H5N1

COVID-19 will almost double acute hunger by end of 2020

Via the UN's World Food Programme: COVID-19 will almost double acute hunger by end of 2020. Excerpt:

The COVID-19 pandemic will see more than a quarter of a billion people suffering acute hunger by the end of the year, according to new figures from the World Food Programme (WFP). 

Latest numbers indicate the lives and livelihoods of 265 million people in low and middle-income countries will be under severe threat unless swift action is taken to tackle the pandemic, up from a current 135 million. 

That is nearly double the number in the newly published Global Report on Food Crises 2020, which estimates that 135 million people in 55 countries currently face acute hunger as a result chiefly of conflict, the effects of climate change, and economic crises. That report was drawn up prior to the emergence of COVID-19 as a pandemic, and the contrasting figures provide a startling insight into the devastating potential of this virus. 

Concern is highest for those in countries across Africa as well as the Middle East, as the virus threatens lives and livelihoods along with the trading networks they rely on for survival. 

“These new projections show the scale of the catastrophe we are facing,” warned WFP chief economist Arif Husain. “We must make sure that tens of millions of people already on the verge of starvation do not succumb to this virus or to its economic consequences in terms of loss of jobs and incomes. 

“Just like in developed nations, governments are doing all they can to assist their people. We need to do the same for tens of millions of people.” 

The greatest worry is for people living in conflict zones and those forced from their homes and into refugee camps, with countries of concern including northeastern Nigeria, South Sudan, Syria and Yemen. 

“These are the people I’m most worried about,” said Husain. “They did not need COVID-19. Even without it their lives were hanging by a thread. They literally depend on us for their lives. If we cannot get to them for any reason they end up paying the ultimate price. We need to prioritize the people and make sure we’re there. Because if it’s not us, it’s no one else.”

Once the breadbasket of Africa, Zimbabwe now on brink of man-made starvation, UN rights expert warns

Via the UN Office of the High Commissioner of Human Rights, a warning about a story far graver than Ebola: Once the breadbasket of Africa, Zimbabwe now on brink of man-made starvation, UN rights expert warns. Excerpt and then another link:

GENEVA / HARARE (28 November 2019) - Despite the constitutional protection of the right to food and a sophisticated set of human-rights based national laws and policies, man-made starvation is slowly making its way in Zimbabwe, said the UN expert of the right to food after visiting the country from 18 to 28 November 2019.  

"More than 60% of the population of a country once seen as the breadbasket of Africa is now considered food-insecure, with most households unable to obtain enough food to meet basic needs due to hyperinflation," said Hilal Elver, Special Rapporteur on the right to food, presenting a preliminary statement at the end of an 11-day visit. 

"In rural areas, a staggering 5.5 million people are currently facing food insecurity, as poor rains and erratic weather patterns are impacting harvests and livelihoods. In urban areas, an estimated 2.2 million people are food-insecure and lack access to minimum public services, including health and safe water.  

"These are shocking figures and the crisis continues to worsen due to poverty and high unemployment, widespread corruption, severe price instabilities, lack of purchasing power, poor agricultural productivity, natural disasters, recurrent droughts and unilateral economic sanctions." 

Elver said women and children were bearing the brunt of the crisis. 

"The majority of the children I met were stunted and underweight," she said. "Child deaths from severe malnutrition have been rising in the past few months. 90 % of Zimbabwean children aged six months to two years are not consuming the minimum acceptable diet.  

"I saw the ravaging effects of malnutrition on infants deprived of breast feeding because of their own mothers' lack of access to adequate food. 

"In a desperate effort to find alternative means of livelihood, some women and children are resorting to coping mechanisms that violate their most fundamental human rights and freedoms. As a result, school drop-outs, early marriage, domestic violence, prostitution and sexual exploitation are on the rise throughout Zimbabwe."  

Elver said people she met in the drought-affected areas of Masvingo and Mwenezi, located in the driest regions of the country, told her they ate only one portion of cooked maize a day. Women, the elderly and children are barely able to meet their minimum food needs and are largely dependent on food assistance, while most of the men are abroad seeking work, she added. 

"Without access to a diversified and nutritious diet, rural Zimbabweans, particularly younger children, barely survive," she said, adding that the agricultural and food system needs immediate reform.  

"I strongly urge the Government to take the necessary measures to reduce the country's dependence on imported food, particularly maize, and to support alternative wheats to diversify the diet. The Government should create the conditions for the production of traditional seeds to ensure the country's self-sufficiency and preparedness for the climate shocks that hit the country." 

The Special Rapporteur said the crisis in Zimbabwe's cities was no less severe than in rural areas.

"I witnessed some of the devastating consequences of the acute economic crisis in the streets of Harare, with people waiting for hours on long lines in front of gas stations, banks, and water dispensaries," she said. 

"The Zimbabweans I spoke to in Harare and its suburbs explained that even if food was widely available in markets, the erosion of their incomes combined with an inflation skyrocketing to over 490%, made them suffer from food insecurity, also impacting the middle-class. 

Elver also said that she received "disturbing" information that public hospitals have been reaching out to humanitarian organizations after their own medicine and food stocks were exhausted.  

Elver also received indication that the distribution of lands or food had been manipulated for political ends throughout the last two decades, favoring those who support the ruling political party. 

"I call on the Government of Zimbabwe to live up to its zero hunger commitment without any discrimination," Elver said.

Meanwhile, The Zimbabwean reports striking doctors say poor conditions in hospitals are causing a "silent genocide":

The senior doctors described the situation at the country’s hospitals as a silent genocide, saying doctors are forced to work without basics such as bandages, gloves, and syringes.

“We have watched the past few months as the situation in our hospitals continues to deteriorate.

“In March this year, the situation in hospitals deteriorated to the point where there were no bandages, gloves, and syringes available forcing senior doctors to highlight the dire situation publicly. It is important to find out why this has taken so long to be resolved as a silent genocide continues to be perpetrated upon the people of Zimbabwe,” the statement said.

Death toll from acute encephalitis in east Indian town rises to 129 children

Via Thompson Reuters: Death toll from acute encephalitis in east Indian town rises to 129 children. 

NEW DELHI, June 23 (Reuters) - At least 129 children have now died of Acute Encephalitis Syndrome (AES) in the town of Muzaffarpur in the eastern Indian state of Bihar since an outbreak earlier this month, a medical official said on Sunday. 

The death toll from AES, a fever that affects the central nervous system, has risen from 97 reported last Monday and medical and government officials are facing mounting criticism for struggling to contain the crisis in the town of nearly 350,000 people. 

AES, known as 'brain fever' is caused by any one of a number of viruses. Symptoms include high fever, vomiting and, in severe cases, seizures, paralysis and coma. Infants and elderly people are particularly vulnerable.  

"I received my last update in the afternoon and according to the latest report that I have, 129 children have died so far," Shailesh Prasad Singh, the top state medical official in Muzaffarpur told Reuters by phone. The town lies about 80 km (50 miles) from Patna, the state capital. 

The precise causes of AES are not known, though a majority of medical professionals say it is linked to a ferocious heat-wave. 

Some studies have blamed toxins in lychees, a fruit grown in abundance in orchards around Muzaffarpur. But many families told Reuters last week that their children had not eaten them in recent weeks. 

Singh said a team of experts, including doctors, paramedics and other government officials were working "round the clock" to contain the spread of AES, which killed more than 350 children in a previous outbreak in Bihar in 2014.  

Doctors from other parts of the country had been dispatched to Muzaffarpur to help staff at the Sri Krishna Medical College Hospital which had to evict a group of sick inmates from a ward to accommodate the surge in AES patients. Most of the children who died were being treated at the hospital.  

Nearly half of all children in Muzaffarpur are underweight, and a similar number are stunted, making them vulnerable to AES, which grips the town almost every year when summer temperatures surge. 

As the death toll mounts, both the Bihar and the federal governments have come under criticism for their inability to save children, and doctors and government officials have faced angry protests. 

On Sunday, the Bihar government suspended a doctor in Muzaffarpur for dereliction of duties, news agency ANI, a Reuters affiliate, said. 

India's Federal Health and Family Welfare Minister Harsh Vardhan, who is himself a doctor, said last week that health officials have finalised plans for construction of a 100-bed paediatric intensive care unit in Muzaffarpur, but gave no timeframe for when it would be built.

Nearly half of all child deaths in Africa stem from hunger, study shows

Via The Guardian: Nearly half of all child deaths in Africa stem from hunger, study shows. Excerpt and then a comment:

One in three African children are stunted and hunger accounts for almost half of all child deaths across the continent, an Addis Ababa-based thinktank has warned. 

In an urgent call for action, a study by the African Child Policy Forum said that nearly 60 million children in Africa do not have enough food despite the continent’s economic growth in recent years. 

A child dies every three seconds globally due to food deprivation – 10,000 children every day – but although figures show an improvement in child hunger at a global level, it is getting worse in some parts of Africa, where the problem is largely a question of political will. 

Nine out of 10 African children do not meet the criteria for minimum acceptable diet outlined by the World Health Organization, and two out of five don’t eat meals regularly. Liberia, Congo and Chad are at the bottom of the chart when it comes to children aged six to 23 months receiving sufficient and diverse food with a healthy frequency. They are followed by Zimbabwe, Guinea-Bissau, Gambia and the Democratic Republic of the Congo. 

“Child hunger is fundamentally a political problem,” said Assefa Bequele, ACPF’s executive director. “It is the offspring of the unholy alliance of political indifference, unaccountable governance, and economic mismanagement. Persistent and naked though the reality is, it remains a silent tragedy, one that remains largely unacknowledged and tolerated, perhaps because it is a poor man’s problem.”  

Bequele added: “It is completely unacceptable that children are still going hungry in Africa in the 21st century. The statistics are truly alarming. Child hunger is driven by extreme poverty, uneven and unequal economic growth, gender inequality and a broken food system. Although Africa now produces more food than ever, it hasn’t resulted in better diets.” 

Hunger impairs growth and cognitive development of children, but also hits the economic performance of the country they come from. Child hunger can cost African countries almost 17% of their GDP, according to the report. The continent’s present GDP is estimated to have been reduced by 10% because of stunting alone.

I wrote about stunting in The Tyee in 2016. It's not as dramatic as Ebola or Lassa fever, but it's far, far deadlier.

North Korea’s silent health crisis

As Kim and Trump meet in Vietnam (a situation unthinkable three years ago), IRIN reports on North Korea’s silent health crisis. Excerpt:

North Korea is frequently portrayed as an unknowable, impenetrable land. However, a substantial amount of data on health indicators is readily available. While it must be treated with caution – malnutrition figures, for example, don’t include political prisoners languishing in camps – the data can be useful for showing longer-term trends.  

When it comes to the effects of malnutrition, the data shows an improvement in the two decades since the famine ended – but also clear indications of a continuing problem. In 1998, a UNICEF survey found evidence of child stunting – when a child’s height falls considerably below what would be expected at that age. About 62 percent of children younger than seven years of age showed stunted growth, while 60 percent were considered underweight. In 2017, UNICEF’s Multiple Indicator Cluster Survey – drawn from household survey data – reported that roughly 19 percent of children were stunted, while about 9.3 percent were underweight.  

This is clearly an improvement. But one in five children are still considered stunted. The children in the 1998 survey are now in their 20s, many likely with children of their own. Today, the World Food Programme estimates that 10.9 million people are undernourished – about 43 percent of the population. And undernourishment is a common denominator for many of the health problems afflicting North Koreans.  

Undernourishment in pregnant women 

Indicators gauging maternal health in North Korea vary widely. The maternal mortality ratio estimates the proportion of women who die during pregnancy – essentially the risk associated with pregnancy in a given country. World Bank data suggests the maternal mortality ratio in North Korea has fallen steadily since a peak in 1999. However, data from North Korea’s own Central Bureau of Statistics says the maternal mortality ratio has fluctuated and even risen in recent years: from 72 per 100,000 live births, to 62.7 in 2014, then a notable jump to 82 in 2015. 

Even using the World Bank’s more optimistic figures, North Korea’s maternal mortality ratio still hasn’t reached pre-famine levels – estimated at 56 deaths per 100,000 live births in 1992. And it’s still far off the mark set by South Korea, where the ratio is 11.  

Current indicators suggest cause for concern. According to UNICEF, nearly one in three women of reproductive age are undernourished, and nearly one in four are underweight. And the UN agency says it couldn’t distribute nutritional supplements to 95 percent of pregnant and lactating women during a nationwide child health campaign last year, due to funding shortfalls. 

Tuberculosis trouble ahead 

There is a funding crisis for tuberculosis treatment in North Korea, and the disease may be killing people at an increasing rate. World Health Organisation estimates for tuberculosis deaths in North Korea are on the rise: from a low of 42 deaths per 100,000 people in 2015, to 63 in 2017. 

The Global Fund – the donor agency financing treatment for HIV, tuberculosis, and malaria around the world – pulled funding for tuberculosis and malaria programmes last year citing oversight concerns in North Korea’s ”unique operating environment”. The decision was met with worried opinion pieces, open letters, and pleas of concern from the medical community.

With the impact of sanctions and the Global Fund’s withdrawal, there are fears this upward trend may continue. In an open letter published in the British medical journal The Lancet, the director of the Korean American Medical Association, which works on tuberculosis treatment programmes in North Korea, warned that medicine rationing triggered by drugs shortages could fuel the ”rapid creation of drug-resistant TB strains”.

Malnutrition, obesity and climate change threaten our future, warns report

The Tyee has published my article Malnutrition, Obesity and Climate Change Threaten Our Future, Warns Report. Excerpt:

Having dropped one bombshell report this month warning that our food choices are destroying the world, the British medical journal The Lancet has now dropped a second that says we’re now in a perfect storm of undernutrition, obesity and climate change.  

The Lancet calls it the “Global Syndemic.” The report’s authors say we’re facing three pandemics — undernutrition, obesity and climate change — that are interacting to form a “synergy of epidemics,” or syndemic, and it’s a global problem. 

Here’s how it works. Undernourished children in low-income and middle-income countries suffer from stunting, which makes them smaller than well-nourished children. But it also makes them more susceptible to obesity (which affects kids and adults in high-income countries even more). By 2015, obesity was affecting two billion people around the world. They’ve been set up to die of cardiovascular diseases, Type 2 diabetes and some cancers.  

The report says, “Economic losses attributable to undernutrition are equivalent to 11 per cent of the GDP in Africa and Asia, or approximately $3.5 trillion annually.” As we add another billion undernourished people by 2030, those losses will worsen.

India’s stunted progress on child health 71 years after

Via Malnutrition Deeply: India’s Stunted Progress on Child Health 71 Years After. Excerpt:

Despite nearly 71 years of independence, Indian children are still bound by malnutrition and poor health, a result of absolute poverty and an ineffective state. It is widely recognized that health issues from nutritional deficiencies in childhood can have a compounding effect in adult life. Inadequate healthcare can be debilitating to society at large from multiple vantage points: public participation, individual freedom and labor supply. 

Healthier citizens are better able to participate in public life and public activities, can choose from a larger set of opportunities, and are more capable in their jobs. Simply put, healthier individuals are able to do more, be more and contribute more. A critical question stares us in the face at this juncture: What is the actual status of child health in India?  

Dire Straits for Children 

There are several indicators that reflect the long-term health and nutritional experience of an individual or population. One can check whether a child is stunted, underweight or wasted. Studies have linked stunting to lower cognitive development, among other unfavorable outcomes. 

In addition, cognitive development is also impaired by anemia (low hemoglobin caused by iron deficiency). Wasting is a result of acute significant food shortage and/or disease and is a strong predictor of under-5 mortality. Figures reveal that over 16 percent of children in India are severely stunted, as many as 58 percent children are anemic, while close to 7 percent are severely wasted. 

These poor outcomes are in part, borne of inadequate diets – less than 10 percent children (6–23 months) receive the minimum acceptable diet. Starvation deaths still occur, as sheer poverty and deprivation have precluded a large number of people from being able to feed themselves or their children restricting their future lives. Age-appropriate vaccination coverage also remains low at 27.4 percent, thereby compounding the magnitude of the health problem. The state of child health in India is grave. Successive governments have recognized this and put into action various programs to tackle the issue.  

Vital, but Falling Short 

The Poshan Abhiyaan (National Nutrition Mission), launched in March 2018, has been one such step and aims to address malnutrition through convergence across ministries, improved technology and better targeting. It is premature to know of its impact, yet, critical in the battle against malnutrition have been Anganwadi Centres (AWCs) under the longstanding Integrated Child Development Services (ICDS) program that began in 1975. As part of the program, children and lactating and pregnant mothers have been eligible for cooked meals, health check-ups, and immunization services.  

Even today, AWCs do not cover all children who require these services: only 1 in 2 children received any service according to National Family Health Survey 4 data. A quarter of ICDS beneficiaries are malnourished, a number that has increased from 15 percent in 2015 to 25 percent in 2017, as per analysis by the Accountability Initiative. This shows that even as ICDS coverage is expanding to include those who need it most, malnutrition remains a problem among those that avail ICDS services.

This is what collapsing health, education, water and sanitation systems look like in Yemen

Via Thomson Reuters, a report by Henrietta H. Fore of UNICEF: This is what collapsing health, education, water and sanitation systems look like in Yemen. Excerpt:

In Yemen, one child dies every 10 minutes from a preventable disease, and on a recent visit to the country, I saw first-hand what that meant.  

At the Al Qateea hospital in Aden, southern Yemen, mothers hold frail, acutely malnourished babies while psychosocial workers offer counseling to terrified children, some of whom have experienced the horrors of war before they are even old enough to go to school. An eight-year-old girl draws a picture of the world she dreams of, one in which the streets are safe, the sun is shining and the birds are chirping – nothing like the real world around her. 

Further north, a similar scene is unfolding at the Al Sabeen hospital in Sanaa. Up to 30 new young patients stream in every day to the hospital’s malnutrition ward. In the neonatal intensive care unit, newborn babies in incubators struggle for every breath.  

Keeping babies alive in a country where nothing works any more is a real challenge: There are not enough respirators and not enough medicine. Health staff diligently report to work even though they have not received their salaries in two years. The malnutrition ward is packed. Parents have no money for health care and by the time they bring their sick babies in, it is often too late. 

This is what a collapsing health system in a war zone looks like. It has the face of a mother who looks on, powerless, as her eight-month-old child, who has the weight of a newborn baby, fights for his life. It has the face of a father who has to choose between buying food for the whole family or buying medicine for his sick wife.  

Yemen had some of the worst health indicators globally even before the current escalation of fighting. Stunting rates are among the highest in the world, at 47 per cent. 1 in 60 women runs the risk of dying from pregnancy-related complications. Under-five mortality is high, at 55 per 1,000 live births. 

Three years into this conflict, more than half of the health facilities are non-functional due to damage or a lack of operating budget and staff. Half of the country’s children do not have clean water. An outbreak of cholera/acute watery diarrhea last year, the biggest on record, killed more than 400 children under the age of five. At least 80 per cent of the population live below the poverty line. 

The whole public service sector in Yemen, not just health, has been left in tatters. Teachers have not been paid in months, forcing many to abandon their classrooms and find other sources of income. Up to 1,500 schools have been damaged due to airstrikes and shelling, or have been occupied by armed forces and displaced persons. 

Sanitation workers too have been expected to come to work although they are not paid. Not doing so poses a serious risk in a country where cholera and famine are persistent risks.  

UNICEF has supported the payment of incentives for doctors, nurses and health workers who run the newborn, pediatric and maternity wards in at least eight hospitals in Yemen that receive the highest number of patients. This support has been crucial since the conflict escalated as it helps maintain some social services at such a critical time for children.  

We need funding to offer similar incentives for teachers and water and sanitation workers. But more importantly, all authorities in Yemen need to step up, recognize the urgency and get public services in the country up and running again.

Rwanda secures $55 million from World Bank to reduce chronic malnutrition

Via allAfrica.com, a New Times report: Rwanda: Govt Secures Rwf47 Billion From WB to Reduce Chronic Malnutrition.

Cases of chronic malnutrition could be reduced by more than 10 per cent thanks to a new financing deal between the Government of Rwanda and the World Bank Group. 

The Government and the World Bank yesterday signed a $55 million deal (about Rwf47bn) to reduce stunting rates among children. 

Part of the $55 million is a $25 million credit provided by the International Development Association (IDA) while the rest will come in as a grant jointly provided by the Power of Nutrition ($20 million) and the Global Financing Facility which injected in $10 million.  

This partnership could see the rate of stunting ratio reduced from the current 43 per cent to less than 33 per cent among highly affected districts, officials said. 

Speaking after the signing ceremony, Claver Gatete, the Minister for Finance and Economic Planning, called the support a timely shot, adding that it will help address the issue of chronic malnutrition, especially among children between 5 and 13 years of age.  

According to Gatete, the project will support the Government in adopting and implementing bold strategies to improve the visibility of stunting in Rwanda, and to deliver harmonised behavior change messages across various platforms. 

 The districts set to benefit from this support include Nyabihu, Ngororero, Karongi, Rubavu, Rutsiro, Rusizi, Nyamagabe, Huye, Nyaruguru, Ruhango, Gakenke, Kayonza and Bugesera.  

The money will be utilised under an existing Social Protection project. 

The Minister for Health, Dr Diane Gashumba, said the package will, among other things, boost malnutrition awareness among pregnant mothers. 

Government is committed and will do everything within its reach to make sure stunting is eradicated once and for all, she noted.

Long-term health impact of diarrheal diseases in children under five

Via The Lancet Global Health: Global disability-adjusted life-year estimates of long-term health burden and undernutrition attributable to diarrhoeal diseases in children younger than 5 years. The summary:

Background 

Diarrhoea is a leading cause of death and illness globally among children younger than 5 years. Mortality and short-term morbidity cause substantial burden of disease but probably underestimate the true effect of diarrhoea on population health. This underestimation is because diarrhoeal diseases can negatively affect early childhood growth, probably through enteric dysfunction and impaired uptake of macronutrients and micronutrients. We attempt to quantify the long-term sequelae associated with childhood growth impairment due to diarrhoea. 

Methods 

We used the Global Burden of Diseases, Injuries, and Risk Factors Study framework and leveraged existing estimates of diarrhoea incidence, childhood undernutrition, and infectious disease burden to estimate the effect of diarrhoeal diseases on physical growth, including weight and height, and subsequent disease among children younger than 5 years. 

The burden of diarrhoea was measured in disability-adjusted life-years (DALYs), a composite metric of mortality and morbidity. We hypothesised that diarrhoea is negatively associated with three common markers of growth: weight-for-age, weight-for-height, and height-for-age Z-scores. 

On the basis of these undernutrition exposures, we applied a counterfactual approach to quantify the relative risk of infectious disease (subsequent diarrhoea, lower respiratory infection, and measles) and protein energy malnutrition morbidity and mortality per day of diarrhoea and quantified the burden of diarrhoeal disease due to these outcomes caused by undernutrition.  

Findings 

Diarrhoea episodes are significantly associated with childhood growth faltering. We found that each day of diarrhoea was associated with height-for-age Z-score (–0·0033 [95% CI −0·0024 to −0·0041]; p=4·43 × 10−14), weight-for-age Z-score (–0·0077 [–0·0058 to −0·0097]; p=3·19 × 10−15), and weight-for-height Z-score (–0·0096 [–0·0067 to −0·0125]; p=7·78 × 10−11). After addition of the DALYs due to the long-term sequelae as a consequence of undernutrition, the burden of diarrhoeal diseases increased by 39·0% (95% uncertainty interval [UI] 33·0–46·6) and was responsible for 55 778 000 DALYs (95% UI 49 125 400–62 396 200) among children younger than 5 years in 2016.

Among the 15 652 300 DALYs (95% UI 12 951 300–18 806 100) associated with undernutrition due to diarrhoeal episodes, more than 84·7% are due to increased risk of infectious disease, whereas the remaining 15·3% of long-term DALYs are due to increased prevalence of protein energy malnutrition. The burden of diarrhoea has decreased substantially since 1990, but progress has been greater in long-term (78·7% reduction [95% UI 69·3–85·5]) than in acute (70·4% reduction [95% UI 61·7–76·5]) DALYs. 

Interpretation 

Diarrhoea represents an even larger burden of disease than was estimated in the Global Burden of Disease Study. In order to adequately address the burden of its long-term sequelae, a renewed emphasis on controlling the risk of diarrhoea incidence may be required. This renewed effort can help further prevent the potential lifelong cost on child health, growth, and overall potential.