INDONESIA: Smoky traditions endanger children

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PENE, 18 August 2011 (IRIN) - In Nusa Tenggara Timur (NTT), one of Indonesia's least developed provinces, child mortality is nearly double the national average and traditions are partly to blame, say aid workers. In a practice thought to be healthy, mother and child are confined to an "umebubu", a grass hut, for 40 days after delivery, with a wood fire burning and no ventilation. The effects of smoke and acute respiratory illness (ARI) can be deadly. According to the World Health Organization (WHO), up to 40,000 children die of pneumonia in Indonesia every year, accounting for nearly 20 percent of all child mortality in the world's fourth-largest country. Today, ARI deaths are largely concentrated among the rural poor, a world away from the images of Indonesia's booming economy, where burning wood for cooking and heat is common, together with a lack of electricity and high rates of malnutrition - a major factor in ARI, Martin Weber, a WHO medical officer of child and adolescent health, told IRIN. "The exposure of children to smoke is not only a problem in the first 40 days, but the first year of life when the child is kept around the cooking fire and exposed to the smoke," he said. "This is where traditional practices put children at risk." Child mortality in NTT is 80 deaths per 1,000 against the national average of 44 per 1,000, according to the most recent Ministry of Health data, with ARI the leading cause. The government said in 2010 nearly half NTT's 4.6 million people had either been diagnosed with or reported symptoms of ARI, compared with 25 percent nationally. "It's related to the condition of the houses, the ventilation and everyone living together in one room," said Gregorius Fernandez, chief field officer in NTT for the UN Children's Fund (UNICEF) in the town of Kupang. Fifty years on Yunus Nitbawi, 54, spent the first month of his life in an umebubu in Pene, a village of 500 households, an hour's drive from the town of Kefamenanu in the West Timor district. "I'm fine, thanks to God," he said, adding, "I only cough in enclosed spaces." As he speaks, a child in the room coughs weakly and the sound of another echoes from outside. Nitbawi said with improved education, fewer women are using the umebubu as a treatment after giving birth. "Since the government intervened in 2009 and 2010 to get women to deliver babies in health centres, fewer people use the umebubu," he said. However, just 300m up the road, a father and son are boiling water over a wood fire in their hut. The ceiling is so low they have to squat and the smoky air is choking - like being in a fireplace with no chimney. While village leaders say awareness of the health risks of umebubus is spreading, such cultural change is difficult and there is a question of how much the tradition has actually been extinguished, Irene Cahyani, a programme officer for Oxfam in Eastern Indonesia, explained. "There aren't signs that anything is really changing at the moment and there is not a big effort to change it," Weber agreed. Some NGOs have introduced "healthy houses" - structures with windows and paved floors, which not only improve ventilation, but also eliminate unsanitary eating conditions on dirt floors. Others encourage the use of gas stoves or the idea that cooking should at least be done with some ventilation and without children nearby. "It's a cultural shift and it's gradually happening, but this is hard to do at the field level," UNICEF's Fernandez said. According to WHO, exposure to indoor air pollution kills 1.6 million people every year, amounting to one death every 20 seconds. nb/mw � IRIN. All rights reserved. More humanitarian news and analysis: http://www.IRINnews.org