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Go BackWELL FACTSHEET - Regional Annex for East AfricaChild Survival and Environmental Health Author: Gerald Rukunga, David Mutethia and Titus Kioko, AMREF April 2006 Quality Assurance: Caroline Hunt Child
survival hinges on families and communities having
the basic needs to support life, survival and
prosperity of children. Among these, a safe and
healthy environment is fundamental. However,
children everywhere are negatively affected by
adverse environmental conditions. Each year at least 3 million children under the age of five
die in the world due to environmental-related
illnesses. Such young children make up roughly 10%
of the worlds population but comprise more than 40%
of the population suffering health problems related
to environment, (WHO 2002). Environmental risks to
children include unsafe water, poor sanitation and
hygiene, indoor air pollution, exposure to toxic
chemicals, injuries and accidents among others. Many
childhood deaths in developing countries can be
attributed to five main causes or a combination of
them; acute respiratory infections (ARI), diarrhoea,
measles, malaria and malnutrition (UNICEF (2000). Worldwide,
diarrhoea claims the lives of 2 million children
each year. 80-90%
of these cases are due to environmental conditions
(in particular inadequate water supply and
sanitation). As
much as 60% of ARI worldwide are related to
environmental conditions and are responsible for the
death of 2 million children (WHO 2002). Almost
42 million people in Kenya, Uganda and Tanzania do
not have access to improved water supply and 13
million do not have improved sanitation facilities
(WHO/UNICEF 2000). Evidence
indicates that the primary causes of many childhood
illnesses in the three countries are water related (Sharm
et al. 1996). Among these illnesses, diarrhoea
remains one of the most important environmental
health problems. In
Kenya, the majority of deaths among children under
five are attributed to unsafe environmental living
conditions. Malaria, diarrhoea, upper respiratory
infections and TB infestations are all leading
contributors to child mortality and morbidity in
Kenya. In Tanzania, one in every five children dies
needlessly due to malaria before they reach five
years (World Vision 2004). The
introduction of Free Primary Education in Kenya and
Uganda has put a lot of strain on the physical
infrastructure including sanitary facilities in
schools. In Uganda in 1999, only 2% of the schools
had adequate latrines, only 37% of teachers had
sanitation training and only 25% of schools had
hygiene information. The situation is worse in camps
for internally displaced persons in Northern Uganda,
(Water, Environment and Sanitation, WES Uganda). It
is also reported that about 3.5 million people are
at risk of schistosomiasis infection and up to 67%
of school going children along the River Nile and
around Lake Victoria are infected with the disease,
(Narcis B.K et al. 2004). Lack
of safe water, inadequate sanitation, poor waste
disposal and indoor air pollution are environmental
health risks related to poverty and lack of
development. Consequently children born into poor
families have a higher chance of dying before their
first and fifth birthday than those born into better
off families. More than 10% of Kenya's 15 million
children are orphans, the majority of whom are
likely to be exposed to poor living conditions,
(UNICEF 2006). Although
new regulatory standards and greater awareness of
children’s vulnerability to such hazards have
improved the situation of childrenin a number of
more developed countries, many children especially
in less developed countries continue to be exposed
to the risks. Their vulnerability is exacerbated by
lack of protective policies and medical and public
health interventions. One
of the challenges in measuring progress on the
improvement in child health and survival is lack of
appropriate indicators. Developing such indicators
would help monitor the impacts of environment on the
health of children highlighting the special
vulnerabilities children are exposed to in relation
to environment and health and to track the progress
of interventions in addressing these
vulnerabilities.
Dimensions of hazards like injuries,
poisoning and drowning in East Africa remain poorly
understood due to a persistent lack of information
and research. The
possible benefits of improved water supplies,
sanitation and hygiene on the health of the
populations are well known and documented. However,
due to weak policies for example those related to
sanitation and environmental health, lack of funding
and inadequate sharing of knowledge on the best
practices and experiences, these interventions are
yet to be implemented on a large scale to
significantly improve the lives of children in less
developed countries. In
line with the Millennium Development Goal on Child
Health, there is a lot of effort within East African
countries to ensure increased access to adequate,
safe water and sanitation facilities for children.
There are also ongoing interventions targeting
reduction and mitigation of the impacts related to
indoor air pollution (IAP) risks. These
interventions focus on improving ventilation in
houses and introduction of improved cooking stoves. Integrated
Management of Childhood Illnesses [IMCI] is the main
framework within which the current child health
interventions among East African countries are
implemented. Stronger emphasis has been on the
treatment and management of cases. However, recently
a community component [Community IMCI] has been
introduced with a set of sixteen key family
practices which aim at addressing child health,
survival and development at household and community
levels. The family practices target among others,
In
East Africa, several organizations have instituted
interventions to address environmental health issues
affecting children. Christian Children’s Fund,
which operates in Kenya, Uganda and Tanzania,
supports child survival through community-based
approaches that help families and care givers to
recognize and treat Acute Respiratory Infections. It
also supports control of diarrhoeal diseases through
hygiene promotion, sanitation and water supply
interventions among other child centred programmes. UNICEF
and its partners have been involved in providing
safe water through installation of water systems and
sanitation through provision of latrines to schools.
UNICEF has also been involved in malaria control
initiatives among the under fives and so far has
distributed 250,000 nets to pregnant mothers and
children below five years. Other
players include Plan International which besides
promoting other childhood welfare services is also
involved in environmental health interventions like
provision of safe water supply, malaria control and
providing safe learning environments. Other
strategies that have been put in place to address
sanitation include the Participatory Hygiene and
Sanitation Education (PHASE) initiative in schools,
Healthy Cities initiative, and water quality
surveillance. There has also been the formulation of
the Children’s Act which among other things gives
guidelines on addressing children’s health needs. Efforts
to increase communities understanding of the linkage
between environment and child health should be
integrated with measures to economically empower
communities to provide basic health services. There
is a great need to document the successes of the
already instituted interventions and their successes
for replication and scale up.
This Region Specific Annex has been prepared by Gerald Rukunga, David Mutethia and Titus Kioko, AMREF Kenya
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