Helena Costa, a smallholder from Sao Tome & Principe, has been investing in her family’s small agribusiness for a decade, wanting it to be more productive, more profitable, and produce quality fruits and vegetable products to supply local and export markets. The quality improvements she’s invested in include food safety practices, shifting to organic production, and planting biofortified crops. However, these food quality improvements are not yet recognized by the market. So, for Helena, improving the nutritional value of her food products is an extra cost that puts her at a disadvantage in relation to her competitors.
Many of us have vivid memories of the joy and excitement of young adulthood, but this can also be a time of stress, apprehension and fear of the unknown. For many young people, this unease can lead to acute anxiety, severe depression or substance use disorders, if not recognized and managed.
Young people living in environments where they face death and suffering daily, such as in West Africa during the Ebola epidemic of 2014-2015, in post-tsunami or earthquake-affected areas, or in countries experiencing extended conflict and violence, are particularly vulnerable to mental distress and illness.
This year’s World Mental Health Day, on Oct. 10, recognizes this critical time in life with the theme “Young People and Mental Health in a Changing World.” Many changes occur during adolescence and the early years of adulthood, but they are not always acknowledged or treated.
Under the East Africa Public Health Laboratory Networking Project, diagnostic capacity has been strengthened through the construction of state of the art laboratories. © Miriam Schneidman / World Bank Group 2018
My interest in public health began in childhood and was marked by my experiences growing up in a low-income country with limited public health infrastructure. I felt firsthand the impact of an inadequate public health system when a beloved cousin succumbed to AIDS. My mother suffered a prolonged, resistant infection with complications after invasive surgery, and my family constantly battled malaria due to drug resistance or counterfeit drugs.
Accumulated scientific evidence shows that proper nutrition and stimulation in utero and during early childhood benefit physical and mental well-being later in life and contribute to the development of children’s cognitive and socioemotional skills. Yet, a critical but often overlooked fact in policy design and program development across the world is the association between maternal depression and childhood stunting -- the impaired growth and development measured by low height-for-age.
On September 20th, 2017, a young hunter, in his 30s, arrived at a health center in Kween District, located in Eastern Uganda, on the border with Kenya. He had symptoms of fever, bleeding, diarrhea, and vomiting. Within 5 days he was dead. Two weeks later, his sister also showed up at the same health facility: she had similar symptoms. Within a week, she too was dead. Posthumous samples confirmed that she had Marburg Virus Disease (MVD), one of the most virulent pathogens known to infect humans. On 19th October, the Ugandan government notified WHO and publicly announced an outbreak of MVD. Not long after this announcement, MVD claimed another victim – this time, the hunter’s brother.
In 2013, I was confronted by the realization of my country’s situation at a parliamentarian workshop organized by UNICEF where I learned about the different forms of malnutrition that we face. There, I discovered that my country, Cameroon, has an overall stunting prevalence of 32% for children under age five. In other words, one in three children under the age of five is affected. I now know of the devastating effects of malnutrition on the health of families, children and adolescents and consequently on the development of our country. As a parliamentarian, I’ve worked to serve my constituency and set up a community health insurance which helps improve the coverage of vulnerable children and young people. These challenges are our daily reality, but I was surprised to see them highlighted by the President of the World Bank in Washington, DC when I traveled there for the World Bank’s Spring Meetings.
The Ebola Virus Disease (EVD) crisis ended more than a year ago in Liberia. It resulted in over 10,000 cases and 5,000 deaths. For many children, the crisis continues through intrusive memories of illness, isolation, and death. These memories are particularly acute for the children directly affected by Ebola; those that were quarantined, separated from family during treatment, or orphaned. The Liberia Ministry of Health (MOH) identified 3,091 such children, and a World Bank working paper calculated that approximately 4,200 Liberian children lost one or both parents to Ebola.
Le changement climatique a déjà des répercussions concrètes et quantifiables sur la santé humaine, qui devraient aller en s’aggravant. Particulièrement exposés aux aléas du climat et moins capables de s’y adapter à cause de systèmes de santé et d’infrastructures défaillants, les pays à revenu faible et intermédiaire sont les plus durement touchés. Heureusement, cela fait des décennies que les experts s’intéressent aux impacts cumulés du changement climatique sur la santé, de sorte que nous comprenons de mieux en mieux les enjeux.
À cause notamment de ses effets délétères sur la santé, le dérèglement climatique pourrait replonger dans la pauvreté plus de 100 millions de personnes à l’horizon 2030. Les agents polluants associés aux émissions de carbone sont déjà responsables de plus de 7 millions de décès prématurés par an. D’ici 2030, ce sont 7,5 millions d’enfants supplémentaires qui risquent de présenter un retard de croissance, dont 4 millions sous une forme sévère (soit une augmentation de 4 %). L’Organisation mondiale de la santé (OMS) estime qu’avec le changement climatique, le nombre d’enfants souffrant de retards de croissance devrait passer à 10 millions en 2050. En Afrique, le renchérissement des denrées alimentaires lié au changement climatique pourrait atteindre 12 % en 2030 et jusqu’à 70 % en 2080 — ce qui porterait un coup brutal aux pays où la nourriture représente plus de 60 % des dépenses des ménages les plus démunis. Quant aux coûts directs pour la santé (hors dépenses dans les secteurs qui ont un impact sur la santé, comme l’agriculture, l’eau et l’assainissement), ils se situeraient dans une fourchette de 2 à 4 milliards de dollars par an d’ici 2030.
Le problème, c’est que 15 % seulement des pays qui se sont dotés de plans d’action contre le changement climatique y ont intégré un volet sanitaire. Conscient de cette lacune et face à l’appel grandissant des chercheurs et des agents sur le terrain, le Groupe de la Banque mondiale a élaboré un programme pour y remédier.
Sergio Carmona and Tendesayi Kufa-Chakezha are guest blog contributers from South African National Department of Health: National Health Laboratory Services and South African National Department of Health: National Institute of Communicable Diseases, respectively.
South Africa has the largest HIV treatment program in the world with over 3 million people currently on antiretrovirals. Every year, millions of VL and CD4 count tests are carried out to check treatment eligibility for new HIV cases (CD4 count) and treatment success in those on antiretroviral therapy (ART). A VL test monitors viral suppression, the goal of ART given to a HIV-infected person. The CD4 count checks whether the patient suffers from immune deficiency due to low CD4 counts and tracks recovery of the immune system during ART. In 2014, close to half of all VL tests carried out in lower-middle income countries were done in South Africa. In addition, large numbers of CD4 cell counts have been done routinely to predict patients’ risks for opportunistic infections and provide preventive therapy where indicated. While VL and CD4 testing are essential to monitor individual ART patients, the data is also useful in tracking the impact and performance of the ART program as a whole.