Disaster and Intervention in Sub-Saharan Africa: Learning from Rwanda

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In the long run, communities with broken sanitation facilities, disrupted education systems, malnutrition and poverty are susceptible to secondary effects such as famine, disease outbreak 4 , 6. Previous studies have also reported a number of factors predisposing people, infrastructure and institutions to the effects of landslides and floods among which include; settling in high risk areas such as mountain slopes, lack of information on mitigation measures to reduce the effects of landslides; instability of slopes; the informal nature of houses which makes them prone to collapsing in the event of a landslide; and low level of preparedness in the district 5.

In the event of a disaster, social characteristics of household members such as age, sex, health status and disability increase vulnerability to the disaster effects 7. Oftentimes, women, children, the sick and the elderly have been reported to be the most at risk groups affected by landslides and floods. In particular the young children and elderly are vulnerable because they are too weak to run and often times remain at home and miss out on the warnings about the threat of landslides and floods 5. In sub-Saharan countries particularly, Uganda, Ethiopia and Rwanda, individuals, households and communities have come up with some local coping strategies.

Coping strategies are a combination of all the strengths, attributes and resources available within a community, society or organization that can be used to avert some or all of the negative effects of a shock or stress 3. For instance, relocation to safer areas if the threats are too great to ignore, receipt of aid and relief, and resorting to subsistence and innovative farming practices such as terracing in order to overcome crop destruction following heavy rains 3 , 8.

In Uganda the national policy for disaster preparedness and management addresses some key coping issues such as resettlement of people living in high risk areas, applying appropriate farming technologies and prohibition of settlement in high risk areas. However, implementation of the Policy actions on landslides remains significantly inadequate. This could probably be because of the limited capacities to manage and reduce disaster risks at both community and national level 9.

In the current advent of climate change and the changing environment, it is anticipated that landslide and flood incidents will be on the increase within exposed communities in Mt Elgon region. However, there is still limited qualitative information on the coping strategies and underlying causes of vulnerability to the effects of landslides and floods in the Mt. This study explored underlying causes and coping strategies used to avert the effects of landslides and floods in the Mt. Therefore, findings on the strategies that have been used to mitigate, to cope positively, recover and learn from the landslides and floods could inform the design of appropriate innovative solutions that can strengthen the capacity of affected populations to become resilient.

This study was conducted in three districts of Bududa, Manafwa, Butalejja located in the Mt.

The Elgon region has semi urban and rural communities with an estimated population of 1,, FGDs and KIIs were best suited to explore underlying causes of vulnerability and the coping strategies for landslides and floods. A total of 48 participants were involved in the 6 FGDs. The FGDs were drawn from the community members, mainly opinion leaders, political leaders, cultural leaders and other categories of individuals who had a good knowledge of the development challenges of the specific community.

All participants were aged 18 years and above. Participants from each focus group had both males and females. Given that gender did not influence behaviour as regards disasters, both males and females were interviewed in the same focus group 3. FGDs participants were from rural areas worst affected by floods and landslides.

The focus of the study was resilience which dealt with the capacity of people and systems to mitigate, cope positively, recover and learn from shocks and stresses in a manner that reduces vulnerability and increases well-being 3. The target districts for this study were Bududa, Manafwa and Butalejja — the most affected communities in the region. We then randomly selected two high risk sub counties from each of the districts ensuring inclusion of rural localities. In each sub county, we conducted two FGDs. The survey questionnaires were translated into the local language and pretested in a similar setting in order to get feedback on questions that were not clear.

This was done prior to data collection. Investigators also participated in the data collection process. During interviews we asked open ended questions followed by targeted questions on predetermined categories. The interview guide focused on factors that empower communities to resist disasters and underlying factors that make communities fail to overcome their vulnerabilities probing for people, physical infrastructure, livelihoods infrastructure and institutions.

The FGDs and KIIs were all transcribed verbatim and those in the local languages translated without altering the meaning. A conventional content analysis approach was used as described by Hsiu-Fang and Sarah 10 with codes and categories arising from the data. Analysis was done in two stages, first, the manifest content analysis and then the latent content analysis.

The transcripts were read and re-read by the authors to achieve immersion. Text data was read to derive codes by highlighting emerging factors based on our understanding of the data. Codes were sorted into categories based on their linkages. The categories were grouped together into meaningful overarching themes i. Strategies that improved long term vulnerability of individuals, households and communities were categorised as positive coping while those strategies that had no impact were put under the category of unsustainable coping 3.

The objectives, benefits and risks of the study were explained to the study participants and informed consent obtained. All data obtained during the study were treated with confidentiality and anonymity. We restricted data access to only the investigators and the research assistants. The results are presented in two thematic topics from the data analysis namely; coping strategies and underlying causes of vulnerability to landslides and floods as discussed in the FGDs and KIIs.

A summary of the key results are presented in Table 1.

Coping strategies for recurrent landslides and floods in the Elgon region. Disasters have occurred repeatedly in the Mt. Focus Group discussions and key informants described a number of coping strategies that have been used by individuals and communities to lessen the effects of landslides and floods. Five FGDs and half of key informants reported adoption of good agricultural techniques e. This was as a result of sensitization and public awareness of the community on disaster mitigation measures. Majority of the key informants explained that sensitization and training were conducted by various agencies to help cope with the effects of the disaster.

We have got NAADs coordinators and service providers who are training people in land soil conservation and better farming practices. We also had NGOs supporting communities in tree planting. The district natural resource office has been able to establish nursery trees where people are given free tree seeds to plant in their gardens Key Informant technical officer, Manafwa. Communities relied on external support from government and other partners in coping with floods and landslides.

Majority of key informants and three FGDs mentioned support from government and other partners e. Tree planting, zero grazing, terracing, contour ploughing. Communities reported small scale diversified wealth creation activities to improve household incomes including small scale businesses on major trading centres, agricultural diversification like poultry and livestock farming and seeking formal employment. Some of us have established retail shops at Bulucheke Trading centre, so when our crops are destroyed by the landslides, we survive on income from these shops.

We also acquire some money to pay for school fees for our children and when they finish and get employed, they support us especially in the event of a landslide FGD, Bulucheke Bududa District. As a positive coping strategy, one key informant mentioned that local communities relied on traditional indigenous knowledge systems for recognition of landslides and floods especially in assessment of risks, weather forecasting and early warning.

They use signs to tell whether it is going to rain heavily and experience a landslide or flood such as the appearance of cracks on the lands. Some of the people see cracks and move after seeing cracks. But mainly after they have seen cracks they report to the district that look here there is this problem. Key Informant District technical officer, Bududa.

However, from a resilience perspective, some of the coping strategies used in managing landslides and floods were ineffective in lessening the effects of these disasters hence unsustainable 3. These included infrastructural maintenance and relocation of displaced populations. Nearly all of the FGDs mentioned infrastructure maintenance such as community road maintenance, creation of water channels, digging trenches and sealing river banks to be unsustainable in reducing the effects of floods and landslides.

They explained that these disasters still come and destroy everything on their way. We have tried to dig trenches but it has failed because when the waters come, the area still floods. Even when we try to raise up the roads, the roads still flood. Although two thirds of the FGDs mentioned relocation as a positive coping strategy, Three key informants were concerned with its effectiveness pointing out that some of the relocated people often returned back to high risk areas due some factors like cultural attachments, funding challenges and failure to involve and consult the community in planning.

One time government tried to shift people from vulnerable places to Kiryandongo, but they never stayed there long. They came back because of their traditional beliefs. Key Informant Key informant, politician Manafwa. They thought for them, they planned for them, they decided for them they took them to Kiryandongo relocated and they were not prepared. Even if it was me I would not stay there. Many of the factors which exacerbate vulnerability to the effects of landslides and floods in the Mt. Elgon region are mainly socio-economic and cultural.

The main economic causes that emerged from the FGDs and key informants were, poverty, construction of weak houses using indigenous materials, limited land, population pressure and lack of access to critical infrastructure and services.

HIV/AIDS in Africa

Consistently across all FGDs and key Informants, the issue of poverty was highlighted as the main cause of vulnerability for landslides and floods. For example it was pointed out that some communities did not have resources to come up with simple measures or innovations to reduce the effects of landslides and floods. Poverty was linked to the non-durable informal structures of houses that were being built.

Five of the key informants mentioned that the houses were built using poor quality materials and therefore could not resist floods or landslides. Key informant District technical officer, Butalejja. The materials they used are not good, in other words the contractors do shoddy work when the river floods, automatically the water will come and sweep away the structures because of the weak foundation. Half of the FGDs mentioned population pressure plus land shortage to force people live in high risk areas.

Population pressure could also influence negative land use patterns e. There was also a widely held view among two key informants that inadequate services and difficulty in accessing critical infrastructure such as roads hindered communities from accessing markets for their produce leading to income insecurity. This complicates survival efforts. We are constructing in places that we are not supposed to because we are over populated and have nowhere to go. We end up constructing in swamps and wetlands that are prone to floods. Key informant representative from NGO, Bududa.

The main social causes of vulnerability that emerged were unsatisfactory knowledge on disaster preparedness and strong cultural beliefs among community members. In addition two FGDs mentioned the influence of strong traditional beliefs in making people fail to overcome their vulnerability e.

We are primitive and do not know what to do to mitigate these problems. This problem can also be attributed to the fact that our children are lowly educated. This can also be attributed to the cultural beliefs, for example, I know of some old man that said that his grand parents and parents were buried here and so he was going no where else but rather stay in his ancestral lands.

The study findings clearly show that some strategies that were used to cope with the effects of landslides and floods had a positive impact and improved wellbeing of communities such as adoption of good farming methods, support from government and other partners, livelihood diversification and using indigenous knowledge in weather forecasting.

However, some strategies used in coping were unsustainable and had not built permanent protection from recurrent landslides and floods such as infrastructural maintenance and relocation of displaced populations. Coping strategies employed by farmers to reduce the impact of landslides and floods in the Elgon region included soil conservation practices and diversification with tree planting, contour farming, and terracing. These practices have been reported to be fairly effective in lessening the effects of shallow landslides and run off from floods 11 and should be emphasized.

Uptake of sustainable farming was as a result of community sensitization on mitigation measures. Generally, education programmes about disasters mitigation have been reported to increase hazard knowledge and this is associated with increase in disaster preparedness behavior This is because people who are sensitized and aware of hazards in their communities are more likely to perceive themselves to be at risk. Communities that perceive themselves to be at risk are more likely to prepare and mitigate future hazardous events thus promoting community resilience Therefore disaster awareness creation at individual, community and organizational level could be a more effective tool in mitigating of disaster risk and ameliorating their effects.

The study also showed that external support from government and other partners in coping with landslides and floods was an effective strategy in helping communities to lessen the effects of landslides and floods. The government of Uganda together with humanitarian agencies have been taking action to reduce the effects of disasters 14 , Some of the activities carried out by government and partners included; early warning and training activities designed to enhance preparedness 3.

Additionally, the number of AIDS-related deaths in in both Africa as a whole and Sub-Saharan Africa alone was 32 percent less than the number in This is due to many factors such as a lack of understanding of the disease, lack of access to treatment, the media, knowing that AIDS is incurable, and prejudices brought on by a cultures beliefs. The belief that only homosexuals could contract the diseases was later debunked as the number of heterosexual couples living with HIV increased.

Unfortunately there were other rumors being spread by elders in Cameroon.

They also claimed if a man was infected as a result of having sexual contact with a Fulani woman, only a Fulani healer could treat him". Because of this belief that men can only get HIV from women many "women are not free to speak of their HIV status to their partners for fear of violence". Unfortunately This stigma makes it very challenging for Sub-Saharan Africans to share that they have HIV because they are afraid of being an outcast from their friends and family. The common belief is that once you have HIV you are destined to die.

People seclude themselves based on these beliefs. They don't tell their family and live with guilt and fear because of HIV.

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This group of individuals under fear of suspicion may avoid being mistakingly identified as stigmatized by simply avoiding HARHS utilization. The rewards of being considered normal' in the context of high-HIV-prevalence Sub-Saharan Africa are varied and great Other potential rewards of being considered normal include avoidance of being associated with promiscuity or prostitution, avoidance of emotional, social and physical isolation and avoidance of being blamed for others' illness" Using different prevention strategies in combination is not a new idea.

Combination prevention reflects common sense, yet it is striking how seldom the approach has been put into practice. Prevention efforts to date have overwhelmingly focused on reducing individual risk, with fewer efforts made to address societal factors that increase vulnerability to HIV. UNAIDS' combination prevention framework puts structural interventions—including programmes to promote human rights, to remove punitive laws that block the AIDS response, and to combat gender inequality and HIV related stigma and discrimination—at the centre of the HIV prevention agenda.

Most new infections were coming from people in long-term relationships who had multiple sexual partners. The abstinence, be faithful, use a condom ABC strategy to prevent HIV infection promotes safer sexual behavior and emphasizes the need for fidelity, fewer sexual partners, and a later age of sexual debut. The implementation of ABC differs among those who use it. For example, the President's Emergency Plan for AIDS Relief has focused more on abstinence and fidelity than condoms [30] while Uganda has had a more balanced approach to the three elements.

The effectiveness of ABC is controversial. People who had talked to the counselors were twice as likely to mention abstinence and three times as likely to mention condom use when asked to describe ways to avoid infection. However, they were no more likely than the uncounseled to mention being faithful as a good strategy.

The people who had been counseled were also twice as likely to have been tested for HIV in the previous year, and to have discussed that possibility with a sex partner. However, they were just as likely to have a partner outside marriage as the people who had not gotten a visit from a counselor, and they were no more likely to be using a condom in those liaisons. There was a somewhat different result in a study of young Nigerians, ages 15 to 24, most unmarried, living in the city and working in semiskilled jobs.

People in specific neighborhoods were counseled with an ABC message as part of a seven-year project funded by the U. Agency for International Development and its British counterpart. The uncounseled group showed no increase in condom use—it stayed about 55 percent. In the counseled group, however, condom use by women in their last nonmarital sexual encounter rose from 54 percent to 69 percent.

For men, it rose from 64 percent to 75 percent. Stigmatizing attitudes appeared to be less common among the counseled group. A survey of 1, Kenyan teenagers found a fair amount of confusion about ABC's messages. Half of the teenagers could correctly define abstinence and explain why it was important. Only 23 percent could explain what being faithful meant and why it was important. Some thought it meant being honest, and some thought it meant having faith in the fidelity of one's partner. Only 13 percent could correctly explain the importance of a condom in preventing HIV infection. About half spontaneously offered negative opinions about condoms, saying they were unreliable, immoral and, in some cases, were designed to let HIV be transmitted.

Eswatini in announced that it was abandoning the ABC strategy because it was a dismal failure in preventing the spread of HIV. One of the greatest problems faced by African countries that have high prevalence rates is "HIV fatigue". In , the Henry J. Kaiser Family Foundation and the Bill and Melinda Gates Foundation provided major funding for the loveLife website , an online sexual health and relationship resource for teenagers.

The TeachAIDS prevention software, developed at Stanford University , was distributed to every primary, secondary, and tertiary educational institution in the country, reaching all learners from 6 to 24 years of age nationwide. The solutions are organized around three strategic pillars: The Roadmap defines goals, results and roles and responsibilities to hold stakeholders accountable for the realization of these solutions between and Chief among these are the traditionally liberal attitudes espoused by many communities inhabiting the subcontinent toward multiple sexual partners and pre-marital and outside marriage sexual activity.

In most of the developed world outside Africa, this means HIV transmission is high among prostitutes and other people who may have more than one sexual partner concurrently. Within the cultures of sub-Saharan Africa, it is relatively common for both men and women to be carrying on sexual relations with more than one person, which promotes HIV transmission. Africa, the West, and the Fight against AIDS , in which her research into the sexual mores of Uganda revealed the high frequency with which men and women engage in concurrent sexual relationships. When infected, most children die within one year because of the lack of treatment.

Rather than having more of a specific group infected, male or female, the ratio of men and women infected with HIV are quite similar. For African countries with advanced medical facilities, patents on many drugs have hindered the ability to make low cost alternatives. Natural disasters and conflict are also major challenges, as the resulting economic problems people face can drive many young women and girls into patterns of sex work in order to ensure their livelihood or that of their family, or else to obtain safe passage, food, shelter or other resources.

In Mozambique , an influx of humanitarian workers and transporters, such as truck drivers, attracted sex workers from outside the area. Sub-Saharan "Africans have always appreciated the importance of health care because good health is seen as necessary for the continuation and growth of their lineage". Unfortunately, "health services in many countries are swamped by the need to care for increasing numbers of infected and sick people.

Ameliorative drugs are too expensive for most victims, except for a very small number who are affluent". With less than 1 percent of global health expenditure and only 3 percent of the world's health workers". When family members get sick with HIV or other sicknesses, family members often end up selling most of their belongings in order to provide health care for the individual.

Medical facilities in many African countries are lacking. Many health care workers are also not available, in part due to lack of training by governments and in part due to the wooing of these workers by foreign medical organisations where there is a need for medical professionals. Currently antiretroviral therapy is the closest to a cure. However, many hospitals lack enough antiretroviral drugs to treat everyone.

This may be because most Sub-Saharan African countries invest "as little as dollars per capita, [so] overseas aid is a major source of funding for healthcare". Relying on other countries for help in general requires more paperwork and faith in another country very far away. Also, delivery of drugs and other aid takes many month and years to arrive in the hands of those that need help. According to a report, male and female circumcision were statistically associated with an increased incidence of HIV infection among the females in Kenya and the males in Kenya, Lesotho , and Tanzania who self-reported that they both underwent the procedure and were virgins.

Similarly, a randomized, controlled intervention trial in South Africa from found that male circumcision "provides a degree of protection against acquiring HIV infection [by males], equivalent to what a vaccine of high efficacy would have achieved". There are high levels of medical suspicion throughout Africa, and there is evidence that such distrust may have a significant impact on the use of medical services.

African countries are also still fighting against what they perceive as unfair practices in the international pharmaceutical industry. Patents on medications have prevented access to medications as well as the growth in research for more affordable alternatives. These pharmaceuticals insist that drugs should be purchased through them. South African scientists in a combined effort with American scientists from Gilead Sciences recently tested and found effective a tenofivir -based anti-retroviral vaginal gel that could be used as pre-exposure prophylaxis.

Since the epidemic is widespread, African governments sometimes relax their laws in order to get research conducted in their countries which they would otherwise not afford. Despite its lack of scientific acceptance, AIDS denialism has had a significant political impact, especially in South Africa under the former presidency of Thabo Mbeki.

Pressure from some religious leaders has resulted in the banning of a number of safe-sex campaigns, including condom promoting advertisements being banned in Kenya. Many people living with HIV in low and middle income countries who need antiretroviral therapy are unable to access or remain in care.

This is often because of the time and cost required to travel to health centres as well as an inadequate number of trained staff such as medical doctors and specialists to provide treatment. A systematic review found that when antiretroviral treatment was initiated at the hospital but followed up at a health centre closer to home, fewer patients died or were lost to follow up.

The research also did not detect a difference in the numbers of patients who died or were lost to follow up when they received maintenance treatment in the community rather than in a health centre or hospital. Incidence, in contrast, measures the number of new infections, usually over the previous year. There is no practical, reliable way to assess incidence in Sub-Saharan Africa. Prevalence in to year-old pregnant women attending antenatal clinics is sometimes used as an approximation. The test done to measure prevalence is a serosurvey in which blood is tested for the presence of HIV.

Health units that conduct serosurveys rarely operate in remote rural communities, and the data collected also does not measure people who seek alternate healthcare. Extrapolating national data from antenatal surveys relies on assumptions which may not hold across all regions and at different stages in an epidemic. Recent national population or household-based surveys collecting data from both sexes, pregnant and non-pregnant women, and rural and urban areas, have adjusted the recorded national prevalence levels for several countries in Africa and elsewhere [ citation needed ].

These, too, are not perfect: Household surveys also exclude migrant labourers, who are a high risk group. Thus, there may be significant disparities between official figures and actual HIV prevalence in some countries. A minority of scientists claim that as many as 40 percent of HIV infections in African adults may be caused by unsafe medical practices rather than by sexual activity.

In contrast to areas in North Africa and the Horn of Africa, traditional cultures and religions in much of Sub-Saharan Africa have generally exhibited a more liberal attitude vis-a-vis female out-of-marriage sexual activity. The latter includes practices such as multiple sexual partners and unprotected sex, high-risk cultural patterns that have been implicated in the much greater spread of HIV in the subcontinent. Uniquely among countries in this region, Morocco's HIV prevalence rate has increased from less than 0. This has been attributed to the Muslim nature of many of the local communities and adherence to Islamic morals.

Ethiopia's HIV prevalence rate has decreased from 3.

HIV/AIDS in Africa - Wikipedia

HIV infection rates in central Africa are generally moderate to high. Christian men and women also had a higher infection rate than their Muslim counterparts. Historically, HIV had been more prevalent in urban than rural areas, although the gap is closing rapidly. Between and , the HIV incidence rate in Tanzania for ages 15—44 slowed to 3.

Uganda has registered a gradual decrease in its HIV rates from The number of newly infected people per year, however, has increased by over 50 percent, from 99, in to , in Young people nowadays no longer see people dying; they see people on ARVs but getting children. We need to re-examine our strategies Leaders at all levels are spending The onset of the HIV epidemic in the region began in with reported cases in Benin, [69] Mali, [ citation needed ] and Nigeria. Nigeria's infection rate number of patients relative to the entire population , however, is much lower 3.

The main driver of infection in the region is commercial sex. However, it is now the worst-affected region in the world. Currently, Eswatini and Lesotho have the highest and second highest HIV prevalence rates in the world, respectively. In Botswana, the number of newly infected people per year has declined by 67 percent, from 27, in to 9, in

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