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Nepal - Sundhed, diarré
NEPAL: Diarrhoeal diseases still a major health problem
IRINnews.org, 8. august 2005
Børnedødeligheden i Nepals fattigste landdistrikter er stor, og den kan ikke blot henregnes som en konsekvens af konflikten med maoisterne eller mangel på medicin. De primære sundhedsforhold i mange af disse områder er meget dårlige, uddannelseforholdene elendige, områderne er meget fattige og der er en stor tilflytning af yderligere grupper af fattige og socialt stærkt udsatte grupper, som det er svært at nå med selv den mest basale sundhedsoplysning.
Both Nwali and Deulekh VDCs are badly affected by the Maoist insurgency that started around nine years ago and health personnel are reluctant to stay there. They have been even instructed by the district authorities not to stay overnight for sake of their own safety, local residents told IRIN.
"Although the District Health Office has managed to send essential drugs to the local people, the supply has been insufficient," said a local health worker on condition of anonymity.
However, deaths from diarrhoea are not unusual in Baitadi nor in other remote and poverty-stricken districts of far western Nepal. According to very approximate government estimates, nearly 15,000 children under five years of age die every year in Nepal. The causes are not just the scarcity of medicine or lack of health workers.
The primary problems are both simple and preventable, including poor sanitation and a lack of basic hygiene measures. Health workers blame parents for a lack of attention to these issues despite their having been told about the issues in government publicity and health education campaigns. The parents continue to contribute to the death of their own children.
"There has been enough awareness about how to prevent diarrhoea cases but it's really a big challenge to change people's attitudes and behaviour from their traditional means of doing things," said Dr. Sunlal Thapa from the health ministry's control of diarrhoeal disease programme.
As the second largest killer of children, diarrhoeal disease is a priority in the government's primary healthcare agenda, which focuses on raising awareness as well as on the distribution of the highly popular 'Jiwan Jal,' an oral rehydration solution. Nearly 3.5 million packets of Jiwan Jal, worth about US $170,000 are distributed free of charge annually, to patients around the country.
"The frustrating part is when we are still unable to convince the mothers to use Jiwan Jal even when they know it can be most effective to prevent their children's diarrhoeal conditions from becoming worse," Thapa said, adding that only 40 percent of the diarrhoeal affected children's parents use the medicine.
An even greater problem than the reluctance to use the medical treatment provided is the continuing use of unhygienic methods of childcare. These include feeding children without first washing hands properly, using dirty utensils to carry drinking water, defecation in inappropriate places and a lack of latrines along with the provision of unsafe drinking water. Collectively, these factors are cited as the leading causes of diarrhoeal disease spreading among the young.
"It's easy to change the habits of the children once they are made aware and alarmed about the dire consequences of poor sanitation and unhygienic practices but it is not the same with adults," explained Larry Robertson from Child and Women's Environment of the United Nations Children's Fund (UNICEF).
Both UNICEF and the government health department’s teams are now actively involving school students and children's clubs in several districts to raise awareness of sanitation and hygiene issues. Children are also involved in helping to promote the concept of the safe construction and maintenance of hygienic latrines.
Most public schools, both in rural and urban areas, have poor sanitation facilities where latrines are badly constructed and lacking in hygiene often constituting a health risk to children. They can often be a source of diarrhoea and other infectious diseases, health and sanitation workers say.
According to the government, less than 40 percent of the country's rural areas have latrines and unrestricted defecation has been seen as the major cause of infection leading to an increase in diarrhoeal diseases.
"What we need to work on is the involvement of the community members themselves to assess, analyse and take action. Once they become less dependent on what outsiders do for them, then the situation will change," said Namaste Lal Shrestha from UNICEF who has travelled to most of Nepal's poorest districts which are frequently rampant with diarrhoeal disease and poor sanitation.
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