Parents and Guardians need to fully support the Condoms for Teens Campaign

Everyday 20,000 girls under the age of 18 give birth, and 95 percent of these pregnancies occur in the developing world. For these young women, the results can be devastating. They not only face increased risk of maternal death and other pregnancy complications, but are less likely to remain in school, which can limit their economic and other opportunities. Of married adolescents in sub-Saharan Africa, 26 percent want to avoid pregnancy, but are not accessing modern contraceptives.

In Eastern and Southern Africa, some 2.7 million people aged 15 to 24 years live with HIV, more than half of all HIV-positive young people globally with the risk of infection is higher among young girls. Back home in Kenya, every two minutes, a youth is infected with HIV from unprotected sex with the average HIV/AIDS prevalence rate standing at 3%. For sure, young people are evidently at risk from unprotected sex and this sad fact cannot be assumed any longer.

In the global debate site, www.debate.org, the question of whether to give teens condoms or not is the most answered one, with proponents for condom use leading with a massive 80% and the general point about their support is that with an increase in reported sexually transmitted diseases (STDs), including HIV/AIDS, among adolescents, teenage pregnancies, communities must take action to protect their youth. One proven method is to provide comprehensive sexuality education along with school based programs that make condoms available to sexually active youth.

Numerous nations in the developing world have already adopted this strategy, notably South Africa with very positive results, and Kenyan parents must not appear to be any conservative to deny this campaign the much needed support to reduce adolescent mortalities from particularly HIV/AIDS. Kenyan parent’s fears are understandable, they want total control of their children’s sexual and reproductive health and rights and most have a strong feeling open introduction of their children to condoms will lead to rampant immorality. Many contend it will rubber-stamp a system failure of the society to reign in on their children to abstain.

But we need the parents and guardians to accept and adopt this global UN campaign fully and support in the HIV/AIDS Prevention strategy of Behavior Change Communication (BCC). At a time when it is frequently difficult for parents to talk with teenagers, that condom opened up avenues for us to discuss AIDS and birth control. When young people feel unconnected to home, family, and school, they may become involved in activities that put their health at risk. However, when parents affirm the value of their children, young people more often develop positive, healthy attitudes about themselves. Although most adults want youth to know about abstinence, contraception, and how to prevent HIV and other sexually transmitted infections (STIs), parents often have difficulty communicating about sex. Nevertheless, positive communication between parents and children greatly helps young people to establish individual values and to make healthy decisions.

Adolescent are not going to be given condoms to promote sex, rubberstamp ABC prevention matrix or parental failure. It is going to promote safe sex due to an extremely high rate of sexually transmitted diseases and teen pregnancies. This is a health issue; if it wasn't then there wouldn't be this launch with massive international support. It needs be clear again to parents that if schools are going to give out condoms to students, its going to be after a proper discussion about sex education and sex practices, and they are going to have a right to accept or refuse to let their children partake the preventive and contraceptive tools. By statistical evidence, teenagers engaging in unprotected sex is a public issue that cannot be thrown under the carpet. The campaign is about availability, access and use for young people so that we can protect the safe ones and prevent the already infected ones from infecting others. Sex yes is an adult topic and behavior but obviously children are ‘acting’ like adults who must be taught to behave responsibly with their sex lives.

Parents in their religious or social groups, professional workplaces and family unions must be mobilized through vigorous sensitizations to embrace this campaign as the current best amongst many strategies meant to secure the future generation of leaders, workforce and key movers of the nation. Youth writer Mary Macleod once said, ‘We have a powerful potential in our youth, and we must have the courage to change old ideas and practices so that we may direct their power toward good ends.’ Parents must shift from conservative ideas and embrace globally appreciated progressive interventions that seek to protect their children.

(The writer Chrispory Juma is a Public Health Officer and Community Mobilization Expert based in South Sudan. Email: chrispory.juma@gmail.com, Twitter: ChrisporyKer)

Why Cholera struck Homa Bay County and what must be done

As a son of Homa Bay, born, bread and schooled within the County up-to Secondary level and a PHO who has spent most of his professional experience within the county, I think I understand it better. I wish to share why Cholera again struck Ndhiwa in Homa Bay, claiming 3 lives and more than 100 cases. I am very sure this will not be the last Cholera outbreak unless any miraculous public health and sanitation investment happens in the shortest time, and the issues I wish to express, well in the public domain, are not given the requisite attention. Any single confirmed cholera case, in any village is a sign of a very poor water, sanitation and hygiene situation. Why in this age would people die from a disease very preventable by mere proper washing of hands, proper cooking of food or proper environmental sanitation? We may mistake it as a matter of cultural negligence but I take it as the repercussion of poor public health governance.

The statistics on the ground do not lie. From report sources, only 2% of the more than 1.2 million residents of the County have access to clean and safe piped water. An average of 14% of residents lack basic sanitation and latrine coverage at its worst. Every day of our lives we live amidst serious danger of water-borne disease outbreaks. Homa Bay town must be having one of the most serious water shortages with the water service provider lacking the technical capacity to supply a growing population and improve its supply chain. The result is a lowering in the quality of life, reduced urban productivity, and increased burden of health care and unmitigated environmental pollution. The acute water shortage can get worse that people drink the raw waters of Lake Victoria. With a child-rich population with the 0-14 year age bracket accounting to 43%, there is clear linkage between the high child mortality rates to the ever present health hazards posed by poor water and sanitation.

In Homa Bay, we enjoy the largest section of Lake Victoria and boast of four rivers: Awach Tende, Awach Kibuon, Riana and Kuja. The argument has understandably been that tapping the Lake Victoria water with the incessant water hyacinth infestation has been expensive and problematic, and therefore we have just to live with the lake beside us. But what about the rivers? Why can’t we have a sustainable plan of connecting communities along the rivers with the available water? A comprehensive water supply plan from our immense fresh water sources is the way forward. It is never in drilling boreholes the way the Governor promised last week over 50 boreholes. South Nyanza ground water has quality issues, too salty and unsafe for human consumption. There is enough evidence from Pala in Karachuonyo to Pala in Koguta that the high fluoride levels in the ground water have serious public health risks.

Plan International, World Vision and other agencies have done tremendous work in Community Led Total Sanitation (CLTS) in Homa Bay County. But must NGOs fund CLTS any longer for our people? Even without CLTS, what energy or funds does it take to invest in low cost toilets, even for the urban poor? With good leadership, we can break away and run the County’s WASH like NGOs ourselves. What can stop us from running a Countywide CLTS Program to ensure all our villages are Open Defecation Free (ODF)?

The County Government is frustrating health professionals. Late payments and poor working conditions have demoralized many health workers to an extent the quality of their service delivery has been immensely affected. Challenges regarding transition of public health management and service delivery have immensely affected community health, with Community Health Extension Workers (CHEWS) and in extension the Community Health Workers (CHWs). Community disease surveillance, reporting, documentation and progress have back-tracked. The frequency of field visits and supervisions have reduced possibly even due to untimely fueling of their motorbikes; now all the funds are managed by the County Treasury. Local Health Centers are ill-prepared to handle Ebola cases, and Rongo Sub-County Hospital was far, and ended up being over-crowded by the patients. Many will tell you they avoided the Homa Bay County Hospital because no quality health care is offered there.

The County’s Ministry of Health must go back to the Homa Bay County Integrated Development Plan (CIDP) and borrow the insights therein regarding improving health care for the people of Homa Bay. It must hold full grip of our Public Health Management System, and get our Disease Surveillance, Community Health Strategy and Community Led Total Sanitation back to its feet.

The three main diseases that the government must give equal focus and responsive prevention strategies are AIDS, Malaria and Water Borne Diseases (Cholera and Typhoid). The burden of AIDS might have blocked our eyes from other real public health matters. This outbreak will once again put spotlight on our County and most like attract more NGOs into the WASH sector but we must offer leadership. I am hopeful that this will help the County’s Ministry of Health WASH Strategy, and Community Mobilization must be at the heart of it. Village Committees, Community Leaders and CHWs must be capacity built, motivated and tooled to mobilize very village to take personal hygiene and sanitation seriously.

Generally, if Cholera killed 9 people in two days you can imagine if it were an Ebola outbreak. In the end you realize that Africa's problem in disease surveillance and disaster response is uniform and the same from West to East: We are under-staffed, ill-equipped, unprepared, clueless, hypocritical and poor learners. The burden of disease is seriously taking tall on us and we look forward to our County leadership mobilizing every citizen so that we can be a model WASH County: Let us manage devolved health care properly, invest heavily in water supply and low cost latrine construction, re-energize community health workers and revive proactive management of Lake Victoria.

(The writer Chrispory Juma is a Public Health Officer and Community Mobilization Expert based in South Sudan. Email: chrispory.juma@gmail.com)

Pollution kills far more people than Malaria or Ebola in the Developing World

Diseases like Ebola, HIV, and malaria rightly get a lot of a headlines, because they can kill millions of people very quickly. But there's another problem that affects even more people, and it's not mentioned as much: pollution. In all, pollution kills 8.9 million people a year, according to a new report, and as many as 200 million people suffer pollution-related health problems, including brain damage from exposure to lead, mercury, and pesticides. From Kenya to Kyrgyzstan, there are still thousands of appallingly polluted places, from electronic waste dumps to toxic old factories where chemicals continue to seep into the ground. One 2013 study of 373 sites in India, Indonesia and the Philippines estimated that 8.5 million people were at risk of serious disease-the equivalent burden of malaria and outdoor pollution combined.

"Most of the countries that are struggling with this have very limited resources to tackle the problem," says David Hanrahan, senior technical advisor to the Global Alliance on Health and Pollution (GAHP), one of the groups behind the report. "In smaller, poorer countries, it may not amount to more than a few hundred thousand dollars. That's very, very little in comparison to what developed countries in Europe or North America spend, and it's also small compared to other international aid flows." The study comes from the Blacksmith Insitutte for Pure Health (a New York nonprofit), the Green Cross in Switzerland, and GAHP. It follows a similar report from last year that identified the world's most polluted places. In addition to drawing attention to pollution, it shows how relatively low-cost interventions can improve lives.

The groups list 10 projects that are "turning a corner on pollution" including one in Dong Mai, a village in Vietnam. The area is covered in lead from recycling and small-scale smelting. Working with local partners, Blacksmith covered the soil with a "geotech" fabric (a semi-permeable material) then placed new dirt over the top. Toxicity levels dropped 30% in three months, all for about $20 per villager. In another example, from Thiaroye Sur Mer, in Senegal, several international groups worked together to dig up the soil around areas where women recovered lead from old batteries (the soil was 20% lead). They took the dirt to a containment site and then provided villagers with hydroponic systems and training, so they could grow vegetables more safely. In a third example, from the infamous Agbogbloshie e-waste dump, in Ghana, cheap recycling machines have reduced the need for "pickers" to burn old equipment to get components out. That reduces their exposure to toxic fumes from plastics and other casing materials.

A fourth example is back home in Kenya, where we have seen Dandora dumpsite take years to relocate as neighbouring residents more-so their children complain of respiratory infections, Nairobi River is back to its old self, very polluted yet still used by people along it to brew illicit liquors and domestic consumption. The foam that formed a long Mbagathi way last year was a good example of how we continue to lose in environmental protection. Water resources are under pressure from agricultural chemicals and urban and industrial wastes, as well as from use for hydroelectric power. Kenya expects a shortage of water to pose a problem in the coming years. For example the damming of the Omo River by the Gilgil Gibe III dam together with the plan to use 30% to 50% of the water for sugar plantations will create huge environmental problems. It is estimated that up to 50% of the water capacity of Lake Turkana will be lost.

In the end, a keen look into these assaults on the environment and their long time health effects reveals that we keep losing more lives through environmental pollution and this largely contributes to lower mortalities in the developing world. And there seems to be less willingness to invest in clean energies for healthier citizens if for example the planned multi-billion Kenyan coal project is anything to go by.

The writer is a Public Health expert on community mobilization (chrispory.juma@gmail.com)