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 .
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 . 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 
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 
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 .
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 .
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 .
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 .
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 
TB Control and Prevention
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 .
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 .
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 .
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 .