PUBLIC-HEALTH. SEXUAL EDUCATION IN SCHOOLS IS A PUBLIC HEALTH PROBLEM.

Lack of School  based  sexuality-education in  conservative  societies is a  public health problem? Such is the topic   of   an exchange on  LINKEDIN between experts of the  GLOBAL  PUBLIC   HEALTH  NETWORK. The  opinions  of  these  experts   encouraged school based  sexuality education  in conservative  societies.

Let  us  speak about arguments of  some and  other  :

Ruth-Isibor,, Environmental and Public Health Specialist ,Royaume-Uni

“Sexual education in schools is regarded as an effective way to increase young people’s understanding of Sexually Transmitted Infections(STIs) including HIV infection, abortion, and infertility; and to overcome sexual herassment . As a range of research evidence have indicated that school-based sex education has the potential to prevent unwanted pregnancy and to promote positive sexual health at the individual, family and community or health system level.
However, in conservative societies, sexual education is not considered a health priority, and reviews have shown that this has resulted in poor sexual behaviours and outcomes in these societies. As Sexual and reproductive illhealth has now become one of the major causes of morbidity and mortality among young people in these locations. Young people in these regions are as a result, now at high risk of STIs and coerced sexual abuse/rape. Also, despite young people making up a large proportion of these populations, there is very little known about their sexual health, knowledge and experience. As most of the conservative populations have odd views about sexual education.
Consequently, it is these effects of the lack of sexual education in these societies that have now lead to a range of growing public health problems. As due to lack of sexual education, young populations in these societies have now been made vulnerable to negative sexualhealth outcomes."

  Filbert Ajax  Idha, Health Coordinator at Fields of Life Uganda, Ouganda

“ With sexuality education, there seems to be lots of resistance upstream as well as downstream! In my context, the adolescent health profile is so bad, with rising teenage pregnancy, high HIV prevalence among adolescents and the momentum of non-communicable diseases is picking up alarmingly with incresing number of tobbacco smokers among the adolescents, low physical activity levels. Truth be told, a cmprehensive adolescent health is needed, beyond the HIV-Abstinence stage 'we' created. If there is real chance for improved health indicators in the future for us in the developing countries, adolescent health and sexuality education can not be ignored; it holds the potential for health gains interms of the prevention options it gives but also the early intervention option. I have had chance to work on many school settings but i can tell you....a lot more needs to be done!”

Nomakula  Shweni, Quality Assurer - Metropolitan Health Risk Management, Région de Johannesburg,Afrique  du  Sud

“Sexuality Education is generally a challenge for adults because they were never informed themselves about sex and what they currently know is from experience,from peers and from information gained whislt at college or university.The strategy then should be parent- based sexuality education so as to enlighten parents on how to impart this knowledge at home.In South Africa there is a subject called Life Orientation which commences from Gr 3 and our children get to be exposed then about their bodies and as they progress they learn a bit abut sexuality.If teachers are themselves uncomfortable about sexuality issues it poses a challenge to our kids as well.I personally think sexuality education should be tackled at all angles.Sexuality is not only about sex,it is about gender aspects,sexual orientation and every issue connected to sexual development which can be dealt with in phases as the child is growing.Governments should consider getting experts in those areas to draw the correct policies on sexuality education for our schools.

With the advent of HIV all of us need to be up in arms in ensuring that children are empowered in all fronts so to keep negative children negative and maintain those positive at lower levels of the virus of which sexuality education forms part of that campaign “

Aaron Ndaa, Public Health Coordinator at Oxfam Great Britain , Zimbabwe

“Short analysis of the contributions above strongly agree there is need for multisectoral approach to tackling sexuality issues. The family, according to most members' views, becomes the first prot of call to ensure every member of the family has understanding of SE, second institutions such as schools, need to be adequately resources (human, material, financial etc), to ensure SE is trongly embedded into the curricula, third, there needs to be pro-SE policies and I think legislation that protect those at risk and perhaps the fourth aspect looks at cross-cultural issues that may convey negative and positive at the deriment of the 'invaded' culture. There are cultural practices that need to be addressed as they constitute part of the major problems youths (adolescents) encounter. There being no rocket science to issues about sexuality, more research is therefore called for to ensure relevant strategies and approaches are developed to close any existing gaps that have been socially accepted behaviours as sexuality is largely a learned behaviour. I believe to date no one understands what sexuality is (need for more research), and it is only when there is body of evidence telling us what sexuality is and how one can control their physiological abberations can we direct appropriate SE messages that are contextually relevant to societies. We are facing a damnin”

  Remi  Akinmade, Community Health Specialist, Nigeria

“ Family Life Education has been incorporated into the education curriculum, in Nigeria especially Lagos State, the curriculum encompass adolescent reproductive heath, self awareness, esteem directed at personal dreams and vision empowered to negotiate sex, STI/HIV/AIDS and family life education. The Government and youth lead and focus organization are part of the curriculum development and implementation.

The stage at which Reproductive Health education starts in school is another issue, in the FLE curriculum, this start in Elementary/Primary School, Classes 5-6 and all ages at middle and high schools and recently HIV & AIDS were introduced to those in lesser grades; through cartoon' Kami and the Big Bird' an introduction to AIDS to especially promote HIV testing and preventing stigma.

On the issue of people's perception that the awareness creation on ARH may expose a child or make a child promiscuous may not be true, this is why we reinforce education of abstinence. If they are not formally informed by teachers and other qualified facilitators, the youths and children learn negatives from their peer.

We can see the result of uninformed youths; teenage pregnancy, drug and alcohol abuse that fuels AIDS, violence, high incidence of ST/HIV & AIDS among youths.

Most Information Education and Communication (IEC) are focused on in-School, but the out-of-School outnumber the in-school especially in sub-Saharan Africa. So efforts on ARH and STI/HIV/AIDS should focus also on these vulnerable group. Our organization, Community Health Information Education Forum (CHIEF) has worked extensively among the out-of-school-youths; www.chiefngo.org.”

Dr. Brijendra Singh N,  RCH, consultant  at Free-Lance,Inde.

•” Let us accept that in countries like India society will not change till they feel the urge to change. Parents feel responsible to suitably support their wards in entering life on points of strength through education, resources, property, contacts and are guided by their own experiences during growing up. Thereby they gain an overpowering control particularly on girls in relation to sexuality. As social norms are changing this control is also waning. Till education and economic avenues are not assured for boys and girls by society, parents will have an sayon level of exposure on sex education through formal education. Economic and social empowerment need to go hand in hand in particular for girls and reduction of parental role in settling down of wards in life is prerequisite for univesal acceptance of sex education in formal education. 

Compiled and presented by

Foussénou   Sissoko

Health   Communication  Expert

foussenou@ymail.com/sissokofouss@yahoo.fr

Role of Family Medicine in Tuberculosis/TB Control

Dr Seema Sahu, India

Family Medicine is the specialty   of medicine which provides comprehensive health care to people of all age. It provides primary as well as continuum of care and surpasses the barrier of age, gender parts of body and diseases. Family Physician is the first contact for the patient for any ailment/discomfort whether it is physical, mental or psychosocial. He is the teacher, counsellor, friend and doctor whom patient   knows for years and trusts completely. Here is the relationship which has developed over years and has mutual trust and affection instead of that of a business client in the specialist clinics.

India is aiming towards universal access to TB control and care. We are trying to mobilize the community by ACSM (Advocacy Communication Social Mobilization) activities, empowering them to take charge of their own health by making them aware of their rights as patients by giving them patients charter, giving them DOT (Directly Observed Treatment) for cure and even trace them if they have defaulted in taking treatment. We are working together with our civil society partners to achieve this and the task is enormous.  With the emergence of MDR (Multi-Drug Resistant) TB it has become more difficult. Had we developed a health system where there were family doctors in the community taking care of each and every patient, it would have been much different. The family doctor would do ACSM as a routine in the community while providing them curative care. As a normal practice any- one who has cough for more than two weeks would consult their family doctor. The doctor would screen him   and would send the sputum sample if required. At the same time he would educate and counsel him regarding TB. If the test is positive, the family doctor would start treatment, notify the disease and follow him up till cure and even thereafter.  If family doctors who are constantly undergoing continued medical education and practicing evidence based medicine are part of our health system, control of any disease which is of public health importance would be much better and effective. We can save a lot of resources. Imagine DOT in a system where Family doctors are placed in the health system. There will be no need to separately engage in so many awareness campaign and meetings just to make the community aware of TB. The job would be done by the family doctor. He would also be the DOT provider and can counsel and retrieve the patient to DOTS with the help of volunteer in case the patient defaults. The patient would listen to him more than anyone else. Family doctor would also know if there is any contact in the family who is coughing   and needs screening. From the vaccination to promotion of good cough, hygiene, treatment, notification and follow up of Tuberculosis can be taken care of by family doctor efficiently and with limited resource . Even when we do not have well trained family physicians in our country and our Rural Health Care Providers are doing the job of family doctor, we can engage them effectively in TB care and control for promotion, prevention, screening, and as DOT provider. They can strengthen the whole process from cough to cure if only we involve them and train them. This is high time our government should make policy to change our medical education and encourage Family Medicine as important specialty.

About the author: Dr Seema Sahu is a Specialist Family Physician and Public Health Professional, currently associated with World Vision India in the Civil Society TB Project supported by GFATM Round 9 Grant, in the capacity of central level Monitoring & Evaluation Manager. In this article, she described the concept of integrating Family Medicine with TB care and control activities that has expanded and long-term public health importance in a high TB-burden country like India.  

SAFE HEALTH INITIATIVE PROGRAMME NIGERIA FIGHTING HIV/AIDS

UCHENA ANOZIE, NIGERIA

Safe health initiative programme was born out ingenuity of Uchenna Anozie and Johnpaul Onwuaso both Nigerians and with the utmost mentorship and support from Dr, Sugata from In India.

Both initiators have been in the field of battling HIV/AIDS for more than 7 years in Nigeria,  They have worked for many local , national and international organizations. It is with their gathered experiences that they decided to launch a pet programme in a pilot scale to fight against AIDS.

They decided to have a peer education program for sex workers in 2 states outs of 36 states in Nigeria namely Ebonyi and Anambra State. In the course of running this programme they found out that people living with HIV/ AIDS in Ebonyi state lacked attention from the Government and even concern of the health facilities, it is due to this factor that safe health initiate programme extended her hands to work with people living with HIV/AIDS using a private health facility (Fellysussy Memorial Hospital)  as an ambulatory hospital for PLWHA in the state.

Today Safe health initiative Programme has 15 sex workers that receive support from the programme and over 16 PLWHA’s receiving support from the initiative, these supports ranges from health promotion, psychosocial support, linking patients to main hospitals that administer (HAART: Highly active antiretroviral treatment)at Federal Teaching Hospital Abakaliki, education on nutrition, free distribution of mosquito nets, HIV screening, ambulatory treatment for PLWHA, blood donation for anemic patients, and even vocational support through other NGOs.

The programme is facing lots of challenges, especially in the area of ensuring that patients receive appropriate attention from Hospitals that Administer HAART but recently through the help of a Nurse in Federal Medical Teaching Hospital Abakaliki called Sister Ann and a Doctor known as Dr. Eze, things are much easier now.

Another challenge is that most people living with HIV/AIDS in our area are women, more especially pregnant women, they are mostly low income earners therefore lots of financial support is needed to help them transport to health facilities, have micro-gardens at homes, vocational trainings and even money to supply them with relief materials such as sanitary materials, mosquito nets and food supplements.

So far we observed that 80% of the women enrolled in the programme are HIV  discordant with their husbands thereby creating  huge social problems for them but it’s part of the programme to educate their spouses on how to cope with HIV discordant relationship.

The initiative hopes to expand her services and even enroll much number of sex workers and PLWHA in future and we solicit for fund, health support materials, food supplements and vitamins, malaria drugs, cloths, food for babies living with HIV/AIDS etc.

The initiative appreciates in a special way Dr. Sugata who has been a mentor and a technical adviser to the initiators of this pet programme we also thank Nurse Ann for her special way of facilitating protocols that are observed in the HAART center in Abakaliki for our patients.

The programme also remembers all her enrolled members both sex workers and people living with HIV/AIDS and encourages them to keep practicing safe and positive health practices.

If you are moved by our programme (Safe health Initiative Programme) please do not hesitate to comment or even write us at: donuchman@yahoo.com or sms+2348033746531 or post mails to No 12 Onitsha street, Abakaliki, Ebonyi State Nigeria. If you want to give any support by donating materials or giving financial support to the programme, please do write us with the above email address so that we can facilitate your donation.

Remember your ideas are very important and we count on them.Thanks for reading.

NJPHA visits Tent City Lakewood

Sarah Simpson, USA

The New Jersey Public Health Association recently visited Tent City located in the Pine Barren woods in Lakewood, New Jersey. For those of you unfamiliar with tent cities, they are makeshift, homeless communities that are springing up all over the United States. These communities are labeled as such because residents live in tents and other collapsible, mobile living quarters. Started in 2005, Tent City Lakewood consists of a community of about seventy people from diverse backgrounds. The camp is led by Reverend Steven Brigham, who was kind enough to show us around the grounds. While, these communities continue to spring up around American cities, this tent city and others like it do raise some concern for the health of its inhabitants and their local communities. Below are some areas of concern observed during our visit to Tent City Lakewood.

Solid and Human Waste Disposal

One of Tent City Lakewood’s biggest issues is their solid and human waste disposal. There is currently a dumpster on the outskirts of Tent City, which is collected by the municipality. However, trucks often have trouble getting to the dumpster, which is located in a small, pot-holed clearing of the woods. Allowing for road paving would help make garbage collection easier.

Another concern is that their bathroom facilities currently consist of pit latrines, which are made by digging a hole into the ground and placing an outhouse type structure over it. Once this hole is filled waste, it is filled in with dirt and a new hole for the latrine is dug. While there are some advantages to using a pit latrine, such as they are cheap and simple to build, there are also some worrying disadvantages. One disadvantage is that this system can lead to the attraction of insects such as mosquitoes and horseflies and vermin such as rats. These possible vectors are attracted to the odor and gases of decaying fecal matter. Another disadvantage is possible seepage into underground water tables because of its location on porous sandy land. If the weather is bad enough, local flooding could flow human sewage into local water systems or into gardens grown by the residents, which can lead to health problems such as norovirus. Some other health issues that were noted were the lack of adequate hand washing facilities at the toilets and in the communal kitchen area.

Food Safety

Unsafe food handling practices might also be a cause for concern, as there is only one chest freezer.  Food is prepared in a central location with grills where residents prepare shared meals using donated food; however the food handling methods employed might be unsafe. Factors such as improper holding temperatures for potentially hazardous foods and inadequate storage of the mostly donated food supply, especially with the summer heat, can lead to serious food-borne illnesses. A closer look at their food safety practices is definitely needed. 

Injury Risk

During the cold New Jersey winters, the residents use wood burning stoves as the primary way to heat their tents, along with propane tanks. While there is a fire extinguisher located near every housing structure, these stoves and propane tanks pose a great risk to injury in the case that there is a fire. With no carbon monoxide detectors, carbon monoxide also poses a risk if smoke ventilation isn’t good. Injuries such as sprains, falls and other accidents should also be of concern along with hypothermia in case residents are not able to properly heat their homes.

Animal and Pest Control

As the community lives with domesticated animals such as dogs, cats and chickens, it is important that there is proper animal and pest control. Cats and dogs must be vaccinated, receive flea treatment and fed properly. If they are not properly being cared for, they become infested with ticks, mosquitoes, and lice, or can be infected with diseases like rabies. Mosquitoes, ticks and other insects also pose a risk to human health,  and exposure to such pests is increased by its location.

There is also a population of chickens being bred on the grounds. Chickens being raised within such close human contact pose a health risk as there are diseases that are communicable from chickens to humans. Bacterial diseases such as salmonella and campylobacteriosis can be contracted through direct contact and exposure to manure. Elderly and other susceptible persons are at risk to severe illness if exposed. However, it should be noted that there are no children living in the Lakewood Tent City.

Other Potential Risks for Illness

Some of the potential risks for illness such as those associated with unsafe food and hand washing safety practices, inadequate waste disposal and animal pest control were mentioned above. Some other illnesses of concern would be influenza and tuberculosis, which are transmitted through the air. For example if residents don’t receive their yearly influenza vaccination and become sick, they pose a greater risk to other residents. Coupled with inadequate hand washing practices and the other risks mentioned before, this could lead to a highly infected population who pose a risk to the local community during regular interactions.

Mental Health Services

We also learned that many residents might suffer from mental health illnesses, which would require targeted mental health services. A needs assessment should be performed in order to see if they are indeed in need of such services. 

Lessons Learned

Overall, tent cities can present some serious environmental health challenges. Even with support, they require vigilance in order to avoid or mitigate pending public health issues. Some recommendations can include adopting guidelines used for disaster camps and shelters such as the Center for Disease Control and Prevention Shelter Assessment Tool. Portable toilets are a short term solution to the human waste problem, but unpaved roads hinder waste pickup by trucks. Proper hand-washing and food safety practices should be reinforced, perhaps through signs and through classes taught by a health educator from the local health department. Proper training can prevent disease transmission and contraction. Tent City Lakewood also provides us with a unique opportunity to understand environmental health issues associated with disaster camps. As we continue to experience extreme weather events, such information would be important to public health responders in understanding critical human needs and protection in disaster situations. NJPHA recognizes that a more in depth assessment is needed, so be sure to stay tuned for our continued involvement with Tent City Lakewood.

About the author of the article: Ms. Sarah Simpson is presently the MPH Epidemiology Candidate, University of Medicine & Dentistry of New Jersey, NJPHA secretary