In Tanzania, the disputes continue between government officials, some of them are saying that the vaccines are not friendly to humans but others asking for proof of why the vaccines are not friendly to humans. Many citizens have been shown to have differing opinions about the vaccines, some are fearing for their safety after receiving the vaccines and thus refusing to be vaccinated, but another group is of people who believe the vaccine is a help to protect themselves from Covid-19, but Another group of people are those who do not know whether to be vaccinated or not so they are waiting for those who have already been vaccinated to see the results before making decisions. The vaccines are now available in the country in various hospitals including government hospitals but also private hospitals, and some people are more considered of getting the Covid-19 vaccines especially those who are at risk of this disease such as a group of the elderly as well as people with Chronicle diseases. as well as health care providers. Some people, including Ms. Khadija, have asked the government to look on the effectiveness of the vaccine first as she does not understand why it has caused opposition for some people to reject it and even some of them are government officials. But also Mr. Masoud said that he is afraid of using these vaccines, but he will have to use them so that he can protect himself, but he really doesn’t want to get those vaccines but due to his health problems it is better to be vaccinated so that he does not suffer from Covid-19. Many citizens want to get the vaccines, but fear has overwhelmed them, and they do not know what is best for them at the moment. The government should provide genuine education on the usefulness of the Covid-19 vaccine to all citizens especially who are afraid to use this vaccine, now the vaccine has become more of a threat than even Corona itself as even some parents forbid their children do not go to school for fear of getting the vaccine.
Circumcision is defined as the surgical removal of the foreskin. The foreskin retractable fold of skin that covers the end of the penis. It is the continuation of the skin that covers the whole penis. Male circumcision has been shown to considerably reduce the risk of sexually acquired HIV infection. Male circumcision is defined as the complete removal of the entire foreskin (the skin that can be rolled forward or back over the head of the penis) and it may be carried out for a number of reasons. Medical reasons:in men, circumcision is most commonly carried out when the foreskin is tight and won’t pull back (retract). Non-medical reasons:circumcision is a common practice in the Jewish and Islamic communities, and it’s also practiced by many African communities. Most non-medical circumcisions are carried out on children.
Medical reasons for men to have a circumcision
In men, circumcision is sometimes considered a possible treatment option for the following conditions.
Tight foreskin (phimosis): phimosis is where the foreskin is too tight to be pulled back over the head of the penis (glans). This can sometimes cause pain when the penis is erect and, in rare cases, passing urine may be difficult;
Recurrent balanitis: balanitis is where the foreskin and head of the penis become inflamed and infected;
Paraphimosis:paraphimosis is where the foreskin can’t be returned to its original position after being pulled back, causing the head of the penis to become swollen and painful. Immediate treatment is needed to avoid serious complications, such as restricted blood flow to the penis;
Balanitis xerotica obliterans:this condition causes phimosis and, in some cases, also affects the head of the penis, which can become scarred and inflamed;
Cancer of the penis: is a very rare type of cancer, where a red patch, wart-like growth or ulcer appears on the end of the penis or under the fore.
Male Circumcision Acceptability
In Tanzania Several observational studies have shown that the traditional patterns of circumcision in Tanzania are changing a substantial number of men belonging to traditionally noncircumcising tribes have been circumcised. For instance, the prevalence of male circumcision increased from 19% to 30% in 2004 in the traditionally non-circumcising populations in Mwanza Region. The prevalence of male circumcision was 21% in selected communities of Mwanza Region in 1994 and 54% in the 2003/04. The changes in the pattern of circumcision may be due to health reasons, social mixing between circumcising and non-circumcising cultures, desire for sexual pleasure. With regard to health reasons, circumcised men are believed to be less susceptible to STDs because the foreskin secretes dirty fluid which is a favourable medium for the growth of disease-causing agents and may be a source of bad smell and also circumcised men heal genital ulcers much faster compared to uncircumcised men. The urbanisation in Tanzania and the establishment of district capitals with government officials from all over the country has led to increased mixing of circumcising and noncircumcising ethnic groups. The mix of ethnic groups is most obvious in secondary schools, and has led to increased acceptance of male circumcision.
Rate of circumcised men in Tanzania
An estimated 70 percent of Tanzanian men are circumcised, according to government surveys, but prevalence varies from region to region. In some districts up to 80 percent of men especially in the western parts of the country are not circumcised. For this case there has to be more effort in providing more education to people so as to increase the rate of circumcised men and reduce the rate of transmission disease such as HIV, STD’S and other infections.
Circumcision Benefits
There is some evidence that circumcision has health benefits, including:
Less risk of urinary tract infections;
A reduced risk of some sexually transmitted diseases in men;
Protection against penile cancer and a lower risk of cervical cancer in female sex partners;
Prevention of balanitis (inflammation of the glans) and balanoposthitis (inflammation of the glans and foreskin);
Prevention of phimosis (the inability to retract the foreskin) and paraphimosis (the inability to return the foreskin to its original location;
Circumcision also makes it easier to keep the end of the penis clean.
Circumcision Risks
Like any other surgical procedure, there are risks in getting circumcision. But this risk is low. Problems linked to circumcision include:
Pain;
Risk of bleeding and infection at the site of the circumcision;
Irritation of the glans;
Higher chance of meatitis (inflammation of the opening of the penis);
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
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.
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
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.
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:
Contaminated needles (i.e., sharing of needles with an infected individual)
Sexual contact – reported to have resulted in the spread of the disease between humans in some cases.
Pregnancy – The parasite is able to cross the placenta, thereby spreading from mother to fetus.
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.
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?
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.
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].
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.”
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.”
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)
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 Blog 