A Review of: Sex initiation camps, child marriages and polygamy, the lesser-known side of cervical cancer in Africa

An article by Samantha Spooner

It is no news when we say that more African women suffer from cervical cancer than women in other continents of the world.

The health care systems in operation across the continent have not been able to effectively address  the issues, hence there is still a lot of work to be done. Such as: creating awareness, organizing screening programs to aid early detection of cancer, developing schemes and programs to educate people about cancer among many others.

There are still some social circumstances which hitherto have led to a high rate of cervical cancer and need to be curbed so as to put a decrease the incidence of cervical cancer amongst African women.

According to the article being reviewed:
Sex initiation camps, child marriages and polygamy, the lesser-known side of cervical cancer in Africa, written by Samantha Spooner.

Generally cervical cancer has been a major problem in Africa, being the most common form of cancer in women from eastern and central Africa , Malawi is said to have the highest rate of cervical cancer in the world with about 3,684 cases and about 500 of them surviving, a 1/7 surviving rate.

Aside from poor health schemes against cancer, some often ignored social circumstances/practices can also predispose women to cervical cancer.  These include but are not limited to;
Sex initiation Camp a common practice among Malawi women which involves taking young girls about the age of eight to teach them how to perform sexual activities in order to groom them to be good cooks, run errands and have sex.

According to World Health Organization, one of the common causes of cervical cancer is an early age of first intercourse. An early age of first intercourse is associated with a high risk of human papillomavirus (HPV) infection, an infection that in susceptible women is responsible for almost all cases of invasive cervical cancer. The prevalence of this cancer-causing HPV is 69.7%.

With most African women being unaware of this fact, the risk of developing cervical cancer by contracting HPV is on the increase.

Child marriage is commonplace in a continent like Africa with statistics showing that child marriage could rise to 15 million by 2030, an alarming figure which could mean more cervical cancer cases in African women. Since child marriage also predisposes a child to early age of first intercourse, one is likely to say child marriage is as bad as sex initiation camp too.
Multiple sex partners and polygamy according to an interview with Evan Sequiera, an expert of obstetric and gynecology based in Kenya, he said that “even more than young age, it’s the multiplicity of partners that causes cervical cancer. This is as a result of the increase in the chances of contracting HPV.

On a concluding note, though factors like timely detection of cancer, immunization against it, treatments and access to quality health care remain problems to be solved, it will be wise and productive to pay attention to our cultural practices and social norms in Africa to curb cervical cancer in our women.

Written By: Jimoh Waliu

Review: How can we reduce the global stillbirth rate? By Karen Hofman

The article begins with the significant attention being showered on Maternal and child deaths in a bid to meet the Millennium Development Goals by the end of 2015, while "Stillbirth targets were omitted from the MDGs and remain absent from the post-2015 Sustainable Development Goals," the writer stated.

Stillbirth : according to the American National Stillbirth Society, is defined as the intrauterine death and subsequent delivery of a developing infant that occurs beyond 20 completed weeks of gestation.

The article however describes still births as the death of babies either during pregnancy or during delivery. Deaths earlier than 28 weeks were categorized as miscarriages.

This is in tune with the WHO definition.

Statistics:

A significant 98% of the occurrence takes place in low- and middle-income countries.

A ranking of stillbirths in 193 countries by the Lancet medical journal, placed South Africa in the 148th position, India at 154th and Nigeria at 192nd. 

Hence, the launch of the Every Newborn action plan in 2014 by the WHO, with a global target to reduce stillbirth rates to ten for every 1000 births by 2035.

In South Africa, the rate is currently 18 still births per 1000 births. However, South Africa hopes to achieve the WHO target by 2016.

The article highlighted the following risk factors :

- Maternal age greater than 34

- Conditions such as :

*High blood pressure

*Diabetes

*Obesity

-Maternal bleeding

-Insufficient oxygen to the baby.

Various efforts and strategies at different levels have been implemented in South Africa to curb this menace.

Some of the strategies implemented include:

- detecting and treating HIV earlier in pregnant women

- managing hypertension and diabetes better

- improving both essential and emergency obstetric care during labor and delivery

- advocating good nutrition well before pregnancy so as to prevent obesity

According to the article, of all the interventions; improved labor and delivery management would have the highest impact and could potentially avert 60% of the stillbirths.

Scaling up these interventions could prevent an additional 5400 stillbirths annually while also preventing the deaths of additional 1300 mothers and 4900 newborns, resulting in a triple return on investment.

The resultant effect will be a drop by 30% of South Africa’s stillbirth rate, thus enabling the Nation to meet the World Health Organization's interim goal for 2030.

The interventions were also found to be affordable and would amount to little more than 0.5% of the total health budget.

Other highlighted areas of improvement include:

- Improvements in the quality of care :

By eliminating delays in accessing services,

ensuring cleanliness, infection prevention, reduced waiting times, drug availability and improved staff attitudes.

- Increased community awareness to enable families recognize danger signs and seek care promptly.

- More research to understand the causes of stillbirths before labor.

- The elimination of "under-reporting" of cases.

In conclusion the article alluded to the fact that although some of the causes are unknown, many of the deaths are preventable. 

According to the Lancet better clinical care, monitoring and interventions could halve stillbirths in poorer countries by 2020.

In my opinion, given the huge global burden of this issue with about 2.6 million deaths annually and majorly in sub Saharan Africa more attention needs to be focused on looking into the causes and possible applicable interventions.   

This is a shout out to the International community to prioritize issues pertaining to still births in the post 2015 era as the World transitions from the MDGs to the SDGs.

Climate Change : Predicted Impacts on sub Saharan Africa ... A World Bank Report

"Turn Down the Heat" a World Bank Report; has warned of the grave consequences of the ongoing global warming. It has predicted that the World's poorest communities will be the most affected and adversely impacted by the effects of climate change.

This report, released on June 19 2015, was commissioned by the World Bank.

It describes the impact of present day, 2°C and 4°C warming across Sub-Saharan Africa, South Asia and South East Asia.

It discusses the risks to agriculture in Sub-Saharan Africa; the rise in sea-level and devastation to coastal areas likely in South East Asia; and the fluctuating water resources in South Asia.

The expansion of the coastal cities of Africa and Asia continues to push the poorest inhabitants of these continents to the borders of habitable land and into the most risky and hazardous regions for climate change.

These informal settlements often are located around riverbanks, low-lying areas with little or no drainage facilities, few or in existent public services, and in most scenarios there is no protection from storm surges, sea-level rise, and flooding.

This report points to the fact that the a fore described communities are among the world’s most susceptible to the consequences of climate change.

Sadly, they also are almost absolutely incapable of accruing the necessary resources to aid adaptability.

The already stretched and thinning food security in sub Saharan Africa will be further severely threatened to extreme limits within the next three decades as we approach year 2050.

Life threatening extremes of weather condition have also been predicted.

In Sub-Saharan Africa, the researchers found that food security will be the overarching challenge, with dangers from droughts, flooding, and shifts in rainfall.

According to the report, between 1.5°C-2°C warming, drought and aridity, will contribute to farmers losing 40-80 percent of cropland conducive to growing maize, millet, and sorghum by the 2030s-2040s.

Multiple studies have revealed that in a 4°C warmer world, around the 2080s, annual precipitation may decrease by up to 30 percent in southern Africa, while East Africa will see more rainfall.

Ecosystem changes to pastoral lands, such as a shift from grass to woodland savannas as levels of carbon dioxide increase, could reduce food for grazing cattle.

It describes in details the risks to agriculture and livelihood security in Sub-Saharan Africa; the rise in sea-level, loss of coral reefs and devastation to coastal areas likely in South East Asia; and the fluctuating water resources in South Asia that can lead to flooding in some areas and water scarcity in others, as well as affecting power supply.

The temperature change seems to be small, a mere  2°C and 4°C change, however the impacts will be quite tremendous and World changing.

Today, communities across the globe are already experiencing the impacts of climate change, with the planet only 0.8 ºC warmer than in the pre-industrial era. 

Without appropriate concerted global action, the next two to three decades may be frothed with the devastating effects of a 2ºC warmer world and consequently a 4ºC increase by the end of the century.

In the words of The World Bank Group President Jim Yong Kim;

“The scientists tell us that if the world warms by 2°C – warming which may be reached in 20 to 30 years – that will cause widespread food shortages, unprecedented heat-waves, and more intense cyclones,"

"In the near-term, climate change, which is already unfolding, could batter the slums even more and greatly harm the lives and the hopes of individuals and families who have had little hand in raising the Earth's temperature.”

A Call to Action

The report emphasizes the need for global attention to the necessary actions needed to hold warming to 2ºC. 

Rachel Kyte, the World Bank’s vice president for Sustainable Development has said that:

“Our ideas at the World Bank have already been put into practice as we move forward to assist those whose lives are particularly affected by extreme weather events.” 

You and I can decide what happens to our World in the next two to three decades.

Join in the campaign today to Turn Down The Heat!

Review : Understanding the roles of faith-based health-care providers in Africa: review of the evidence with a focus on magnitude, reach, cost, and satisfaction

The paper begins the review with a discussion on the significance of this strategic time in history as the world transits from the far from reached MDGs to the SDGs to analyze the roles of faith based health care in the strengthening of Africa's health care systems with a focus to further foster enduring partnerships between national systems and faith based health care(FBHPs) .

The paper supports the idea that (FBHPs) continue to be an integral part of health provision systems in fragile health systems and importantly in sub Saharan Africa.

 In the words of James Wolfensohn of the World Bank (2002) “half the work in education and health in sub Saharan Africa is done by the church…but they don't talk to each other, and they don't talk to us.”

In a way we lost track of the work and contributions of Faith-based providers of health and education in the world of research and policy despite the fact that Christian and Islamic hospitals were some of the first modern health-care providers to be founded. 
Also post colonization, many developing economies have had to rely on FBHPs to  maintain health care provision irrespective of the national restructuring of health systems.

The recent tilt towards public health and the lack of total trust in the FBHPs as a result of proselytization are some of the reasons proffered by the review for the seeming neglect of the work done by FBHPs.

The paper focussed its review on sub Saharan Africa and Christian Faith based health providers due to the lack of robust evidence for other types of faith based care.

Some highlights of the review:

- FBHPs engaged in health from a policy level in the past decade have received more attention.

- The scarcity of systematic and consistent data for FBHPs. 

- Evidence of higher level of satisfaction by households from FBHPs than from public counterparts.

- Lower than expected market shares by FBHPs.

- The key roles played by FBHPs in many African countries, and moreso in fragile health systems. 

- Limited by certain weakness, finances, problems with adapting to changing health settings. 

- The appreciation of their contribution to health care is clouded by controversies tied to their faith.

 - The need to refrain from broad generalisations about faith-based organisations.
 - The need for more partnership oriented policy implementation strategies for engaging and relating with FBHPs.

- The need for more intense research on the contributions of FBHPs to universal health coverage at national levels.

The review alluded to the fact that most of the evidence available about the work of faith based organizations is in relation to their work on HIV/AIDS. This limits the scope of those who seek to understand the functioning and effects of specific health systems. 

At the beginning of the 21st century, minimal information was available about the number of available FBOs and their scope of operation.

Sadly comprehensive and consistent evidence about their scope of work and activities is still limited today.

However a general consensus by most of the stake holders in the health sector is that Faith based organizations and NGOs constitute a major force in health care delivery across Africa and in post conflict zones when compared with other health care providers.

In a comparison between FBOs in the Kenyan Mukuru settlement and their secular counterparts; a third of the 194 programs focused on HIV/AIDS were classified as faith based.

Generally, FBOs have been active in all aspects of public health : immunization, anti malarial campaigns, child and maternal health services, and tuberculosis. 

However the comparative magnitude of this involvement is not available.

To evaluate the magnitude of their involvement historically, FBOs during the era of the colonial masters dominated the health systems; in terms of number of facilities and magnitude of services.

Post independence, FBHPs have experienced substantial shifts in this role with new national governments taking strong leadership roles and the rapid expansion of public systems amidst a series of health sector reforms.

The governance of FBHPs was thereafter transferred from international denominational bodies to local churches, resulting in substantially reduced support from traditional sources and sometimes reduced growth of FBHP services. This also led to a drastic reduction in the source of funds to run FBOs.

 FBHPs currently source for funds for their services from government resources, user fees from patients, development assistance from bilateral and multilateral donors, and funding and in-kind contributions from within-country faith groups and local communities.

Some partnerships; albeit reluctantly have been forged between FBHPs and governments
which have resulted in improved public–private awareness. 
Such partnerships between ministries of health and Christian organizations exist in Chad, Malawi, Uganda, Tanzania, Zambia, Lesotho, Benin, Ghana, Kenya, and Cameroon. 
With FBOs committing to support public health sector goals and priorities (in particular, serving poor people in hard-to-reach areas), and in return, the government commits to some kind of financial compensation, often in the form of salary support, and usually negotiated to match bed-based market-share estimates. 

Needless to say several of the partnerships are strained, and frothed with failure to fulfil service-level agreements and conflicts with finance and human management systems.

FBOs funds are difficult to track, although efforts are being made to track them. It is however clearly evident that FBOs have several means of raising funds formally and informally and within local borders and internationally. 
Several studies have shown that many of the Faith based initiatives are run with local community based funds and resources (including local volunteers) with minimal contributions from external sources.

Many FBHPs were started with the aim to serve the poor in hard-to-reach areas, this intent often times is controversially associated with other motives such as proselytism. 

Evidence, however lends credence to the presence of FBHPs in remote rural areas in Africa. As a result of a commitment to serve the underprivileged or to fill a gap in areas not already met by government services.

Household surveys from 14 African countries show that  FBHPs seem to serve poor people slightly more than public providers (with 17% of patients in the poorest quintile).

There were higher household satisfaction rates with FBHPs.
Most studies show that this might not be directly related to religion.

Few indications suggest that patients choose FBHPs based on religious affiliation.

Lower out-of-pocket costs for households and perceptions of a higher quality of service than obtained at public health providers are some of the determining factors.

High quality of service is often associated with attention paid to the dignity of patients as well as more compassionate care than received elsewhere. This comparison is poorly subtantiated by evidence and the motivations are not clear as FBOs workers tend to work for longer hours for lesser pay due to reasons that may have a relationship to their faith.

The review being focused on the growing evidence of the nature of health care provided by faith-based health providers in Africa, hence the reviewers believe that the comparative weaknesses and potential negative effects associated with some FBHPs should also be examined. 

Published work commonly states that FBHPs can be of poorer quality than their public counterparts in some locations and that they may have weak governance  in terms of financial and human resource management due to the employment of managers and administrators due to their religious affliations and not for skills. 
More so the mixing of  theology with health-service policy have produced negative health effects especially as regards sexual and reproductive health in the past.

Emerging evidence from studies have shown that FBHPs are still very relevant and play key roles in the rebuilding of fragile health systems, although not much is known about how they function.

More quantitative and qualitative data is needed to provide support at management and policy levels on the day to day functioning of FBHPs within their health systems. 

The review proposed the need for the abandonment of broad generalisations of the magnitude and character of FBOs and further proposed that an understanding should be sought of the interactions of the management practice, organisational culture, pharmaceutical supply, cost recovery, and human resource management, and how these affect (clinical) quality, satisfaction, and use, and then how this affects access, reach to poor people, and broader goals such as universal health care.

Non-Christian providers, non-mainstream religious groups, and non-anglophone contexts are worryingly absent from the present analyses; this missing information is urgently needed if FBHPs are to align with their national governments in a way that strengthens the health system.
 
As the world deliberates on restructuring health care in sub Saharan Africa. This is a good time to examine the roles of faith based health care providers and faith based organizations so as to avoid duplication of care and available resources, and perhaps we may be able to come up with ways to benefit from the existing structures and pull resources together to build new programs, strategies, policies and initiatives on frame works provided by FBHPs and FBOs for an enduring Health system in Africa.

Review: G7 and Global health: inaction or incisive Leadership?

Source: The Lancet

Volume 385, No. 9986, p2433, 20 June 2015

Editorial

The paper discusses the analysis of "well meaning" critiques on the recent G7 summit held in Germany.

It touched on the importance of the G7 leaders seizing the moment at such a peculiar time in history, with the coming inception of the brand new sustainable development goals in September and the climate treaty in December.
A statement by Ban-ki-moon before the summit was centered on the leaders "seizing the moment and protecting the people and the planet."

Further more the special attention given to climate change and environmental protection was highlighted.
G7 leaders recognised the need for an ambitious solution at the COP21 meeting in Paris, and they reaffirmed that the increase in global temperature must be kept below 2°C, an important red line that seemed in the past to have been sacrificed to the exigencies of politics. As part of a global response, they committed to reduce their greenhouse gas emissions towards the upper end of the 40–70% reductions that the Intergovernmental Panel on Climate Change recommended by the end of the century.

Unlike the issue of climate change, according to the paper other pressing issues of equal global importance did not seem to have received financial commitments.
On the issue of health, Ebola and pandemics, verbal promises to help strengthen health systems were made; of which Joanne Liu of MSF has pronounced “lip service” to the seriousness of the threats posed by pandemics. She believes that action points not mere talk is needed at this point to combat these global health threats.

G7 leaders were also accused of being silent and having failed to commit to funding AMR research and Innovation (the new Global anti microbial resistance innovation fund). This according to the paper is frustrating to NGOs as people, especially the economic minority continue to die from anti microbial resistance.

Neglected tropical diseases, ending preventable child deaths, and improving maternal health were also touched on.

Are the criticisms surrounding the last G7 conference well founded?

The paper believes the condemnation is unfair. And that the summit showed that G7 leaders can agree on the importance of crucial universal issues—such as protecting health and climate. With these commitments being welcome proof of political will, actions (not advocacy) must now follow.

In my opinion we can not conclude yet as to the true intentions of the G7 leaders until we see the action points highlighted and the promises made at the summit become fully operational.
Words have been wasted in times past after empty promises were made which were followed by relative inaction.

Hence we call on the G7 leaders, the International community and every member of the public to be effective watch dogs of the declarations made at this summit.

Let's cooperate to hold our leaders responsible for the promises they made on our behalf.

The Boko Haram insurgency: implications for Public health ( in Nigeria ) by Seye Abimbola et al : A synopsis

Published on line : March 4 2015

Source : The Lancet; volume 385, 9972

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)60207-0/fulltext

Main highlights of the publication :

-  The Boko Haram insurgency

-  Worsening health indices in the affected 3 states.

- The effect of the crisis on  vaccine preventable diseases such as polio and measles.

-  The scourge of diarrheal diseases, such as cholera and malaria amongst the displaced people.

- A call for help. 

 The Boko Haram group has for 6 years terrorized Northeast Nigeria. 3 states : Yobe Adamawa and Borno have been seriously and adversely affected.

The maternal and child mortality figures are not encouraging in these regions.

Public health threats such as Polio may re emerge due to this crisis. There is currently an ongoing Measles outbreak in the said region.

Diarrheal diseases have been found to be most prevalent in the official and unofficial camps. The official camps are said to host just about 150000 of the over 980000 internally displaced people.

There is poor access to health care and poor sanitary conditions in the said camps.

Pregnant women,people with chronic diseases and children have little or no access to healthcare and medications.

A call is being made to policy makers and global health leaders nationally and internationally to rise up to the challenges being faced in the camps and relieve the suffering of the people.