Poverty and health

Concepts of ‘what constitutes mental illness’, the presumed aetiology and preferred treatment options, vary considerably from one cultural context to another. In this study, participants from four locations in Burundi, South Sudan and the Democratic Republic of the Congo, were invited to describe ‘problems they knew of that related to thinking, feeling and behaviour?’ Data were collected over 31 focus groups discussions (251 participants) and key informant interviews with traditional healers and health workers. While remarkable similarities occurred across all settings, there were also striking differences. In all areas, participants were able to describe localised syndromes characterised by severe behavioural and cognitive disturbances with considerable resemblance to psychotic disorders. Additionally, respondents throughout all settings described local syndromes that included sadness and social withdrawal as core features. However, attributed causes varied from supernatural to psychosocial and natural. The authors conclude that local conceptualisations have significant implications for the planning of mental-health interventions in resource-poor settings recovering from conflict.

With the world's highest population growth rate, the East African highlands have historically undergone extensive transformation to feed a poor population largely dependent on subsistence farming. Most available land has been adapted for agricultural use as dairy pastures or croplands. The lost of forest areas, mainly due to subsistence agriculture, between 1990 and 2010 ranged between 8,000 ha in Rwanda and 2,838,000 ha in Ethiopia. These unmitigated environmental changes in the highlands have led to a rise in temperature and a correlated increase in numbers of malarial mosquitoes, with several epidemics observed in the late 1980s and early 2000s. Although malaria has decreased through intensified interventions from the mid-2000s onwards, the authors of this study argue that environmental changes might further increase the risk of malaria in the region, particularly if the current interventions are not sustained.

This report explores the paradox of food insecurity in Malawi, with inpredictable rainfalls and a focus on a maize staple that is vulnerable to uncertain weather patterns. Further between 1998 and 2001, the World Bank and International Monetary Fund recommended that the Malawi government cut spending. The government eliminated a small but effective program of seed and fertilizer distribution, and maize production fell 40 percent by 2002. The World Bank and IMF then persuaded the government to sell off its food reserves. These measures are reported by the author to underlie a famine that prompted the government to resume its food reserves and to re-establish a broad input subsidy program intended to put good seeds and fertilizer into the hands of poor farmers, a programme that international funders refused to support as it was seen as inimical to free market principles. The programme was reported to be a success, and within a few years Malawi had grown enough maize to export some to neighboring countries. The 2002 famine motivated activists to campaign for a Right to Food Bill that enshrines in law every Malawian’s right to “the progressive realization of the right to food,” committing the government to advance such rights. The Right to Food Bill awaits legislative approval. Further government is distributing seeds for beans, pigeon peas, groundnuts, soybeans to diversify diets, offer crops that ripen at different times of the year, and replenish the soil with nitrogen and organic matter. Farmers have rejecting the high-tech agriculture heavily promoted by international funders and are rebuilding the fertility of depleted soils by intercropping nutritious legumes while growing a vitamin-rich, resilient variety of maize. The author suggests that maybe this is what the progressive realization of the right to food will look like in Malawi.

Poor rains have heightened food insecurity in Kenya's northwestern region of Turkana, where malnutrition rates in children under five have risen above the emergency threshold, according to humanitarian officials. About 74% of the population (550,000) already depends on food aid, according to the International Rescue Committee (IRC). It said at least half of child deaths in the region were due to malnutrition or had malnutrition as an underlying cause of death. ‘In [the north-central] Samburu district, the percentage of children under-five considered at risk of malnutrition increased to 29.4% from 21.8% in June. In Moyale [in the northeast], the nutrition status of children below five years declined, with the percentage of children rated at risk of malnutrition rising to 35% in June from 30.6% in April.’ The decline was attributed to higher food prices and reduced availability of food, with pneumonia, malaria and diarrhoea as the three main diseases responsible for deaths among under-fives in Turkana.