In 2013, there were about 198 million malaria cases in the world and an estimated 584,000 deaths from the disease. The countries endemic for malaria are also some of the poorest countries in the world. The burden of malaria on the poor, including migrants and displaced populations in these countries further fuels the cycle of poverty. IOM works with governments and partners, mostly in Africa and Asia, to ensure universal access to health care, including malaria prevention, early diagnosis, and treatment services among migrants and hard-to-reach populations. This year’s theme for World Malaria Day on April 25th was 'Invest in the Future: Defeat Malaria'. It focused on reaching 2015 malaria targets in all malaria-endemic countries, as well as scaling up efforts in malaria elimination and control beyond 2015.
Values, Policies and Rights
Breaking the Rules 2014 (BTR) is a 237-page monitoring report which describes evidence of 813 Code violations, from 81 countries, collected between Jan 2011 and Dec 2013. The Rules are the International Code of Marketing of Breastmilk Substitutes and subsequent World Health Assembly resolutions (the Code), which are the yardstick to measure compliance by all companies in all countries. Following the request for clarification of ‘inappropriate promotion’ of foods for infants and young children, BTR: in Brief provides examples of marketing tactics that should not be allowed. The emphasis is on toddler milks or growing up milks (GUMs), a product which has been generating huge profits for the baby food industry over the past decade or more. The inappropriate promotions reported are Code violations. This abridged report is meant to show how the 16 largest baby food companies continue to ignore international recommendations adopted to protect infants and young children the world over so the public and investors can hold them to account.
The global agenda for malaria has, once again, embraced the possibility of eradication. The author argues that as history has shown, there will be no single magic bullet that can be applied to every epidemiological setting. Africa has a diverse malaria ecology, lending itself to some of the highest disease burden areas of the world and a wide range of clinical epidemiological patterns making control with our current tools challenging. This commentary highlights why the epidemiology of Plasmodium falciparum malaria in Africa should not be forgotten when planning an eradication strategy, and why forgetting Africa will, according to the author, once again, be the single largest threat to any hope for global eradication.
The Millennium Development Goals (MDGs) galvanised attention, resources and accountability on a small number of health concerns of low- and middle-income countries with unprecedented results. The international community is presently developing a set of Sustainable Development Goals as the successor framework to the MDGs. This review examines the evidence base for the current health-related proposals in relation to disease burden and the technical and political feasibility of interventions to achieve the targets. In contrast to the MDGs, the proposed health agenda aspires to be universally applicable to all countries and is broad in encompassing both communicable and non-communicable diseases as well as emerging burdens from, among other things, road traffic accidents and pollution. The authors argue that success in realising the agenda requires a paradigm shift in: 1) ensuring leadership for intersectoral coherence and coordination on the structural drivers of health; 2) shifting the focus from treatment to prevention through locally-led, politically-smart approaches to a far broader agenda; 3) identifying effective means to tackle the commercial determinants of ill-health; 4) further integrating rights-based approaches; and 5) enhancing civic engagement and ensuring accountability. The authors are concerned that neither the international nor the global health community truly appreciates the extent of the shift required to implement this health agenda which is a critical determinant of sustainable development.
The author argues that the proposed food policy in South Africa shies away from confronting capital interests within the food value-chain. Apart from acknowledging that the emerging agricultural sector is in need of assistance, the policy is reported to be silent on the influence of big-business in the food system.
Strengthening the protection of sexual and reproductive health and rights in the African region through human rights uses rights-based frameworks seeks to address some of the serious sexual and reproductive health challenges that the African region is currently facing. The authors provide human rights approaches on how these challenges can be overcome. Human rights issues addressed by the book include: emergency obstetric care; HIV/AIDS; adolescent sexual health and rights; early marriage; and gender-based sexual violence.
Female Genital Mutilation (FGM) is outlawed in Kenya. In this interview, Kenyan activist John Wafula holds the view that: “FGM is not a culturally enriching choice but rather a tool to isolate women and girls for disempowerment, domination and stagnation. If FGM negates girls’ right to education and healthy bodies then it ceases to be tenable as a cultural identity”. Prior to interventions to address FGM, he reports undertaking a baseline study to establish the prevalence of FGM in refugee camps, survivors, practitioners. The reasons why FGM was practiced, mostly among refugees of Somali descent, included perceptions that uncircumcised women would otherwise be unfaithful and ineligible for marriage. Their efforts to prevent FGM entailed creating awareness about its health, social and psychological consequences at the community level. They also invited religious scholars to engage the community on religion-based myths that were peddled to justify FGM. They sensitized school children on human rights, which also encompassed protection against any form of violence, FGM included. They targeted refugee community leaders for sensitization because of their visible position as community gatekeepers. The 2014 Kenya Demographic Health Survey indicated a nation-wide prevalence of 23%, down from 27% in 2008-09 and 32% in 2003. After enactment of the Prohibition of Female Genital Mutilation Act in 2011, an Anti-FGM Board was established that is reviewing a FGM policy with vigorous media campaigns to sensitize the public on the Act, supported by insights from research.
Expanded mobility and cross-border trading across the road transport sector in Southern Africa have contributed to increased HIV prevalence rates among key populations and communities living in the region. To support a strengthened and co-ordinated response to the unique public health challenges this presents, the Southern African Development Community (SADC) approved the Regional Minimum Standards and Brand for HIV and other Health Services Along Road Transport Corridors in the SADC Region (RMSB) in November 2015. It includes guiding principles on the right to health; health-promoting workplaces; gender mainstreaming; empowerment of commercial sex workers and effective partnership. It sets minimum standards on service delivery and a minimum package of services for those involved in road transport corridors.
A multi-pronged approach is needed to end female genital mutilation (FGM) in one generation. This includes prevention, protection, provision of services, partnerships and prosecutions. States must live up to their international obligations to protect women and girls. Over the last 12 months, the campaign against FGM has received renewed support from different actors committed to ending the practice. According to UNICEF, Kenya has led the way with falls in prevalence from middle-aged women to adolescent girls from 49% to 15%, albeit with an increase in the percentage of FGM performed by health personnel. 2014 also saw a significant increase in the prosecution of FGM cases globally and verdicts in a few countries. This article discusses the global challenges and successes of addressing FGM and makes recommendations towards eliminating FGM in a generation.
Although a substantial literature suggests that orphans suffer disadvantage relative to non orphaned peers, the nature of this disadvantage and the mechanisms driving it are poorly understood. Some evidence suggests that orphans experience elevated fertility, perhaps because structural disadvantage leads them to engage in sexual risk-taking. An alternative explanation is that orphans intentionally become pregnant to achieve a sense of normality, acceptance and love. Data from the 2006 wave of the Malawi Longitudinal Study of Families and Health on 1,033 young adults aged 15–25 were used to examine the relationship of maternal and paternal orphanhood with sexual risk indicators and desired and actual fertility. Regression analyses were used to adjust for covariates, including social and demographic characteristics and elapsed time since parental death. Twenty-six percent of respondents had lost their father and 15% their mother. Orphanhood was not associated with sexual risk-taking. However, respondents whose mother had died in the past five years desired more children than did those whose mother was still alive (risk differences, 0.52 among women and 0.97 among men). Actual fertility was elevated among women whose father had died more than five years earlier (0.31) and among men whose mother had died in the past five years (1.06) or more than five years earlier (0.47). The elevations in desired and actual fertility among orphans are consistent with the hypothesis that orphans intentionally become pregnant. Strategies that address personal desires for parenthood may need to be part of prevention programs aimed at orphaned youth.