The International Committee of the Red Cross (ICRC) has launched an emergency nutrition programme in the main prison of the capital Abidjan in a bid to stamp out a beriberi epidemic.

The life-threatening disease is caused by a vitamin B1 deficiency and generally results in neurological and cardio-vascular disorders.

Twice a week for a month, the ICRC will be handing out a food supplement containing vitamins and minerals, which the 5,000 inmates will take with their normal rations.

“As soon as we were told about the beriberi epidemic in June, we started distributing medicine. But we could only give medication to the people we knew to have the disease, and the problem is spreading.” explained Chiara Traverso, the ICRC’s prisons coordinator for Côte d’Ivoire. According to the prison dispensary there have been 181 cases of beriberi so far, and seven people have died. “In consultation with the authorities, we decided to eradicate the problem by adopting a global preventive approach.”

“The programme we are launching today should have short-term effects,” said Claude-Alain Zappella, head of the ICRC’s regional delegation in Abidjan. “To prevent relapses, it will be necessary to make prison food more varied.”

International Committee of the Red Cross

Two years after an illegal toxic dumping operation in the Ivorian capital Abidjan created a widespread medical emergency and political scandal, UN contamination expert Okechukwu Ibeanu warns the clean-up effort has stalled.

“The sites have still not been decontaminated and continue to pose a threat to the health of thousands of people,” Ibeanu, the UN Special Rapporteur on the adverse effects of the illicit movement and dumping of toxic and dangerous products and wastes, said in Abidjan earlier in August, after completing a one-week assessment mission.

International waste removal experts in protective suits and masks swarmed across Abidjan in September 2006 after it emerged toxic waste had been dumped in several areas of the city.

The chemical waste arrived in Abidjan, a port city, in August 2006 on a ship chartered by the Netherlands-based commodities company Trafigura Beheer and apparently dumped in residential neighbourhoods by a local contractor. The substance contained the potentially lethal hydrogen sulfide, according to a UN report.

Some 16 deaths were attributed to the waste which was found at seven sites including in densely populated slum areas, and Ivorian emergency medical service officials said more than 100,000 people went to hospitals and clinics for evaluation.

Human rights expert Ibeanu said many of those affected by the waste have received little or no assistance since the 2006 media-storm over the dumping died down, despite a US$198 million indemnity fund being provided by the company behind the Dutch boat.

“We met many of the victims who still show symptoms of their exposure to the waste. They still have headaches and sores… among the victims there are particularly vulnerable people – those who have little money to feed themselves, let alone to get treatment.”

Some of the victims have had no choice but to return to their homes and businesses alongside the deadly waste.

Ibeanu said the health ministry should carry out a full survey of the affected population and provide urgent medical assistance to those who need it, including setting up dedicated units in hospitals to treat victims. “The government needs to do more for its people,” he said later in a statement.

The expert also suggested that the international community and the government earmark money specifically for constructing safe waste disposal sites, to ensure the disaster will not be repeated.

IRIN 

The Ivorian Ministry of Health has confirmed 19 people have been infected with yellow fever since May, while the World Health Organisation (WHO) warns Cote d’Ivoire is at an “elevated” risk of yellow fever epidemics.

“Since the beginning of May, Abidjan has been threatened with a yellow fever epidemic,” confirmed Felix Bledi Touin, a senior health official. “Three cases have been found in the [Abidjan suburbs] Treichville and Cocody. At this stage, 19 cases have been confirmed and 1,500 people have been vaccinated,” he said.

Yellow fever is spread by mosquitoes. Epidemics touch on average 20 percent of people in affected areas, half of whom may die, according to the WHO. There is no cure for people already diagnosed with the fever, but a vaccination can prevent infection.

WHO vaccinated 26,000 people against yellow fever in February 2006 in Bouna, in the east of the country. A vaccination campaign was also conducted in the capital, Abidjan, in 2001.

The Ivorian government and WHO have announced another vaccination campaign for this year targeting almost two million people in Abidjan.

“Despite a large vaccination campaign conducted in 2001, the rate of coverage is still only around 60 percent,” the WHO said in a statement.

The early symptoms of yellow fever are similar to malaria, making it hard to recognise, experts say. After experiencing fevers, sore muscles, and nausea, an infected person may relapse into jaundice, bleeding from the eyes, nose and mouth. Resulting kidney failure can lead to death.

Yellow fever is on the rise again in Africa, although an effective vaccine has been available for 60 years.

IRIN 

With a severe respiratory infection and a prescription for medicines that would cost 35,000 CFA francs (US$83) at official prices, Drissa Kone has a problem – he has no hope of raising enough money to buy the medicines.

His solution? The stalls of counterfeit medicines at Abidjan’s Adjame market that will sell him an illegal reproduction of the original drug at a fraction of the price.

“I can buy the same medicines at the market by the individual tablet not the packet, and pay just 150 CFA francs (US$0.35) per pill,” he said. “For 500 CFA francs (US$1.19) I can get enough medicine to last me three days!”

The downside of Kone’s thrift is that the medicines might at best be considerably less effective than the originals – a serious problem when treating potentially deadly illnesses like malaria. At worst, fake medicines sometimes contain a mix of chemicals which further harms health.

Dr Ambroise Kouadio, a doctor in Abidjan, says that even though the risks of using counterfeit medicines are fairly well understood, the number of people like Kone who are turning to them is increasing.

“The rate of use of health centres remains relatively low, while the consumption of street medicines is increasing,” he said.

The last time a formal survey of the problem was conducted was in 1998 when the World Bank concluded that 20 percent of Ivorians used counterfeit medicines.

Health experts say that proportion might have risen to between 30 and 50 percent or even higher today, for a mix of reasons including worsening poverty, and the spread of cheaper and cheaper counterfeit drugs around the country.

Also, Cote d’Ivoire as other developing countries in Africa, Asia and Latin America has experienced high inflation this year, due to an upward spiral in world food and fuel prices.

The price of medical consultations and of buying drugs in the formal sector has remained relatively stable.

“The state has built many more health centres and hospitals, but the people are still poor. They have to choose between healthcare and eating and they usually choose to eat,” said Dr Kouadio.

The government has made several efforts at sensitising people about the dangers of counterfeit medicines with information campaigns, leaflets and radio commercials.

At the end of May, the health ministry announced it was going to take a new approach – cutting the price of the legitimate medicines.

“Considerable price reductions will be made in all pharmacies… to permit people to get what they need at a lower cost,” the ministry said in a statement.

Observers said that the move is in the right direction. “The fight against street medicines is not going to be won with repression or a crack down,” said Ernest Bouady, an Ivorian economist.

“They need to think instead about how to improve people’s living conditions.”

Bouady said the ultimate solution would be a functioning system of social insurance which he says the government first promised it would put in place six years ago. “The government promised universal health insurance… but the programme was never put in place,” he said.

“While there is no overall policy in place to help people get access to medicines, they will always turn to counterfeit drugs.”

“Right now, the statistics are stagnant,” he said. Between 2003 and 2008, 172,000 children between zero and five years-old died every year from malaria in Cote d’Ivoire, he said, equivalent to eight children per hour.

Some 60 percent of consultations at state-run health clinics are malaria-related, he added. At least 20 percent of pregnant women have malaria, frequently causing low birth weights among their infants.

According to the UN Development Programme in Cote d’Ivoire, the combination of poverty and high levels of malaria around the country mean 90 percent of Ivorians are at “high risk” of infection.

However health officials say they have little in the way of support to either treat or prevent infections. “Some illnesses are underfinanced,” said Magloire Kablan N’Zi, a nurse at Grand-Yapo, a village 60km outside the country’s financial centre Abidjan.

Cote d’Ivoire’s health ministry says it has made low-cost anti-malarial medicines available for 420,000 people. It has requested funds from the Global Fund to fight AIDS, Tuberculosis and Malaria to provide more medicines, bed nets and sensitisation programmes.

The World Bank Board of Executive Directors approved a grant for US$308 million to the Republic of Côte d’Ivoire to clear its arrears dating from 2004 to the World Bank Group and provide US$35 million in budget support.  This operation paves the way for a strong re-engagement by the World Bank with a further US$226.5 million to support Côte d’Ivoire’s post-conflict reconstruction efforts, especially in the areas of economic reform, governance, community rehabilitation, and the provision of basic social services.
 
“The clearance of IBRD and IDA arrears constitutes a landmark in our collaboration with the Government of Côte d’Ivoire, opening the way not only for the Bank to resume funding support for medium- and long-term economic development and reconstruction efforts, but also for other donors to contribute towards the government’s goal of stabilizing and re-building this very important country that was a regional leader in Africa before the conflict,” said Obiageli Ezekwesili, the World Bank Vice-President for Africa.
 
The key objectives of the Bank’s re-engagement will be threefold: (i) support the stabilization of the country by assisting in the implementation of the Ouagadougou peace agreement; (ii) assist war affected populations through community rehabilitation and support to the provision of basic social services; and (iii) assist economic recovery by focusing on economic governance reforms, institutional building and supporting economic production.
 
A US$120 million pre-arrears clearance grant for Post Conflict Assistance was approved in August 2007.  In addition to the grant approved on April 1, Côte d’Ivoire now has access to US$122.5 million of new grants to fund an Emergency Urban Infrastructure Project (US$90 million), a US$20 million project to combat the HIV/AIDS pandemic, a Governance and Institutions Program (US$10 million) and US$2.5 million to help protect a national park.  Four existing projects in education, rural development and the transport sector, on which US$104 million remains to be disbursed, will also be reactivated.
 
 “The full re-engagement of the Bank, as well as the increased support anticipated from other development partners, should help set Côte d’Ivoire solidly on the road back to economic recovery, reconstruction and stabilization,” said Bernard Harborne, the World Bank Country Manager for Côte d’Ivoire.

The World Bank

Cote d’Ivoire’s government has announced emergency measures to cut prices of food and basic services following protests against the cost of living, but demonstrators have warned they are ready to go back on to the streets as soon as prices creep up again.

The government has promised to temporarily suspend taxes on staple goods including rice, oil, milk, flour, sugar and fish, in a statement released on 1 April.

Francois Kablan, spokesperson for the Ivorian Consumers Association (ACCI) which organised protests on 31 March Said that the price reductions must be immediate. “If tomorrow [2 April] prices are not falling as promised by the government, we will go back out on the street even more determined to fight,” he warned.

Protests on 31 March started in the Abidjan neighbourhoods of Cocody and Yopougon. There were more clashes between riot police and demonstrators in both districts in the morning of 1 April.

In poor neighbourhood close to the airport, Port-Bouët, one civilian was reportedly killed on 1 April by riot police and 20 other demonstrators were wounded.

According to the independent newspaper L’Inter, government officials have warned newspapers against covering the food price protests.

State run media in Cote d’Ivoire has not reported on the demonstrations.

Source: IRIN