Taking actions to reduce neonatal disorders

By Pooja Senthamaraiselvan – Art in Tanzania internship

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

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

Actions at the health facility level to save newborn lives

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

Actions at the family and community level to save newborn lives

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

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

References

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

The Effect of COVID – 19 on African Tourism

By Dilyara Shantayeva – Art in Tanzania internship

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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/

CAUSES OF CHILD LABOUR IN TANZANIA

By Rosemary David – Art in Tanzania internship

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

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

CAUSES OF CHILD LABOUR IN TANZANIA

Personal Variables

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

Socio – economic Aspects

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

Social – cultural Aspects

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

Family Characteristics

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

Single Parenthood

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

Community Variables

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

 Political Factors

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

The Social Capital Theory

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