- May 31, 2002Bubonic Plague Adds To Woes
UN Integrated Regional Information Networks
May 31, 2002
Posted to the web May 31, 2002
Malawi's existing health challenges of cholera, malnutrition, malaria and HIV/AIDS have been joined by another - the bubonic plague.
Seventy one cases of the medieval-sounding disease carried by fleas and rodents have been reported in the far south of the country since April, the World Health Organisation (WHO) said on Thursday.
The first victim this year was a nine-year-old girl from Zavedo village. Outbreaks of bubonic plague have occurred in Nsanje district at the southern tip of the country since 1994 with the number of cases peaking at 304 in 1999. There were no reported cases for the two years before April.
The plague, which has a case fatality ratio of up to 60 percent if left untreated, has also been reported in Mozambique leading to cross-border collaboration between Mozambican and Malawian health teams.
"WHO is concerned due to the fact that the current epidemic is combined with malnutrition because of the food shortage in the country. It is a well-known fact that prevalence and severity of all infectious diseases increase where malnutrition is rampant," a statement said.
A World Food Programme (WFP) assessment released this week estimated that 3.2 million Malawians face food shortages due to anticipated food shortages this year. The country is only just recovering from a cholera epidemic which killed over 900 people.
Malawi's overstretched health services now share the added burden of finding chemicals to spray against fleas and rodents and staff who know how to treat the disease.
The UN children's agency, UNICEF, and WHO response includes providing cash to districts to buy insecticides for household spraying and sending a consultant to give front line health workers refresher training.
Hunger Underlined By Poverty
UN Integrated Regional Information Networks
May 31, 2002
Posted to the web May 31, 2002
Just one US dollar was all that Yusuf Kwajedwa needed to buy fertiliser so that he could plant a crop this year.
But, even if he had made the 10 reed mats he needed to barter for the fertiliser, and if his wife Sakina had swapped some firewood for seed, he, like others in Nkhonde village in Malawi's impoverished southern Dedza district, would have been too sick with cholera to plant the crops.
He was among 33,211 people throughout the country who contracted the water-borne disease. He survived, but by the end of April, 926 people were dead in 10 districts. At least 90 were from Nkhonde and the surrounding villages.
The story of Yusuf and Sakina and their five children is the story of hundreds of thousands of Malawians. They battled to survive through food shortages that led President Bakili Muluzi to declare a disaster this year. Then a cholera epidemic which made their malnutrition worse, and now a new struggle to access seed and fertilizer.
But behind it all is their biggest enemy, severe poverty.
"The reason those people died was because they were hungry and their bodies couldn't withstand cholera," said Sakina breastfeeding their tiny seven-month-old. His stick-thin arms tug at his mother. The older children sit shyly in the doorway, their tummies, like those of the other children in the village, protrude through ragged filthy clothes - a tell-tale sign of malnourishment.
A neighbour's tiny child, her hair an orange fuzz caused by the related condition of kwashiorkor, sits weakly nearby on the crumbling mud porch. Sakina explained: "We had a problem with food this year because we didn't grow much - my husband was sick."
To keep her ailing husband and family alive from January to March, she dug up banana roots and pounded them into a flour which she cooked into a porridge. "Things are little better now, but we won't have enough," she said.
"It was difficult this year because I had no seed, no fertiliser and I was feeling sick," said Yusuf. "Now that I'm better I'm going to the river to get reeds to make sleeping mats and go from village to village to exchange them for food."
He was referring to the village at the top of the steep footpath. Up there people are better off - they have crops that they irrigate, they didn't eat all their seed out of hunger and some received help from family who have work. It's there that the people of Nkhonde go for odd jobs to raise cash, and it's there that Sakina swapped a bundle of firewood she scavenged off the mountain slopes for about 10 small pumpkins.
She'll use this for all the family's meals over the next three days. When that runs out she has a few of the prickly-skinned wild cucumbers to fall back on and will search for more wood to barter, or will look for more odd jobs. Luxuries are unheard of in their household.
According to the Malawi National Human Development report released on Thursday, 65 percent of Malawians are poor and 28 percent are ultra-poor.
When asked what his wish was, Yusuf said: "I just want to buy some fertiliser so that I can plant."
Yusuf will struggle to put aside the money to buy the fertilizer he needs because the government no longer subsidises this. His weakened body will also have to walk a long distance out of the valley to a shop to buy it.
"They have no money at all," said health worker Jennings Balankhondo.
It is health workers like him who cycle the long dirt road, and the even longer footpath, to reach remote villages like Nkhonde. There he gives health advice and advises who should make the long trip by foot for treatment at a clinic. He doesn't dispense any medicines.
It is also up to him to report cases of severe malnutrition to the local health centre. This information is passed on and eventually villages like Nkhonde are included in emergency feeding operations.
Though Yusuf's pride says that his family is coping and that he can provide, the World Food Programme (WFP) has targeted his village for emergency distribution.
Dr Yusuf Chellouche, World Health Organisation (WHO) Acting Resident Representative in Malawi, said the link between food shortages, malnutrition and cholera - all daily realities for many Malawians - is pernicious.
"When there are food shortages people's hygiene considerations go down - they are trying to fill their stomachs and will eat anything. They get infected with cholera, then diarrhoea. When they have diarrhoea the body doesn't absorb nutritients and this creates malnutrition. It's a vicious circle.
"Combined with HIV/AIDS this contributes to excess mortality," Chellouche said.
A WHO study found that the main causes of the cholera outbreak was that people were forced to eat anything out of hunger, there was poor sanitation, poorly trained health workers, bad case management, inadequate surveillance skills to respond properly and no coordination between the agriculture, water and sanitation sectors.
Also a shock was the discovery that while families religiously kept drinking water clean and separate, they appeared unaware that they shouldn't wash utensils with unsafe water and place "safe" food and water in unsafe utensils.
Richard Pendame, Malawi's health secretary shakes his head when asked about mismanagement. He said that with cholera endemic in Malawi since 1973, the health department prepared for it in the same way every year.
They order drugs to cure it and send out circulars reminding health officials to conduct their awareness campaigns. Last year they expected the usual 3,000 cases in the "hot areas" and planned accordingly along with WHO and the UN children's agency UNICEF.
"But something was happening to water between where it was collected and where it was stored," said Pendame. "Also, we don't make intravenous fluids here so we had to order them from abroad - everybody was jumping up and down because they couldn't get anything."
He said Malawi's situation was aggravated by cholera epidemics in Zambia and South Africa. The drug company they ordered from in South Africa was unable to keep up. But the WHO report found that staff were also incorrectly giving the intravenous fluids to most patients instead of the oral rehydration solutions.
But while the cholera situation may have improved, Malawi's long term food difficulties have not. According to a recent WFP and Food and Agriculture Organisation (FAO) assessment, 3.2 million Malawians are in need of food aid.
The report said: "A poor harvest in 2000/02, very low levels of stocks of maize, rapidly rising food prices, a generally late start to the planting rains for the 2001/02 season, and a dry spell early in 2002, exacerbated the food crisis in Malawi."
Malawi's Daily Times reported on Thursday that Agriculture Minister Aleke Banda said the hunger situation was easing with government expecting to get up to 550,000 mt of maize from donors with about 250,00 mt of maize for free distribution to the worst hit areas. But he echoed WFP warnings that the present respite would be short.
Meanwhile, in Nkhonde village children ran away at the sight of the "faceless man". Every year he comes in his frightening costume to cleanse the graves but this year he was late. Even sacred rituals were delayed because there wasn't enough food to make it complete.
Zimbabwe treason case
By Alastair Leithead
BBC correspondent in Johannesburg
The leader of the opposition in
Zimbabwe, Morgan Tsvangirai, has
appeared in court with two other
high-ranking party officials charged with
But the case has again been
postponed, this time until August.
Mr Tsvangirai, leader of
the Movement for
Democratic Change, and
Ncube and Renson Gasela
have been accused of
plotting to assassinate
President Robert Mugabe.
Walking out of the courtroom, Mr Tsvangirai
described the five minute hearing as "a circus".
"I don't know what's going on here," he said.
He and his co-accused deny charges of treason
over allegations they plotted to assassinate
They argue they were set up by government
agents trying to discredit Mr Tsvangirai in the
lead-up to the March presidential election.
President Mugabe won
the election, but the
result was described as
severely flawed by the
and rejected by the
The case has been
remanded until 2 August,
after the judge accepted
the prosecutor's request
for another delay.
The state now has three
months to decide
whether to indict the men for trial in the High
Court if convicted they face the death penalty.
The charges have been condemned by western
countries as a form of political retribution, an
accusation the government denies.
Mr Tsvangirai was released on bail after being
formally charged with treason in March.
He was ordered to pay 1.5 million Zimbabwean
dollars (around $27,000), and surrender deeds to
property and his passport.
Commonwealth observers said the presidential
election in March was marred by a climate of fear
and violence against opposition supporters.
As a result Zimbabwe was suspended from the
Commonwealth for a year.
MSF applauds Zimbabwe's plan to fight
The humanitarian group Medecins sans Frontieres (MSF ? Doctors without
Borders) "fully supports" the emergency plan to fight Aids announced this
week by Zimbabwe's government, the group said in a statement received on
Friday in Harare.
"We can only praise the decision taken May 27 by Zimbabwe's government
to declare Aids a national emergency," MSF said.
"Doctors without Borders fully supports this action, which will allow patients
to have access to generic antiretrovirals, even if they are still protected by a
patent in that country," it said.
"This is the first time that government .. has declared its intention to bypass
patents to improve access to medication when its price is too high," it said.
The scheme will "considerable reduce the cost of treatment," MSF said.
On Monday, the government in Zimbabwe declared the next six months an
emergency period to combat HIV/Aids, allowing the importation and
manufacture of anti-Aids generic drugs.
The emergency order, prompted by the rapid spread of HIV among
Zimbabweans, will allow for the increased availability of drugs to treat the
disease which is killing about 2 000 people per week in the country.
Along with neighbouring South Africa, Zimbabwe is one of the countries
hardest hit by Aids.
One in every four adults in Zimbabwe is infected with the HIV, the precursor
At least 15% of new HIV infections are found among children and it is
projected that nearly half of all children will be orphaned by HIV/Aids in the
Life expectancy dropped from 60 in the 1980s to 39 and experts have
estimated that it could fall to 27 this decade.
Aids is expected to bring Zimbabwe's population growth down to zero this
year. - Sapa-AFP
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