Tackling Cardiovascular Diseases in Tanzania


Background

Cardiovascular Diseases (CVDs), a group of disorders that affect the heart and/or blood vessels are the leading causes of deaths and disability-adjusted life-years (DALYs) globally. In 2017, CVDs were responsible for an estimated 17.8 million deaths, with more than 80% occurring in low- and middle-income countries (LMICs). LMICs are experiencing a higher burden of CVD deaths due to rapid urbanization, aging, and health and nutrition transitions. It is projected that by the year 2030, CVDs will cause more than 23.6 million deaths with stroke and coronary heart diseases being the main contributors if no appropriate measures are taken to alleviate the problem [1].

Tanzania, like other developing countries, is also facing a higher burden of CVDs. CVDs alone account for 13% of the total deaths caused by non-communicable diseases in Tanzania with adults aged 25–64 years being affected the most [2]. Age-standardized mortality rates attributed to CVDs were reported to be higher among Tanzanian men compared to women (473 versus 382 per 10,000 population) [3].

Trends of CVD death rates in SSA, including Tanzania, are highly driven by lifestyle changes, characterized by low levels of physical activity, excessive alcohol consumption, tobacco use and unhealthy eating. Poor management of these factors has resulted in intermediate risk factors such as raised blood pressure, raised blood cholesterol, diabetes, overweight and obesity, that have direct linkage with CVDs. All these factors occur as a result of rapid urbanization, modernization, socio-economic status and increased advertisement of the Westernized food market [3].

Despite the rising prevalence of CVDs in Tanzania, knowledge about their risk factors and warning signs in the Tanzanian general population is generally low, especially among individuals from rural areas. However, even those with adequate knowledge of CVDs are subjected to the risk of developing them due to disparity between their health literacy and lifestyle choices [4].

5 Most Common Cardiovascular Diseases

  1. Heart Attack

A heart attack, also known as myocardial infarction, refers to death or permanent damage of an area of the heart muscle which occurs when it is cut off from the oxygen it needs to operate. It is a medical emergency which happens because the blood flow delivering that oxygen has been significantly reduced or stops entirely. This is due to atherosclerosis, or the slow buildup of plaque, which includes fat, cholesterol, and other substances, in the coronary arteries. Blood clots can then form around the plaque, which tend to slow or block the blood flow and cause a heart attack. A heart attack may be severe enough to cause death or it may be silent.

  1. Stroke

Stroke is considered a heart disease because the condition centers around blood flow. However, a stroke is due to problems with blood flow to the brain rather than the heart. Ischemic strokes account for 87 percent of all strokes and occur because of blockage in a blood vessel that delivers blood and oxygen to the brain. Without blood and oxygen, parts of the brain can suffer damage or die off if not treated quickly. Hemorrhagic strokes make up about 13% of stroke cases and occur when weakened blood vessels in the brain rupture or burst resulting in bleeding in the brain. When blood accumulates in the tissue around the rupture, it puts pressure on brain cells and damages them. Hemorrhagic strokes may have various causes such as a vascular malformation or abnormal growth of brain blood vessels.

  1. Heart Failure

Heart failure, also called congestive heart failure, refers to the heart not pumping blood as well as it should. It does not mean the heart has stopped beating entirely, as the name might suggest. The heart continues to pump blood, but not at a high enough rate for the body to continue to function. The fatigue and shortness of breath that can result from untreated heart failure can greatly interfere with everyday activities like walking or climbing stairs.

  1. Arrhythmia

A heart arrhythmia is any abnormal rhythm of the heart: too slow, too fast, or at an irregular beat or tempo. Without proper rhythm, the heart doesn’t work as effectively. The heart may not be able to pump enough blood to deliver oxygen and nutrients to other organs.

  1. Heart Valve Complications

Like arrhythmias, heart valve complications can cover a variety of different abnormalities. Stenosis means the valves in the heart don’t open enough to allow blood to flow through normally. Regurgitation occurs when the heart valves do not close correctly, which enables blood to leak through. Like the arteries in your heart, the heart valves also need to operate properly to stave off life-changing complications [5].

Risk Factors

Risk factors for CVDs fall into three broad categories: intermediate, modifiable/behavioural, and non-modifiable as illustrated in the schematic below [3].

Intermediate risk factors

Intermediate risk factors are health/medical conditions that appear as a result of uncontrolled behavioral risk factors. Key intermediate risk factors for CVDs include raised blood pressure (hypertension), diabetes, raised blood cholesterol, and overweight and obesity.

1.     Hypertension

Uncontrolled blood pressure can result in more health complications, including CVDs such as myocardial infarction, aneurysms, and stroke and other heart diseases. According to the 2014 WHO country profile report for non-communicable diseases (NCDs), approximately 31.6% of men and 29.4% of women in Tanzania were hypertensive. Moreover, there is a rapid increase in prevalence of hypertension in Tanzania, with significant variation between rural and urban settings that is characterized by sedentary lifestyles, urbanization and aging population. Results from prospective observational study conducted at the Cardiovascular Center of Muhimbili National Hospital in Dar es Salaam showed that, 45% of the heart failure patients were hypertensive. Despite a higher prevalence of hypertension in different areas of Tanzania, many people are not aware of the related risk factors, with low rate of diagnosis and treatment [3].

2.     Raised cholesterol

It is known that raised blood cholesterol is a common risk factor for CVDs, including ischemic heart diseases, stroke and heart failure. Prevalence of raised blood cholesterol is influenced by sedentary lifestyles and rapid urbanization. Furthermore, poor dietary diversification contributes to increased blood cholesterol. Lower intake of fruits and vegetables and higher intake of red meat have been linked to increased levels of blood cholesterol. Nearly 20% of males and 24% of females in Tanzania had high blood cholesterol >5 mmol/L according to WHO estimates in 2010. Kilimanjaro region have been reported with highest prevalence of raised cholesterol (17.4% of men and 19% of women) compared to other regions of Tanzania like Morogoro (5% of men and 6.7% of women) and Mara (4.8% of men and 6.9% of women) [3]. 

3.     Diabetes

Diabetes is a prime risk factor for cardiovascular disease (CVD). Vascular disorders include retinopathy and nephropathy, peripheral vascular disease (PVD), stroke, and coronary artery disease (CAD). Diabetes also affects the heart muscle, causing both systolic and diastolic heart failure. According to 2017 International Diabetes Federation estimates, more than 1.7 million people living in Sub-Saharan region are diabetic and Tanzania has been mentioned as among the country with the highest prevalence of diabetes. Results from the 2012 national survey showed that more than 9% (8% of men and 10% of women) of adult population aged ≥25 years were diabetic. Higher prevalence of diabetes is highly driven by rapid urbanization, sedentary lifestyles, and nutrition transition, which tend to promote overweightness and obesity [3].

Lack of diabetes guidelines, screening tools, poor reporting system, inadequate drug therapy and lack of training among healthcare providers and beneficiaries have been found to be potential reasons as to why many dispensaries and healthcare centers fail to provide valuable diabetic care in Tanzania. All these lead to the increased diabetic complications including angina, myocardial infarction, stroke, peripheral artery disease, and congestive heart failure. Despite the growing trends of diabetes in Tanzania, still there is low rate of awareness on diabetes and its complications in the population [3].

4.     Overweight and obesity

Overweight and obesity are defined as a body mass index of ≥24.9 and ≥29.9 kg/m2, respectively. The likelihood of chronic diseases such as diabetes, hypertension, as well as CVDs including coronary artery disease and and stroke, increases with increased body mass index (BMI ≥24.9 kg/m2). Both socio-demographic characteristics and economic factors influence occurrence of overweight and obesity in the population. However, lack of enough statistics, together with socio-cultural beliefs, create greater challenges in understanding the trends of overweight and obesity as public health challenges in African countries, including Tanzania. Findings from multi-country cross-sectional study conducted in 2016 in four SSA countries showed higher prevalence of overweight and obesity of 46% in rural Uganda, 48% in peri-urban Uganda, 68% in urban Nigeria, 75% in urban Tanzania and 85% in urban South Africa. Prevalence of overweight and obesity are still increasing in Tanzania as reported in the STEPwise survey conducted in the country in 2012, which showed 26% of the adult population aged >25–64 years were overweight and obese, with women being more affected than men (37% of women versus 15% of men). Few studies conducted in the country, especially in urban Der es Salaam, showed higher prevalence of overweight and obesity among school-age children. For example, a study by Mpembeni and colleagues reported the prevalence of overweight and obesity of 15% (10.1% boys and 19.4% girls) among primary school children in Dar es Salaam, Tanzania [3].

Modifiable risk factors

Modifiable/behavioral risk factors are most common preventable risk factors that underlie the development of CVDs. These include unhealthy eating, tobacco use, excessive alcohol intake, and physical inactivity. Poor management and prevention of these risk factors leads to metabolic/physiological changes that accelerate the development of CVDs.

  1. Alcohol use

Alcohol consumption has been associated with increased risk of developing CVDs including atrial fibrillation (an abnormal cardiac rhythm), cardiomyopathy, acute myocardial infarction, hemorrhagic stroke, and ischemic stroke as it promotes raised blood cholesterol, high blood pressure, platelet coagulation and increased fibrinolysis.  In 2012, prevalence of alcohol consumption among men and women in Tanzania were reported to range from 23–38% and 13–13%, respectively. Further results showed that 29.4% (38.3% men and 20.9% women) of the adult population were current alcohol users. Among them, 27.4% of men and 13.4% of women were binge drinkers. Moreover, 17.2% of adults aged 15–59 years were reported as current alcohol users in urban settings, and this was associated with socio-economic status of urban dwellers. Some of the chronic diseases such as hypertension, and diabetes are increasing in Tanzania due to the high number of alcohol drinkers. Higher prevalence of hypertension (50%) was reported among alcohol users compared to non-alcohol users (49.3%) in a study conducted in Mafia Island. Furthermore, alcohol consumption was related to increased CVD risk factors, such as diabetes (9.8%) hypertension (53.3%), overweight and obesity (73.3%) among study participants [3]. 

  1. Unhealthy diets

Diet plays an essential role in the etiology and pathophysiology of different CVDs. Diet and nutrition have been recognized as major contributors atherosclerotic plaque formation and development of CVDs, including coronary heart disease and stroke. Unhealthy diet is linked to other CVD risk factors such as high blood pressure, elevated blood cholesterol, diabetes, overweight and obesity. According to a subnational STEP survey conducted by WHO in 2012, only 9.2% of individuals aged 25–64 years in Tanzania consumed at least less than 5 servings of fruits or vegetables on average per day. A study conducted in peri-urban Tanzania revealed the association between use of palm oil as cooking oil, inadequate consumption of fruits and vegetables and high intake of meat with increased blood cholesterol. Higher prevalence of hypertension in urban areas, especially among women, has been related to higher consumption of meat and coconut oils. Moreover, higher consumption of protein-rich foods, particularly meat, milk and blood with an inadequate intake of fruits and vegetables were associated with increased risk of hypertension among Maasai living in Simanjiro district. Higher consumption of highly processed foods, dietary salt with low levels of physical activity, and low knowledge of dietary choices were associated with increased prevalence of hypertension in different settings of Tanzania [3].

  1. Physical inactivity

People who do not engage in regular exercise or physical activity are more likely to have hypertension, high blood cholesterol and be overweight or obese. In Tanzania, low levels of physical activity have been associated with increased body weight, diabetes, unfavorable lipid patterns and other CVD risk factors in rural and urban settings. Urban settings represent lower levels of physical activity compared to rural areas, which might be due to sedentary lifestyles adopted by urban dwellers as opposed to manual activities performed by rural dwellers. Therefore, the urban population in Tanzania faces a higher incidence of overweight, obesity, and elevated blood cholesterol levels than the rural population. A prospective cohort study conducted in Tanzania showed that migration from rural to urban areas reduced the level of physical activity by 52.9% (79.4% to 26.5%) in men and 21.9% (37.8% to 15.6%) in women [3].

  1. Tobacco use
Smoking is a major contributor of CVDs as it can potentially cause atherosclerosis and raise blood pressure. Currently, there is no much information concerning the use of tobacco in Tanzania, however, few studies have documented higher incidence of tobacco use among men and women. In 2018, the prevalence of smoking in Tanzania was 13.30%, a 0.8% decline from 2016 [6]. This refers to the percentage of men and women aged 15 and over who currently smoke any form of tobacco product including including cigarettes, cigars, and pipes, and excluding smokeless tobacco on a daily or non-daily basis. The rates are age-standardized. Additionally, the prevalence of hypertension was observed to be higher (52%) among smokers compared to non-smoker (26.1%) in a study conducted in Dar es Salaam [3].

Non-modifiable risk factors

Non-modifiable risk factors are factors that cannot be changed which include age, sex, race or ethnicity, and family history. The more of these risk factors you have, the greater your chance of developing CVDs.

  • Increasing Age. The majority of people who die of coronary heart disease are 65 or older. While heart attacks can strike people of both sexes in old age, women are at greater risk of dying (within a few weeks).
  • Male gender. Men have a greater risk of heart attack than women do, and men have attacks earlier in life. Even after women reach the age of menopause, when women’s death rate from heart disease increases, women’s risk for heart attack is less than that for men.
  • Heredity (including race/ethnicity). Children of parents with heart disease are more likely to develop heart disease themselves. African-Americans have more severe high blood pressure than Caucasians, and a higher risk of heart disease. Most people with a significant family history of heart disease have one or more other risk factors. Just as you can’t control your age, sex and race, you can’t control your family history. So, it’s even more important to treat and control any other modifiable risk factors you have [7].

Tanzania is experiencing rapid growth of modifiable and intermediate risk factors that accelerate CVD mortality and morbidity rates. In both rural and urban settings, cardiovascular risk factors such as tobacco use, excessive alcohol consumption, unhealthy diet, hypertension, diabetes, hyperlipidemia (high level of cholesterol or triglycerides in blood), overweight, and obesity, are documented to be higher. Increased urbanization, lifestyle changes, lack of awareness and rural to urban movement have been found to increase CVD risk factors in Tanzania. Despite the identification of modifiable risk factors for CVDs, there is still limited information on physical inactivity and eating habits among the Tanzanian population that needs to be addressed [3].

References

[1]https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-020-09956-z

[2]https://world-heart-federation.org/cvd-roadmaps/wp-content/uploads/sites/6/2019/08/CVD-Sc orecard-Tanzania.pdf

[3]https://jxym.amegroups.com/article/view/5361/html

[4]https://bmccardiovascdisord.biomedcentral.com/articles/10.1186/s12872-020-01648-1

[5]https://www.dignityhealth.org/articles/a-list-of-cardiovascular-diseases-the-5-most-common

[6] https://www.macrotrends.net/countries/TZA/tanzania/smoking-rate-statistics

[7]https://www.heart.org/en/health-topics/heart-attack/understand-your-risks-to-prevent-a-heart-attack

Taking actions to reduce neonatal disorders

By Pooja Senthamaraiselvan – Art in Tanzania internship

Tanzania is making great strides in reducing child mortality, but has demonstrated slower progress in reducing neonatal deaths. There has been a declining trend in NMR over the past decade but it indicates a very gradual improvement. In order to meet the Millennium Development Goal (MDG) 4 for child survival, the number of newborn deaths in Tanzania must be greatly reduced. At the current rate of progress, Millennium Development Goal 4 could be met, if more attention is given to newborn survival [1].

Most neonatal deaths are due to preventable and treatable causes. Up to two-thirds of newborn lives could be saved if essential care reached mothers and babies [1]. Hence, there are opportunities to lower mortality rates even further with interventions at both the health facility level and the community level in Tanzania to ensure better healthcare provision to these parties. This will mainly require implementing improvements in resources for maternal and neonatal care in terms of quality, availability, accessibility, and affordability as well as creating more awareness about birth plans for labour and delivery among the people in Tanzania, particularly pregnant women.

Actions at the health facility level to save newborn lives

  • Improve infrastructure and supplies – ensuring every district hospital has a neonatal unit, practices Kangaroo Mother Care (KMC) and all health facilities have functional equipment and essential drugs such as gentamicin for treating neonatal sepsis
  • Recruit and retain quality staff – filling vacant posts and addressing turnover among existing staff; ensuring competence in key skills such as neonatal resuscitation
  • Improve guidelines and service delivery – establishing or improving procedures for routine postnatal care and management of preterm and sick newborns
  • Integrate services – linking emergency obstetric services with newborn care and improving transport and referral mechanisms
  • Use data locally for quality improvement – recording and auditing neonatal deaths and stillbirths [1]

Actions at the family and community level to save newborn lives

  • Identify a means to reach every mother and baby in the early postnatal period (within the first two days after birth)
  • Invest in primary health care at the village level by ensuring appropriate supervision, remuneration and working conditions for village health workers
  • Strengthen community – Integrated Management of Childhood Illness (IMCI) to effectively reinforce healthy behaviours, recognition of danger signs and timely care seeking, to identify harmful traditional practices and awareness of key newborn health packages, such as routine postnatal care, KMC and IMCI
  • Engage communities in birth preparedness, including planning to give birth at a health facility and emergency transport
  • Reduce the economic burden of a facility birth on women and their families [1]

These actions depend on leadership at all levels. Tanzania’s decentralised health system ensures that public health interventions are linked to those who need them but more effort is needed to integrate newborn health packages into district level budgets and planning. Newborn lives can be saved by implementing appropriate policies, improving staffing levels and supervision in health facilities and providing an enabling environment for community-level care. There is an immediate opportunity for Tanzania to implement the recommendations within the Road Map/One Plan to improve newborn health from the highest level in both public and private health facilities and to infl uence the care newborns receive at home. Tanzania’s future depends on the ability of these newborns to survive and thrive. This situation analysis sheds light on the current state of care and the opportunities to save lives. While better data, policy change and revised guidelines will make a difference, it takes people to act to save newborn lives. Will you use this information to become a champion of the country’s most vulnerable and precious citizens?

References

[1]https://www.countdown2015mnch.org/wp-content/uploads/2013/02/Tanzania_SituationAnalysis_Newborn.pdf

The Effect of COVID – 19 on African Tourism

By Dilyara Shantayeva – Art in Tanzania internship

Tourism is an important economic sector for Africa. According to the United Nations World Tourism Organisation, Africa received 71.2 million international arrivals in 2019 amounting to about US$ 40 billion in revenue. This represents a 4 percent growth in arrivals over that of the previous year. Tourism has witnessed sustained growth on the continent as governments continued to pursue it as a viable economic option due to its contribution in terms of jobs, revenue, foreign exchange, and infrastructure.

Africa is increasingly becoming a preferred destination for many international tourists looking to enjoy its sunny beaches, ecotourism products, national parks and safaris and exotic culture and food. Unfortunately, the projected growth of between 3 to 5% in international arrivals for the continent cannot be realised: like every continent, Africa’s tourism industry is shattered, and the inflow of the tourist dollar has ceased due to the impact of COVID-19. The highly contagious spread of the coronavirus ultimately stopped most of the traveling to many touristic destinations is still causing many discrepancies these days as well. This article will overview the main effects of COVID – 19 on African tourism.

“We live in very challenging and uncharted waters at the moment,” says Nigel Vere Nicoll, President of the African Travel and Tourism Association (ATTA), an organization which he founded 25 years ago. ATTA has around 700 members in Sub-Saharan Africa, split relatively evenly between buyers – such as tour operators – and suppliers (hotels, lodges, and transportation companies). In the interview with the journalist from the Africa Outlook, he mentioned that one of the biggest problems currently facing the industry is confusion over cancelled bookings. Travellers who’ve already booked the tours and tickets and the situation have changed very rapidly, they have loads of questions concerning refunds, re-bookings, and other related issues.

He also mentioned the economic issues that Africa had encountered during the pandemics: “Take one small boutique lodge in Africa with, say, 10 rooms,” he says. “They would employ about 50 people, but their extended suppliers – so, the person who does the laundry, or brings in the eggs every day – probably equates to around 1,000 extra people. If that lodge packs up, then 1,000 people have no income.”

There are also other, less obvious effect: In Kenya, for example, many conservancies have been established on land belonging to the Masai Mara peoples. They remove their grazing cattle from the land and lease it to organisations building safari lodges that conserve it for wildlife, the revenue from tourists providing an income to the Masai people.

“That model works fine until there’s a nonessential travel warning, and then no money is coming in and they can’t pay the Masai,” Vere Nicoll adds. “One my closest friends has just been to see one of the chiefs and explained the situation, telling him ‘we’re going to go on paying you out of reserve funds, but we don’t know how long this is sustainable for.’

“If this goes on for a long time, all this work on conservancies will be put in jeopardy, because if the Masai don’t get revenue then their livelihood is at stake.”

So, what is the solution? How can the African tourism industry keep going?

Vere Nicoll believes the answer lies in domestic tourism. As there are such low levels of COVID-19 within many African countries now, travel is still possible.

“It’s not possible to cross borders within Africa, because they all have the same warning on, but it is possible to create domestic tourism,” he explains. “In fact, this is an amazing opportunity to create cashflow for survival with the local market. Kenya, for example, has a huge number of Europeans living within the country, who could become domestic tourists.”

Another saving grace is that it’s currently low season in East Africa, so tourism companies and hotels in that area anticipate having fewer customers this time of year. Some smaller safari lodges are even closed, ready to reopen for summer’s high season.

“What we are hoping is that tourism will recover in the English autumn, and they’ll have the chance to get some bookings in the late season, leading up until Christmas,” Vere Nicoll says. “If it lasts any longer, we’re in a totally different ball game.”

However, he concludes our conversation on a note of optimism. “The bottom line is that the tourism industry is very resilient. It always has been. We’ve been through many problems over the years, especially in eastern and southern Africa, and we’ve always come through in the end.

“I think the industry will come out of it much stronger. A lot of relationships will be built up. And I think that once the coronavirus goes, if it’s a short-term thing, then the industry will bounce back tremendously.”

In general, the tourism industry has been heavily impacted by the pandemic as people’s economic lives are halted and their freedom of movement curtailed. Chiefly among these impacts on African economies is the reduction in foreign income. With the closure of the world economy and the associated redundancy as well as closure of international borders, international tourist inflows into Africa have ceased.

The United Nations World Tourism Organisation (UNWTO) indicates that international tourist arrivals to Africa decreased by 35% between January to April 2020 as a result of the pandemic. Countries such as Gambia, South Africa, Egypt, Kenya, and a host of others that are heavily dependent on the expenditure of international tourists have witnessed dwindled injections of tourism-based foreign income. Equally, and associated with this, is the closure of tourism businesses. Tourism businesses are forced to close either because of internal measures to help stop the spread of the coronavirus or directly because of the absence of tourists.

Either way, the closure of tourism businesses such as hotels, attractions, travel and tour operations, food and beverage services, and other support businesses have resulted in massive job losses across the tourism industry in Africa. Both direct jobs that are primarily targeted at serving tourists and those in the value chain have all been impacted.

Ultimately, the closure of tourism businesses coupled with massive job losses have resulted in the reduction of corporate and individual income tax revenue to African governments and thereby affected their abilities to provide the required public services and infrastructure. Such tourism-dependent African economies are therefore compelled to increase their borrowing, thereby spiraling their debt burden and potentially perpetuating their poverty cycle. For instance, South Africa, a country with a significant tourism sector, for the first time in its history took a loan of US$ 4.3 billion from the IMF. Interestingly, this amount is less than its annual foreign income from the tourism industry.

Similarly, countries like Ghana that has tourism as its fourth foreign income earner, contributing more than over US$ 1 billion a year, have contracted a US$ 1 billion loan facility from the IMF. This has become an all too familiar story across the continent with many African countries with significant tourism industries losing out on tourist dollars.

While tourist dollars have stopped flowing to the continent, for the time being, there is hope, with the UNWTO indicating that confidence in recovery in Africa remains very strong compared to other world regions.

To achieve this, there is the need for the gradual easing of lockdown measures, including the opening of international borders, to allow the inflow of international tourists. Also, African governments should institute safety protocols to guarantee the safety of both tourists and employees at the ports of entry into individual countries, and at tourism facilities and attractions. And African governments through their national tourism organizations can begin to bundle their tourism products to reduce the cost of travel.

The bundling can be done to cut profit margins on individual tourism elements and therefore reduce the overall cost. This will also have the advantage of compelling tourists to visit many attractions and stay longer and thereby spend more at destinations. Tourism facilities can also offer discounts or complementary services to entice customers, especially domestic tourists at the initial stages of re-opening.

Further, there should be aggressive marketing of African destinations in international circles to re-assure Western and, to some extent, Chinese tourists about visiting Africa once more. Lastly, African governments can offer tax exemptions and holidays to tourism businesses to help them recover from the consequences of the pandemic. Such tax holidays and exemptions will help them grow back their earnings into their businesses to recover and grow in the short term.

CAUSES OF CHILD LABOUR IN TANZANIA

“By Rosemary David – Art in Tanzania internship”

Child labour or child labor refers to the exploitation of children through any form of work that deprives children of their childhood, interferes with their ability to attend regular school, and is mentally, physically, socially and morally harmful.Such exploitation is prohibited by legislation worldwide ,although these laws do not consider all work by children as child labour; exceptions include work by child artists, family duties, supervised training, and some forms of child work.

All over the world, children are being exploited through child labour. This mentally and physically dangerous work interferes with schooling and long-term development—the worst forms include slavery, trafficking, sexual exploitation and hazardous work that put children at risk of death, injury or disease

CAUSES OF CHILD LABOUR IN TANZANIA

Personal Variables

Physical and mental attributes of children influence their abuse. Physical disabilities have long been associated with child abuse and neglect, as these children are often victims of discrimination, sexual exploitation and social exclusion. More often than seldom, the abused or the victims of abuse do not report such cases to the authority, for fear of reprisal by the abuser who may be a parent and due to ignorance.

Socio – economic Aspects

Modern socio-economic developments, have diminished the traditional role and power of women. This change in status, has brought about strains in family life and decreased the value of children, resulting into more frequent occurrences of child abuse and neglect.

Social – cultural Aspects

Social-cultural aspects, play a vital role in contributing to the increasing rate of child labour in many developing countries today. Traditionally, children have been viewed as personal property and were generally expected to work. There was a maximum division of labour, where girls were expected to do all the house chores and the boys went hunting. These roles were meant to prepare the children for future adulthood, especially girls who were often subjected to early marriages when they clocked the age of puberty, while their male counterparts went to school .It is however important to note that, some of the household work is too excessive and exploitative and can be categorized under child labour.

Family Characteristics

Family characteristics, have played a crucial role in the employment of children based on the type of family (polygamous and monogamous), family size and the employment of parents. Household poverty, is one of the underlying causes of child labour that affects school enrollment, as many cannot afford school fees and school  materials. Child labour becomes a majority option for most families for survival, which eventually affects the academic performance of some children, who labour for fees which endangers them physically and psychologically. While it might seem obvious that, children had to fend for their families, parental consent to work, comes in the way as a major issue of maximum consideration in child employment.

Single Parenthood

Many studies indicate that, children who reported their parents as no longer staying together, or those who had lost one of their parents and in most cases drained in poverty, engaged in work. The increasing number of orphans and children raised by single parents, undoubtedly necessitated the employment of children.

Community Variables

At community level, societal transformation and challenges therein, act as a stressor on families and diminishes the capability of families to look after their children properly. The rampant slum developments, which are a manifestation of poor socio- economic conditions and overcrowding, represent a bigger challenge to the life of a child than the society itself.

 Political Factors

Political factors, refer to conditions that cause civil and national strife and unrest including wars inter alia as considered. Children migrate to bigger cities in search for help. These children sometimes go accompanied by their parents and some unaccompanied, especially orphans. War zones, serve as catchment areas for vulnerable children who end up on the streets and involve themselves in child labour for survival.

The Social Capital Theory

The social capital theory, offers a beginning point in the theoretical analysis of the street children phenomenon in Tanzania. This theory draws a correlation between family structure and home-leaving. Most of street children end up to be employed at small age.

Serengeti National Park safari

Serengeti National Park

By Farzad Ghotaslou- Art in Tanzania internship

Serengeti is popular park for Art in Tanzania visitors. The Great Migration is at its best from June to September but animals are abundant all year around.

Chances are that you have dreamt of Africa, and when you did, you probably dreamt about the Serengeti. Countless wildlife movies have been recorded in the Serengeti, and with good reason: this is the home of the Great Migration and may very well be one of the last true natural wonders on planet earth.

Serengeti National Park is a World Heritage Site teeming with wildlife: over 2 million ungulates, 4000 lions, 1000 leopard, 550 cheetahs and some 500 bird species inhabit an area close to 15,000 square kilometers in size. Join us on a safari and explore the endless Serengeti plains dotted with trees and kopjes from which majestic lions control their kingdom; gaze upon the Great Migration in awe or find an elusive leopard in a riverine forest.

Or perhaps see everything from a bird’s-eye view and soar over the plains at sunrise during a hot air balloon safari. Accommodation options come in every price range – the sound of lions roaring at night is complimentary.

It’s the only place where you can witness millions of migrating wildebeest over the Acacia plains, it’s the cradle of human life, and probably the closest to an untouched African wilderness you will ever get welcome to Serengeti National Park. Where time seems to stand still, despite the thousands of animals constantly on the move.

The magic of Serengeti National Park is not easy to describe in words. Not only seeing, but also hearing the buzz of millions of wildebeests so thick in the air that it vibrates through your entire body is something you will try to describe to friends and family, before realizing it’s impossible. Vistas of honey-lit plains at sunset so beautiful, it’s worth the trip just to witness this. The genuine smiles of the Maasai people, giving you an immediate warming glow inside. Or just the feeling of constantly being amongst thousands of animals – it doesn’t matter what season of the migration you visit the Serengeti National Park, it’s magical all year round.

Serengeti National Park was one of the first sites listed as a World Heritage Site when United Nations delegates met in Stockholm in 1981. Already by the late 1950s, this area had been recognized as a unique ecosystem, providing us with many insights into how the natural world functions and showing us how dynamic ecosystems really are.

Today, most visitors come here with one aim alone: to witness millions of wildebeests, zebras, gazelles, and elands on a mass trek to quench their thirst for water and eat fresh grass. During this great cyclical movement, these ungulates move around the ecosystem in a seasonal pattern, defined by rainfall and grass nutrients. These large herds of animals on the move can’t be witnessed anywhere else. Whereas other famous wildlife parks are fenced, the Serengeti is protected, but unfenced. Giving animals enough space to make their return journey, one that they’ve been doing for millions of years.

History of Serengeti National Park

In the late 1800s and early 1900s, explorers and missionaries described the Serengeti plains and the massive numbers of animals found there. Only minor details are all that were reported before explorations in the late 1920s and early 1930s supply the first references to the great wildebeest migrations, and the first photographs of the region.

An area of 2,286 square kilometers was established in 1930 as a game reserve in what is now southern and eastern Serengeti. They allowed sport hunting activities until 1937, after which it stopped all hunting activities. In 1940 Protected Area Status was conferred to the area and the National Park itself was established in 1951, then covering southern Serengeti and the Ngorongoro highlands. They based the park headquarters on the rim of Ngorongoro crater.

So, the original Serengeti National Park, as it was gazetted in 1951, also included what now is the Ngorongoro Conservation Area (NCA). In 1959, the Ngorongoro Conservation Area was split off from the Serengeti National Park and they extended the boundaries of the park to the Kenya border.

The key reason for splitting off the Ngorongoro area was that local Maasai residents realized that they were threatened with eviction and consequently not allow to graze their cattle within the national park boundaries.

To counter this from happening, protests were staged. A compromise was reached wherein the Ngorongoro Crater Area was split off from the national park: the Maasai may live and graze their cattle in the Ngorongoro Crater area but not within Serengeti National Park boundaries.

In 1961 the Masai Mara National Reserve in Kenya was established and in 1965 the Lamai Wedge between the Mara River and Kenya border was added to Serengeti National Park, thus creating a permanent corridor allowing the wildebeests to migrate from the Serengeti plains in the south to the Loita Plains in the north. The Maswa Game Reserve was established in 1962 and a small area north of The Grumeti River in the western corridor was added in 1967.

The Serengeti National Park was among the first places to be proposed as a World Heritage Site by UNESCO at 1972 Stockholm conference. It was formally established in 1981.

The name “Serengeti” approximates the word siringet used by the Maasai people for the area, which means “the place where the land runs on forever”.

The Serengeti gained fame after the initial work of Bernhard Grzimek and his son Michael in the 1950s. Together, they produced the book and film Serengeti Shall Not Die, widely recognized as one of the most important early pieces of nature conservation documentary.

On the eastern portion of the Serengeti National Park lies the Serengeti volcanic grasslands which is a Tropical Grassland Ecozone. The grasslands grow on deposits of volcanic ash from the Kerimasi Volcano which erupted 150,000 years ago and also from the Ol Doinyo Lengai Volcanic eruptions which created layers of calcareous tuff and calcitic hard-pan soil.

Geography

The plains that cover a third of the park were formed in volcanic eruptions. The main eruption in its formation was by Kerimasi, a dormant volcano near Lake Natron. The major eruption happened 150,000 years ago. Ol Doinyo Lengai has been active, erupting 15 times since the 19th century most recently in 2007.

The plains extend from the northeast near Lake Natron, to the west as far as Seronera.[8] The park covers 14,750 km2 (5,700 sq mi)[citation needed] of grassland plains, savanna, riverine forest, and woodlands.

The Park lies in northwestern Tanzania, bordered to the north by the Kenyan border, where it is continuous with the Maasai Mara National Reserve. To the southeast of the park is the Ngorongoro Conservation Area, to the southwest lies Maswa Game Reserve, to the west are the Ikorongo and Grumeti Game Reserves, and to the northeast and east lies the Loliondo Game Control Area.

Together, these areas form the larger Serengeti ecosystem. The landscape of the Serengeti Plain is extremely varied, ranging from savannah to hilly woodlands, to open grasslands. The geographic diversity of the region is due to the extreme weather conditions that plague the area, particularly the potent combination of heat and wind.

Many environmental scientists claim that the diverse habitats in the region originated from a series of volcanoes, whose activity shaped the basic geographic features of the plain and added mountains and craters to the landscape.

The Park is usually described as divided into three regions:

Serengeti plains: the almost treeless grassland of the south is the most emblematic scenery of the park. This is where the wildebeest breed, as they remain in the plains from December to May. Other hoofed animals – zebra, gazelle, impala, hartebeest, topi, buffalo, waterbuck – also occur in huge numbers during the wet season. “Kopjes” are granite floriation’s that are very common in the region, and they are great observation posts for predators, as well as a refuge for hyrax and pythons.

In the Serengeti National Park lies the Serengeti volcanic grasslands. The Volcanic Grasslands is a edaphic plant community that grows on soils derived from volcanic ash from nearby volcanos. This zone of the plain is also famous for granite outcroppings called kopjes, that interrupt the plains and play host to separate ecosystems than are found in the grasses below.

Western corridor: the black clay soil covers the savannah of this region. The Grumeti River and its gallery forests is home to Nile crocodiles, patas monkeys, hippopotamus, and martial eagles. The Grumeti River is famed for its thrilling river crossings during the Great Migration alongside Mara River. The migration passes through from May to July. There are sometimes rare Colobus Monkeys. It stretches almost to Lake Victoria.

Northern Serengeti: the landscape is dominated by open woodlands (predominantly Commiphora) and hills, ranging from Seronera in the south to the Mara River on the Kenyan border. It is remote and relatively inaccessible. Apart from the migratory wildebeest and zebra (which occur from July to August, and in November), this is the best place to find elephant, giraffe, and dik dik. This zone of the plain is also famous for granite outcroppings called kopjes, that interrupt the plains and play host to separate ecosystems than are found in the grasses below.

Human habitation is forbidden in the park with the exception of staff of the Tanzania National Parks Authority, researchers and staff of the Frankfurt Zoological Society, and staff of the various lodges, campsites and hotels. The main settlement is Seronera, which houses most research staff and the park’s main headquarters, including its primary airstrip.

Wildlife

The Park is known worldwide for its abundance of wildlife and high biodiversity.

The migratory – and some resident – wildebeest, which number over 1.5 million individuals, constitute the largest population of big mammals that still roam the planet. They are joined in their journey through the Serengeti-Mara ecosystem by 200,000 plains zebra, 300,000 Thomson’s gazelle and Grant’s gazelle, and tens of thousands of topi and Coke’s hartebeest.

Masai giraffe, waterbuck, greater kudu, impala, common warthog and hippopotamus are also abundant. Some rarely seen species of antelope are also present in Serengeti National Park, such as common eland, klipspringer, oribi, reedbuck, roan antelope, sable antelope, steenbok, common duiker, bushbuck, lesser kudu, fringe-eared oryx and dik dik. Herds support 7,500 hyenas, 3,000 lions, and 250 cheetahs. There are more than 500 birds and 300 mammal species.

Perhaps the most popular animals among tourists are the Big Five, which include:

Lion: the Serengeti is believed to hold the largest lion population in Africa due in part to the abundance of prey species. More than 3,000 lions live in this ecosystem.Since 2005, the protected area is considered a Lion Conservation Unit together with Maasai Mara National Reserve and a lion stronghold in East Africa.

African leopard: these reclusive predators are commonly seen in the Seronera region but are present throughout the national park with a population of around 1,000.

African bush elephant: the herds have recovered successfully from population lows in the 1980s caused by poaching, now numbering over 5,000 individuals, and are particularly numerous in the northern region of the park.

Eastern black rhinoceros mainly found around the kopjes in the centre of the park, very few individuals remain due to rampant poaching. Individuals from the Maasai Mara Reserve cross the park border and enter Serengeti from the northern section at times. There is currently a small but stable population of 31 individuals left in the park.

Cape buffalo: the most numerous of the Big Five, with around 53,000 individuals inside the park.

Carnivores include the cheetah, which is widely seen due to the abundance of gazelle, about 3,500 spotted hyena, two species of jackal, African golden wolf, honey badger, striped hyena, caracal, serval, seven species of mongooses, two species of otters and the East African wild dog of 300 individuals, which was recently reintroduced (locally extinct since 1991).

Apart from the safari staples, primates such as yellow and olive baboons, patas monkeys, and vervet monkey, black-and-white colobus are also seen in the gallery forests of the Grumeti River.

Other mammals include aardvark, aardwolf, African wildcat, African civet, common genet, zorilla, African striped weasel, bat-eared fox, ground pangolin, crested porcupine, three species of hyraxes and cape hare.

Serengeti National Park also attracts great ornithological interest, boasting about more than 500 bird species; including Masai ostrich, secretary bird, kori bustards, helmeted guinea fowls, Grey-breasted spurfowl, blacksmith lapwing, African collared dove, red-billed buffalo weaver, southern ground hornbill, crowned cranes, sacred ibis, cattle egrets, black herons, knob-billed ducks, saddle-billed storks, goliath herons, marabou storks, yellow-billed stork, spotted thick-knees, white stork, lesser flamingo, shoebills, abdim’s stork, hamerkops, hadada ibis, African fish eagles, pink-backed pelicans, Tanzanian red-billed hornbill, martial eagles, Egyptian geese, lovebirds, spur-winged geese, oxpeckers, and many species of vultures.

Reptiles in the Serengeti National Park include Nile crocodile, leopard tortoise, serrated hinged terrapin, rainbow agama, Nile monitor, chameleon, African python, black mamba, black-necked spitting cobra, and puff adder.

Great migration

The great migration is a iconic feature of the park. It is also the world’s longest overland migration.[18] Roughly 1.5 million wildebeest migrate north from the south all the way through the park north into Maasai Mara. From January to March (calving season), half a million wildebeests are born which makes sure the herd survives to the next year.

Attacks by the largest lion population in Africa are common this time. In March, the herds leave the southern plains and start the migration. Giant eland, plains zebra, and Thomson’s gazelle will also join them on the way.[18] In April and May, they will pass the Western Corridor. When this happens, smaller camps must close due to impassable roads.

When the dry season comes, the herd moves north to the Maasai Mara where there is lush green grass.

They will have to pass the Grumeti and Mara rivers though and 3,000 crocodiles that wait and suddenly lunge at them. For everyone wildebeest captured by the crocodiles, 50 drown. It is a reason why the Serengeti is so famous. When the dry season comes to an end in late October, they will head back down south to where they started their journey a year earlier. The full trip is 800 km (500 mi).

Annually, around 250,000 wildebeest and 30,000 plains zebras die usually due to predation, exhaustion, thirst, or disease.

Threats

Massive amounts of deforestation in the Mau Forest region has changed the hydrology of the Mara river where its’s source is. The river dried up for the first time in the 2010s. Leopards started cannibalizing each other in the late 2010s. It is not uncommon for leopards from the same family to eat each other.

Proposed road across the northern Serengeti

In July 2010, President Jakaya Kikwete renewed his support for an upgraded road through the northern portion of the park to link Mto wa Mbu, southeast of Ngorongoro Crater, and Musoma on Lake Victoria. While he said that the road would lead to much-needed development in poor communities, others, including conservation groups and foreign governments like Kenya, argued that the road could irreparably damage the great migration and the park’s ecosystem.

The African Network for Animal Welfare sued the Tanzanian government in December 2010 at the East African Court of Justice in Arusha to prevent the road project. The court ruled in June 2014 that the plan to build the road was unlawful because it would infringe the East African Community Treaty under which member countries must respect protocols on conservation, protection, and management of natural resources. The court, therefore, restrained the government from going ahead with the project.

References:

  1.  World Database on Protected Areas (2021). “Serengeti National Park”. Protected Planet, United Nations Environment World Conservation Monitoring Centre. Retrieved 24 May 2021.
  2.  UNESCO World Heritage Centre. “Serengeti National Park”. UNESCO World Heritage Centre. Retrieved 18 November 2020.
  3.  Poole, R. M. (2012). “Heartbreak on the Serengeti (continued)”. National Geographic Magazine. Archived from the original on 29 June 2012. Retrieved 26 September 2019.
  4.  Neumann, R.P. (1995). “Ways of seeing Africa: colonial recasting of African society and landscape in Serengeti National Park”. Ecumene. 2 (2): 149–169. doi:10.1177/147447409500200203.
  5.  Wanitzek, U. & Sippel, H. (1998). “Land rights in conservation areas in Tanzania”. GeoJournal. 46 (2): 113–128. doi:10.1023/A:1006953325298.
  6.  Makacha, S.; Msingwa, M.J. & Frame, G.W. (1982). “Threats to the Serengeti herds”. Oryx. 16 (5): 437–444. doi:10.1017/S0030605300018111.
  7.  Boes, T. (2013). “Political animals: Serengeti Shall Not Die and the cultural heritage of mankind”. German Studies Review. 36 (1): 41–59. JSTOR 43555291.
  8.  Jump up to:a b “About the Serengeti Plains Formation | Natural High”. Natural High Safaris. 6 January 2021. Retrieved 23 May 2021.
  9.  Scoon, Roger (2018). Geology of National Parks of Central/ Southern Kenya and Northern Tanzania: Geotourism of the Gregory Rift Valley, Active Volcanism and Regional Plateaus. Springer. pp. 69–79. ISBN 9783319737843.
  10.  www.olduvai-gorge.org. Retrieved 14 November 2020.
  11. Wikipedia
  12. Serengeti.com

Fight Against Tuberculosis

by Senthamaraiselvan Pooja – Art in Tanzania internship

Background of Tuberculosis

Tuberculosis (TB) is an airborne infectious disease caused by a bacterium called Mycobacterium tuberculosis. The United Republic of Tanzania is one of the 30 countries with the highest burden of TB in the world. According to WHO, 142 000 people (253 per 100 000 population) fell ill with TB in 2018 [1].

A large proportion of persons with the illness (90% to 95%) have latent TB infection (LTBI) in which case they do not exhibit any symptoms as the immune system will contain and control the infection. However, the infection typically does not get eliminated and most people with LTBI do not know that they are infected because they do not feel sick.

The bacteria can remain inactive for many years and the chance of developing active TB decreases over time [2].

Approximately 5% to 10% of individuals are not able to control the initial infection and will develop primary tuberculosis. The dormant bacteria can also become active again in a few of those with LTBI due to various factors that compromise the immune system. Active tuberculosis among this group is referred to as reactivation tuberculosis [3].



Main Differences between Latent and Active TB
Latent TB
●                     TB bacteria are “asleep” in your body
●                     You do not have symptoms and you feel well
●                     You cannot pass TB on to others
●                     It can only be detected through a blood test or TB skin test
 
Active TB
●                     TB bacteria are “awake” and making you ill
●                     You will have symptoms that make you feel unwell
●                     You can pass TB to others if it is in your lungs
●                     It shows up on a chest x-ray if you have TB in the lungs [4]
 
Symptoms of Active TB
Tuberculosis most often affects the lungs and respiratory tract. This is known as pulmonary TB. However, TB can affect almost any organ system. Active tuberculosis can manifest as pulmonary or extrapulmonary disease irrespective of whether the individual is a primary or reactivation case. However, approximately 80% of clinically manifested tuberculosis is pulmonary among individuals with good immune function, while extrapulmonary tuberculosis can be seen more frequently in immunocompromised people.
 
Pulmonary TB can be mild or severe and present with any of the following symptoms: excessive coughing (sometimes with blood in the sputum), chest pain, general weakness, lack of appetite, weight loss, swollen lymph glands, fever, night sweats, chills, and fatigue. Extrapulmonary TB can also present with fever, fatigue, night sweats, and progressive weakness, but prominent symptoms will typically stem from the affected organ system.
 
Extrapulmonary TB commonly involve the pericardium (thin sac surrounding the heart), lymph nodes (small, oval-shaped cluster of immune cells located throughout the body), urogenital area, gastrointestinal tract, central nervous system, adrenal glands, bones, eyes, and skin [3]. If untreated, active TB can be life-threatening.

TB Transmission

TB is spread to susceptible individuals when they breathe in contaminated droplets that are released into the air when an infected person (with Active Tuberculosis) nearby sneezes, coughs, talks or laughs. Humans can also get ill with TB by ingesting unpasteurized milk products contaminated with Mycobacterium bovis, also known as Bovine Tuberculosis [2].

Risk Factors for Progression and Development of Active TB Disease

In general, people at high risk for developing active TB once infected with M. tuberculosis include:

  • People living with HIV/AIDS
  • Children younger than 5 years of age
  • Persons who are receiving immunosuppressive therapy
  • Persons who were recently infected with M. tuberculosis (within the past 2 years)
  • Persons with a history of untreated or inadequately treated TB disease
  • Persons with silicosis, diabetes, chronic renal failure, leukemia, lymphoma, or cancer of the head, neck, or lung
  • Persons who have had a gastrectomy or jejunoileal bypass
  • Persons who weigh less than 90% of their ideal body weight
  • Cigarette smokers and persons who abuse drugs or alcohol
  • Populations defined locally as having an increased incidence of TB disease, possibly including medically underserved or low-income populations [5]

TB Control and Prevention

Individual Level

  • Keep your immune system strong by eating healthy and exercising
  • Avoid exposure to people known to who have active TB.
  • Surgical masks should be worn by patients with active TB to prevent infectious droplets from being expelled into the air.
  • Only consume pasteurized milk products.
  • Travellers at higher risk should have a pre-departure tuberculin skin test (TST) and be re-tested upon their return home.
  • Those at increased risk should also consult their healthcare provider to determine if the Bacillus Calmette-Guérin (BCG) vaccine is recommended [2].

Community Level

There are several critical factors that need to be taken into account to implement an effective tuberculosis control and prevention program to protect the community.

  1. Significant resources including public health infrastructure and personnel are required to enact and sustain tuberculosis control programs. Sustainability is critical because control of this disease requires a long-term effort. As such, a strong commitment by government agencies, which can mobilize the necessary resources and infrastructure, is essential for regional control of tuberculosis.
  • Rigorous case finding and treatment is obviously critical to save the affected individuals as well as stop transmission of infection to contacts. Case identification must combine microscopy and clinical symptoms, and treatment should consist of the short-course of directly observed therapy (DOTS) elaborated below.
  • Exhaustive contact tracing for contacts of each active tuberculosis case should be carried out in the field so that new infections can be identified and treated before becoming active cases.
  • A good surveillance system is fundamental to the control of any infectious disease. An administrative system for recording cases and monitoring outcomes is necessary to estimate the occurrence of disease and identify temporal trends and spatial clusters.
  • An adequate supply of tuberculosis medications must be available to populations with endemic tuberculosis. This may seem obvious, and it is, but unfortunately the lack of a consistent supply of medication has hampered many control programs particularly in poor areas of the developing world [3].

Technology

Germicidal ultraviolet lamps can be installed to kill airborne bacteria in buildings where people at high risk of tuberculosis live or congregate. A germicidal lamp is an electric light that produces ultraviolet C (UVC) light. UVC light kills tuberculosis bacteria, including drug-resistant strains, by damaging their DNA so they cannot infect people, grow or divide [6].

TB Treatment

Treating tuberculosis requires a long-term commitment. Specifically, at least 6 months of treatment are required because of the heterogeneous population of M. tuberculosis in an infected individual, which is composed of bacteria in active and dormant states. Medication that is effective against active mycobacteria may not work against latent mycobacteria and, thus, extended treatment ensures that the whole population of M. tuberculosis will eventually be exposed to the drug. Inactive tuberculosis may be treated with an antibiotic, isoniazid (INH), to prevent the TB infection from becoming active. Active tuberculosis is treated, usually successfully, with isoniazid in combination with one or more of several drugs, including rifampin, ethambutol, pyrazinamide, and streptomycin.

However, drug-resistant TB is a serious, as yet unsolved, public-health problem, among several regions including Africa. Undergoing treatment over a long time favors the emergence of drug-resistance gene mutations in the M. tuberculosis population.

Thus, at least two effective drugs must be administered: this reduces the probability of developing drug-resistant bacilli.

Poor patient compliance, lack of detection of resistant strains, and unavailable therapy are also key reasons for the development of drug-resistant TB. Non-adherence can lead to treatment failure in the individual as well as the development of antibiotic resistant forms of M. tuberculosis.

Therefore, adherence to treatment with the full regimen is essential for treatment success. To effect complete resolution of infection in the individual and mitigate the spread of antibiotic resistance in the population, WHO recommends the short-course strategy of directly observed therapy (DOTS) regimen, comprised of four drugs (typically isoniazid, rifampicin, pyrazinamide, and ethambutol) for two months, followed by two drugs (typically isoniazid and rifampicin) for four months.

DOTS regimen requires a healthcare worker to monitor each tuberculosis patient closely and observe the patient taking each dose of anti-tuberculosis medication to ensure proper compliance [3].

References

1 https://www.who.int/publications/m/item/united-republic-of-tanzania-tb-community-network-a-platform-for-a-stronger-community-response-to-tuberculosis

2 https://www.iamat.org/country/tanzania/risk/tuberculosis

3 http://www.infectionlandscapes.org/2013/04/tuberculosis.html

4 https://www.thetruthabouttb.org/latent-tb/what-is-latent-tb/

5 https://www.cdc.gov/tb/webcourses/tb101/page121.html

6 https://www.everydayhealth.com/tuberculosis/guide/risk-factors-causes-prevention/

Katavi National Park

By Farzad Ghotaslou – Art in Tanzania Internship Project

Due to its long distance Art in Tanzania team goes rather seldom to Katavi. We need minimum 3 participants to make the long drive to Katavi and back to keep the cost reasonable. However Katavi is always worth it as it is still the real wilderness of Africa.

Katavi National Park, located about 35 km southwest of Mpanda, is the third largest national park in Tanzania (added to the two contiguous “game reserves”, the protected area extends over a territory of 12,500 sq km) , as well as one of its most pristine natural areas. Although this is an isolated and less crowded alternative to other such destinations around Tanzania (Serengeti National Park receives more visitors per day than Katavi receives throughout the year), the lodges here are luxurious. as in any other park in the country, and for backpackers it is one of the cheapest and easiest to reach destinations; as long as you have the time and energy to get here.

The park is named after the Wabende spirit, Katabi, who according to local legend lives in a tamarind tree near Lake Katavi. Locals looking for blessings from his spirit still leave offerings at the foot of the tree. The area was first protected in 1911 during the German occupation and was later named Rukwa Game Reserve under British occupation until 1932. In 1974, an area of just over 2,200 km² was declared a National Park and the larger area was finally gazetted in 1996 and opened officially with the name Katavi National Park in 1998.

The main feature of the Katavi territory is its vast (425 sq km) alluvial plain, the Katisunga Plain, whose wide grassy expanses occupy the heart of the park. In the western and central part of the park the plain gives way to large tracts of scrub and forest, and these are the best places to spot tawny antelopes and black antelopes; along with Ruaha National Park, Katavi is one of the few places where you have a good chance of seeing both of these species. Some small rivers and large swamps that do not dry up during the dry season are the ideal habitat for hippos and crocodiles; moreover, the Katavi is populated by about 400 species of birds.

Wildlife features include large animal herds, particularly of Cape Buffaloes, zebras, wildebeest, giraffes, and elephants, plus along the Katuma river, crocodiles and hippopotami which upon annual dry seasons results in mud holes that can be packed with hundreds of hippos. Carnivorous animals that roam this park are cheetahs, wild dogs, hyenas, leopards, and lions. Some sources claim a very high biodiversity in the park, although there are also reports of wildlife decline due to illegal hunting and poaching, presumably ‘bushmeat’ sustenance. Katavi has fewer human visitors and jeeps conducting game drives than other Tanzania parks.

Art in Tanzania safaris. Tansanian safarit

It is during the dry season, when the floodwaters retreat, that Katavi truly comes into life. The Katuma, reduced to a shallow muddy trickle, forms the only source of drinking water for miles around, and the flanking floodplains support game concentrations that defy belief. An estimated 4,000 elephants might converge on the area, together with several herds of 1,000-plus buffalo, while an abundance of giraffes, zebras, impalas and reedbucks provide easy pickings for the numerous lion prides and spotted hyena clans whose territories converge on the floodplains.

Katavi’s most singular wildlife spectacle is provided by its hippos. Towards the end of the dry season, up to 200 individuals might flop together in any riverine pool of sufficient depth. And as more hippos gather in one place, so does male rivalry heat up – bloody territorial fights are an everyday incident, with the vanquished male forced to lurk hapless on the open plains until it gathers sufficient confidence to mount another challenge.

The number of visitors to the park on an annual basis is extremely low, in comparison to better known parks, just above 1,500 foreign visitors out of a total 900,000 registered in the whole Tanzania National Parks system during 2012/13. A survey of the actual rooms sold by the available ‘Safari’ style accommodations might reveal the number, but based on total room count and season length, an upper limit can also be estimated. In addition to a public campsite (located at SO 06’39’19.1 E0 031’08’07.9), as of 2013, there were only three permanent camps permitted to operate at Katavi, namely the Mbali Mbali Katavi Lodge and the Foxes on the Katuma Plain and the Chada on the Chada Plain. These camps each have a visitor capacity limit of approximately one dozen each.

Getting to Katavi for visitors will likely be arranged by the hosting camp, with one of the available charter flight services being the Mbali Mbali Shared Charter (operated by Zantas Air Services) or Safari Air Link. All flights will require landing on a dirt airstrip; the Ikuu airstrip (near the Ikuu Rangerpost) has minimal services. It is very approximately a three-hour flight from Katavi to Dar es Salaam and two-hours flight to Mwanza via a small, bush-compatible light aircraft. A flight to Arusha is similarly ~3 hours distant and operates on limited service usually only twice a week on Mondays and Thursdays.

Access to Katavi via ground transportation: estimates vary widely; it is generally discussed not in hours but in days. The town of Mbeya is (550 km/340 miles) distant and is described as a “…tough but spectacular…” drive; Google Maps indicates that Mbeya is 838 km from Dar es Salaam, making the total distance approximately 1,400 km (870 mi) and requiring 20+ hours. The most direct route to Dar es Salaam as per Google Maps is approx. 1250 km (~800 miles) and requiring 16+ hours. Arusha is similarly distant: 1000+km /13.5 hours. The percentage of transit on unpaved surfaces is unknown, but parts of all of these routes will definitely be on dirt roads. Since all of the above times from Google Maps assume an average transit speed of 80 km (50 mph), all these indicated travel times should be considered to be optimistic.

The park no longer offers vehicle rentals, but Marula Expeditions charges US $ 150 to US $ 200 per day depending on how far you want to travel, while the less flexible Riverside Camp (see Overnight) offers two off-road vehicles with canopies. retractable at a cost of US $ 250 per day.

Walking safaris (short / long US $ 10/15 per group) are permitted with the accompaniment of an armed forest ranger; Bush camping is also allowed (US $ 50 per person plus walking fee) throughout the park, making it a great option for the budget traveler. However, keep in mind that this is one of the most infested parks with tsetse flies. The road to Lake Katavi, another of the seasonal floodplains, is a good destination for walking; the road starts from the park management offices, so you don’t need any vehicles.

The main activity, of course, is game viewing, which can be done on both game drives and guided walking safaris. The bonus of game drives in Katavi National Park is that you’re unlikely to come across any other humans. Walking safaris are an experience not to be missed to really get up close to the African bush, its sights, sounds and aromas.

Fly camping is offered. This is the definition of bush camping, where normal tents (don’t expect luxury!) are set up in the bush at a temporary campsite. No fences, no flush toilets or showers. It’s living in the wild; cooking food over a fire and spending evenings chatting around the campfire, staring up at the breathtaking African night sky and listening to the nocturnal calls of wild animals.

Katavi National Park offers great game viewing all year around but reaches its peak during the dry season from June to November or December when the animals gather in their thousands around scarce water sources.

During the wet season, the floodplains turn to lakes and offer spectacular birdwatching opportunities.

References

  1.  “Tanzania National parks Corporate Information”. Tanzania Parks. TANAPA. Archived from the original on 20 December 2015. Retrieved 22 December 2015.
  2.  Katavi NPArchived 2008-02-06 at the Wayback Machine information from tanzaniaparks.com
  3. ^Parks arrivals highlightArchived 2015-12-20 at the Wayback Machine from tanzaniaparks.com
  4.  Campsite info from tanzaniaparks.com
  5.  Katuma Bush Lodge official site
  6.  Foxes of Africa official website
  7.  Chada Camp official website
  8.  Safari Aviation official website
  9.  Highway route on Google Maps
  10. Wikipedia

CAUSES OF CHILD LABOUR IN TANZANIA

By Rosemary David – Art in Tanzania internship

Child labour or child labor refers to the exploitation of children through any form of work that deprives children of their childhood, interferes with their ability to attend regular school, and is mentally, physically, socially and morally harmful. Such exploitation is prohibited by legislation worldwide, although these laws do not consider all work by children as child labour; exceptions include work by child artists, family duties, supervised training, and some forms of child work.

All over the world, children are being exploited through child labour. This mentally and physically dangerous work interferes with schooling and long-term development -the worst forms include slavery, trafficking, sexual exploitation and hazardous work that put children at risk of death, injury or disease.

CAUSES OF CHILD LABOUR IN TANZANIA

Personal Variables

Physical and mental attributes of children influence their abuse. Physical disabilities have long been associated with child abuse and neglect, as these children are often victims of discrimination, sexual exploitation and social exclusion. More often than seldom, the abused or the victims of abuse do not report such cases to the authority, for fear of reprisal by the abuser who may be a parent and due to ignorance.

Socio – economic Aspects

Modern socio-economic developments have diminished the traditional role and power of women. This change in status, has brought about strains in family life and decreased the value of children, resulting into more frequent occurrences of child abuse and neglect.

Social – cultural Aspects

Social-cultural aspects, play a vital role in contributing to the increasing rate of child labour in many developing countries today. Traditionally, children have been viewed as personal property and were generally expected to work. There was a maximum division of labour, where girls were expected to do all the house chores and the boys went hunting. These roles were meant to prepare the children for future adulthood, especially girls who were often subjected to early marriages when they clocked the age of puberty, while their male counterparts went to school. It is however important to note that, some of the household work is too excessive and exploitative and can be categorized under child labour.

Family Characteristics

Family characteristics have played a crucial role in the employment of children based on the type of family (polygamous and monogamous), family size and the employment of parents. Household poverty, is one of the underlying causes of child labour that affects school enrollment, as many cannot afford school fees and school materials. Child labour becomes a majority option for most families for survival, which eventually affects the academic performance of some children, who labour for fees which endangers them physically and psychologically. While it might seem obvious that, children had to fend for their families, parental consent to work, comes in the way as a major issue of maximum consideration in child employment.

Single Parenthood

Many studies indicate that, children who reported their parents as no longer staying together, or those who had lost one of their parents and in most cases drained in poverty, engaged in work. The increasing number of orphans and children raised by single parents, undoubtedly necessitated the employment of children.

Community Variables

At community level, societal transformation and challenges therein, act as a stressor on families and diminishes the capability of families to look after their children properly. The rampant slum developments, which are a manifestation of poor socio-economic conditions and overcrowding, represent a bigger challenge to the life of a child than the society itself.

 Political Factors

Political factors, refer to conditions that cause civil and national strife and unrest including wars inter alia as considered. Children migrate to bigger cities in search for help. These children sometimes go accompanied by their parents and some unaccompanied, especially orphans. War zones, serve as catchment areas for vulnerable children who end up on the streets and involve themselves in child labour for survival.

The Social Capital Theory

The social capital theory offers a beginning point in the theoretical analysis of the street children phenomenon in Tanzania. This theory draws a correlation between family structure and home-leaving. Most of street children end up being employed at small age.

Tarangire National Park

By Farzad Ghotaslou – Art in Tanzania internship

Tarangire National Park is a common safari destination for Art in Tanzania visitors. It is mostly combined with visits to Lake Manyara, Serengeti and N’gorongoro crater.

Ranking as the 6th largest National Park in Tanzania and covering an area of 2,600 square kilometers, The Tarangire National Park is most popular for its large elephant herds and mini-wildlife migration that takes place during the dry season which sees about 250,000 animals enter the park. Located slightly off the popular northern Tanzania Safari Circuit, the park lies between the meadows of Masai Steppe to the south east and the lakes of the Great Rift Valley to the north and west.

Within the northern part of Tarangire is the permanent River Tarangire also known as the lifeline of the park particularly in the dry season when most of the region is totally dry. This flows northwards until it exits the park in the northwestern corner to pour into Lake Burungi. There are several wide swamps which dry into green plains during the dry season in the south.

The name of the park originates from the Tarangire River that crosses the park. The Tarangire River is the primary source of fresh water for wild animals in the Tarangire Ecosystem during the annual dry season. The Tarangire Ecosystem is defined by the long-distance migration of wildebeest and zebras. During the dry season thousands of animals concentrate in Tarangire National Park from the surrounding wet-season dispersal and calving areas.

It covers an area of approximately 2,850 square kilometers (1,100 square miles.) The landscape is composed of granitic ridges, river valley, and swamps. Vegetation is a mix of Acacia woodland, Combretum woodland, seasonally flooded grassland, and baobab trees.

The Park is famous for its high density of elephants and baobab trees. Visitors to the park in the June to November dry season can expect to see large herds of thousands of zebras, wildebeest, and cape buffalo. Other common resident animals include waterbuck, giraffe, dik dik, impala, eland, Grant’s gazelle, vervet monkey, banded mongoose, and olive baboon. Predators in Tarangire include lion, leopard, cheetah, caracal, honey badger, and African wild dog.

The oldest known elephant to give birth to twins is found in Tarangire. A recent birth of elephant twins in the Tarangire National Park of Tanzania is a great example of how the birth of these two healthy and thriving twins can beat the odds.

Home to more than 550 bird species, the park is a haven for bird enthusiasts. The Park is also famous for the termite mounds that dot the landscape. Those that have been abandoned are often home to dwarf mongoose. In 2015, a giraffe that is white due to leucism was spotted in the park. Wildlife research is focused on African bush elephant and Masai giraffe. Since 2005, the protected area is considered a Lion Conservation Unit.

Every year during the dry season from June to November Tarangire hosts a wildlife migration which is not as dramatic as the Wildebeest Migration in the Serengeti, but receives a somewhat large number of animals. As most of this part of the country is dry, the Tarangire River remains the only source of water and consequently attracts large numbers of wildebeests, elephants, gazelles, zebras and hartebeest, buffaloes plus various predators like lions that come to drink and graze around the riverbanks. during the rain months of November to May, the zebras as well as large herds of wildebeests move into the north-western direction towards the Rift Valley floor amongst the large numbers of animals that spread across the large open areas of the Masai Steppe and dispersing all the way to Lake Manyara.

Because Tarangire is manly a seasonal national park, its wildlife differs depending on the season and also considering that It is part of a bigger ecosystem. As earlier mentioned, the dry season is the best time to visit Tarangire and you will be able to encounter various animals. This Park is home to one of the largest elephant populations in Africa with several herds of up to 300 members per herd. In addition, there are large numbers of impalas, elands, buffaloes, giraffes, Bohor reedbuck, Coke’s hartebeest, Thompson’s gazelle, the greater and lesser kudu and on rare occasions, the unusual gerenuk and fringe –eared Oryx are also seen.

A few black rhinos are also thought to be still present in this park. You will obviously see big numbers of elephants gather here as well as the wildebeests and zebras. Among the other common animals in the Tarangire are the leopards, lions, hyenas, and cheetah that seem to be popular within the southern open areas. The wild dogs are only seen occasionally

The birds within the Tarangire are also quite many, there are over 545 species that have been identified here. The stunning yellow collared lovebirds and the shy starlings are in plenty here in addition to other species.

During the dry months the concentration of animals around the Tarangire river is almost as diverse and reliable as in the Ngorongoro Crater. However, the ecosystem here is balanced by a localized migration pattern that is followed by the majority of game that resides in and around the park. As a result, Tarangire is superb in season but questionable the rest of the year. Elephants are the main attraction, with up to 3,000 in the park during the peak months. Peak season also sees good numbers of wildebeest and zebra as well as giraffe, buffalo, Thompson’s gazelle, greater and lesser kudu,

eland, leopard and cheetah. The real prizes in the park are dwarf mongoose, oryx and generuk – but viewings are very rare.

Herds of up to 300 elephants scratch the dry riverbed for underground streams, while migratory wildebeest, zebra, buffalo, impala, gazelle, hartebeest and eland crowd the shrinking lagoons. It’s the greatest concentration of wildlife outside the Serengeti ecosystem – a smorgasbord for predators – and the one place in Tanzania where dry- country antelope such as the stately fringe-eared oryx and peculiar long-necked gerenuk are regularly observed.

During the rainy season, the seasonal visitors scatter over a 20,000 sq km (12,500 sq miles) range until they exhaust the green plains, and the river calls once more. But

Tarangire’s mobs of elephant are easily encountered, wet or dry. The swamps-tinged green year-round, are the focus for 550 bird varieties, the most breeding species in one habitat anywhere in the world.

On drier ground you find the Kori bustard, the heaviest flying bird; the stocking-thighed ostrich, the world’s largest bird; and small parties of ground hornbills blustering like turkeys.

More ardent bird-lovers might keep an eye open for screeching flocks of the dazzlingly colourful yellow-collared lovebird, and the somewhat drabber rufous-tailed weaver and ashy starling – all endemic to the dry savannah of north-central Tanzania.

Disused termite mounds are often frequented by colonies of the endearing dwarf mongoose, and pairs of red-and-yellow barbet, which draw attention to themselves by their loud, clockwork-like duetting.

The permanent Tarangire River is the most dominant feature here and it’s after this river that the park was named. there are a number of large swamps that feed off some of its tributaries however, these are usually dry for most of the year but get very impassable during the rains .The Tarangire park is usually very dry, in fact drier than the Serengeti, however its vegetation is much more green especially with lots of elephant grass, vast areas with mixed acacia woodlands and some of the wonderful ribbons of the aquatic forest not to forget the giant baobab tree that can live up to 600 years storing between 300 and 900 liters of water.

Located slightly off the main safari route, Tarangire National Park is a lovely, quiet park in Northern Tanzania. It is most famous for its elephant migration, birding and authentic safari atmosphere. Most travelers to the region either miss out Tarangire altogether or venture into the park for a matter of hours – leaving swathes of Tarangire virtually untouched!

Tarangire safaris are the main activity, however, staying outside the park makes walking and night safari a possibility. There are no boat safaris on the rivers here, but Oliver’s Camp offers adventurous fly camping trips and very good walking safaris. Both Oliver’s Camp and Swala have recently started night safaris within the park itself. Ask us for more information as the regulations here seem to change every year!

During your Safari in Tarangire, you are highly recommended to stay for a couple of days especially in the south of the park which offers a less crowded safari experience and gives you the opportunity to enjoy an authentic African feel of the Tanzania’s countryside.

Art in Tanzania safaris – Selous game reserve. Tansanian safari ohjelmat

Tarangire is the surprise package on the Northern circuit. Often overshadowed by the Serengeti and the Ngorongoro Crater, Tarangire has huge concentrations of animals in the peak months and a fraction of the visitor numbers of any of the other Northern parks. From July through to October safaris here are superb, and the atmosphere and habitats are completely different from other parks. Tarangire is surprisingly large, giving visitors the quietest game viewing environment of all the parks in the region. The South of Tarangire is especially quiet, and lodges such as Swala and Oliver’s Camp are the perfect place to explore this remote area, and to really get away from any other travellers. Overall, a superb little park that offers great value compared to its neighbours and a seriously good option for getting away from it all.

The game viewing from July through to October is exceptional but for the remainder of the year most of the game migrates out of the park, onto the floor of the Rift Valley and to the grazing grounds of the Masai steppe. As a result, we would advise visitors not to expect high concentrations of game in the off-season months but would still recommend travelling here to those who want to avoid the crowds.

The best time to visit Tarangire is probably in the dry season from June – October, where the game viewing is at its best. Tsatse flies tend to be bad from December to March so although this is a good time to go to the Serengeti for the wildebeest calving, Tarangire is best avoided at this time.

Reference:

  1. “Tanzania National parks Corporate Information”. Tanzania Parks..
  2. “Trunk Twins : Elephant Twins Born in Tarangire | Asilia Africa”.
  3. Hale, T. (2016). “Incredibly Rare White Giraffe Spotted In Tanzania”. Retrieved 2016-01-27.
  4. IUCN Cat Specialist Group (2006). Conservation Strategy for the Lion Panthera leo in Eastern and Southern Africa. Pretoria, South Africa: IUCN.
  5. Wilkipedia
  6. https://www.tanzaniatourism.go.tz
  7. Trip Advisor

THE IMPORTANCE OF MENSTRUAL HYGIENE EDUCATION TO ADOLESCENCE STAGE IN TANZANIA

By Rosemary Balyagati – Art in Tanzania internship

Menstruation (also termed period or bleeding) is the process in a woman of discharging (through the vagina) blood and other materials from the lining of the uterus at about one monthly interval, from puberty until menopause (ceasing of regular menstrual cycles), except during pregnancy. This discharging process lasts about 3-5 days.

What are the signs and symptoms of menstruation?

Beside the bleeding, other signs and symptoms of menstruation may include headache, acne, bloating, pains in the low abdomen, tiredness, mood changes, food cravings, breast soreness and diarrhea.

When does menstruation begin? When does it end?

The menstrual cycle is a hormonal driven cycle; day 1 is the first day of your period (bleeding) while day 14 is the approximate day you ovulate, if an egg is not fertilized hormone levels eventually drop and at about day 25 the egg begins to dissolve, and the cycle begins again with the period at about day 30. Menstruation begins day 1 and normally ends days 3-5 of the menstrual cycle.

The average age for a girl to get her first period in the range of age is about 8 to 15 years old. Women usually have periods until about ages 45 to 55.

So at this average age of her first period is the time for menstrual hygienic education has to be given to girls.

Importance of menstrual hygienic education at adolescences stage.

Menstruation is a basic right for women and girls around the world, in many countries there are huge barriers to Menstrual Hygienic education for girls living in poverty. Menstrual hygienic education is essential in ensuring girls get the support they need on their periods and to able to ask questions about menstrual challenges. Menstrual hygienic education is a step towards removing shame from talking about periods for many girls in countries like Tanzania.

Menstruation is seen as taboo in Tanzania; therefore girls feel uncomfortable talking to family, peers and teachers, let alone attending school during their cycle. Most girls during their menstrual period experience stigmatization, this excludes girls from learning about their own bodies and from opportunities to learn about hygiene and use of sanitary products.

Lack of sexual education in schools, particularly in Tanzania, means that boys add to the stigma around periods. Girls are embarrassed by comments made by boys who do not understand menstruation. Menstrual hygienic Education is the key for both male and female students to aid in eradicating period poverty.

Menstrual hygienic education breaks down the barriers faced by girls in Tanzania and many other developing countries. Cultural barriers often stand in the way of providing girls with knowledge and ability to manage their periods, therefore menstrual education provides an open space to break down taboos. By normalizing menstrual education schools will become better equipped with period-friendly toilets and sexual education classes that will benefit all students.