This report from Building Resources Across Communities’s (BRAC) Youth Watch team in Uganda. It shares lessons from the Research and Evaluation Unit's mixed-methods research, including a nationally representative survey of youth, focus groups, and in-depth case studies. Chapter 1 introduces the conceptual framework used in this report and describes the research methodology. Chapter 2 presents the asset portfolio of Ugandan youth. Chapter 3 outlines the position of youth in the family, community and political participation. Chapter 4 discusses the perceived opportunities of Ugandan youth, versus their aspirations. Chapters 5 to 7 outline the health outcomes for Ugandan youth, focusing on risky sexual behaviour, examples of success stories among youth and policy recommendations. The report points out the need for a comprehensive approach that emphasises employment and institutional support to avoid conditions that lead to early pregnancy in young women and sexually transmitted infections and HIV. "Improved support from communities and local governments along with increased access to financial services and vocational training are key to facilitate healthy transition of youth into adulthood.....The combination of the multiple barriers facing youth - including limited assets and support, difficult economic, political and social environments, and limited perceived opportunities for the future - negatively influences the self-esteem, motivations, and aspirations of youth."
Poverty and health
Cardiovascular disease is a rising health burden among the world’s poor with hypertension as the main risk factor. In sub-Saharan Africa, hypertension is increasingly affecting the urban population of which a substantial part lives in slums. This study aims to give insight into the profile of patients with hypertension living in slums of Nairobi, Kenya. Socio-demographic and anthropometric data as well as clinical measurements including BP from 440 adults with hypertension aged 35 years and above living in Korogocho, a slum on the eastern side of Nairobi, Kenya, was be collected at baseline and at the first clinic visit. The study population showed high prevalence of overweight and abdominal obesity as well as behavioural risk factors such as smoking, alcohol and a low vegetable and fruit intake. Furthermore, the majority of hypertensive patients do not take anti-hypertensive medication and the ones who do show little adherence.
Unsafe water, sanitation and hygiene claim the lives of an estimated 1.5 million children under the age of five each year. Almost 884 million people are living without access to safe drinking water and approximately three times that number lacking basic sanitation. This report confirms that advances continue to be made towards greater access to safe drinking water. Progress in relation to access to basic sanitation is, however, insufficient to achieve the Millennium Development Goal (MDG) target to halve, by 2015, the proportion of people without sustainable access to safe drinking water and basic sanitation. The vast majority of people without access to water and sanitation live in rural areas (eight out of ten and seven out ten people respectively). A similar disparity is found between poor and non-poor people. A comparison between the richest and poorest 20% of the population in sub-Saharan Africa reveals that the richest are more than twice as likely to use an improved drinking-water source and almost five times more likely to use improved sanitation facilities. Although there is insufficient data at present, country data available confirms similar disparities elsewhere.
With 87% of the world’s population or approximately 5.9 billion people using safe drinking water sources, the world is on track to meet or even exceed the drinking water target of the Millennium Development Goals (MDGs), according to this new report. The report confirms that advances continue to be made towards greater access to safe drinking water. In contrast, progress in relation to access to basic sanitation is insufficient to achieve the Millennium Development Goal (MDG) target to halve, by 2015, the proportion of people without sustainable access to safe drinking water and basic sanitation.
On the occasion of the Day of the African Child, 16 June 2009, the Africa Public Health Alliance and 15%+ Campaign called on African governments to end the ‘5 by 5 Tragedy’ by stopping the estimated five million African children under the age of five from dying annually of preventable, manageable or treatable health causes. The campaign blames the existing situation on a failure of government policy on child health and protection in particular, and health development and financing in general. [To] meet the Millennium Development Goal 4 on reversing and ending child mortality, African governments are called on to meet their pledge to allocate 15% of national budgets to health, and significantly increase per capita investment in health. Strategic investment in vaccinations, health systems, human resources for health and social determinants of health, such as clean water, sanitation, food security and nutrition, must also be implemented.
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.
Rates of gender-based violence (GBV) in South Africa (SA) are among the highest in the world. In societies where social ideals of masculinity encourage male dominance and control over women, gender power imbalances contribute to male perpetration and women’s vulnerability. The drivers that cause men to perpetrate GBV and those that lead to HIV overlap and interact in multiple and complex ways. Multiple risk and protective factors for GBV perpetration by males operate interdependently at a number of levels; at the individual level, these include chronic anxiety and depression, which have been shown to lead to risky sexual behaviours. This study examined psychosocial risk factors (symptoms of anxiety and depression) as well as protective factors (social support and self-esteem) as self-reported by a cohort of males in rural KwaZulu-Natal (KZN) Province, SA; and to determine whether there are differences in anxiety, depression, social support and self-esteem between perpetrators and non-perpetrators. The participants were relatively young (median age 22 years); over half were school goers, and 91% had never married. Over 43% of the sample reported clinical levels of anxiety and depressive symptoms. Rates of GBV perpetration were 61%, 24% and 10% for psychological abuse, non-sexual physical violence and sexual violence, respectively. GBV perpetration was associated with higher depression, higher anxiety, lower self-esteem and lower social support. Interventions to address GBV need to take modifiable individual-level factors into account.
This paper focuses on the importance of psychosocial support services for adolescent girls in fragile contexts. Its starting point is that adolescence is a pivotal time in the life course but given the physical, cognitive and emotional changes triggered by the onset of puberty, it can also be a period of heightened sensitivity and vulnerability to trauma, social isolation, bullying by peers, a lack of supportive adults and gender-based and sexual violence. The authors’ findings highlighted why humanitarian and biomedical approaches in their current form are inadequate to address these complexities. Drawing on qualitative fieldwork, the authors argued that going beyond biomedical approaches and considering the social determinants of health, including approaches to tackle discriminatory gendered norms and barriers to service access, are critical for achieving broader health and wellbeing. While all three case study countries are classified as post-conflict, the political economy dynamics vary with associated implications for experiences of psychosocial vulnerabilities and the service environment. The study concludes by reflecting on actions to address psychosocial vulnerabilities facing adolescent girls through tailoring services to ensure gender and age-sensitivity, investing in capacity building of service providers to promote service uptake and enhancing strategies to regulate and coordinate actors providing mental health and psychosocial support services.
In May 2010, the World Health Assembly adopted Resolution EB126.R11, its Global Strategy to Reduce the Harmful Use of Alcohol, based in part on an extensive amount of evidence on both alcohol's contribution to the global burden of disease and the policies capable of ameliorating the harm it causes. Now that the strategy has been adopted, this article calls for public health science to take on two new challenges. The first is to expand the evidence base so that it applies not just to the developed countries where most of the world's alcohol consumption is concentrated, but also to the low- and middle-income countries where alcohol consumption is increasing and where the policy response is still weak. The second challenge is to use scientific research to guide the adoption of effective alcohol policies at the national and international levels. The author of the article urges for a systematic investigation of the alcohol industry itself as a vector for alcohol-related disease and disability. Aggressive marketing of alcoholic beverages in low-consumption developing countries needs to be monitored, as does industry compliance with its own codes for responsible advertising. More stringent measures to protect young people from exposure to irresponsible advertising need to be considered, as self-regulation codes are easily circumvented and not enforceable.
The objective of this study was to explore trends in perceived drinking water safety in South Africa and its association with disease outbreaks, water supply and household characteristics. The authors drew on General Household Surveys from 2002-2009, which included a question about perceived drinking water safety. Trends in responses to this question were examined from 2002-2009 in relation to reported cholera cases. The results suggest that perceptions of drinking water safety have remained relatively stable over time in South Africa, once the expansion of improved supplies is controlled for. A large cholera outbreak in 2000-2002 had no apparent effect on public perception of drinking water safety in 2002. Perceived drinking water safety is primarily related to water taste, odour, and clarity rather than socio-economic or demographic characteristics. This suggest that household perceptions of drinking water safety in South Africa follow similar patterns to those observed in studies in developed countries. The stability over time in public perception of drinking water safety is particularly surprising, given the large cholera outbreak that took place at the start of this period.