ZIMBABWE-NATIONAL PROFILE ON THE STATUS OF CHILDREN'S ENVIRONMENTAL

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ZIMBABWE-NATIONAL PROFILE ON THE STATUS OF CHILDREN'S ENVIRONMENTAL Powered By Docstoc
					      ZIMBABWE-NATIONAL PROFILE ON THE STATUS OF
           CHILDREN’S ENVIRONMENTAL HEALTH

                                CONTENTS
Table of Contents                                         1
1.0 Background                                            2
2.0 Introduction                                          3
        2.1 Overview of Children’s Environmental Health   3
        2.2 Key Environmental Health Issues in Zimbabwe   5
        2.3 Burden of Disease                             10
3.0 National Government Role                              11
        3.1 National Policies that Support Children’s
            Environmental Health                          11
        3.2 Health Sector                                 13
        3.3 Environmental Sector                          15
        3.4 Education Sector                              16
        3.5 Other Pertinent Ministries and Sectors        17
4.0 Society Role                                          19
        4.1 Communities                                   19
        4.2 Nongovernmental Organisations                 19
        4.3 Professional Associations                     20
        4.4 Academia                                      20
        4.5 Private Sector                                20
5.0 Science                                               21
6.0 Data and Reporting                                    22
7.0 Communication                                         23
8.0 Conclusion                                            23
9.0 Recommendations                                       24
Appendix I: Abbreviations Used in this Report             26
Appendix II: Key Causes of Mortality/Morbidity for
               Children 0-14 years (2001)                 28
Appendix III: High Risk/Vulnerable Groups and
               Demographic Profile                        29

Appendix IV                                               35




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                              1.0 BACKGROUND


Zimbabwe is a member of the Southern Africa Development Community. The
preliminary report for the 2002 population census presented the population as
11 634 663 broken down as 5 631 426 males and 6 003 237 females or 94 males per
100 females. The population in the 1999 census had been 11.9 million with 48%
male and 52% female. Of this population, those 14 years and below made
36.64%, 15 to 64 years 56.82 and 65 years and over made 3.54%, a situation
characteristic of population demographics in developing countries where the
population is dominated by fairly young individuals and very few elderly
people. There has been a great decline in the life expectancy at birth from 49 in
995 to 40 in 1999. Analysis of the 2002 census figures is still in progress.

With a total surface area of 390 757 square kilometres this gives an average
population density of 30 persons per square kilometer. The country lies between
Latitude 15 and 22 degrees South and Longitude 25 and 33 degrees east. The
country is landlocked and bordered by Mozambique in the east, Republic of
South Africa in the south, Botswana in the west and Zambia in the north and
north-west. About 5% of the country is land area is more than 1500 metres above
sea level. Generally temperatures decrease and rainfall increases with altitude
ranging from the cool wet eastern highlands to the hot, dry river valleys of the
Zambezi, Limpopo and Save Rivers.

The Country divides into five agro-ecological zones, depending on the level of
rainfall received in an average year. Natural region I-the most fertile- receives
over 1000mm of rainfall and is dominated by the production of timber and cash
crops such as horticulture, tea and coffee. Natural region II, accounting for 75%
of the area planted to crops, has rainfall between 800 and 1000mm.The main
crops here are maize, cotton, wheat, soybeans, coffee, tobacco, and some
horticultural crops. In the remaining regions the land is increasingly arid and
livestock farming tends to be extensive rather than intensive. Natural regions IV
and V receiving less than 650mm are too dry for crops except under irrigation,
but smallholders continue to grow maize, sorghum and millet in the wetter
areas, albeit with low yields. The remainder is suitable mainly for ranching.


Drought is an increasing problem in Zimbabwe, with the country experiencing
serious disruptions to its rainfall every eight years or so, with apparently
increasing severity.




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                              2.0 INTRODUCTION

2.1 Overview Of Children’s Environmental Health

The World Health Organization defines Environmental Health as the control of
those factors in the physical environment that have or may have a deleterious
effect on man’s survival and well being. It also defines health as a state of
complete physical, mental and social well being not merely the absence of
disease or infirmity.

The environmental health of the children of Zimbabwe has enormous threats. As
a Third World and underdeveloped country, the threats have their roots in the
country’s Socio-historical origins, the climate and the general economic and
industrial development. The environmental threats to the health of the
Zimbabwean child have a direct link to the underdevelopment of the country
and the resultant poverty which predispose children to communicable diseases
due to poor hygiene in overcrowded, and ill-ventilated housing. The heavy
reliance on wood, kerosene (paraffin) and cow dung for fuel, as electricity is not
available to the majority of the population and is unaffordable, exposes large
numbers of children to smoke and pungent gases as well as to unprotected fires
and heated water in buckets resulting in burns and scalds. As a result of
poverty, many children are exposed to cold especially in the winter months. The
reliance on open fires increases indoor air pollution leading to numerous cases of
chest infection in children in winter. In the summer months walking barefooted
exposes the children to infestation with worms.

The sources of outdoor air pollution in Zimbabwe as in other countries on the
continent are power stations, cement plants, chemical factories, paper mills,
mining, and mineral processing industries as well as other manufacturing
processes. Control for these industries is limited because of resource constraints.


The other source of outdoor air pollution is the emissions of leaded fuel from old
and unroadworthy vehicles. The purchase of unleaded fuel is well beyond the
country’s means as the country is not able to meet its fuel requirements even of
the relatively cheaper leaded fuel.

Lack of safe water for domestic use and sanitation predisposes children to
diarrhoea, dysentery, typhoid, cholera and skin diseases including scabies while
the relocation and confinement of the African population following their
subjugation and colonisation in the arid, malaria, trypanosomiasis and bilharzia
infested Native Reserves or Tribal Trust Lands now known as Communal Lands
threaten more acutely the health of the Children in these areas.


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The perennial droughts that ravage the country are a major climatic threat to the
environmental health of the Zimbabwean child. The droughts result in under
nutrition leading to stunting and wasting as well as mortality. Hunger is a
constant and actual reality to a large number of Zimbabwe’s children due to
scarcity of food. The drought dries up boreholes and wells leading to scarcity of
safe water thereby placing an even heavier burden on women and children who
have to fetch water from long distances. The inadequate amount of safe water
for domestic use predisposes children to diarrhoeal diseases, eye infections and
skin diseases.

The dependence on natural resources in the rural (communal) areas for wood for
fuel and for dwellings (pole and dagga huts), food especially wild fruits, as well
as water, imposed an intolerable pressure on the land resulting in soil erosion
and siltation of major rivers in the country. The soil erosion has further reduced
the fertility of the soil which was already poor in these areas while the siltation of
rivers has deprived the population of fish for food and water for drinking and
for watering their livestock and vegetable gardens. The recurrent burning of
forests and the veld deprive children of wild fruit and meat as animals and other
natural resources are destroyed by the fires.

AIDS is currently a serious environmental threat to the health of the
Zimbabwean child as orphan hood strips the child of protection from parents
exposing the child to all forms of abuse including sexual abuse with the resultant
sexually transmitted infections including HIV and AIDS.

The progressive impoverishment of the native population is reflected in the
disease pattern of the majority of Zimbabwe’s population. They suffer and die
from diseases of poverty and underdevelopment. The 1995 Zimbabwe Poverty
Assessment Study found that 62% of households in Zimbabwe were poor with
46% of these households being classified as very poor. The level of poverty can
be anything up to 80% at the moment. The United Nations Conference on Trade
and Development has classified Zimbabwe as a highly unequal society in which
the richest 20% of the population receives 60% of the nation’s income. For the
majority of the children in Zimbabwe “Poverty is the greatest Pollutant” which
has to be addressed as a matter of urgency as it is the primary source of all the
environmental threats to the health of the Zimbabwean child.




                                                                                    4
2.2 Key Environmental Health issues.

2.2.1   Water Safety and Water Quality

Nationally about 85% of households have access to safe water. However there
are disparities. Virtually universal access among urban households coexists with
low access among rural households. UNICEF (1999) reports that while most
urban households have their water source on the premises (93%) half of rural
households are more than 500 metres from the source and 13% more than 1km
away. It is usually the households whose water source is unsafe that have the
greatest distance to travel and that tend to use untreated water for cooking and
drinking.

Cost continues to be a major barrier to improving access. It can cost up to Z$2
million to sink a borehole (2002). Hand-pumps require maintenance but a
breakdown in the community-based maintenance system in the last 3 years has
seen up to 60% of hand-pumps out of operation (National Coordination Unit
2003).


2.2.2   Sanitation and Waste Management

This includes basic sanitation in rural and peri-urban areas solid waste storage,
removal and disposal, liquid waste quality, and disposal of health care wastes
and other hazardous wastes. The ventilated improved pit latrine has been the
latrine of choice in rural sanitation for a long time. Ecological sanitation models
have also started to become popular, especially in crowded informal peri-urban
settlements where the alternative communal pit latrines have proved to be a
serious nuisance and health hazard.

Access to sanitary facilities in rural areas has increased from 7% at independence
to 40% in 2001. Government subsidies for the private construction of pit latrines
together with a health extension service and community mobilization have
helped this increase in access.

Health and hygiene education stressing the importance of washing hands,
storing and using water properly keeping the home clean and disposing of refuse
has also been widely disseminated.

Access to flush toilets varies from 83% to 98% in urban areas but systems in peri-
urban areas are often used by numbers far in excess of their capacity.
Consequently most peri-urban Zimbabweans are much worse off in terms of
sanitation facilities than rural Zimbabweans with a properly built pit latrine.


                                                                                      5
Because of foreign currency shortages refuse removal systems in urban areas
have become very difficult to maintain. As a result there are frequent vehicle
breakdowns with consequent failure to cope with the accumulations of refuse.
Pests such as flies and rodents find suitable breeding and harbouring material in
the refuse. Children are also exposed to injury and poisoning by hazardous
wastes

The non-availability of specific regulations on health care waste disposal also
threatens children’s environmental health.

2.2.3   Pest and Vector Control

A number of pests can be found in the environment. Some of them constitute a
mere nuisance while others are vectors of disease. Unfortunately we still do not
have regulations to control the activities of pest control companies.

Education on the control of the various pests is given to the community. At the
same time Pest and vector control programmes are undertaken to kill the pests
and vectors. Mosquitoes, rats, fleas, lice, mites, flies, bilharzia snails, tsetse flies
are some of the pests/vectors that are dealt with.

The national malaria control programme has given special consideration to the
needs of women and children. Insecticide treated mosquito nets are distributed
to pregnant women and to families with under 5 children. Save the Children
Fund (UK) has started a programme to involve children in malaria prevention
and control. School children form health clubs which perform various malaria
control activities eg. larviciding in open water bodies, taking blood slides,
performing drama and songs with malaria messages at public events and
identification of sick children for treatment by the school health masters.


2.2.4   Air Pollution Control

The majority of people in rural areas and a substantial number in urban and peri-
urban areas burns low-grade fuels such as wood, dung and crop residues for
cooking and heating. The levels of air pollution found in their houses are many
times above the maximum levels found or permitted with outdoor air pollution.
Studies done in Matebeleland South found that the concentration of respirable
particles in rural household kitchens was 14 times above the WHO
recommended levels and 23 times above the National Health and Medical
Research Council. The greatest exposures occur in women because of their
customary involvement in cooking for long periods of time. Children under 5


                                                                                           6
years are also exposed as they are often present in the kitchen during cooking.
This has serious health consequences for the women and children. Children
have a greater risk of exposure and harm than adults for a number of reasons.
Their behaviour and activity patterns bring them into greater contact with
various agents in the indoor environment. They have immature developing
organs and tissues that are more susceptible to harm from toxic exposures. Their
immature metabolic and physiological systems less effectively protect them from
toxic exposure and effects. Other additional pathways of exposure for children
include in utero, via breast milk and via products and other materials found
indoors. Lastly, children have much more life ahead of them during which time
they will be exposed and may develop health problems as a result.

Exposure to indoor air pollution has been associated with many respiratory
conditions and symptoms like reduced lung function, cough, bronchitis and an
increased incidence of acute respiratory infections. Exposures in pregnancy also
lead to low birth weight babies who are more likely to die in infancy. No
programme is in place to control indoor air pollution as such. However health
education on the construction of well ventilated houses is ongoing. The
government’s present rural electrification programme and the solar energy
project before it aim to increase access to cleaner forms of energy in the rural
areas.

Monitoring of air quality in industrial areas is done by environmental health
officers and chemists to detect air pollutants. Association has been established
between such pollution and incidence of acute respiratory infections among
children in the affected areas. Inspection of Industrial processes and installations
is done and appropriate advice given. Enforcement of regulations on the control
of smoke, dust, gas and fume emissions is done in terms of the Atmospheric
Pollution Prevention Act.

Recent monitoring of environments around industrial processes have shown
high levels of air pollutants. For example, in the City of Harare the average
Sulphur dioxide levels for year 2002 were reported as 88 µg/m3 which was above
the world Health Organization standard of 50ug/ m3. Particulate was at 51.1µg/
m3 against WHO’s 50µg/ m3. Unfortunately, the environmental support project
which had been initiated to develop an adequate capacity for a reliable air
quality monitoring programme was discontinued due to withdrawal of donor
funding.

Smoke emissions from domestic kitchens are not controlled by law
while polluting industries that are considered to be strategic to
national development are exempted from the provisions of the law.
Examples are cement factories and fertilizer companies.

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2.2.5   Injuries

Globally, injuries cause nearly 6 million deaths a year. Death and disability from
injuries occur disproportionately among children and the poor. Although
injuries consume about 1-2% of the country’s GDP they have been neglected and
little is done to prevent them. Part of the problem is that injuries, particularly
non-fatal ones often go unreported. Injuries result from road traffic accidents,
drowning, falls and burns. Improved surveillance is needed so as to show
decision makers the gravity of the problem, and research to improve the
evidence base of injury prevention strategies.

Most children in rural areas do not have adequate blankets and many sleep on
bare floors with the only warmth derived from open fires in the huts leading to
the many cases of burns as the scanty bedding catches fire.

Injuries are reported in the National Health Information system by type and not
by cause. In 1998 the most common type of injury in children under 5 years were
burns, accounting for 1467 cases (29.7%) of all injuries. Fractures were next for
this age group with 834 cases, followed by open wounds and all other injuries
(697 cases). (National Health Profile, 1998)


2.2.6   Chemical Safety

Chemicals are widely used in agriculture as pesticides, fungicides and
herbicides. They are also used in public health and veterinary services to control
vectors of diseases.

Pesticides used in Zimbabwe are registered in terms of the Pesticide Regulations
of 1997 under the provisions of the Fertilizer, Farm Feeds and Remedies Act and
are classified as Group II or Group III chemicals under the Hazardous Substances
and Articles Act.

A chemical safety training programme was carried out by the World Health
Organization in 1998. Focal persons were trained. Health and Hygiene education
is given to the communities on how to use the chemicals. The sale of
unregistered chemicals for pest (cockroaches and rats) control is becoming more
and more rampant. The public is attracted by the chemical’s knock down effect
without considering its hazardous nature. Cases of accidental and suicidal
poisoning have been reported.

A study carried out in Kariba by Chikuni and others of the University of
Zimbabwe in1997 showed high levels of DDT in human breast milk samples.


                                                                                  8
DDT is a persistent organic chemical. Cases of acute poisoning from pesticides
have been reported over the years.


Another study on childhood poisoning done by Dexter Tagwireyi and others at
the University of Zimbabwe showed that household chemicals especially
paraffin and rodenticides accounted for the highest number of hospital
admissions for children less than 12 years of age. There is need for preventive
programmes aimed at making parents aware of the dangers of improper storage
of these chemicals. The same study also found out that there are high rates of
mortality among children associated with traditional medicine. The question
asked was whether the traditional medicines had inherent toxicities that were
responsible for these deaths or whether the condition being treated gets worse,
leading to death.


2.2.7   Food Safety and Hygiene

The Food and Food Standards Act constitutes the basis for food standards
control in Zimbabwe. A number of regulations have been promulgated under
this Act to control standards for various manufactured foods. They stipulate
standards for such things as food labeling, composition of manufactured food,
permitted additives and prohibited substances. Food hygiene is also controlled
by the Public Health Act. Monitoring of hygiene in food serving institutions
including schools, hospitals, restaurants and hotels is an on-going exercise.
Surface samples are taken from food preparation surfaces, food preparation
equipment and from other structures. Food samples are also taken and sent to
the laboratory for analysis. Enforcement of food regulations is done to ensure
that manufactured food sold on the market complies with stipulated standards
and that it is not adulterated or falsely described. Enforcement is applied to both
local and imported foods.

Fresh fruits and vegetables are also monitored for pesticide residues. Food
animals are inspected before and after slaughter in order to remove any diseased
meat from the food chain.


2.2.8   Housing and Hygiene

Rapid urbanization results in high population pressures on city environmental
quality and resources in our cities. There continues to be a deterioration of the
health conditions in high density housing areas. Proliferation of backyard



                                                                                    9
shanties results in overcrowded conditions and overloading of the sewerage
system leading to blockages.

The Housing and Housing Standards Act stipulates housing standards in terms
of structural stability, lighting, ventilation, floor space per room, adequacy of
cooking, living and sleeping space, and access to domestic water and acceptable
sanitation. The provisions of this Act have for practical purposes, always been
applicable to urban areas. Standards for rural areas have by and large been left to
the individual owners’ initiative.

Public Health by-laws help to ensure a hygienic and nuisance free environment.
Health and hygiene programmes have adopted more participatory approaches in
an effort to influence positive behaviour change.

The pressures of rapid urbanization and poverty have resulted in the growth of
unplanned informal settlements. Housing standards and environmental
conditions in such settlements are poor and promote disease outbreaks. In most
of these settlements housing Units are made of plastic paper, pole and mud,
metal scrap or such other material. The floors are not dust proof, they are poorly
ventilated and poorly lighted. Sanitation facilities are inadequate and poorly
maintained. Refuse removal is usually highly unsatisfactory and domestic water
supply inadequate. Privacy of family members is compromised by inadequate
living rooms available to the members.

The pillar of the National Housing Policy is that the public and private sectors
are involved in housing delivery system.


2.3 Burden of diseases related to the environment of children.

As can be seen from the key causes of morbidity and mortality in children in
Zimbabwe (Appendix II), all the causes or conditions are related to the
environment of poverty and underdevelopment. Respiratory infections are due
to smoke, dust, gases, cold and overcrowding. Maternal under nutrition leads to
slow foetal growth, low birth weight and difficult birth as maternal
undernutrition increases the cephalo-pelvic disproportion leading to birth
trauma and even mortality since obstetric emergency services are poor. Vector
borne diseases continue to burden the population as the resources for the control
of mosquitoes and other vectors are inadequate. Infrastructure like roads,
bridges, telephones, schools, clinics and food production are inadequate and
reflect the underdevelopment and the poverty of large sections of the population.
Diarrhoeal diseases are a result of inadequate safe water and sanitation while
kwashiorkor is a result of inadequate food intake. The burden of diseases related


                                                                                   10
to the environment in children in Zimbabwe is therefore almost 100%. This
situation is compounded by the HIV and AIDS pandemic which is having a
telling effect on the population in general.

There are little of the diseases of affluence in Zimbabwe’s children. They suffer
and die from diseases of poverty and underdevelopment most of which are
preventable.


                    3.0 NATIONAL GOVERNMENT ROLE

3.1 National Policies that Support Children’s Environmental Health.

Zimbabwe recognises the human rights of children and is Party to the United
Nations Convention On The Rights Of The Child and other International Treaties
that protect children from abuse and exploitation such as the ILO Convention
138 on Minimum Age for Admission into employment and 182 on the
Elimination of the Worst Forms of Child Labour and the Convention on the
Elimination of All Forms of Discrimination Against Women. The country has
developed a National Programme of Action for Children in line with the1990
United Nations General Assembly World Summit on Children and The General
Assembly Special Session On Children in order to provide a co-ordinated and
systematic implementation and monitoring of the United Nations Convention
On The Rights of the Child. Through ratification of these International
Conventions, the nation recognises its obligation to uphold the rights of the child
to life and survival, development to their fullest potential in a loving family and
friendly physical environment, protection from physical, mental and sexual
abuse and their participation in issues that have a bearing on their lives. For the
decade 2000-2010 and beyond the National Programme of Action for Children in
Zimbabwe, like elsewhere in the world will be guided by the United Nations
General Assembly document entitled a “World Fit For Children”.

Faced with the HIV and AIDS scourge that has resulted in the phenomenal
increase in orphan hood, the nation developed the National AIDS Policy, which
led to the establishment of the National Aids Council and Trust Fund to provide
resources for the care and protection of the infected and affected, guided by the
National Orphan Care Policy. Other policies include the iodisation of all salt for
human consumption to prevent goitre in children, exclusive breastfeeding for the
first 6 months to prevent mortality from unhygienic handling of formulas,
villagisation to improve the standard of housing in villages and resettlement
areas, rural electrification at the bear minimum to schools and clinics in the
remote areas which will improve the learning environment and the proper
maintenance of the cold- chain in the immunisation programme, the land reform


                                                                                11
policy to improve the nutritional status of the population and alleviate the
poverty of the majority. Underpinning all these policies are the Acts of
Parliament, which include The Public Health Act instituted to ensure the
survival and proper physical, mental and social well being of the child. In
addition to The Public Health Act and the new Environmental Management Act
which has incorporated the Atmospheric Pollution Prevention Act, the
Hazardous Substances and Articles Act and The Noxious Weed Act ensure that
the environment is not rendered harmful to the health of the population as well
as the preservation and protection of the environment for the benefit of present
and future generations.


The Education Act provides for the establishment of educational institutions
including the provision of safe drinking water and basic sanitation, learning
materials and adequately trained teachers. The Children’s Protection and
Adoption Act provides for the care and protection of the poor, abandoned,
neglected and orphaned child while the Land Acquisition Act guides the
redistribution of land in fight against poverty.

The regulations under the Air Pollution, Prevention Act promote children’s
environmental health. Also policies on basic sanitation and water supplies
promote children’s environmental health.

In the rural areas we have not yet regulated that each household should have a
latrine. As a result people continue to use the bush as latrines in some areas. In
2001 only 40% of the rural communities were found to have access to basic
sanitation.

The policy of registering schools ensures that children in the school have access
to reasonable latrine facilities, standard classroom structures and to safe drinking
water. However the proliferation of spontaneous makeshift boarding facilities at
some of the rural day secondary schools is cause for concern. The term “bush
boarders” has been coined for children living in these self-constructed and
substandard dormitories where they are exposed to sexual abuse by adults and
to the temptation of prostitution so as to secure money for food.

The country does not have a policy yet on the use of leaded fuel and this exposes
children to lead - laden fumes and deposits. However, efforts are underway
through the Biosafety Board of Zimbabwe to propose policy on this.

In the last few years gold panning activities have been allowed to get out of
control. This has resulted in serious environmental degradation while at the
same time mercury is used indiscriminately during processing. The open pits left


                                                                                 12
by the gold panners have become breeding grounds for malaria carrying
mosquitoes during the rainy season. This has resulted in serious malaria
outbreaks and deaths.

Children under 2 years often find themselves in prisons when their mothers are
imprisoned. They are exposed to the harsh prison conditions such as
overcrowding, unsanitary surroundings, dirty linen, inadequate clothing, and
the risk of diseases such as tuberculosis. There are no special facilities to cater for
inmates with children. There is need to support the establishment of a taskforce
by the Ministry of Justice Legal and Parliamentary Affairs to look into the
problem of children who live with their imprisoned mothers.


3.2 Health Sector

The Public Health Act is the principal Act that protects public health. The Act
deals with the notification of infectious diseases, international health regulations,
water and food supplies, and sanitation and housing. The specific Part relating to
children is that dealing with Infant Nutrition. The Act has a number of
regulations controlling specific activities for the protection of public health.

Training in diarrhea control and management has been going on throughout the
country. The Ministry of Health and Child Welfare has a deliberate policy to
distribute insecticide-treated mosquito nets to pregnant women and those with
children under 5 years of age. The curriculum for nurses now includes training
on environmental threats to humans.

The National Malaria Control Programme is well established. Components of the
programme include indoor residual spraying to kill adult vector mosquitoes,
case management, larviciding, and the use of insecticide-treated bednets,
mosquito repellents and environmental controls. However, activities on
schistosomiasis and leprosy control are less prominent. Because of the number of
school children that test positive for schistosomiasis and because of the terrible
disability that leprosy can cause, programmes for the prevention and control of
these diseases are necessary.

Field staff (environmental health technicians) conducts special hygiene education
and disease prevention and control sessions. They use participatory health and
hygiene education methodologies in their work.

The urban areas have always been regulated by law - sanitation, water supplies,
refuse disposal, housing standards, pest and vector control, etc. Rural areas, on



                                                                                   13
the other hand, were not controlled by regulations. However some Rural District
Councils have started to make public health by-laws for rural settings.

We have regulations to control the use of tobacco in public places and the sale of
tobacco and alcohol to people below 18 years of age. The law on Health Care
waste management is still under formulation.

A micro nutrient study conducted by the Ministry of health and Child Welfare
and UNICEF indicated that vitamin A deficiency was a problem of public health
importance. However a statutory instrument on universal salt iodation and close
monitoring of levels of iodine in salt have helped to control iodine deficiency.
Iron supplementation is given to pregnant mothers. Fortification of food with
Vitamin A has been done on a pilot basis and is soon to be spread countrywide.
Vitamin A capsules are given to children of 6-11 months of age and to lactating
women. Children 6-11 months are given 100 000 IU every 6 months. Those 12-59
months are given 200 000 IU every 6 months, while lactating women are given
200 000IU within 6 weeks of delivery. Supplementation is however expensive
and so plans are underway to identify other vehicles for micronutrient
fortification, particularly Vitamin and Iron.

Nutrition education and nutrition gardens form part of health and development
programmes in Zimbabwe while child supplementary feeding is provided to
under five children. Guidelines on complementary feeding and dietary
management of HIV and AIDS are being developed . The guidelines focus on
hygienic food preparation. It has been established that young children and
people living with HIV and AIDS are prone to diarrhoeal infection particularly
when the food has not been properly handled and prepared.

The negative impact of poverty on child and maternal nutrition in Zimbabwe can
never be overemphasized. The situation has been worsened by the 2002 drought
and by inflationary pressures currently affecting the country. As a result of
poverty we have seen an increase in street children. The national response to
street children has been limited and ineffective, partly because there is no
consensus on whether children should be helped on the streets or taken off the
street. A number of committees have been formed to look at the street kids issue
but they have not produced tangible results.

A national poverty assessment study will be conducted between November and
December this year by the Ministry of Public Service, Labour and Social Welfare.
The purpose of the study is to assess the levels of poverty in the country so as to
come up with district level geographical poverty maps which are crucial for
designing of targeted poverty reduction interventions in the areas of food
security, health education and other social services.


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Promotion of exclusive breastfeeding for the first six months of life is being done.
Exclusive breastfeeding is important as it stimulates optimal milk production –
introduction of any other foods or fluids, including water reduces the child’s
demand on breast milk and may interfere with the maintenance of lactation
ending with early termination of breastfeeding. When infants are given solids or
even non-milk fluids the prevalence of diarrhoea is much greater due to
contamination of the bottles or food. A statutory instrument on breast milk
substitutes was put in place in 1998.


3.3 Environmental Sector

Poverty has also encouraged a sizeable number of the population to engage in
illegal gold panning leaving the holes uncovered which defeats the larviciding
efforts to prevent malaria as not all these increased water collection sites can be
sprayed. Gold panning also increases land degradation as it increases soil
erosion and pasture as well as increasing the pollution of water supplies to urban
centres as illegal settlers break into city water reticulation systems. Even the
registered large industrial and mining concerns continue to pollute and degrade
the environment. They are reluctant to institute measures to control the pollution
as these would “eat into their profits”. They would most likely move elsewhere
where the regulations may not be as rigorous if strictly enforced. Further studies
would need to be carried out to exclude industrial pollution as causes of eczema,
and asthma that affects children in large industrial centres of the country.


Until recently, environmental legislation did not have human health as one of its
components. Since December 2002 a new Environmental Management Act was
promulgated. Although the Act came into operation in March 2003 the structure
of the Environmental Management Agency and its modus operandi are still being
formulated. The Act provides for the sustainable management of natural
resources and protection of the environment, the prevention of pollution and
environmental degradation, and the preparation of a National Environmental
Plan and other plans for the management and protection of the environment. It
provides for the conducting of Environmental Impact Assessments, (which
include possible impact on health) for all development projects. By instituting
effluent discharge registers and environmental impact studies before
development projects, the nation is striving to secure ecologically sustainable
management and use of natural resources while at the same time promoting
justifiable economic and social development.




                                                                                 15
The permanent secretary in the Ministry of Health and Child Welfare is a
member of the National Environmental Council whose function is, inter alia, to
advise on policy formulation and give direction on the implementation of the
Act.

The new Act has brought Air pollution control and hazardous substances control
under its control. These have been up until now responsibilities of the health
sector. Consideration of children in the Environmental Management Act is only
implied and not expressly stated.

3.4 Education Sector

The opportunity for health and environmental education in the Zimbabwe
education system are abundant. The education system has an education for
living syllabus besides the teaching of biology, chemistry, physics and
geography. The school health programme in conjunction with the Ministry of
Health and Child Welfare educates children on hygiene and the importance of
safe water and how to make water safe by boiling or chemical treatment and
proper excreta disposal for the prevention of diarrhoeal diseases. Some NGOs
have introduced the concept of school health clubs which involve school children
in malaria control activities.

The Programme also educates school children on HIV and AIDS and other
sexually transmitted infections as well as malaria and bilharzia control.
Competitions are encouraged for primary and secondary school children on the
preservation of the environment by such non-governmental organisations as
Environment Africa and Environ Tech. Zimbabwe has schools in both the urban
and rural areas and has achieved a primary school enrolment rate of 89% and
completion rate of 80% for the decade 1990 to 2000. Gender disparities remain,
however, with girl children lagging behind boys with an enrolment rate for boys
averaging 91.5% compared to 86.8% for girls.

Schools in the rural areas like any other service are few and long distances have
to be covered to access them. Poverty militates against the education of many
rural children and poor urban children. The government together with non-
governmental organisations assists these children with school fees, uniforms and
food including food packs to take home, as there is not much food in these
poverty stricken households. Hunger has resulted in many children fainting in
school for lack of food. The assistance is always grossly inadequate.




                                                                                 16
3.5 Other Pertinent Ministries and Sectors

Other Ministries/Sectors that implement programmes for health of children and
their environment other than The Ministry of Health and Child Welfare, Ministry
of Education Sport and Culture, are The Ministry of Environment and Tourism,
Ministry of Lands, Agriculture and Rural Resettlement, Ministry of Local
Government, Public Works and National Housing, Ministry of the Public Service,
Labour and Social Welfare, Ministry of Home Affairs, Ministry of Youth
Development, Gender and Employment Creation, Ministry of Justice Legal
Parliamentary Affairs, Ministry of Information and Publicity as well of non-
governmental organisations and United nations Agencies.


The Ministry of Health and Child Welfare has the responsibility to administer
the Public Health Act which covers the provision of all health services to ensure
the survival of the child including immunisation and the education of the public
in hygiene, safe water, sanitation and the control of vector borne diseases.

The Ministry also co-ordinates the implementation of the United Nations
Convention On The Rights of the Child through the National Programme of
Action for Children. The Ministry of Education Sports and Culture also conduct
public education on environmental health of children both by education of the
school children and through the children, reaching out to their parents.

The Ministry of the Environment and Tourism regulates the discharge of
effluent, the control of Hazardous Substances, control of air pollution, noxious
weeds and other pollutants that affect the environmental health of children. The
Ministry of Lands, Agriculture and Rural resettlement provides the population
with the land, an important means of production in an agriculture-based
economy. Through its extension officers the Ministry educate the farmers on how
to grow crops to feed the children to reduce under nutrition. They also source
for food even from outside the country in times of drought through the Grain
Marketing Board to provide drought relief and supplementary feeding especially
for the under fives.

The Ministry of Local Government, Public Works and National Housing,
through local authorities under it, administers the services that enhance the
environmental health of children like cleaning the streets, refuse collection,
provision of housing to the population, recreational facilities and the care of
orphans and street kids with assistance from non-governmental organisation and
other line Ministries like Health and Child Welfare, Public Service, Labour and
Social Welfare, Home Affairs and Education Sports and Culture.



                                                                               17
The Ministry of the Public Service, Labour and Social Welfare administer the
Children’s Protection and Adoption Act which provides for the provision of
places of safety for abandoned, neglected and abused children as well as
assistance with their education and care. They select and process adoptions for
the abandoned and orphaned children. They are therefore responsible for the
care and protection of the poor and vulnerable children who are also known as
children in difficult circumstances.


The Home Affairs Ministry through the police assists abused children. They also
apprehend the perpetrators of abuse or neglect and, through the office of The
Registrar General, provide birth certificates for the identity of all children. To
increase the population access to the registration facilities, mobile teams have
been established that regularly visit remote rural areas and plans are underway
to open registration offices at hospitals. Over 80% of Zimbabwean children have
birth certificates.

The Ministry of Youth Development, Gender and Employment Creation assist
young people, many of whom are below the age of 18 years, to be self assertive
especially in HIV and AIDS prevention and providing them with skills training
to empower them economically. Children are also exposed to national debates
on issues concerning the environmental health of children through The
Children’s Parliament and Junior Councils. The Children’s Parliament and Junior
Councils were established to commemorate The Day of the African Child in
memory of the school children of Soweto in South Africa who were gunned
down by the Apartheid regime. Like the adult parliament and councils, the
children debate issues of concern to the population although they do not meet as
regularly as the adult parliament and councils.

The Ministry of Justice, Legal and Parliamentary Affairs is charged with the
environmental health of juvenile offenders, particularly their care and welfare
while in custody to ensure that their health is not adversely affected as well as
the health of those infants who have to go with their mothers into prisons. The
Ministry of Information and Publicity provides public education through the
media on the environmental health of children. Non-Governmental
Organisations work with the communities in supporting and complementing
governmental undertakings to enhance the environmental health of children
while The United Nations Agencies provide both technical and financial support
to children’s environmental health programmes




                                                                               18
4.0 SOCIETY ROLE

4.1 Communities

Those local authorities that have established Health Departments can carry out
public information campaigns on environmental health. For the rural local
authorities, the Ministry of Health and Child Welfare has always advised on
environmental health issues.

Zimbabwe has an administrative structure that begins at the village or
community level culminating at the national or central government level. The
structure was instituted at independence in 1980 to facilitate development. The
structures are Village Development Committees, Ward Development
Committees, District Development Committees and Provincial Development
Committees. The Committees develop plans that are incorporated into the
national development plans. They are administered by village headmen,
councillors, District Administrators, Provincial Administrators and Executive
Mayors of cities with the overall leadership of the Provincial Governors who are
also resident Ministers within the Ministry of Local Government, Public Works
and National Housing. Through Rural District and Urban Councils these
administrative structures enact by-laws which complement national legislation
to protect the environmental health of children. For example, the care of orphans
and vulnerable children, refuse collection and disposal, malaria and bilharzia
control as well as supplementary feeding. They are charged with enforcing
national legislation including public awareness and education on disease
prevention and control. They are however constrained by inadequate resources
to produce and distribute the information on children’s environmental health.

4.2 Non-Governmental Organisations

Non-governmental organizations (NGOs) are members of all the developmental
committees at all levels. Key NGOs and United Nations Agencies involved in
the national campaign on children’s environmental health are Environment
Africa, the Catholic Relief Services, SAVE the Children Fund (UK) and Save the
Children Fund (Norway), Plan International, World Vision and WHO, UNICEF,
UNESCO, UNDP and UNAIDS. An Italian NGO, CESVI, has a Child
Supplementary Feeding Programme in Mount Darwin.

A local NGO Mvuramanzi Trust is involved in the promotion of sustainable
sanitation options in the rural and peri-urban areas. They also promote safe
drinking water, health and hygiene education, as well as small-scale drip
irrigation schemes in the rural areas. Other active NGOs include, Christian Care,
Care International and ORAP


                                                                              19
4.3 Professional Associations

Various professional associations with an interest in children and environmental
health exist. The Zimbabwe Medical Association, the College of Primary Care
Physicians, the Zimbabwe Environmental Health Practitioners Association, and
the Zimbabwe Nurses Association are some of them. In addition, the 8
professional Councils which constitute the Health Professions Authority can be
involved in a national campaign on children’s environmental health. On the
international scene the International Federation of Environmental Health would
have a keen interest in participating in children’s environmental health issues, as
would the Clinical Epidemiology Network funded by the Rockefeller
Foundation.

4.4 Academia

Zimbabwe now has Universities in the majority of its provinces in addition to the
University of Zimbabwe, which is the oldest University in the country and the
only one providing medical training. At least 2 universities provide
environmental health training. All the Universities would and are required to
promote children’s environmental health through research, advocacy and
publication of research findings. They already undertake this role with varying
degrees of success. They would however intensify this role if they secured
financial and material support. A particular area of interest that needs research
and documentation in the environmental health of children is the use of
herbicides, larvicides, natural mosquito repellents as well as the nutritional value
of the abundant wild fruits and plants. Research is also needed on the effects of
gold panning on children’s environmental health. In addition to the Universities,
Zimbabwe has within the Ministry of Health and Child Welfare the Blair
Research Institute and the De Beers research laboratories for the control of
communicable diseases. Their work in water and sanitation has been
outstanding. All medical research is regulated by the Medical Research Council,
which encourages research into the well being of the population including
children.

4.5 Private Sector

There are private companies in Zimbabwe that are interested in the
environmental health of children and they produce and promote products that
enhance the health of children. These range from food processing industries like
National Foods. They fortify, label and inform the consumers on the food value
of their products and expiry dates on both adult and infant foods. There are also
companies that produce childcare products like Lever Brothers and Johnson &
Johnson, companies that produce pesticides for vector control and


                                                                                 20
pharmaceutical companies that produce the drugs for the treatment of diseases
like malaria and bilharzia. Private companies including banks provide
scholarship for the education of poor and exceptionally bright children. They
sponsor sporting activities and make food and clothing donations to poor and
vulnerable children. They also support projects which provide safe water
supplies to schools and communities in rural areas.

There is in Zimbabwe a significant public – private partnership in the provision
of industrial health care in the form of hospitals and clinics as well as
occupational health education, which in these days include HIV and AIDS
prevention at the work place.


                                  5.0 SCIENCE

Several studies have been conducted in the country on the environmental health
of children. The Blair and De Beers Research laboratories’ main mandate is to
conduct research and publish results on the communicable diseases affecting the
population including children. Their research into wells, ottway pits, ventilated
pit latrines, bilharzia control, operational research and verification of HIV and
AIDS cure claims by traditional healers has been tremendous. While Blair
Research Institute does not focus specifically on children, it has done a lot of
research in malaria, water and sanitation, bilharzia, diarrhoeal diseases and HIV
and AIDS. It provides support to operational research by Departments and
individuals. However, funding for national essential health research is limited.
The Institute also needs funds to conduct health systems research training. The
Institute itself lacks some essential equipment and has suffered from the current
brain drain in the country.

Universities have conducted research in appropriate technology, for example, in
the use of solar energy, which has benefited sizeable numbers of villagers as well
as studies in the conditions of orphans and vulnerable children. The findings on
the need for psychosocial support to these children have been of immense benefit
to programmes that assist orphans and other vulnerable children. The findings
in the studies of conditions of women and children in the mining industry and
commercial farms have benefited the child welfare programmes in these sectors.
Studies have been done on the impact of industrial pollution on human health
but the results are not yet out. An environmental health officer in the Ministry
recently studied domestic indoor pollution and associated health effects in
women and children for his Masters Degree studies, while a PhD student at the
University of Zimbabwe studied childhood poisoning in Zimbabwe. An
Evaluation of DDT and DDT residues in human milk was also done by the
University of Zimbabwe.


                                                                               21
Studies in the physical environment and its effect on the health of children has
been undertaken. There is a Ministry of Science and Technology housed in the
President’s Office charged with finding proven strategies for development. All
other ministries conduct periodic operational research to inform and improve
their service delivery to the population.

                         6.0 DATA AND REPORTING

There is generally an agreement by both WHO and UNICEF that the health data
collection system in Zimbabwe is geared to produce high quality data. Collection
of data has however, been affected by the brain drain that has affected the whole
country, and sometimes by industrial action by the nursing staff. A number of
our health centres are currently manned by untrained nursing aides. Normally
completeness and timeliness rates of 97% have been achieved.

Health data is collected through the National Health Information System. At
health centre level the information on diseases is collected through the T5 form.
The T5 form collects data by age groups: below 5 years, 5-14 years and 15years
and above. It is therefore easy to see which diseases are a problem among
children and institute appropriate preventive and control measures.

The collected data is consolidated at the end of every month and sent to the
District Level who also consolidate and send to the Province. The Province
transmits data from all its Districts to Head Office. At each level the data is
analysed and discussed by the health personnel at that level. If need be,
appropriate action is taken at that level. At Head Office the data is analysed by
epidemiologists and disease control experts in the Ministry and from WHO at a
disease surveillance meeting which is held every Tuesday.
The Environmental health information system is currently under development.
The indicators have already been agreed and the various data collection
instruments available have been evaluated.


                            7.0 COMMUNICATION




                                                                                22
Radio and television as well as newspapers are used for disseminating
information. The radio reaches more people including those in rural areas
through its 4 broadcasting stations. One of the stations broadcasts in 7 minority
languages in addition to the 2 main languages. Newspapers and television cater
mostly for urban people.

Recently a successful awareness campaign on the land reform programme was
mounted in the media. Efforts are currently being made to use similar campaign
approaches in malaria awareness by the Ministry.

At Head Office the data collected through the T 5 is analysed by epidemiologists
and disease control experts in the Ministry and from WHO at a disease
surveillance meeting which is held every Tuesday. Anomalies and discrepancies
are communicated to the reporting centres for action.

                               8.0 CONCLUSION

Zimbabwe is committed to the improvement of the environmental health of its
children. The expanded programme on immunisation has reached even the
remotest parts of the country resulting in the near elimination of neo-natal
tetanus, the near eradication of polio, iodine deficiency and drastically reduced
deaths from measles. Coverages of about 80% for all antigens have been
achieved. Vitamin A supplementation, nutrition gardens as well as child
supplementary feeding were efforts to reduce levels of undernutrition and
starvation.

Malaria control has spared the lives of many children in the endemic areas. The
control of diarrhoea with public education in the use of sugar and salt solution
has become common knowledge with as many as 95 % of women in the country
knowing how to prepare the solution. Water and sanitation provision has
increased to 75% and 60% respectively from about 35% safe water in rural areas
and 4% sanitation at independence according to the 1999 Demographic and
Health Survey.

The biggest challenge for the improvement in children’s environmental health is
the country’s poor economic status, which hopefully will improve with increased
agricultural production. Resettled areas have an urgent need for water,
sanitation, clinics and schools in addition to the requirements of the remote areas
being opened up such as Siakobvu, Binga,Tsholotsho and others. The
government with assistance from the international donor community and
participation from private industry is and has to be the main engine to move this
developmental process forward and register success in the improvement of



                                                                                23
children’s environmental health even in the era of the HIV and AIDS scourge
which is rapidly reversing the health gains of the early independence period.


        9.0 RECOMMENDATIONS WITH PROPOSED TIME FRAME



RECOMMENDATIONS                                                   TIME FRAME
  1 Need to revise the Public Health and the Environmental        December 2005
     Management Acts. The new Acts to also address
    children specifically.
  2 Enforce the Housing and Housing Standards Act and             December 2005
     formulate policies to extend it to rural areas

   3 Educate the public on the necessity of conserving the        Immediate
     environment for future generations

   4 Extend the use of bottom up participatory approaches in      Immediate
     community mobilization and empowerment such as the
     Ministry of Agriculture’s heifer programme


   5 Ensure adequate household food security through the          December 2004
     provision of inputs such as seed, fertilizers, pesticides
     and herbicides for the new and communal areas farmers
   6 School health clubs to be sustained and supported as         Jan–Dec 2004
     educative tools for better sanitation, hygiene and health
     in general. The right messages need to be provided to
     the health clubs.

   7 Enhance children´s participation in community                Jan-Dec 2004
     developmental activities eg. water point committees
   8 Assess the urban refuse management systems and               Jan- Dec 2004
     support the development of new disposal sites

   9 Evaluate the morbidity and mortality impact of the           June-Dec 2004
     malaria programme and re-establish a national
      schistosomiasis and leprosy control programme
   10 Investigate and introduce innovative environmentally        Jan 2004 – Dec
       friendly technologies for alternative fuels and lighting   2008

   11 Establish a programme to monitor the effects of             Jan 2004- Dec


                                                                                 24
   industrial pollution on the health of children             2005


12 Assess the environmental and child health implications     September 2004
  of the informal gold mining sector


13 Establish ways of ensuring available support reaches       June 2004
  also families and households with children in difficult
   circumstances
14 Strengthen the infrastructure that delivers services to    Jan- Dec 2004
    households under stress and to orphans and other
    vulnerable children
15 Enhance poverty alleviation programmes and                 Mar - Dec 2004
   rehabilitate street children

16 Replace all forms of “bush boarding” facilities in         Jan 2004 – Dec
   secondary schools with proper boarding facilities          2006
17 Educate children, parents and officers on the prevention   Jan–June 2004
   of child abuse

18 Educate youth on the dangers of alcohol and tobacco        Jan–June 2004
   smoking


19 Educate youths on dangers of glue sniffing and the use     Jan–June 2004
  of other drugs


20 Educate parents on chemical risks in pest control          Mar – Sept 2004



21 Strengthen family unit concept. Children to accord      Jan 2004- Dec
   respect to their parents and not to look down upon them 2008
   because of their educational, economic or social status




                                                                          25
APPENDIX I

ABBREVIATIONS USED IN THIS REPORT



AIDS         Acquired Immune Deficiency Syndrome

ARI          Acute Respiratory Infections

CITES        Convention on the International Trade in Endangered Species

DDT          Dichlorodiphenyltrichloro-ethane

GDP          Gross Domestic Product

HIV          Human Immuno Virus

ILO          International Labour Organisation

IU           International Units

NGO          Non Governmental Organisation

ORAP         Organisation for Rural Associations for Progress

PhD          Doctor of Philosophy

STI          Sexually Transmitted Diseases

UK           United Kingdom

UNAIDS       United Nations AIDS

UNDP         United Nations Development Programme

UNESCO       United Nations Educational, Scientific and Cultural Organization

UNICEF       United Nations Children’s Emergency Fund

WHO          World Health Organization



                                                                            26
APPENDIX II



Key Causes of Mortality/Morbidity for Children under 5 years (2001)

Table 1: Children under 1 year
Cases (In-patients)                              Deaths (In-patients)
- Malaria - 4004                                 - Pneumonia - 538
- Pneumonia* - 3980                              - Slow foetal growth - 326
- Slow foetal growth, foetal                     - Other diseases of the resp system - 135
      malnutrition and immaturity -              - Hypoxia, birth asphyxia
   2310                                          - Ill defined intestinal infections - 109
- Acute respiratory infections - 1602
- Ill-defined intestinal infections - 1277


*Pneumonia is reported separately from acute respiratory infections in the health
 information form (T5)




Table 2: Children 1-4 years
Cases (In-patients)                          Deaths (In-patients)
- Malaria - 11567
- Pneumonia - 3053                           - Kwashiorkor - 232
- Ill defined intestinal infections - 1625   - Ill defined intestinal infections - 174
- Infections of skin and subcutaneous        - Malaria - 174
   tissue - 1340                             - Infections of skin and subcutaneous
- Kwashiorkor - 1026                           tissue - 170
                                             - Pneumonia -170




                                                                                    27
APPENDIX III

HIGH RISK/VULNERABLE GROUPS AND DEMOGRAPHIC
PROFILE.

The Zimbabwe National Health Profile is disaggregated according to age, sex
condition, district, province and city but not according to ethnicity or socio-
economic status. Information on ethnicity or socio-economic status is not
routinely collected but is derived from research studies. The main reason for not
routinely collecting data on ethnicity and socio-economic status is that the
majority of the Zimbabwe population is poor. Also there are not many ethnic
groups to warrant such disaggregation. The Khoisan, a very small minority in
the South Western region of Zimbabwe bordering Botswana are the only African
ethnically distinct group from the general Bantu peoples in the country besides
the Europeans, Asians and Coloureds (those of mixed race). Zimbabwean is
therefore largely a homogenous country with the majority of its population
falling into two distinct tribes, the Shonas and Ndebeles both of whom are Bantu.

Besides the general groupings of Shona and Ndebele, other Bantu peoples in the
country are the Kalanga, Shangani, Venda, Hwesa, Sotho, Tonga, Chikunda,
Doma, Shangwe, Korekore, Chewa/Nyanja. Barwe, Sena, Nambya, Fingo/Xhosa
and Tswana. The non-Bantu groups are the Khoisan, Asians, Europeans and
Coloureds.

Socio-economic status and burden of diseases as a classification of different
groups is used when assessing need for drought relief, food assistance and
regional vector-borne diseases control. Currently even the distributed mosquito
nets are given to all households with children under five and to pregnant women
in the endemic areas. Very few households in these areas can afford to purchase
nets for themselves.


1. The Tonga of Binga and Kariba Districts


The lowveld areas along the Zambezi, Limpopo and Sabi rivers have poor
rainfall and are infested with mosquitoes that cause malaria and for the Zambezi
valley tsetse flies as well. The Tonga and Khoisan are especially vulnerable to


                                                                              28
vector borne diseases, undernutrition and diarrhoeal diseases as well as sexually
transmitted infections including AIDS as their level of poverty and inadequate
infrastructure is more intense than for the general population who are
themselves also poor. The Berlin Conference that partitioned Africa among the
European powers separated The Khoisan and Tonga from their kinsmen in
Botswana and Zambia. They lost the social support from relatives as they were
cut off by international boundaries.

For the Tonga the flooding of their land in the development of Lake Kariba in the
1950s increased their vulnerability to hunger and diseases as they were forced to
relocate to arid land depriving them of fish, which formed an important part of
their diet. They do not and cannot afford to fulfil the requirements to secure
fishing rights on the lake and neither can they afford hunting certificates. Like
The Khoisan who also live adjacent or in the game parks hunting and fishing for
these groups is done illegally through “poaching”. The electricity generated by
the dam or lake that displaced them has not reached them. Ninety-six percent of
the population of Binga District and almost 100% of the population of Siakobvu
(Kariba District) do not have access to electricity, even the hospital (Siakobvu) is
not connected to the national grid. Their location in or adjacent to game parks
discourages initiatives in crop production as the crops are destroyed by wild
animals especially elephants. Schools and clinics are on average 80kms away
from the district centres on rough terrain and dirty roads through wildlife areas
where even lions roam freely with little or no public transportation network.

The few secondary schools in the area do not provide boarding facilities leading
to children putting up for themselves make-shift structures near the schools to
save them from travelling distances of over 30kms one way on average to school
daily. These school children that attend school from these shanty structures are
now known as (bush boarders). They do not have parental or school authorities
supervision and care. Many do not have enough food to sustain themselves for
the school term and many fall victim, as a result, to the unscrupulous who
sexually abuse them in return for sustenance. They live in substandard
accommodation with no sanitary facilities.

At the time of completing this report the two Districts of Binga and Kariba were
experiencing a cholera outbreak that had claimed the lives of more than 30
people out of a total of over 500 cases.


2. The Khoisan of Tsholotsho




                                                                                 29
For the Khoisan the tragedy is that they are losing their identity as their language
is dying. Very few of the adults let alone the children can speak it let alone write
it. They yearn to learn their language. They yearn to also develop like the
Kalanga and Ndebele peoples around them and for whom they are herdsmen
and domestic workers rather than colleagues and equal community members.

The Khoisan people have no cattle, goats and sheep or adequate water in the
Tsholotsho District visited. All the community empowerment developmental
strategies of central government and non-governmental organisations do not
reach the Khoisan who the Bantu Ndebele and Kalanga call Masili meaning “the
lazy lot”. The British called them “Bushmen”. They have even come to accept
these names, as they are powerless to shake them off. They would rather be
called the Vatwa and would appreciate the provision of at least one or two
elephants for food per year. They live adjacent to game parks and have for time
immemorial been hunters and gatherers an activity that would render them
criminals as “poachers” in the age of the Convention on International Trade in
Endangered Species (CITES). They need desperately more boreholes for the
development of nutrition gardens, assistance with the provision of improved
ventilated pit latrines, boreholes, clinics and the education of their children who
currently spend their lives herding cattle belonging to the Ndebeles and
Kalangas at the “Mulaga”or far-away pasture. They also desire that their
children be taught how to speak and write their own language.

The government of Zimbabwe has opened up these remote areas like Binga,
Siakobvu, Tsholotsho and Gokwe by providing at least a tarred road to the
centres and providing electricity as at Binga and Tsholotsho, the construction of
district hospitals, clinics, schools and the control of communicable and vector
borne diseases, particularly malaria schistosomiasis and trypanosomiasis.
Together with non- governmental organisations including churches, donors and
United Nations agencies these communities have been provided food relief.
Boreholes have also been provided but they are long distances apart. The few
boreholes available cater for both humans and livestock with very little water left
for even very small vegetable gardens. Health education in the prevention of
malaria, diarrhoea and AIDS is provided through the hospitals, clinics, schools
and outreach programmes. Because of the terrain, meaningful food production
in these areas is only possible with massive investment in irrigation and electric
fencing to prevent access by wild animals. An alternative would be the
relocation and resettlement of these communities where the weather and soils
are more favourable. However these communities would need to be extensively
consulted before such an undertaking as efforts to resettle the Tonga of Chief
Sinakatenge in Binga were reported to have met with stiff resistance.




                                                                                 30
3. The Shangani of Chiredzi in Masvingo Province.

The Shangani constitute the indigenous Bantu ethnic group in Chiredzi. They
have little or no value for formal schooling. They however rear cattle and goats.

Most girl children drop out of school after Grade 6 or 7 (12-14 years). At this age
the girls go through the initiation ceremony known as Komba. During this one
and half months ceremony the girls are taught about their culture, family matters
and a wife’s roles and responsibilities. Loyalty and obedience to the husband,
the right way to dress, respect for elders, etc are also taught to the girls.
Manipulation of genital organs is also done in preparation for their sexual roles.

The boys also go through their own initiation ceremony known as Hoko which
also lasts about one and half months. During the ceremony the boys are
circumcised, they are taught how to build houses, how to hunt and how to be
brave men who can protect their wives and children. They are also taught about
important herbs such as aphrodisiacs and those for treating sexually transmitted
infections.

Because the Shangani encourage polygamy the girls and boys are taught how to
handle polygamous marriages.

One thing that is impressed on the girls by the elder women who teach them
during Komba is that after Komba they are now women and they must get a
husband and start their own family. As a result virtually all the girl children
drop out of school after the ceremony and the Komba teachers recommend
husbands for them.

The drop-out rate for boys is less than that for girls. However, a good number of
them leave school after Grade 7 and “jump” the border into South Africa which
has become the destination for most young Shangani men. They work on farms
in that country.

Environmental health among the Shangani has remained poor. Sanitation
coverage is very low as the people place very little importance on the provision
and use of toilets. Sanitation and Hygiene do not form part of the training and
education during Komba and Hoko and so the young graduates start their own
homes without enough skills and knowledge on sanitation and hygiene. Because
they leave formal school at a young age, they have not yet grasped the concepts
of sanitation and hygiene.




                                                                                  31
Eye infections were reported to be a problem recently in some parts of Chiredzi
probably because of poor hygiene and the reported abundance of flies.




4. Vulnerable groups in the Zambezi Valley (Mashonaland
         Central)

The Zambezi Valley presents various Challenges towards Children’s
environmental health.

a) Guruve District

Towards the border with Zambia in Kanyemba we find 2 Bantu ethnic groups:
the Doma and Chikunda. The Doma are a nomadic group who up until now
have lived in the mountains among wild animals. They are hunters who live on
meat, honey and fish. They neither rear animals nor do any farming and their
children do not go to school.
While the Chikunda people have now accepted to communicate with other
people, they are, however, still backward.

The major problems facing these ethnic groups in Kanyemba are malaria,
diarrhoeal diseases and poverty. The area has the highest malaria burden in the
province of Mashonaland Central and Water and Sanitation coverages are low.
An intensified community-based malaria prevention and control programme has
been in place since 1998 involving the distribution of bednets, indoor residual
spraying, larviciding, case management, personal protection and health
education.

The WHO/AFRO Regional Director Dr Samba was personally involved in a
project to provide clean drinking water to the Kanyemba people. Sewing
machines and material for bednet-making were also donated together with 2000
mosquito nets. The programme proved to be sustainable as the villagers raised
money from the donated nets and from the ones they made themselves. Most of
the money generated is used to purchase more materials while some of it is made
available for household/family use.




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WHO has also donated a motorcycle to the Environmental Health Technician in
Kanyemba to enable him to support health and development issues in the area.

Sanitation coverage for Guruve is only 17%. Chapoto Ward in Kanyemba with
2000 households was affected by a cholera epidemic in 1999. No household had
a toilet. WHO started a sanitation project in 2000 and to date 56% of the targeted
ventilated improved pit toilets have been reported as complete. A piped water
scheme for the clinic and school jointly funded by WHO and the District
Development Fund is near completion.




b) Mount Darwin District

Most of the diseases occurring in the District are environment-related. Mt
Darwin District shares a border with the Tete Province in Mozambique.
Mukumbura Clinic right at the border reports high cases of malaria throughout
the year. Recorded clinical cases increased from 196 in July, 274 in August to 316
in September 2003.
The clinic has not had a qualified nurse since June 2003. A nurse aide assisted by
a general hand and a village health worker is giving minimal care. The EHT has
no motorcycle to go round the villages. Most of the medical problems they
handle seem to originate from across the border in Mozambique. The clinic
reported a sudden increase in scabies (from 0 cases in July, 5 in August to 29
cases in September), Sore eyes (10 in July, 24 in August, 119 in September) and
Acute Respiratory Infections (ARI) (64 cases in July, 56 cases in August and 117
cases in September) Sexually Transmitted Infections (STIs) were also reported to
be high with children below 18 also being affected. Other problems reported are
dental problems, TB, malnutrition, bilharzia, bloody diarrhoea, roundworm
infection, low water and sanitation coverage, and low immunization coverage.
World Vision has a water and sanitation programme going on in Mt Darwin.
They have managed to rehabilitate broken down boreholes and drill some new
ones. They are still to do the sanitation component.

The general shortage of gas has also hit the immunization programme in the
District. Immunizations are now done by a mobile team from the District
Hospital.

The people had a poor harvest in 2003. They grow cotton and maize mostly.
There are no poverty alleviation programmes in the Mukumbura area and all the



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people depend on food handouts. An Italian NGO, CESVI, has a Child
Supplementary Feeding Programme in the area.


APPENDIX IV

LIST OF PERSONS CONSULTED

   1. Sr Kalupi Sister in Charge Siakobu Hospital Kariba District
   2. Mrs Matumba (nee Jeche) Environmental Health Technician, Siakobvu
       Ward, Kariba District
   3. Mr. Chris McIvor, Country Programme Director, Save the Children (U.K.)
   4. Mr. David Proudfoot, Director, Mvuramanzi Trust
   5. Mr. Dombo Chibanda, Ass. Director of Health Services, City Health
       Department, Harare
   6. Prof. Nathoo, Department of Paediatrics, Harare Central Hospital
   7. Dr. Angela Mushavi, Head, Paediatrics Central Harare Hospital
   8. Dr. I.M.H. Ticklay, Department of Paediatrics Harare central Hospital
   9. Dr. Susan L. Mutambu, Acting Chief Medical Research Officer, Blair
       Research Institute (Ministry of Health and Child Welfare)
   10. Dr. Festo P. Kavishe, Representative, Unicef
   11. Dr. Elizabeth Mason, IMCI, WHO/AFRO, Harare
   12. Dr E Xaba, Permanent Secretary, Ministry of Health and
            Child Welfare
   13. Mr P Nyathi, Ministry of Education Sport and Culture,
            Matebeleland North
   14. Mr. N. Muleya, Environmental Health Technician/ TB
            Coordinator. Tsholotsho
   15. Dr. Abednigo T. Chidzoba, Tsholotsho District hospital
   16. Mr Abisher S Nyamundanda, Principal EHT, Tsholotsho
   17. Mrs Gandari, District Nursing Officer, Tsholotsho
   18. Mr D Ncube District Health Services Administrator,
            Tsholotsho
   19. Mr Nhliziyo, District Administrator, Ministry of Local
           Government, Tsholotsho
   20. Sikente Clinic Staff, Tsholotsho
   21. Khoisan villagers at Sikente led by Mr Muchina
   22. Mrs ES Tshuma District Nursing Officer, Binga (Acting
            District Medical Officer)
   23. Mr. Canaan Ntini, Env. Health Tech. (TB Coordinator)
            Binga District Hospital
   24. Mr. Freedom Zulu, Acting Matron, Binga District Hospital
   25. Villagers at the Tonga Homesteads of Manjolo and Bokisi


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         (Siachilaba), Binga District
26. Mr. Artwell Maneswa, EHT at Hatcliffe Extension, Harare
27. Dr. Timothy Stamps, Advisor, Office of the President and
         Cabinet, former Minister of Health and Child Welfare
28. Mr Pedzisai Moyo, Senior Teacher Gurungweni Primary
         School, Chiredzi
29. Mrs Chengeto Muzondiona, Senior Environmental Health
        Technician Health Information Office, Provincial Medical
        Director Masvingo
30. Mr Martin Netsa, Principal Environmental Health Officer,
        Guruve District Mashonaland Central
31. Mr Goldberg T Mangwadu, Provincial Environmental
         Health Officer Mashonaland Central
32. Mrs Nyamufukudza, Nurse Aide, Mukumbura Clinic,
        Mount Darwin
33. Dr O Chikuni, Department of Clinical Pharmacology,
         University of Zimbabwe
34. Mr Dexter Tagwireyi, Department of Clinical
         Pharmacology, University of Zimbabwe
35. Mr F Muvirimi, Manager Livestock Development Trust,
         Ministry of Lands, Agriculture and Rural Resettlement
36. Mr SM Sibanda, Undersecretary Housing, Ministry of
         Local Government, Public Works and National Housing




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