This study involved 671 children aged 12-59 months living in the Agincourt sub-district, rural South Africa in 2007. Anthropometric measurements were taken and HIV testing with disclosure was done using two rapid tests. Z-scores were generated using WHO 2006 standards as indicators of nutritional status. Prevalence of malnutrition, particularly stunting (18%), was high in the overall sample of children. HIV prevalence in this age group was 4.4%. HIV positive children had significantly poorer nutritional outcomes than their HIV negative counterparts. Besides HIV status, other significant determinants of nutritional outcomes included age of the child, birth weight, maternal age, age of household head, and area of residence. HIV is an independent modifiable risk factor for poor nutritional outcomes and makes a significant contribution to nutritional outcomes at the individual level. Early paediatric HIV testing of exposed or at risk children, followed by appropriate health care for infected children, may improve their nutritional status and survival, the authors conclude.
Poverty and health
The Alliance for a Green Revolution in Africa (AGRA) and the Gates Foundation represent the interests of biotechnology companies like Monsanto that are attempting to monopolise Africa’s seed industry, according to the author of this article. With Monsanto among the Foundation's portfolio investments, the author questions the legitimacy of the Foundation’s drive to promote genetically modified (GM) crops produced and patented by Monsanto. The risks to farmers of fully adopting industrial agriculture in general and GM seeds in particular include: transferring their food and farming decisions to global corporations; losing ecological and agricultural diversity as GM crop varieties spread; increased use of pesticide and fertiliser normally required for GM crops; and driving small- and medium-scale family farmers off their land because they cannot afford the expensive inputs that industrial agriculture demands, like patented GM seeds. Instead, the author argues for an approach based on traditional knowledge, with small-scale farmers growing diverse crops for local markets, planting farmer-selected crops from seed saved year-on-year (referred to as heirloom varieties), and, drawing on case studies, argues that integrated farm management based on traditional knowledge – without using pesticides or chemical fertilisers – have proven to yield greater harvests. To address the issues of nutrition security, poverty and health in Africa, farmers and governments should not be coerced into following the Western industrial agricultural model, and the Gates Foundation and AGRA should not be regarded as genuine partners in finding solutions to the food crisis in the continent.
The International Baby Food Action Network, through its campaign called ‘One Million Campaign: Support Women to Breastfeed’, submitted a petition to the President of World Health Assembly, Mr. NS de Silva, which was signed by more than 45,000 people from 161 countries. The petition demanded concrete support systems for breastfeeding women and urged the Assembly to adopt a resolution in 2010 to deal with four key issues: to prepare a specific plan of action on infant feeding, which is budgeted and coordinated in the same way as action plans for immunisation; to ensure the end of promotion of baby milks and foods intended for children under two years old in a time-bound manner, that is, by 2015; to end partnerships in the area of infant and young child feeding and nutrition with commercial sector corporations that present conflicts of interests; and to create support and maternity entitlements for women both in the formal and informal sectors, so that mothers and babies can stay close to each other for six months at least.
In this open letter to the United States President, the Oakland Institute and the Solidarity Movement for a New Ethiopia announce their submission of a petition signed by over 8,000 supporters of the indigenous and local communities of Gambella, Ethiopia - 70,000 people in all - who are being forcibly relocated to make land available for large-scale agriculture. There are plans to relocate an additional 150,000 people, most of whom are subsistence farmers who have been able, until now, to feed their families without receiving government or foreign aid over the last twenty years. The Oakland Institute's field research in Ethiopia has reported allegations of violence, coercion in and unrealised benefits for relocated communities, confirmed by a Human Rights Watch study earlier in 2012. The Ethiopian government's plans for economic growth are reported to include this large scale land acquisition in Gambella and the Lower Omo Valley, where half a million people are projected to lose their lands. Ethiopia is one of the largest recipients of US development aid (more than $1 billion a year since 2007), and the letter points to the food insecurity that will result from these trends.
In 2010, Urban LandMark undertook a survey of 568 households in two peri-urban sites in Maputo, Hulene B and Luis Cabral, to understand how ordinary urban dwellers access, hold and transact land. Although they are both located in the suburbs of Maputo city, Luis Cabral was established as a settlement for workers from the Maputo harbour, and has a longer history of urban settlement than Hulene B. Hulene B houses mainly internally displaced people from the civil war and floods. While most the plots in Luis Cabral have been surveyed, have wider roads and are generally better planned, Hulene B is largely unplanned. Despite the differences between the two neighbourhoods, the study found no variations in the nature of land ownership and tenure. In both settlements, the vast majority of households do not have formal title. Most land is acquired through mechanisms that are outside the formal land registration system. These findings challenge conventional understandings of the formal and informal sector in African cities. First, informal systems are not always the chaotic mess they are perceived to be. Secondly, although much of the land is accessed and secured verbally or through agreements with social networks, state agents are often critical to lending credibility to informal practices. Thirdly, despite the fact that few households in the study areas have formal title to land or documentation, 68% of households reported that their sense of rights to place were strong because the local land practices had social legitimacy.
Sugarcane outgrower schemes are central to several policy and donor strategies for driving agricultural growth and reducing poverty, including the Southern Agricultural Growth Corridor project in Tanzania (SAGCOT). But field research into the outgrower component of Kilombero Sugar Company, Tanzania’s largest and best regarded sugar producer, demonstrates a pressing need for change. Sugarcane production in Kilombero has had benefits for farming households as well as the local and national economy. However, unsustainable expansion and governance issues in the outgrower scheme have created new risks. There are pressures on food security as a result of a decline in land for food crops, and on incomes, particularly when outgrowers’ cane remains unharvested and farmers’ payments are delayed. These problems have been aggravated by the importation of foreign sugar into the country. For this industry to provide its maximum benefits to the economy and to the household, a policy, legal and institutional framework is needed that provides greater efficiency, accountability and transparency, as well as greater security for all participating stakeholders. There are lessons for the sugar industry, as well as donors and investors of ongoing and future agribusiness developments in Tanzania.
Urbanisation can and should be beneficial for health. In general, nations that have high life expectancies and low infant mortality rates are also those where city government leaders and policies address the key social determinants of health. Within developing countries, the best local governance can help produce 75 years or more of life expectancy; with bad urban governance, life expectancy can be as low as 35 years. Better housing and living conditions, access to safe water and good sanitation, efficient waste management systems, safer working environments and neighborhoods, food security, and access to services like education, health, welfare, public transportation and child care are examples of social determinants of health that can be addressed through good urban governance. Failure of governance in today’s cities has resulted in the growth of informal settlements and slums that constitute an unhealthy living and working environment for a billion people. National government institutions need to equip local governments with the mandate, powers, jurisdiction, responsibilities, resources and capacity to undertake “healthy urban governance”. A credible health agenda is one that benefits all people in cities, especially the urban poor who live in informal settlements.
Millions of South Africans still lack access to basic sanitation, including at least 500 000 in Cape Town. The report found that 26 percent of the toilets in Khayelitsha’s informal settlements do not work, with 15 percent of them blocked, 12 percent without water, and 6 percent without a sewage pipe. The report’s key findings also showed a lack of proper worker safeguards: janitors do not have proper training, protective gear, or the required cleaning equipment, and only one in eight cleaners is inoculated against disease. By attempting to verify public service delivery and facilitating transparency and accountability, the community-led social audit approach has been successful in exposing—and, over time, reducing—corruption and enhancing basic services in India and Ghana, and elsewhere in the global South. In South Africa, the community used a social audit to investigate how ZAR 60 million (about US$5 million) of public resources was utilized. The audit included the residents of Khayelitsha and various partners in inspecting 528 toilets and interviewing 193 Khayelitsha residents and 31 janitors. The report calls for specific and workable government actions to rectify gaps in services that are provided by the private sector via the local municipality.
This is a synthesis report of eight case studies conducted across South Africa to investigate sanitation and the delivery of clean water. The findings and conclusions have been captured under four cross-cutting issues: public participation and politics; accountability and regulation; service levels, financing and affordability; and institutional approaches. The research showed that finding workable solutions and taking appropriate decisions can only be achieved through a thorough understanding of the local context and realities. There is no one-size-fits-all best-approach, and institutional models work best when they are developed on the basis of robust, comprehensive local assessment of what the key challenges are and how best to meet them. The author argues for a multi-jurisdictional water utility model, across more than one municipality, as having the potential to make the best use of available skills and resources and achieve economies of scale. Sufficient municipal capacity, consolidation of services, clear organisational objectives, and staff commitment and capability are identified as critical to success. The studies indicate that, internationally and nationally, there is a need to shift away from an excessive preoccupation with institutional approaches, which tend to rely on layers of capacity and governance that are generally quite rare or undeveloped, and rather focus on the basics of good operational practice.
Farmers in Southern Africa are experiencing changes to their climate that are different in magnitude to what they have experienced in the past. Farmers interviewed for this report say that these changes are increasing the risk of poor yields or crop failure. The observations of farmers are largely borne out by meteorological data, particularly on rising temperatures – ongoing climate change, bringing increasing temperatures and changes to precipitation patterns, is projected to make food production more difficult. Southern African farmers are already actively experimenting with changing agricultural practices, and looking for ways to diversify their livelihoods in response climate and other stresses, within their resource constraints. But where large-scale farmers, in the main, can access the resources needed to adapt, small-scale farmers face major obstacles. The authors argue that policy makers need to identify the barriers for farmers, particularly smallholder farmers, as they attempt to adapt to the new climate and other environmental, economic and political pressures.