Despite the lack of reliable trend data on maternal mortality, some investigators now believe that progress in maternal health has been very slow in sub-Saharan Africa. This study uses a unique combination of health facility- and individual-level data collected in the slums of Nairobi, Kenya to: describe the provision of obstetric care in the Nairobi informal settlements; describe the patterns of antenatal and delivery care, notably in terms of timing, frequency, and quality of care; and draw policy implications aimed at improving maternal health among the rapidly growing urban poor populations. It shows that the study area is deprived of public health services and that despite the high prevalence of antenatal care (ANC), the proportion of women who made the recommended number of visits or who initiated the visit in the first trimester of pregnancy remains low. Household wealth, education, parity, and place of residence were closely associated with frequency and timing of ANC and with place of delivery. There is a strong link between use of antenatal care and place of delivery. The findings of this study call for urgent attention by Kenya’s Ministry of Health and local authorities to the void of quality health services in poor urban communities and the need to provide focused and sustained health education geared towards promoting use of obstetric services.
Poverty and health
The study seeks to improve understanding of maternity health seeking behaviors in resource-deprived urban settings by identifying factors which influence the choice of place of delivery among the urban poor, with a distinction between sub-standard and “appropriate” health facilities. Methods The data are from a maternal health project carried out in two slums of Nairobi, Kenya. A total of 1,927 women were interviewed, and 25 health facilities where they delivered, were assessed. Facilities were classified as either “inappropriate” or “appropriate”. Although 70% of women reported that they delivered in a health facility, only 48% delivered in a facility with skilled attendant. Besides education and wealth, the main predictors of place of delivery included being advised during antenatal care to deliver at a health facility, pregnancy 'wantedness', and parity. The influence of health promotion (i.e., being advised during antenatal care visits) was significantly higher among the poorest women. Interventions to improve the health of urban poor women should include improvements in the provision of, and access to, quality obstetric health services. Women should be encouraged to attend antenatal care where they can be given advice on delivery care and other pregnancy-related issues. Target groups should include poorest, less educated and higher parity women.
The aim of this study was to describe current infant growth patterns using WHO Child Growth Standards and to determine the extent to which these patterns are associated with infant feeding practices, equity dimensions, morbidity and use of primary health care for the infants. A cross-sectional survey of infant feeding practices, socio-economic characteristics and anthropometric measurements was conducted in Mbale District, Eastern Uganda in 2003; 723 mother-infant (0-11 months) pairs were analysed. The adjusted analysis for stunting showed stunting was more prevalent among boys (58.7% versus 41.3%). Having brothers and/or sisters was a protective factor against stunting, but replacement or mixed feeding was not. Lowest household wealth was the most prominent factor associated with stunting with a more than three-fold increase in odds ratio. In conclusion, stunting is related to sub-optimal infant feeding practices after birth, poor household wealth, age, gender and family size.
Using a cross-country data, drawn from sub-Saharan Africa and a multiple regression analysis, this paper examines the extent to which low nutrient intake has impacted on infant mortality rate in sub-Saharan Africa. The results indicate that low nutrient intake has a significant influence on infant mortality rate, thus fulfilling the a-priori expectation that the lower the nutrient intake, the higher the rate of infant mortality rate in sub-Saharan Africa. Given this, measures such as, increase in food availability, macro-economic stability (especially, a reduction in inflation rate and exchange rate stability), improved nutrition through micro-nutrients fortification and supplementation, ensuring good governance and combating ethnic/religious/ civil conflicts and HIV/AIDS are suggested as possible solutions to improving nutrient intake in sub-Saharan Africa.
Pimbert’s book covers a range of topics related to food sovereignty. He looks at local food systems, livelihoods and environments, and the ecological basis of food systems before explaining how the current multiple crises in food, agriculture and environment arose, in terms of the social and environmental costs of modern food systems. The book concludes with the author’s vision of a way forward: He presents food sovereignty as an alternative paradigm for food and agriculture and discusses how to promote national policies and legislation and global multilateralism and policies that promote food sovereignty.
Cholera can rapidly lead to severe dehydration and death if left untreated. Oral rehydration salts (ORS) can successfully treat 80% of cholera patients - both adults and children –and should be given early at home to avert delays in rehydration and improve survival. WHO outlines in the report that it does not see any contradiction in making ORS packages available to households and non-medical personnel outside health care facilities. In contrast, making ORS available at household and community levels can avert unnecessary deaths and contributes to diminishing case fatality rates, particularly in resource-poor settings. Providing nutritious food as well as continuing breastfeeding for infants and young children should continue simultaneously with administering appropriate fluids or ORS.
During his three-day visit from 16-19 December 2008, Dr Sambo held discussions with national authorities and partners on ways and means of bringing an end to the spread of the cholera epidemic. Dr Sambo advised that beyond cholera, other specific health problems may become worse if the key social and economic determinants of health are not urgently improved. He highlighted the importance of inter-sectoral approach in the prevention of cholera and reached agreement with the Minister of Health to establish the Cholera Command and Control Centre, jointly operated by WHO and the Ministry of Health of Zimbabwe, to coordinate and boost the country’s capacity to manage the response particularly in the areas of disease surveillance, case management, water and sanitation, social mobilisation and logistics.
In this article exploring the history of socio-economic inequality, the author calls for an interpretation of the current food crisis over the historical long term. As a direct consequence of an entrenched, centuries-old capitalist system, the market as a ‘modernising’ force has consistently enriched the lives of a few while impoverishing a poor majority. Understanding the food crisis rests first and foremost on re-considering humanity’s relationship to nature and championing historical narratives true to the voices and experiences of the global poorest of the poor. Up till now, analysts have been discussing the current food crisis from the perspective of the last few decades, which is very short term, suggesting that the problem is momentary and conjunctural. It is neither and has been in the making for a very long time, as far back as 1491.
This study analyses the report, Circumstances of Orphan and Non-orphan Children and their Care Providers in Mwanza, Tanzania, which sampled 1,960 children aged 6–19. It focuses on vulnerability indicators in children's living arrangements, education, paid work and psychosocial well-being, particularly girls, who are most vulnerable. Particular emphasis should be paid to girls within situation analyses. Vulnerabilities associated with widespread and chronic poverty underlie vulnerabilities related to demographic factors and household restructuring. Their complex interplay reiterates the need for AIDS impact mitigation measures to be built on a comprehensive and robust social protection programme that is driven by poverty reduction objectives.
Citizens have demanded that world leaders keep promises to achieve the Millennium Development Goals and end inequality. More than 116 million people – nearly 2% of the world’s population – mobilised at events in 131 countries on 17–19 October as part of the Stand Up and Take Action campaign. The mobilisation, which was ratified by the Guinness Book of Records as breaking the world record for the biggest mass mobilisation on a single issue, sends a clear message to world leaders that citizens want promises to end poverty to be fulfilled. At least five million additional people – many in Africa and Latin America – participated at events not submitted before the Guinness deadline. The United Nations Millennium Campaign has vowed not to stop mobilising and advocating for action until the Millennium Development Goals are achieved for the poorest people in the world.