COVID-19 Delta Variant

By Gwamaka Mwakyusa – Art in Tanzania internship

Delta variant, a strain of Covid-19 that wreaked havoc during India’s second wave, has been identified in at least 85 countries. According to the World Health Organization (WHO), the delta covid variant is the most transmissible of all the variants identified so far. Acknowledging the contagious nature of the delta Covid-19 variant that was first identified in India, the WHO on June 25 urged vaccinated people to continue wearing masks.

The delta variant, or B.1.617.2, which was first identified in India in October 2020, has now become the dominant strain in the UK, currently accounting for more than 90% of coronavirus cases there. Meanwhile, in the US, the delta variant accounts for more than a third of new cases, according to Financial Times analysis. The former commissioner of the US Food and Drug Administration, Dr. Scott Gottlieb told ‘CBS News’ Face the Nation’ that the United States is likely to witness “very dense outbreaks” due to the delta variant.

The US Centers for Disease Control and Prevention (CDC) estimates that delta accounted for 20.6% of all Covid-19 cases between June 5 and June 19.

This surge has led Dr. Anthony Fauci, chief medical advisor to the White House, to label the variant as the “greatest threat” to the country’s attempt to eradicate Covid-19.

Both the UK and US have high vaccination rates, and it remains to be seen whether their populations are protected against this Covid strain. But in much of the rest of the world, where Covid-19 vaccines have not been administered at the same level, the concerns are even greater.

Covid delta variant on WHO’s radar

On June 25, the World Health Organization’s Dr. Maria Van Kerkhove in a press conference said that the delta variant is a dangerous virus. “It is more transmissible than the Alpha variant, which was extremely transmissible across Europe, across any country that it entered. The Delta variant is even more transmissible,” she explained during the conference.

Thus far, there are four “variants of concern” flagged by the WHO and seven “variants of interest.” Despite the strain being identified last year, the delta variant was tagged as a variant of concern only on May 11. This is because the WHO uses three parameters—increased transmissibility, more virulence, and decreased effectiveness of public health measures—to determine its seriousness.

The delay is also because there wasn’t enough genome sequencing data coming from India during its brutal second wave. Now, data from the Public Health England (PHE), the UK government’s health executive arm, have given scientists and public health experts around the world some ability to make sense of this Covid-19 variant.

What is the delta variant?

When Covid-19 infections broke out in Wuhan, China, that first strain was a “wild type” virus. This was the strain used by scientists across the world to develop testing kits, treatment plans, and even Covid vaccines.

It is in the nature of viruses to mutate, and it did. But not all mutations are serious, and usually do not require countries to reimagine their public health measures.

The variants of concern—Alpha (first identified in the UK), Beta (South Africa), Gamma (Brazil), and Delta—are different from all other countless variants for this very reason.

The delta variant has certain significant mutations in the spike protein of the virus—the pointy elements that give it the shape of a crown (which is why it’s called the coronavirus). These spikes are like hooks that have to find the receptors in a human cell to link with. Studies have shown that these spikes hook onto receptors called ACE-2. Once these spike proteins can unlock the cells, the infection spreads by replicating the genetic code of the virus.

Some key mutations in the delta variant—such as the E484Q, L452R, and P614R—make it easier for the spikes in the virus to attach to ACE-2 receptors. This means it can infect and replicate faster, and even evade the body’s natural disease-fighting immunity more efficiently.

The spike protein mutations make the delta variant the “fastest and fittest” variant yet, according to the WHO. The disease caused by this variant might also exhibit different symptoms than other viral mutations. Those infected with the delta variant develop symptoms such as headaches, sore throat, and a runny nose, replacing cough and loss of taste or smell like the most common symptoms.

Is the delta variant more transmissible?

“Most studies indicate delta is 50-60% more transmissible than the Alpha variant,” says Dr. Bhramar Mukherjee, associate director for quantitative data sciences at the University of Michigan Rogel Cancer Center. “The Alpha variant itself was nearly 50-60% more transmissible than the original strain.”

This, according to Mukherjee, implies that if the reproduction number for the original strain was around 2.4-2.6, the one for Alpha is 3.6-4.2, and for delta, it is 5.6-6.7. In layman terms, if a person infected with the original strain could infect nearly two people, a person with the Alpha variant could infect four people. With delta, one person could infect nearly seven other people. It’s important to remember that these are averages, not absolute numbers; one delta carrier might infect zero people, or 25.

Its higher reproduction number is likely why entire families in crowded Indian cities like Delhi and Mumbai were infected together. It would also explain the tsunami-like surge of cases in the country in April and May.

The other consequence of a higher reproduction number (denoted as R in epidemiological data) in an epidemic is that it increases the threshold for herd immunity. That is, more people will need to have the antibodies—either through infection or vaccination—to be protected as a community against the delta variant. “With an R of 2.5, the threshold for herd immunity is 60%, but with an R of 6, it is 83%,” explains Mukherjee.

Do vaccines work against the delta variant?

According to the CDC, studies show that the currently authorized vaccines which include Pfizer-BioNTech, Moderna, and Johnson&Johnson or Janssen work on the circulating variants.

Dr. Gautam Menon, professor at the departments of physics and biology at Ashoka University in India said, “It is reasonably certain that the delta variant also exhibits some immune escape, although estimates vary as to the extent.” For instance, single doses of Covid-19 vaccines, according to data from the UK, are only 33% efficacious against the disease.

But there is hope that those who are fully vaccinated are reasonably protected against serious disease. According to data from PHE, Pfizer’s mRNA vaccine is 96% effective, and the AstraZeneca vaccine 92% effective against hospitalizations after two doses. These, PHE says, are comparable to efficacy against the Alpha variant.

This also means that getting a large part of the population fully vaccinated is crucial for countries where the delta variant is prevalent. For countries like the US, where nearly half the population is fully vaccinated, scientists suspect a varied impact of the delta variant. “I would expect some breakthrough infections and transmission happening even in highly vaccinated areas in the US, but would not expect a spike in hospitalizations and deaths,” Mukherjee says.

“We cannot be complacent with a large percentage only partially vaccinated, dropping masks and Covid-appropriate behaviors,” she adds. “We need full vaccination for a large fraction to fight the delta variant.” She also expects that in pockets of the US with lower vaccine coverage, cases of delta variant could rise.

Experts from WHO reiterated that the delta variant is spreading rapidly among unvaccinated populations. However, the health agency quickly noted that “vaccines are effective at preventing severe disease and death, including against the delta variants.

Can masks keep the delta variant in check?

Public health experts are investigating whether booster shots of vaccines will be needed to protect the population against the new variant.

Hence, the WHO is once again highlighting the need to wear masks. “Vaccine alone won’t stop community transmission,” said Mariangela Simao, the WHO’s assistant director-general for access to medicines and health products, during a briefing at the organization’s headquarters in Geneva. “People need to continue to use masks consistently, be in ventilated spaces, [practice] hand hygiene, [maintain] physical distance, avoid crowding,” she said,

Although Covid cases in the US have been steadily declining as vaccination rates are going up, it might be reaching an impasse. Joe Biden had set a target of immunizing 70% of adult Americans by July 4, but the country will fall short, reaching 67% of all eligible adults. Some 20% Americans say they don’t want to get the vaccine.

What is the delta plus variant?

The delta variant has developed a new mutation of a type that was first found in the Beta variant. The new variant—which is being labeled delta plus, though not officially by the WHO yet—additionally has the K417N mutation in its spike protein, which is associated with increased immunity escape.

Shahid Jameel, a top virologist in India, has said that delta plus could also render cocktail antibody treatments—like the one given to former US president Donald Trump—ineffective in fighting the disease. This variant could also potentially lead to vaccines being less effective. India has officially flagged delta plus a “variant of concern,” though after a great deal of indecision.

Menon says the delta plus variant is not a cause for worry yet but would be “if it began to replace the existing variants.” “Currently, there is no evidence that this is the case,” he says, “so there is no cause for immediate worry, but this may change, and we should be watchful for this.”

Mukherjee warns that India, where 40% of the population is below the age of 17 and not eligible for vaccines, needs to adhere to strong public health interventions to control the coronavirus pandemic. Besides scaling up vaccinations, she suggests better studies around the variants, an area where India has been particularly slow. “We need to study properties of these variants: what the clinical manifestations are, whether our diagnostic tests work well to detect them, whether treatments work well.”

The delta plus variant has now been detected in at least nine countries, including the UK, US, China, and Japan.

COVID-19 Vaccination Status in Western World

By Gwamaka Makyusa –  Art in Tanzania internship

After lagging behind the United States and United Kingdom on the distribution of COVID-19 vaccines this spring, the European Union is on track to catch up by July. Following initial missteps, the EU has developed a better strategy on vaccine procurement. Even when in distress, the bloc has showed solidarity between its larger and smaller economies — limiting space for Russian and Chinese vaccine diplomacy in Europe — and towards the developing world, which will pay dividends in the future. By learning from its mistakes and capitalizing on international solidarity, Europe will be better equipped for future pandemics and increase its international soft power.

Europe fell behind the U.S. and other countries because of its slow negotiation process for procuring vaccine doses. The EU had no prior experience on the matter; health was a member state competence. The member states’ approval of the European Commission vaccine plan on June 17, 2020 — which set aside the vaccine “alliance” initiated by France and Germany, later joined by Italy and the Netherlands, for a joint procurement led by the EU’s largest economies — stemmed from the idea of avoiding competition over vaccines inside the EU. Yet, this put a huge burden on the unprepared commission, which then treated vaccines as a trade matter rather than an emergency negotiation, preferring lower prices over timely deliveries. Widespread vaccine skepticism was also a problem, and when negotiations were carried out last summer, Europeans thought they largely had the pandemic under control, so they were not desperate for a vaccine. But COVID-19’s variants proved them wrong and ultimately the EU fell behind in the rollout, especially compared to the speed of the United Kingdom or Israel.

Yet, recent facts suggest that the EU is learning from its mistakes. First, rollout has significantly improved across the continent. By early May, the daily pace of vaccine injection had increased by 60% in France, 90% in Italy, and 145% in Germany compared to a month prior, matching the U.K. The EU is now vaccinating more than 3 million people daily, nearly twice as many as the United States (albeit with a larger population). The majority of EU member states now have at least 30% of their population at least partially vaccinated, including the five largest: Germany (38.2%), France (33.3%), Italy (32.8%), Spain (33.3%), and Poland (31.3%). While the overall EU rate of 32.9% still lags behind Israel (60.1%), the U.K. (55.4%), and the U.S. (47.9%), infection and death rates are down across the continent and EU officials expect to catch up with the U.S. in July. While logistics improvements like enabling military facilities and family doctors to administer vaccines were crucial to this performance, the EU seems to have found a solution to its most important problem on the supply side.

After being criticized for lack of leadership, President of the European Commission Ursula von der Leyen announced negotiations for and ultimately concluded a deal for over 1.8 billion doses through 2023 with Pfizer and BioNTech. Such deliveries will be facilitated by a scale-up in production in Pfizer manufacturing sites, while the commission’s diplomatic initiative is likely to set a precedent for a bolder EU role in future health crises. After the experience of unmet delivery promises with AstraZeneca, there has been substantial pressure from NGOs and debate between EU member states to buy and share the ownership of vaccine patents to disentangle European public health from the fortunes of a handful of private companies. While member states disagree over the U.S. proposal for a broader liberalization of COVID-19 vaccine patents — with Germany fearing a negative impact on intellectual property, while Italy and France support Washington — the EU holds a strong position at the negotiating table given its massive efforts in vaccine production and regulatory power, and therefore has an important role to play in worldwide response to future pandemics or similar crises. The European Council is currently assessing a temporary suspension of vaccine patents.

It is true that the advantages of shared European procurement seemed slim at the beginning given the slowness of the EU’s vaccine rollout. However, there were important benefits to an EU-led approach, from a geopolitical standpoint. If Brussels had not taken centralized action, it is fair to assume that larger European countries would have cooperated to negotiate with pharmaceutical companies from a stronger position. They would then have distributed vaccine doses to others after meeting their domestic needs, similarly to the United States. However, it would be wrong to assume that smaller European countries would have been patiently waiting. So far, Hungary is the only EU member state using the Russian vaccine Sputnik V. Yet fights over purchases or distribution of Sputnik V have led to government reshuffles in the Czech Republic and Slovakia. Hungary also turned to the Chinese vaccine Sinopharm for additional doses, and Poland considered it. While the case of Hungary is not surprising, interest from other countries indicates that the absence of shared procurement may have led member states to turn to and rely on China and Russia for jabs, offering Beijing and Moscow an opportunity for greater influence in the EU.

Lastly, the EU has given proof of solidarity even in hardship, which will pay off in the future. Set aside the one case of blocking the export of AstraZeneca vaccine to Australia as the company had not fulfilled its commitment to the EU; since December 2020, the EU has exported more than 159 million doses to 87 countries and supported the global vaccine initiative COVAX with 2.2 billion euros. The United States, on the other hand, only started to unlock 60 million doses of unutilized AstraZeneca vaccines in April after the rapid deterioration of the situation in India. It is true that the EU also pushed AstraZeneca to supply the EU market first, but this did not result in an export ban; instead the EU used these doses to assist the developing world. Perhaps these EU efforts are too little too late, given how the delays impacted both lives and economies across Europe. Perhaps they will never be acknowledged by the EU citizens, who are also unhappy with their national governments’ management of the vaccine rollout. But it is still remarkable how the EU was able to adapt in an area that had been a national responsibility. Improving its capabilities by learning from past mistakes and investing in solidarity will set Europe up well for tackling these challenges more effectively in the future, domestically and globally

Tropical Diseases in Africa – Malaria

by Shravya Murali – Art in Tanzania internship

As a significant health problem in several tropical regions of the world, malaria costs almost 435,000 lives annually. A substantial fraction of these deaths occurs in Africa. The proportion of cases and deaths In Tanzania alone constitutes to 3% of those globally. Over the past few years, the number of malaria cases have been on the rise, with a staggering increase by 3.5 million from 2016 to 2017 as reported by the WHO.

How does malaria spread?

Malaria in humans is caused by four kinds of parasites from the Plasmodium genus – Plasmodium falciparum, Plasmodium vivax, Plasmodium ovale, and Plasmodium malariae. A fifth species Plasmodium knowlesi, is a zoonotic species infecting animals. Of the five species, P.falciparum results in the most severe form of malaria and is responsible for the majority of malaria-related deaths, especially among children below the age of five.

Malaria is transmitted to humans through the bite of a female Anopheles mosquito that is infected by one of the malaria-causing parasites. The Anopheles mosquito can also spread the parasite from a human to another human when it feeds on an infected human’s blood meal, and later goes to bite another human.

Human-to-human transmission can also occur through blood transfusion, organ transplant, or sharing needles containing contaminated blood as the malaria parasite can be found on red blood cells. Malaria can also be transmitted from a pregnant mother to her child before or during delivery, which is also known as congenital malaria.

However, malaria is not contagious and cannot be transmitted through casual contact (i.e., by sitting next to someone infected) or sexual contact.

What are the effects of the disease?

Those infected with malaria often experience flu like illnesses and fever. Symptoms often include headache, fatigue, chills, muscle soreness, nausea, vomiting, and diarrhoea. As malaria can cause a loss of red blood cells it may lead to anemia, and jaundice, which is the yellow colouring of skin and eyes. If left untreated malaria becomes life-threatening as it can cause kidney failure, mental confusion, seizures, coma, and death. Usually, these symptoms occur about 10 days after a malaria infection.

Malaria caused by P.vivax and P.ovale may occur again and the parasites may reside in the liver for up to around four years after an individual has been bitten by an Anopheles mosquito. These dormant parasites may become active later and invade the individual’s red blood cells, causing another malarial infection.

How is malaria treated?

If a patient is suspected to be infected with malaria, a drop of his/her blood is often observed under a microscope to detect the malaria parasite. Treatments for malaria vary based on the severity of malaria, clinical status of the patient, the Plasmodium species causing the infection, and prior use of anti-malarial drugs.

In Mainland Tanzania, artemether lumefantrine, a drug that can be orally consumed, is used for uncomplicated malaria. In Zanzibar, however, artesunate and amodiaquine are used. For severe malaria, artesunate and quinine are injected in patients in both Mainland Tanzania and Zanzibar. Quinine is another drug that is only used when other drugs are ineffective, as quinine is known to have more side effects than the others. However, quinine is used to treat malaria in the first trimester of pregnancy as it is not known to have significant effects on the child at therapeutic doses.

What could be done to prevent the disease?

To prevent malaria, one could consume anti-malarial drugs (i.e., atovaquone, chloroquine, doxycycline). While it is possible to provide infants and children some of these drugs, not all drugs are suitable for children and doses are based on the weight of the child.

Apart from anti-malarial drugs, one should also prevent mosquito bites (specifically at night), which could be done by sleeping under insecticide-treated bed nets, wearing fully covered / long-sleeved clothing at night, and carrying an insect repellent.

With the increase in the number of malaria cases over the years, it is crucial that members of the public and healthcare professionals cooperate in fight against the disease. While the research for vaccination against malaria is ongoing, it is also essential for everyone to play a part by taking precautions to avoid malaria.

References:

1. Carfagno, J. (2018, July 16). Noninvasive Malaria Test Wins Royal Academy of Engineering’s Africa Prize. Docwire News. https://www.docwirenews.com/docwire-pick/future-of-medicine-picks/noninvasive-malaria-test-wins-royal-academy-of-engineerings-africa-prize/

2. Centers for Disease Control and Prevention. (2021, January 26). CDC – Malaria – About Malaria – FAQs. Centers for Disease Control and Prevention. https://www.cdc.gov/malaria/about/faqs.html.

3. Mutabazi, T. (2021, June 6). Assessment of the accuracy of malaria microscopy in private

health facilities in Entebbe Municipality, Uganda: a cross-sectional study. Malaria Journal. https://malariajournal.biomedcentral.com/articles/10.1186/s12936-021-03787-y

4. Ryan, S. J. (2020, May 1). Shifting transmission risk for malaria in Africa with climate

change: a framework for planning and intervention. Malaria Journal. https://malariajournal.biomedcentral.com/articles/10.1186/s12936-020-03224-6

5. Tanzania. Severe Malaria Observatory. (2007, January 17). https://www.severemalaria.org/countries/tanzania.

6. Thomas, D. L. (2020, March 13). Triple therapies effective and safe in malaria. News. https://www.news-medical.net/news/20200312/Triple-therapies-effective-and-safe-in-malaria.aspx

Sport Inspires

By Racquel Hudson – Art in Tanzania internship

“Sport has the power to change the world. It has the power to inspire. It has the power to unite people in a way little else does. It speaks to youth in a language they understand. Sport can create hope where once there was only despair. It is more powerful than the government in breaking down racial barriers.” – Nelson Mandela.

Nelson Mandela’s quote holds an accurate depiction of the effect that sports have on individuals and groups of people all over the world. Mandela expresses how sports can end the divide between people and cultures as well as inspire people to come together. Sports allow people to build bonds and establish relationships that typically would not have occurred in another setting. It is a form of communication that encourages people to express themselves through play. Essentially, in most countries, sport is not entirely competition-based. Instead, they are portrayed as an activity in which people can get out to have fun and exercise. There is less pressure on winning and more pressure on the expectation that people are communicating and expressing themselves with those around them.

In terms of children, sports help bring them out of their comfort zone and bring them great joy.  It is not always necessarily about competition, rather it is how it can make you grow and benefit as an individual. Sports are for people of all ages and backgrounds, which provides  structure for unity than any other method. It is all about what you like to do, who you engage yourself with, and how much you are willing to explore your options and try things that you did not expect to do.

Furthermore, sports are an essential source of socialization and social integration for informing young people and further their development. Social interaction through team sports teaches young people to associate with their friends, solve and prevent conflicts, communicate, and socialize better with their teammates. Whether it is the friends you bring or the people seated next to you, sporting events bring people together.  Perhaps it is the common interest in the different teams that starts the conversation. Whatever the reason, if you talk to any sports fan, you are bound to hear a story or two about mid-game encounters with interesting people.

For instance, sports in South Africa are largely separated into different parts on ethnic lines. In South Africa, sports are treated as a national religion, language group, and transcending race that helps unify the entire country. The focus of sport is primarily to create an active and winning nation. It focuses on bringing many opportunities for Africans to celebrate in sport while still instilling country values.

Especially, football(soccer) without a doubt is one of the most popular sports admired by most Africans. Football is an exciting game with origins tracing back to the 1800s, when the British, French, and Portuguese colonists introduced the sport to Africa. Unlike other sports, football required minimal resources, and for this reason, it has penetrated every part of Africa. Many African footballers had to surmount some obstacles, including poverty, amongst other things before they achieved all the glitz and glamour they are now associated with. The football talent in Africa mostly begins at the grassroots level, and for this reason, many football stars come from hardship.

Fredrick Odhiambo, also known as Abedi, was born in the city of Kisumu in Kenya. He grew up in the poorest neighborhood out of Manyatta. Like many people from that area, life was not easy. To Fredrick and other fellow African athletes, football is everything. It is not only something to keep them busy and out of trouble, but it was also a chance at a better life —a way out of poverty. Abedi fell in love with football at the age of ten, where he quickly began to establish himself as a leader playing as a center-back. He once said, “Growing up in the slums, if I didn’t play football, I would have never gone to school.” He grew up in a family of seven kids, where his parents could not afford to take them to school. One evening, he went out to play on the football field, some high school coaches noticed his talents and agreed to pay for his schooling. He received an opportunity to attend school, whereas thousands in his village are not as lucky.   Abedi’s journey growing up as a kid lead him to create a program and organization for people that were like himself and give them the opportunity to be included and engage positively as kids. 

On another account, Yaya Toure grew up with similar hardships as Abedi and used football as an outlet in order to prevail. Growing up with his four other siblings and both parents, Yaya Toure often tried to normalize his childhood experiences whenever he spoke about it, but the truth is he grew up poor. According to Toure, ” I did not have football boots until he was ten years old because his parents could not afford them.” However, his boots later served him as he impressed the coaches at the Asec Mimosas academy. He earned himself a move to Europe with Dutch club Waasland Beveren. That move served as a springboard that opened new opportunities at European clubs such as Metalurh Donetsk, Olympiacos, Monaco, Barcelona, and Manchester City. Yaya Toure had a long and distinguished career that saw him win two La Liga titles, one Champions League, one Copa del Rey, three Premier League titles, one FA Cup, one Nations Cup, and many others. Safe to say, he made up for all of his childhood struggles. He is a four-time African footballer of the year grant champ now and routinely is in the discussion of most noteworthy African footballers.

Tanzania’s Football team

Athlete development is a continuous process. It begins when an athlete first engages in a sport until an athlete withdraws from the sport itself. There are various stages of learning that outline the various stages of learning that an athlete undergoes to acquire new skills and techniques. Youth athletes are among some of the hardest-working people all across the world. Many factors contribute to their success. However, athletes at all levels have their motivation and will that push them to strive for greatness. We all have obstacles and hardships along the way, yet it is the process, the hope, the unity we partake in the sport of football that molds us along the way. Sport has the power to inspire.  

Tropical Diseases in Africa – Malaria

By Shravya Murali – Art in Tanzania internship

As a significant health problem in several tropical regions of the world, malaria costs almost 435,000 lives annually. A substantial fraction of these deaths occurs in Africa. The proportion of cases and deaths In Tanzania alone constitutes 3% of those globally. Over the past few years, the number of malaria cases have been on the rise, with a staggering increase by 3.5 million from 2016 to 2017 as reported by the WHO.

How does malaria spread?

Malaria in humans is caused by four kinds of parasites from the Plasmodium genus – Plasmodium falciparum, Plasmodium vivax, Plasmodium ovale, and Plasmodium malariae. A fifth species Plasmodium knowlesi, is a zoonotic species infecting animals. Of the five species, Plasmodium falciparum results in the most severe form of malaria and is responsible for the majority of malaria-related deaths, especially among children below the age of five.

Malaria is transmitted to humans through the bite of a female Anopheles mosquito that is infected by one of the malaria-causing parasites. The Anopheles mosquito can also spread the parasite from a human to another human when it feeds on an infected human’s blood meal, and later goes to bite another human.

Human-to-human transmission can also occur through blood transfusion, organ transplant, or sharing needles containing contaminated blood as the malaria parasite can be found on red blood cells. Malaria can also be transmitted from a pregnant mother to her child before or during delivery, which is also known as congenital malaria. However, malaria is not contagious and cannot be transmitted through casual contact (i.e. by sitting next to someone infected) or sexual contact.

What are the effects of the disease?

Those infected with malaria often experience flu like illnesses and fever. Symptoms often include headache, fatigue, chills, muscle soreness, nausea, vomiting, and diarrhea. As malaria can cause a loss of red blood cells it may lead to anemia, and jaundice, which is the yellow coloring of skin and eyes. If left and treated malaria becomes life-threatening as it can cause kidney failure, mental confusion, seizures, coma, and death. Usually these symptoms occur about 10 days after a malaria infection. Malaria caused by P.vivax and P.ovale may occur again and the parasites may reside in the liver for up to around four years after an individual has been bitten by an Anopheles mosquito. These dormant parasites may become active later and invade the individual’s red blood cells, causing another malarial infection.

How is malaria treated?

If a patient is suspected to be infected with malaria, a drop of his/her blood is often observed under a microscope to detect the malaria parasite. Treatments for malaria vary based on the severity of malaria, clinical status of the patient, the Plasmodium species causing the infection, and prior use of anti-malarial drugs.

In Mainland Tanzania, artemether lumefantrine, a drug that can be orally consumed, is used for uncomplicated malaria. In Zanzibar, however, artesunate and amodiaquine are used. For severe malaria, artesunate and quinine are injected in patients in both Mainland and Zanzibar. Quinine is another drug that is only used when other drugs are ineffective, as quinine is known to have more side effects than the others. However, quinine is used to treat malaria in the first trimester of pregnancy as it is not known to have significant effects on the child at therapeutic doses.

What could be done to prevent the disease?

To prevent malaria, one could consume anti-malarial drugs (i.e. atovaquone, chloroquine, doxycycline). While it is possible to provide infants and children some of these drugs, not all drugs are suitable for children and doses are based on the weight of the child.

Apart from anti-malarial drugs, one should also prevent mosquito bites (specifically at night), which could be done by sleeping under insecticide-treated bed nets, wearing fully covered / long-sleeved clothing at night, and carrying an insect repellent.

With the increase in the number of malaria cases over the years, it is crucial that members of the public and healthcare professionals cooperate in fight against the disease. While the research for vaccination against malaria is ongoing, it is also essential for everyone to play a part by taking precautions to avoid malaria.

Tropical Diseases in Africa – Sleeping Sickness

by Shravya Murali – Art in Tanzania internship

Human African Trypanosomiasis, also known as ‘Sleeping Sickness’ is a neglected tropical disease, and a recurrent public health problem in Sub-Saharan Africa. The deadly sleeping sickness has robbed tens of thousands of lives of individuals in Africa annually, and about 65 million people continue to be at risk of falling prey to it. Fortunately, internationally coordinated efforts have led to a drastic drop in death rates after 2000, with the reported cases of infection being 992 in 2019. It is vital to sustain these global efforts to eradicate the disease for the safety of millions residing in Sub-Saharan Africa.

How does sleeping sickness spread?

This life-threatening disease is spread to humans via bites from tsetse flies that carry the parasite (Trypanosoma brucei) causing the disease. Tsetse flies are exclusively found in Africa, specifically in the south of the Sahara. While there are about 30 species or sub-species of the tsetse fly, only six are known to be able to transmit the sleeping sickness parasite to humans.

However, this disease can also spread from an infected individual to another individual via:

  1. Contaminated needles (i.e., sharing of needles with an infected individual)
  2. Sexual contact – reported to have resulted in the spread of the disease between humans in some cases.
  3. Pregnancy – The parasite is able to cross the placenta, thereby spreading from mother to fetus.
  4. Mechanical transmission – The parasite may spread from human-to-human through other insects that feed on blood.

What are the effects of the disease?

The disease can manifest in two forms caused by different subspecies of the Trypanosoma brucei sleeping sickness parasite – T.b.rhodesiense and T.b.gambiense. The former is commonly associated with the presentation of a painful inflammation, known as ‘chancre’, at the site of the bite. The latter rarely results in a chancre although this has been occasionally observed in infected travellers from non-endemic regions. The “Winterbottom’s sign”, or swollen lymph nodes, is more commonly observed in infections caused by T.b.gambiense.

Regardless of the subspecies of the parasite, the disease comprises of two stages at which it can be clinically diagnosed – the early stage, and the late stage. Furthermore, the symptoms are usually common, causing difficulties in identifying the subspecies that resulted in the disease.

In the early stage, the parasite is found in the blood and the lymphatic system. Its symptoms commonly include:

  • Restlessness
  • Fatigue
  • Headache
  • Itchiness
  • Joint pain

Signs such as weight loss, intermittent fevers that occur could for a day up to a week, and swelling of the liver and spleen, are usually indicative of an early-stage infection.

In T.b.gambiense infections, the disease progresses slowly as it proceeds from the early stage to the late stage after about 300 to 500 days. On the other hand, T.b.rhodesiense infections advance quicky from the early to the late stage in only around 21 to 60 days.

The late stage is known to be riskier as the parasite enters the central nervous system and results in inflammation of the brain – a condition known as meningoencephalitis – which causes neuropsychiatric problems and tends to be fatal. Some of the neuropsychiatric issues include reversal of the sleep-wake cycle (hence the name “Sleeping Sickness”), hallucinations, anxiety, aggression, and mania. The patient may also enter coma, and if left untreated, this stage leads to death.

How is sleeping sickness treated?

The sleeping sickness, after infection, is normally treated by administered specific drugs depending on the stage of infection. For early-stage infection, pentamidine or suramin is used. Both drugs produce unwanted side-effects and can only be used for early-stage infections. While suramin can result in allergic reactions, pentamidine, is commonly well-tolerated by patients. In the late stage, melarsoprol, eflornithine, and nifurtimox are usually used. While melarsoprol can be used to treat both gambiense and rhodesiense infections, it is obtained from arsenic, hence resulting in serious side effects such as reactive encephalopathy – altering brain function. Eflornithine and nifurtimox are less toxic, but the former is only effective against gambiense infection, while the latter has not been studied for its effectiveness against rhodesiense infections. Hence, the current treatments against late stage rhodesiense infections are still inadequate, drawing an urgent need for sufficient treatment considering the quick progression of infection caused by this subspecies.

What could be done to prevent the disease?

Due to the lack of drugs or vaccines to allow for immunity against sleeping sickness, the only way to prevent the disease currently is to avoid contact with tsetse flies. In countries where tsetse flies are found, the following precautions can be taken:

  • Checking vehicles before travelling in them, as tsetse flies are drawn to motion and dust from vehicles in motion.
  • Wearing fully covered clothing, such as pants and shirts with long sleeves.
  • Ensure that clothes worn are of neutral colours or blend with the environment, as tsetse flies are attracted to colours that stand out in the environment.
  • Avoiding bushes, where the tsetse flies often reside.
  • Using insect repellent to prevent bites from other blood-sucking insects other than tsetse flies that can spread the disease – as tsetse flies are not significantly affected by insect repellents.

The World Health Organisation (WHO) aims to completely eradicate the African Trypanosomiasis by 2030, with international research organisations coordinating to study potential treatments that are more effective, and drugs that may help prevent the disease. At the same time, it is also important that individuals play their part in avoiding transmission of the disease by taking the necessary precautions for the safety of all.

Government Expenditure to Combat Pandemic Situation

JAMES MATHEW MGAYA – Art in Tanzania internship

Other Africa countries have prioritized the pandemic and the accompanying lockdowns measures that have worsened the severe food insecurity problem, increasing the population of people living in extreme poverty. While Tanzania has opted for a different approach. Though Tanzania’s unconventional approach to COVID-19 may be slow in response ad seem to lack in direction, its uniqueness illustrates the need for government to form context-specific smart containment strategies and recovery plans. The Tanzania government’s expenditure was to maintain multiple competing priorities, so far the government did not ignore the pandemic by increase public health funding. Tanzania’s interest was to contain the transmission of the virus along all its borders and coordinate closely with its partners, maintain diplomatic relationships, ensure trade is not severely disrupted, and invest in formal small-holder farmers to produce for domestic economy.

How did it work?

Tanzania used its government expenditure to refocus on financial services which makes them among 14 African countries that did not introduce any social safety measures, such as cash transfers. Instead, the government focused on responding with some economic measures through the Bank of Tanzania with various policies to ease liquidity and safeguard the stability of the financial sector. The bank reduced the discount rate, lowered the minimum reserve requirements ratio, incentivised the restructuring of loans for severally affected borrowers, and relaxed limits on mobile money use.

Tanzanian government expenditure focused on increasing its capacity to maintain and manage the virus, while pursuing sustainable economic development. In other words, Tanzania can learn to adapt and live with the virus in a way that is not detrimental to the economy, but not overwhelming the health system. They fund health centres and witness the Covid-19 emergence facilities and also Government built special covid-19 health centres to combat it and increase public health funding to local health centres to implement mass testing, enforce social distancing, and sanitation measures.

Tanzanian government expenditure uses the Strategic Cities Project for Tanzania development objectives to facilitate the Additional Financing (AF) which enhances the development impact and sustainability of the investments financed by the original project by investing in equipment and operation, and maintenance capacity for existing infrastructure, and deepening local government capacity for urban management. These initiatives enable the government to maintain multiple competing priorities, managing the transmission rate, while ensuring food security creating and protecting jobs. 

Conclusion

The COVID-19 pandemic will have short-, medium-. and long-term effects on territorial development and sub-national government functioning and finance. One risk is that many governments respond to focus only on the short term. But the Tanzanian government use it’s expenditure to longer-term priorities must be included in the immediate response measures in order to boost the resilience of regional socio-economic systems. Much effort of Tanzanian government redirected to growth of economy during pandemic so as government expenditure was driven by strong public investment and export earnings. The government’s firm focus and commitment during this pandemic have been to avoid a complete halt of economic activities. 

Resources

The International Growth Centre – COVID-19 in Tanzania: Is business as usual response enough?

COVID-19 AND ECONOMY IN TANZANIA

JAMES MGAYA – Art in Tanzania internship

The pandemic has forced to switch the plans globally. All fashion, sport, and technology events have been cancelled or have changed to be online. Possible instability generated by an outbreak and associated behavioural changes could result in temporary food shortages, price spikes, and disruption to markets.

Such price rises would be felt most by vulnerable populations who depend on markets for their food as well as those already depending on humanitarian assistance to maintain their livelihoods and food access. In Tanzania it was the season of cashew nut during Asian outspread of Covid 19 pandemic as we all know that Asians their the consumers of cashew nuts for years now the Vietnam, India; Malaysia and so on.

During the period the shipment stops due to curfews and lockdowns. Mtwara’s economy went down with it although it was the year before but now it was devastated situation and desperate moment for farmers who were hungry for money due to last year recovery.

  We witness Global stock markets crashed in March 2020, but in tourism industry unemployment was inevitable , tourism enterprise experience bankruptcies, The pandemic has had a significant impact on the aviation industry due to the resulting travel restrictions as well as a slump in demand among travellers air Tanzania incurs tremendous loss which is facing accumulated losses of TZS150 billion Tanzanian shillings (USD64.6 million).

Thank to God Tanzania’s macroeconomic performance has been strong for the last decade, but the current crisis is an unprecedented shock that requires strong, well-targeted and sustained policy response.

The gravity of the situation was easy to Tanzanians, the impacts of COVID-19 are being felt in different ways and the measures taken by the respective governments have also differed on the areas of focus and comprehensiveness.

When our late President John Magufuli let people to continue working this bring relief to low-income earners who eat according to the day and work, they do. If measures of lockdown implemented like other nation people of Tanzania Most in big cities would starve for food more than pandemic. Thanks to him we Tanzanians at least overcome fear of unknown although many international organisations went on lockdown.   

The pandemic has been affecting the entire food market system due to border closures, trade restrictions and confinement measures have been preventing farmers from accessing markets, including for buying inputs and selling their produce, and agricultural middle men from harvesting crops, thus disrupting domestic and international food supply chains and reducing access to healthy, safe and diverse diets. 

We experience panic buying which lead to genuine shortages of spices, citric fruits and vegetables regards of fear of the unknown, which is caused by emotional pressure and uncertainty to food security. This increases the amount of entrepreneurs who seize opportunities to produce different products, and the spread of lies rumours of preventive measure and commodities to social medias so as people can earn income.

During the earlier stage of the pandemic, supply shortages were expected to affect a number of sectors due to panic buying, increased usage of goods to fight the pandemic, and disruption to factories and logistics. There have been widespread reports of shortages of pharmaceuticals product with many areas seeing panic buying and consequent shortages of food and other essential grocery items.

The verdict

Tanzanian economy, including lower export demand, supply chain disruptions for domestic producers and suppressed private consumption. International travel bans and caution against contracting the virus have severely hurt the tourism sector, which had been one of the fastest-growing sectors in the economy.

The pandemic is impacting lives and livelihoods particularly those in urban settings relying on self-employment and informal/micro enterprises. However, government has already taken, and this forecast assumes the authorities will take additional health and economic policy measures to mitigate negative impacts. 

Typical Skin diseases Tanzania

By Gwamaka Mwakyusa – Art in Tanzania internship

Skin diseases such as acne, psoriasis, and eczema are associated with a significant impairment in the quality of the patient’s daily life. Several instruments assess quality-of-life (QoL) in adults and children with skin disease and help us understand its impact. Three groups of investigators have recently examined the psychosocial effects of skin disorders.

Smidt and colleagues developed and tested a new instrument specifically designed to assess these issues in adolescents, who are particularly vulnerable to issues of self-esteem. Skindex-Teen addresses such age-specific matters as sports participation, peer relationships, and clothing choices. In the 200 patients studied, acne was the most common skin condition. The reliability of the 21-item scale was greater than 0.4, and test-retest reliability was supported by acceptable intraclass correlation coefficients for the total score, physical symptoms scale score, and psychosocial functioning scale score.

Numerous observations and limited studies have suggested that psoriasis increases stress and depression. Kurd and colleagues mined the British General Practice Research Database to assess the association of psoriasis with depression, anxiety, and suicidality in a large population. Compared with 766,950 patients without psoriasis, 149,998 psoriasis patients had significantly more clinically diagnosed psychiatric diseases. Additionally, among the psoriasis patients, those with most severe cutaneous disease was more likely to have depression, anxiety, and suicidality diagnoses.

Evers and colleagues analyzed the effects of psychological stressors on skin disease in patients with psoriasis. This report follows their earlier finding of clinical exacerbation of psoriasis in the month following stressful life events. The present longitudinal, prospective study assessed how stressors affect serum levels of cortisol, a key component of the hypothalamic-pituitary-adrenal (HPA) axis, in psoriasis patients. They found that peak levels of daily stressors were significantly associated with lower cortisol levels and that patients with persistent high stress had lower mean cortisol levels than patients with lower stress. The stress response involves activation of both the HPA axis and the autonomic nervous system, both of which interact with the immune system. Therefore, stressful events could exacerbate and prolong chronic inflammatory diseases such as psoriasis. Other investigators have reported a blunting of the HPA axis in some subjects with psoriasis, which could account for inadequate secretion of cortisol and a resulting exacerbation of clinical disease.

The common issues for clean drinking water availability in the Eastern Africa

By Ekaterina Kilima – Art in Tanzania internship

The shortage of freshwater resources is considered a global problem which affects many parts of the world, including the Eastern African countries. It is often wrongly believed that, because the majority of the Earth’s surface is covered with water, the availability of clean drinking water for humans is abundant. In reality, only 3% of the global water is considered freshwater suitable for drinking (WWF). Therefore, there is a high need for a well-balanced management of the available water resources.

One of the main issues for high water demand in the Eastern Africa is the ongoing population growth and urbanization, which in fact increases the standards of living and requires more water per capita. For example, urban population in Tanzania has increased by 7.2 million people between 2005 and 2015 but the water sector bodies fail to respond adequately to these changes (GIZ 2018). It may sound like a paradox that, while the Eastern African states hold the largest amount of on ground water reservoirs on the continent, with Lake Victoria being the second largest freshwater lake in the world, at least half of the population is vulnerable to the water scarcity problem. Nonetheless, there are several socio-economic and socio-political causes which enhance the problem of drinking water availability.

Lake Victoria

One of these causes is an increasing water demand in agriculture which receives water for irrigation from the nearby freshwater resources such as rivers and lakes. Some amount of freshwater from the wetlands is being lost in the process because of inefficient irrigation methods. Due to the increasing population, the conflict between the water needs of citizens and the water needs of farming is going to become more explicit. Moreover, surface water reserves often get polluted because of the closely located industrial activities, for example oil extraction or transportation. Water contamination can also happen due to nutrient and wastewater transportation from urban and rural areas which is closely connected to poor sanitation practices. After getting polluted, this water cannot be used in households unless using multi-stage water filters.

Perhaps, one of the most complex causes for freshwater scarcity for the Eastern Africa is the trans-boundary ownership of the water sources as well as their weak management. Most countries in the Eastern Africa must share water resources with each other which often leads to uneven distribution of the fresh water (IJWRD 2016). Therefore, the problem is not in the lack of water reservoirs but in the unfair distribution and poor management. The inaccuracy of the water management involves inadequate implementation of the environmental law, corruption of interests among authorities but also lack of problem-specific knowledge and funds.

There is no universal list of solutions that would help all the countries in the Eastern Africa. The perfect mix of solutions for each country would depend on the criteria such as population, climate, level of corruption, economic and political stability, and others. However, there are some suggestions that are critical for each country. One, it is important to support local farmers in their transition to more efficient irrigation practices which would allow more water to be available for drinking and household needs. Second, governments should increase the global awareness on the positive changes in the region to attract more foreign investments. Governments should work closely with international organizations and NGOs to develop more sustainable projects to provide equitable access to clean drinking water. Third, it is critical to legally protect African wetlands from human-led contamination and avoid any disturbance of the ecosystem.