Poverty and health

The UN Secretary-General has warned in a new report that the gains made in reducing extreme poverty are under threat from the rise in global food and fuel prices and global economic slowdown. According to World Bank data, the number of extreme poor has fallen – from 1.8 billion to 1.4 billion – between 1990 and 2005, with the biggest gains made in eastern Asia, in particular, China. In sub-Saharan Africa and the Commonwealth of Independent States, however, the number of poor has increased in the same period. While these figures confirm that the global poverty rate is likely to be halved by 2015 – achieving the first MDG - the UN report indicates that the worldwide increases in food prices will push another 100 million people into absolute poverty.

Gender-based violence (GBV) represents a major cause of psychological morbidity worldwide, and particularly in low- and middle-income countries). Although there are effective treatments for common mental disorders associated with GBV, they typically require lengthy treatment programs that may limit scaling up in low- and middle-income countries. This study tested the effectiveness of a new 5-session behavioural treatment called Problem Management Plus (PM+) that lay community workers can be taught to deliver. In this single-blind, parallel, randomised controlled trial, adult women who had experienced GBV were identified through community screening for psychological distress and impaired functioning in Nairobi, Kenya. Participants were randomly allocated in a 1:1 ratio either to PM+ delivered in the community by lay community health workers provided with 8 days of training or to facility-based enhanced usual care (EUC) provided by community nurses. Participants were aware of treatment allocation, but research assessors were blinded. The primary outcome was psychological distress as measured by the total score on the 12-item General Health Questionnaire (GHQ-12) assessed at 3 months after treatment. Between 15 April 2015 and 20 August 2015, 1,393 women were screened for eligibility on the basis of psychological distress and impaired functioning. Of these, 37% screened positive, of whom 81% were women who had experienced GBV. Of these women, 209 were assigned to PM+ and 212 to EUC. Follow-up assessments were implemented. The study found that among a community sample of women in urban Kenya with a history of GBV, a brief, lay-administered behavioural intervention, compared with EUC, resulted in moderate reductions in psychological distress at 3-month follow-up.

Southern Africa’s unprecedented El Niño-related drought and weather-related stress has triggered a second shock-year of hunger and hardship for poor and vulnerable people with serious consequences that World Food Programme (WFP) say will persist until at least to the next harvest in 2017, with the 2015-16 maize harvest insufficient to cover full cereal needs for the region without significant importation. El Niño conditions have caused the lowest recorded rainfall between October 2015 and January 2016 across many regions of Southern Africa in at least 35-years. The period also recorded the hottest temperatures in the past 10 years. Short-term forecasts, based on more recent data, (February to May) indicate the high probability of continuing below-normal rainfall across the region, signalling this may become one of the worst droughts in recent history. El Niño’s impact on rain-fed agriculture is severe. Poor-rainfall, combined with excessive temperatures, has created conditions that are unfavourable for crop growth in many areas. In Lesotho, South Africa, Swaziland, Zambia and Zimbabwe, planting was delayed by up to two months or more and is expected to severely impact maize yields. Already by early 2016 an estimated 15.9 million people in southern Africa were highly food insecure, not including a growing number in South Africa. Zimbabwe, Malawi, Lesotho, Madagascar were the hardest hit from the 2015 poor harvest and early impacts from El Niño, with Swaziland, Angola and Mozambique show increasing signs of concern. WFP note that El Niño is usually accompanied by economic slowdown in Southern Africa, associated with reduced agricultural output and contraction in industrial activities. Current macro-economic conditions, including falling international commodity prices and currency depreciations, may inhibit countries’ capacity to secure sufficient food supply. Crop failure and economic contraction threaten both rural and urban livelihoods as it undermines people’s capacity to meet their basic social and economic needs, coupled with increasing levels of livelihood stress and unemployment, El Niño incurs social, economic and political consequences. The WFP note that regional coordination and government leadership of critical contingency, preparedness and response planning is crucial to guarantee sufficient food supply and access for the most vulnerable people.

Malawi hovered for years at the brink of famine. After a disastrous corn harvest in 2005, almost five million of its 13 million people needed emergency food aid. But this year, a nation that has perennially extended a begging bowl to the world is instead feeding its hungry neighbors. It is selling more corn to the World Food Program of the United Nations than any other country in southern Africa and is exporting hundreds of thousands of tons of corn to Zimbabwe. In Malawi itself, the prevalence of acute child hunger has fallen sharply.