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

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/

Sober House Art

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The future Art Gallery and Cafe

When wandering through the alleys and byways of Stone Town, every once in a while you’ll come up to a little square, a little breathing space. It’s at one of these that I am to meet Kasim Nyuni and Saleh, the driving forces behind an upcoming art gallery. When I get there – through the able guidance of my fellow AIT volunteer Sue Wagstaff – we find Kasim negotiating with a carpenter in rapid Swahili. The whitewashed house with the L-shaped patio will not only serve as an art gallery, but also as a cafe and Bed & Breakfast, Sue explains, so new furniture is required.

When we sit down to talk, Kasim and Saleh explain to me that this won’t be a regular art gallery. All the art for sale will be produced by recovering addicts and the proceeds will flow back to the NGO that supports their recovery. “Quitting drugs isn’t enough,” explains Kasim, “You need to change your outlook on life.” Kasim, himself a former addict, has devoted his life to helping others recover from their addictions. In the sober houses, recovering addicts can take part in various activities: English classes, computer classes, art classes. “People don’t come to us because they want to be artists, they come to us because they want to stop being addicts. But in the course of their programme, we often discover their talent and help them develop it.”

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Meeting the “fundhi”, the carpenter

Sue, who worked as an AIT volunteer at the sober house last year, is back to help them set up the art gallery, as well as teaching art at the sober house. “These aren’t trained artists,” she explains, “They’ve been on the street, on the outside, their art comes from a different place entirely.”

Soft-spoken Saleh is one of the many who have been helped by Kasim. Once an addict, he is now a fashion designer and painter, who in 2013 exhibited his designs at the Zanzibar Fashion Week in front of hundreds of people. “During the show, we shared my story with the audience. It was great to feel their support. It’s important that we fight prejudice against addicts,” he says, “We want to show the community that we can change, that we can be valuable and productive members of society.”

Kasim agrees. “Addiction takes everything from you. Addicts are disconnected from their families, from the community. We help them bridge that gap.”

Through the art gallery and cafe, Kasim and Saleh want to generate some income for the organisation, so they are less dependent on donations and subsidies. Equally important, however, is that they try to involve the Stone Town community. “We want to keep the prices at the cafe as low as possible, so ordinary Zanzibari can come, have a cup of coffee and see what our recovering addicts can achieve.”

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From left to right: Kasim, Sue and Saleh

 “Every morning I wake up and I think ‘What can I change today?’” says Kasim. It seems to me that, slowly but surely, they are teaching the people of Zanzibar that addiction is a disease, not a sin, and that it can be overcome.

An opening date for the gallery hasn’t yet been set, but keep an eye on this blog. (Originally published on Apr 30, 2014)

Pupils from One School in Dar es Salaam receive donations through AIT

By David Kiarie (Originally published on Nov 1, 2013)

Pupils from One school of Tegeta in Dar es Salaam are a happy lot following the completion of a modern sanitation block at the school.

The toilets were constructed with funds from a volunteer at Art In Tanzania who saw the need for the school to have clean sanitation facilities.

The funds also saw the school connected with piped water by Dar es Salaam Water and Sanitation Company (DAWASCO), bringing to an end the problem of water shortage that the school had to contend with for a long period of time.

“We are glad the pupils now have clean sanitation blocks for both boys and girls and a reliable source of clean water that is safe for domestic use,” said the school head Obedi Rusumo.

Rusumo said although the school had been funded to put up a sanitation block, the administration minimized costs and saved enough money to buy a water storage tank and have piped water connected.

“We used to order between 200-300 litres of water daily which cost us between Tsh. 15,000-Tsh.20,000, about 10-13 US dollars. We no longer need the services of the water vendor and we can use the money we are saving for other purposes.

” We have also managed to clear a Tsh 2 million debt that we owed DAWASCO after connecting us with clean piped water,” said the school headteacher Obedi.

He further said that the ministry of education officials who paid a visit to the school that was facing closure due to poor sanitation have hailed the project and have already registered the education centre, as a nursery school, with the government.

The government has also promised to donate land to the school to enable it grow into a primary school. Presently, pupils who study at the private nurserly school have to join other schools for primary education.

The school with six teachers has two levels of baby and middle classes with pupils age ranging from three and six years old.

The school also plans to have electric power connected and has mobilized some funds for the same although they have a Tsh 700,000 deficit. The total cost of the exercise is Tsh 1.2 million according to Rusumo.

”I credit our school development to Art In Tanzania through whom we meet our esteemed sponsor Carol Wood who has stood with us for this long,”

Carol, a former volunteer with Art In Tanzania, also sends monthly donations that goes into purchase of flour to make porridge for close to 200 pupils at the school.

The sponsor also donated sleeping mats which are used by baby class pupils who have to take a nap every day at the school before they go home at noon.

The headteacher further expressed his gratitude with AIT for offering volunteers to teach pupils at the school.

”The volunteers and interns teach our pupils both written and spoken English among other subjects,” Rusumo said adding that it has helped to improve their performance in class. Another volunteer from Art In Tanzania Rick Jonnes also built desks for the school several years ago.

Art In Tanzania organizes free HIV testing at Kunduchi public beach

By David Kiarie (Originally published on Sep 26, 2013)

Over 30 people from Kunduchi village in Dar es Salaam are now aware of their HIV status thanks to a free HIV counseling and testing exercise organized by Art In Tanzania last Thursday.

A total of 38 villagers most of them youthful men took the bold step after a team of AIT staff and volunteers conducted a HIV and AIDS sensitization campaign at the beach village.

A health officer from PASADA, one of the 483816_10151200538731930_1590266374_n-300x225Unicef children agenda partners, offered the testing services.

By the time darkness fell, a number of villagers who had registered for the test were still queuing to have the important test done. A big number of them were advised to go for the test the next time AIT takes the services at the village.

According to Tanzania Health Demographic Survey 2010, the HIV prevalence of people between the ages 15 -49 is 5.7 per cent.