women in the six countries apparently turned to traditional birth attendants and relatives for giving birth; unskilled birth attendants and family members delivered almost 10,000 more babies in the year following the training than they had before, while doctors, midwives and nurses delivered 2,500 fewer, according to the study.

The percentage of babies born in birth attendants’ homes doubled, while those born in hospital decreased by 2.5 percent. Births in clinics increased by 3 percent.

Stop-gap?

The head of WHO’s Making Pregnancy Safer programme, Monir Islam, said investments in untrained birth attendants delay long-term improvements to maternal and infant care by drawing patients away from the services that sorely need improvement, reducing pressure on governments to fix them.

“People who do these training programmes have good hearts, but we push developing countries to remain in development by accepting a lower standard of care,” he told IRIN. “There is no incentive to move forward and improve health care services.”

Neonatologist Engmann told IRIN it is possible to push for skilled health workers and better facilities as well as better-trained traditional birthing attendants. “It is not an ideal situation, but are we to stand by the sidelines, wring our hands and do nothing? It would be unethical to not do something.”

Fifty-seven countries, most of them in Africa and Asia, face severe health worker shortages. It would take more than four million people to fill the gaps, according to WHO.

WHO’s Islam said temporary measures can weaken chances for long-term change. “We have been using stop-gap measures for the last 20 years and have fallen into the trap of transition. You and I will be having this conversation for the next 20 years.”

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http://www.irinnews.org/report.aspx?ReportId=88201SANAA Sunday, February 21, 2010 (IRIN) - It was every little girl’s dream - she was to get a new dress, jewellery, sweets and a party for all her friends. What 10-year-old Aisha* did not know was that after the wedding party she would have to leave school, move to a village far from her parents’ home, cook and clean all day, and have sex with her older husband.SANAA Sunday, February 21, 2010 (IRIN) - It was every little girl’s dream - she was to get a new dress, jewellery, sweets and a party for all her friends.

What 10-year-old Aisha* did not know was that after the wedding party she would have to leave school, move to a village far from her parents’ home, cook and clean all day, and have sex with her older husband.

“He took out a special sheet and laid me down on it,” Aisha told IRIN, wringing her small plump hands. “After it, I started bleeding. It was so painful that I was crying and shouting, and since then I have seen him as death.”

After a week of fighting off her husband every night, Aisha’s father was called. He had received 200,000 Yemeni Rial (US$1,000) for his daughter in `shart’, a Yemeni dowry, which he could not pay back.

“My Dad made a cup of tea and put some pills in it, which he gave me. The pills made me feel dizzy,” said Aisha. “My Dad told me to sleep with my husband, or he would kill me, but I refused.”

Instead Aisha broke a glass bottle over her head in a desperate attempt to stay awake. “My Dad hit me badly. I was bleeding from my mouth and nose,” she said.

After spending a few months in her husband’s home, where she said he would regularly drug her and beat her, Aisha managed to escape. Now, two years later, aged 12, she is unable to divorce him.

No child protection

A bill passed in parliament in February 2009 setting the minimum age for marriage at 17 was rejected by the Islamic Sharia Codification Committee which said it was un-Islamic, according to local women’s rights organizations.

So, for now, there is no law protecting children against early marriages in Yemen.

”I don’t call it marriage, but rape,” said Shada Mohammed Nasser, a lawyer at the High Court in Sanaa. She has represented several child bride divorce cases in court, but admits she has lost most of them. Only a handful of child brides have successfully managed to divorce their husbands.

“The law on marriage stipulates that a girl should not sleep with her husband until she is mature,” said Nasser, which according to the law is the age of 15. “But the law is not enforced.”

A girl can be married at just nine, but cannot legally seek a divorce until she is 15 or older. The money paid by the husband for his “wife” is a further obstacle to divorce, while the case can only be heard in a court in the governorate where the marriage took place.

“Usually the marriage will have been signed in the husband’s governorate and the judges may look more favourably on their own kinsmen,” said Nasser. “Many judges are governed by arcane views on women.”

Just under half of Yemeni girls, 48 percent, are married before they turn 18, according to the Washington DC-based International Centre for Research on Women (ICRW). This is classified as underage, according to the UN Convention on the Rights of the Child.

In some governorates as many as half of all girls under the age of 15 are married, according to an unpublished study from 2007 on early marriage by Sanaa University’s Gender Development Research and Study Centre. 

Yemen has signed the Convention on the Rights of the Child and the Convention on the Elimination of Discrimination against Women (CEDAW).

A glimmer of hope?

"The greatest problem facing Yemeni women today is child marriages," said Wafa Ahmad Ali from the Yemeni Women’s Union, which has long campaigned for a raise in the minimum age of marriage.

"These early marriages rob the girl of the right to a normal childhood and education. The girls are forced to have children before their bodies are fully grown instead of going to school and playing with other children," she said.

However, Minister for Human Rights Huda al-Ban told IRIN that President Saleh had recently agreed to put forward - for discussion in parliament in May - the bill with 17 as the minimum marrying age. “If the bill is successful it could be passed as a law in September,” she said.

While politicians wrangle in parliament, young girls like Aisha are caught up in a violent world of adults which they are too young to understand, let alone escape.

”These are our traditions,” said Aisha’s father. However, he admits that Aisha might have been too young for marriage. Though she now has a lawyer, Aisha cannot divorce until the two men who control her (her father and husband) agree on how much money each will receive.

What Aisha wants is clear: “I’d rather die than go back to him,” she said, wiping a tear from behind her veil.

(*not her real name)

asf/hm/ed/cbhttp://www.irinnews.org/report.aspx?ReportId=88138KABUL Wednesday, February 17, 2010 (IRIN) - Only a tiny proportion of children of the Kuchi community in southern and eastern Afghanistan get a formal schooling, and community leaders say government education efforts are not enough.KABUL Wednesday, February 17, 2010 (IRIN) - Only a tiny proportion of children of the Kuchi community in southern and eastern Afghanistan get a formal schooling, and community leaders say government education efforts are not enough.

A social rather than ethnic grouping, the traditionally nomadic but increasingly settled Kuchi face mutiple humanitarian issues compounded by the fact that the majority are illiterate, according to government officials and community leaders.

The government agrees that Kuchi children’s access to education has been limited by their nomadic lifestyle, and is trying to do something about it: It has built over 10 schools for Kuchis in the south and east, and established 26 learning centres for Kuchi children who settle temporarily in a given area, according to Education Ministry officials.

“In the summer when Kuchis arrive in Sorobi District [east of Kabul] we organize classes for their children while they are there,” said Asif Nang, an Education Ministry spokesman.

Nang implied some Kuchi parents appear to have little interest in educating their children: “We have a brand new school with all facilities for Kuchis in Paktia Province but it lies empty,” Nang told IRIN.

Kuchis counter that the government is not doing enough. “The government claims it has built schools for Kuchis in some provinces but those are empty buildings with no teachers, no books and no other facilities,” Mahmood Khan Silaimankhil, head of the Independent Directorate of Kuchi Affairs (IDKA), told IRIN.

School attendance among Kuchi children has been lower even than for other minority groups - 6.6 percent for boys and 1.8 percent for girls, according to a National Multi-sectoral Assessment on Kuchis in 2005. IDKA says over 90 percent of Kuchi children still do not go to school.

According to the National Education Strategic Plan 2006-2011, the Education Ministry should ensure at least 35 percent of Kuchi children have access to formal education by 2010.

Kuchi children take part in animal husbandry work, and their parents can ill-afford to be without their help, aid workers say.

“Like their right to health, Kuchis’ right to education is enjoyed considerably less than other segments of Afghanistan’s population,” said a December 2009 report by the Afghanistan Independent Human Rights Commission.

ad/cb/bphttp://www.irinnews.org/report.aspx?ReportId=88135N'DJAMENA Wednesday, February 17, 2010 (IRIN) - Teachers demanding more pay to face higher food prices entered the third day of a nationwide strike. The government has called their demands "illegal" and "unjustified", because the "high cost of living is a general problem that does not concern only [the teachers' union]", said Employment Minister Fatimé Tchombi. N'DJAMENA Wednesday, February 17, 2010 (IRIN) - Teachers demanding more pay to face higher food prices entered the third day of a nationwide strike. The government has called their demands "illegal" and "unjustified", because the "high cost of living is a general problem that does not concern only [the teachers' union]", said Employment Minister Fatimé Tchombi.

Primary school teacher Aubin Golmbaye told IRIN his US$200 monthly salary was not enough to feed his family. "In addition to food I need to pay for the house, medical care, school fees - even if I spend $4 a day on food, what would I have left for our other needs, and transport to get to work?"

Government has estimated that poor rainfall in 2009 reduced cereal production by 31 percent reduction compared to previous years. The shortage could keep cereal prices, which are higher than they have been for five years, at current levels through March, according to the US-funded early warning group, FEWS NET.

Poor families, who often barter livestock for other foodstuffs, find that their animals are buying them less. High prices and below-normal pastoral income due to disease and animal malnutrition are depleting what little food stock families saved from the last growing season, and "steep" food price hikes, starting in April, were predicted in FEWS NET's most recent report on food security in Chad.

Final exams are scheduled to begin in late May but secondary school student Clarisse Koularambaye feared the academic year could be lost. "We are not in class. Teachers plan to strike until a solution is found - I just hope the government will do something for us," she told IRIN.

Education Minister Khadidja Hassaballah said the government would not negotiate salaries with the teacher union when all public sector employees faced the same cost of living.

Among primary school-age children, 30 percent of girls are enrolled and 40 percent of boys; by the time they reach secondary school, only five percent of girls and 13 percent of boys in that age group still attend school.

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