Wednesday, January 17, 2018

Willfully exposing people to HIV poses moral, legal dilemma

 

By Peter Muthamia pmuthamia@tz.nationmedia.com

Word of caution! This is not meant to stigmatise, criminalise or victimise anyone but to bring out the stark reality of some odd cases where a patient, knowingly spreads the Human Immunodeficiency Virus (HIV) to the unsuspecting.

Jane* was a barmaid in Dar es Salaam where this writer lived a couple of years ago. The moment she was diagnosed with HIV, she decided to have intimate affairs with as many men as she could lay her hands on, young and old alike.

Jane’s story was disclosed by a fellow barmaid who had accompanied her to her Iringa home after she became too ill. The symptoms of the disease had become full blown and her fellows could not afford to foot medical bills. Later she died.

There is yet another story of a man who did something akin to that. He was a great friend. After doctors diagnosed him with HIV, he did not bother to protect others from the virus.

Using money (he had plenty of it), he solicited for sex from as many unsuspecting women. When he died, he left behind a list of women he allegedly infected with the virus, including people’s wives!

In the same vein, is not lost to memory that not so long ago, driven by superstitious beliefs and ill-advice from traditional healers, some men knowingly infected young girls with HIV.

It was a common belief that by having sex with virgins, they would purge themselves of the virus. One such incidence was reported in Malawi. In our own backyard, two men were in 2012 sentenced to life imprisonment for defiling minors in separate incidents in Bukombe District, Geita Region. A hospital report later showed that the minor had contracted HIV, highlighting the gravity of the matter.

Is law alone a panacea?

According to the HIV and Aids Prevention and Control Act of 2008, any person who intentionally transmits HIV to another person commits an offence, and on conviction shall be liable to imprisonment to a term of not less than five years and not exceeding ten years.

The Head of legal unit at Tanzania Commission for Aids (Tacaids) Ms Elizabeth Kaganda says the laws were not put in place for the purpose of criminalising, victimisation or even stigmatisation but envisaged the broader perspective of protecting vulnerable groups.

“It should be noted that the main intention of this provision is to ensure that the vulnerable population such as women, girls, young persons, prisoners and homeless remains safe,” she tells Your Health.

“Most of the victims of these acts are those who are either economically challenged or whose consent to sex cannot expressly be obtained; it suffices to say those who commonly undergo sexual assaults,’’ she explains further.

Ms Kaganda cautions that the provision was not intended for pregnant women as one cannot establish evil mind (motive) out of them when they accidentally transmit HIV during childbirth.

But, she notes, the evidence of malicious intention is key when prosecuting cases of wilful infection of HIV.

“Premeditated evil intentions is one of the key ingredient of this offence. There has to be the proof that there was an intention to transmit HIV maliciously through evidence adduced that the person knew if they already are HIV zero status, if they have been using medication, are there chances of viral load suppression? Other considerations include whether they disclosed their HIV status before having sex and whether due care was taken including use of any protection including condom,’’ she explains.

The dilemma

It has been argued that criminalised deliberate infection goes against human rights considerations. Perhaps it is because such a legislation is viewed as not being humane and negating the whole process of HIV control. Indeed, law and can be seen as a force for good and it can also be a force for bad.

However, according to Ms Kaganda, there are challenges to the prosecution of such cases owing to confidentiality and under-the-table settlement of the cases to ensure that they are kept away from the authorities.

“In Tanzania we have been getting challenges on the execution of this provision of law due to complications arising from the issues of confidentiality, scientific evidence and victims opting to be financed by the accused instead of going to court,” she added.

The UNAids International Guidelines on HIV and Human Rights outline how states can effectively manage the spread of HIV. The guidelines stress that this can only be achieved through the promotion of human rights for those living with the disease;

“States should review and reform criminal laws and correctional systems to ensure that they are consistent with international human rights obligations and are not misused in the context of HIV or targeted against vulnerable groups.”

According to the Criminalisation of HIV Non-Disclosure, Exposure and Transmission: Background and Current Landscape published by UNAIDS, since 2007, at least 12 jurisdictions – Burkina Faso 23, Cape Verde24, Chad 25, China (Gansu province) 26, Congo 27, Democratic Republic of Congo 28, Equatorial Guinea 29, Kenya 30, Mauritania 31, Nigeria (Lagos state) 32, Singapore 33 and Tanzania 34 – have enacted or implemented new laws that criminalise HIV non-disclosure, exposure and/or transmission.

Dr Chris Peterson, a medic based in Dar es Salaam says sexual matters being private, it becomes very difficult to prosecute such cases. The only thing any doctor can do is to counsel any patient who is found culpable. In the absence of explicit laws that render deliberate spread of HIV criminal from the medical point of view, the dilemma that laws alone is far from being a panacea for infection abound. Doctors have to also deal with situations where a partner consents to sex even when they are fully aware that the other partner is infected.

“Medically speaking, counselling to curtail the spread of the behaviour is what we do – we let patient know that it is not healthy to spread the disease deliberately. Sexual matters require the consent of those partaking of it and is shrouded by secrecy. We have had cases where one of the consenting partners very well knows that the other partner is infected and goes ahead and has sex without protection. We encourage them to abstain for at least three months and then take HIV tests,” he said.

advertisement

Wednesday, January 17, 2018

Cosmetic surgery: It matters to read ads and warnings



Dr Syriacus Buguzi

Dr Syriacus Buguzi 

By Dr Syriacus Buguzi

This week, I stumbled on two online links that left me with the desire to inform my readers.

One link was an advert and the other was a caution. The advert was about the presence of cosmetic surgery services in Dar es Salaam.

It was calling on people, especially women, to go for services that can give a dramatic twist to their personality, making them look and feel better.

Such services include breast surgeries, face lifts, liposuction and tummy tuck. There are others such as Botox injections and dermal fillers and laser treatments.

When I saw the advert, I recalled being asked a question some months ago by a friend who is a communications expert at one of the big banks in Dar es Salaam. She asked, “Hey, Doc. Are cosmetic surgeries not harmful for one’s health?” We had a long talk about it.

However, one of the things I asked her to do was to keep watching the developments because, as technology advances, medical scientists are keen on discovering new things—perhaps, some of the health risks could be noted in the process.

And, just this week, one of the links I stumbled on, was a latest study that issued a caution about breast implants—it’s a must read for this friend, and perhaps for others who have the desire to reconstruct their bodies.

Published in the Jama Oncology, a medical journal, it revealed that more women with implants are increasingly being diagnosed with a rare type of cancer called anaplastic large-cell lymphoma.

The study noted further that doctors may be missing the signs of the disease.

Daphne de Jong, a pathologist at the Netherlands Cancer Institute and one of the authors told The Citizen’s sister paper in Nairobi, Business Daily that textured implants or those with rough surfaces pose a higher cancer risk compared to smooth ones.

‘‘We and others have also found lymphoma (cancer) associated with micro textured breast implants. Smooth implants are still somewhat under debate, but likely these bear the least risks,’’ he said.

“However, it should be noted that market shares and use of implant types have varied over the years and therefore we cannot make strong conclusions on specific risks for lymphoma with specific types,’’ he added.

There were more details

The researchers said the cancer which forms around the implant is typically slow-growing and can develop even 14 years after the surgery.

This is not the first warning, however. In 2011, the US Food and Drug Administration reported a link between implants and the disease, prompting the addition of warnings on product labels.

Stay safe, make informed health choices!

advertisement

Wednesday, January 17, 2018

GUEST COLUMNIST: This is how TB spreads in the air



Jerry Hella

Jerry Hella 

By Jerry Hella jhella@ihi.or.tz

Tuberculosis (TB) is an airborne disease that is transmitted from one person to another through small air droplets also known as droplet nuclei.

These droplets can remain suspended in air from few minutes to two hours. They are produced in massive amounts when a patient who can potentially infect another coughs and sneezes.

Presence of good ventilation systems in indoor location ensures that air is constantly mixed and that you have “new” clean air from outside that is exchanged with indoor air.

Locations with poor ventilation increase the time for the droplet nuclei carrying TB particles suspended in air and this may result in increased probability of being rebreathed by the next person in the room.

We carried out a study and found that certain locations have the potential for being transmission hotspots due to poor air ventilation as captured by our new method and the large number of people whom we interacted with at such locations in one year.

Prisons in particular are a problem because most people who end up in jail are from a low socio-economic status, succumb to poor nutrition while in jail (both factors are epidemiologically related to TB disease) and lastly unfortunately in developing countries prisons are mostly overcrowded making TB transmission rates higher than in the general population.

However, congestion alone is not a problem as long as there is adequate system to support good ventilation i.e., air exchange between the indoor location and the “air outside the particular room/building”.

However, policies which address both congestion in public locations e.g., transport, prisons, night clubs etc., with clean air quality policies will result into better control of TB by reducing significantly transmission from such locations.

What we already know from studies elsewhere; is that only approximately 20 per cent of TB is transmitted at household level, meaning about 80 per cent of TB is transmitted in other locations apart from ones household.

The challenge ahead is to appropriately estimate the proportion of TB transmission in different locations and to highlight locations with highest probability of transmission at the population level.

The gaps in terms of prevention needed are mainly due to lack of policy for indoor air quality addressing ventilation status. Once we have this policy, we can then build tools and basis of enforcing this policy.

We were successful in introducing smoking ban under the Tobacco Products (regulation) Act of 2003 which made it illegal to smoke inside public transport, hospitals, schools etc., we need policies which prevent/control from congestion in public places and installation of ventilation system in infrastructures which are accessed by the mass.

We are actually focusing on Dar es Salaam for clear reasons. It’s a city with the highest number of people in the country. It is leading in TB notification each year accounting for about of 22 percent of all TB patients notified to the program each year.

Suffice to mention, Dar es Salaam is among the fastest growing cities in Africa which unfortunately like elsewhere is faced with uncontrolled urbanization resulting into many slum like dwellings which are notoriously known for fueling TB transmission.

Drivers are at a greater risk than passengers. Here, one needs to take into consideration the time of exposure simply meaning the total time that one is exposed to poor ventilation conditions.

When you think about it, passengers spend less amount of time in the bus during one day as compared to drivers. If you model this relationship during one year, the risk of TB transmission is higher among drivers. For example the probability of a passenger to be in a bus with one TB patient during one route e.g. from Temeke to Mwananyamala is the same for the passenger and the driver.

However the driver will have many trips increasing his probability during the day and the year. A good intervention will be to ensure public transportation is not congested which will result into very low risk of transmission for drivers and even lower for passengers.

advertisement

Wednesday, January 17, 2018

Watch that ‘burning’ sensation in your chest

 

By Insiyah Amiji insiyah_amijee@hotmail.com

You may have experienced a “burning” sensation in the upper and central part of your chest or throat, right after taking meals or spicy food, and perhaps you wondered why.

At one moment, it came in the middle of the night, waking you up as if the chest was on fire. This is simply “acidity” in your food canal.

From my point of view as a medical doctor, it is important to differentiate these cases of chest pains which could range from just a simple heartburn to a more severe life threatening condition, for example, a heart attack.

By the way, a heartburn has nothing to do with the heart. Some of its symptoms, however, are similar to those of a heart attack or heart disease but it’s merely an irritation of the esophagus.

A heartburn is also called “acid – reflux” also known medically as GERD. This occurs when stomach contents flow back into the food pipe (oesphagus).

Now, let’s look at what would cause someone to have a heartburn every day, as we address what actually causes it.

Stomach abnormalities – our stomach can be visualized as a bag with tight sphincters which closes when it contains food in order to churn, digest and prevents backflow. Loose tone the sphincter between the stomach and esophagus and abnormalities like hiatal hernia causes backflow of its content.

Increased acid production – this could be hereditary or due to life style factors like smoking, stress, certain food triggers (fatty food, spices, caffeinated and fizzy drinks, citrus fruits, alcohol, garlic) or hyper secretory acid states.

Pregnancy – increasing the hormonal levels combined with pressure effects of the foetus and increase backflow of stomach contents into the oesophagus.

Others include– Medicine (aspirin, diclofenac, and ibuprofen), obesity, and old age, laying down right after meal and eating heavy meals before bedtime.

Triggers differ from person – person. Usually an individual suffering from an acid- reflux will complain of the following;

Feeling of a burning sensation in the central and upper part of the chest and throat. Often giving a metallic, acidic, sour taste. It could be a few minutes after a meal or during fasting (empty stomach) and aggravated when laid down.

Abdominal pain which is usually in the upper part called the epigastric region.

Bloating – feeling of fullness

Relief of the complains after taking an anti - acid

Rush of saliva after the episode

Statistics reported from Tampa Bay – reflux Center USA in October 2016 showed that between 20 – 30 per cent of adult Americans experience acid reflux symptoms every week.

Of the people who experience heartburn, 40 per cent say that night time heartburn affects their job performance the next day. African regions show a lower prevalence of this condition.

In Tanzania studies have shown potential risk factors to be spicy food, silver cyprinid fish commonly known as “dagaa”, a mixture of beans and cooked green banana meal commonly known as “matoke” in East Africa, milk, and alcohol.

Most people who suffer from occasional heartburn are able to control their symptoms through simple dietary or other lifestyle changes.

For some, though, this can be a sign of a more serious condition like GERD. If you notice that you’re suffering from heartburn on a regular basis, it is important to seek medical attention without delay.

Long term cases of GERD causes repetitive injury to the lower portion of esophagus. A small percentage of people will develop a condition called Barret’s Oesophagus, the abnormal changes in the cells of the esophagus. Barrett’s esophagus is associated with an increased risk of developing cancer of the oesophagus. Although the risk is small, hence, it is important to have regular checkups to detect it early.

The author is a medical doctor based at Muhimbili University of Health and Allied Sciences (Muhas).

advertisement

Wednesday, January 17, 2018

ONCOLOGY ISSUES: Dear ladies, don’t ignore these symptoms, it could be cancer



Dr Chris Peterson

Dr Chris Peterson 

By Dr Chris Peterson sonchispeter@gmail.com

Salome’s* documents made me pause! As I went through her new patient’s report, I came to realise that this lady, in her 30s, had not seen a doctor for a quite long time.

It was not until last month, when she was referred to me after untreated prolonged irregular menstruation and vaginal discharge.

She was a suspect of chronic cervitis, a condition caused by infection in the cervix.

I stepped into the examination room where this lady sat expectantly in a hospital dress. After some light conversation to help her relax, I examined her by pinching off small samples of tissues from her cervix, while asking typical questions, “How long have you been experiencing this, does it hurt?”

In the process, I saw light vaginal bleeding, a common symptom of cervical cancer.

Based on what I knew from this lady, this didn’t surprise me. This didn’t mean cancer yet, we would only know after a results came back from the lab.

In most cases, women neither expect to be diagnosed with cervical cancer, nor are they aware of its risk factors and common symptoms.

I have seen a large number of women who tend to be surprised when receiving cervical cancer news and this is only due to the fact that they ignore symptoms.

Most of them confuse the symptoms with those of other common genital infections and not cancer, thus they don’t seek medical consultation on time.

Salome’s story goes on. A week later, when she returned, I was able to give her some bad or some what good news with her results.

The news was good beacuse, findings showed that her cancer was only still confined to the cervics—it hadnt spread further.

At this stage, cancer can be managed and completely cured. (Atleast salome was lucky). I then started to a prompt a treatmen plan for her.

This story reminds us of two things: that cervical cancer awareness in our societies is still somewhat a mountain to climb.

Women have no culture of getting frequent cervical cancer screening.

Cervical cancer is the leading type of cancer that claims a large number of women’s lives.

Another thing is that women tend to turn a blind eye when cervical cancer knocks in their doors, they take those cervical symptoms for granted. In most cases, it is hard to know whether the sympmtoms that women are experiencing are caused by cervical cancer, or common genital infection.

Infact, almost all cervical cancer symptoms disguise themselves as either genital infection or pelvic diseases. Salome assumed her irregular vaginal bleeding could be caused by chronic cervicitis.

I therefore urge all women to pay attention to the symptoms and seek immediate medical care. These symptoms highly include: prolonged leg pain, vaginal discharge,unusual bleeding, disconfort during urination, irregular menstrual cycle, uncomfortable sex, pelvic pain, back pain, unexplained weight loss and fatigue.

advertisement

Wednesday, January 17, 2018

Liver disease that requires your attention

 

By Wilson Lugano lugano_wilson@yahoo.com

Four months ago I attended to a 56-year-old patient from Chamwino district in Dodoma region who had been brought to the hospital due to swelling of her abdomen.

Her problem was reported to have begun gradually but it went on progressively. I was told that at first, she used to complain that she felt something hard in the left lower part of her abdomen below the umbilicus.

On arrival at the hospital, I examined her and elicited more findings that gave me a clue that something was wrong with her liver. Her veins on the abdomen were distended and her feet were swollen (oedema).

After a battery of tests, she was then diagnosed with a liver disease known medically as liver cirrhosis. “Doctor, am I going to recover?” that was her first question when she was told about her diagnosis.

Such conditions are uncommon

To me, it was uncommon to meet a patient with liver cirrhosis in Dodoma—practically on a weekly basis. However, it was very unfortunate that most of them came to the hospital late—at a time when the liver disease was too complicated to deal with. Liver cirrhosis is a complication that normally involves loss of liver cells. Worse enough, it also involves unruly and irreversible scarring of the Liver.

Blamed on alcohol

In Tanzania the most common cause of liver diseases is alcohol. In rural areas, people are under abject poverty but they still afford buying local brews. At times, they don’t have money but they will strive and exchange maize or any possession available at home with alcohol.

In most urban areas that I have travelled to, and others where I have lived, drinking beer and other spirits in casinos and bars is the order of the day.

Hepatitis, certain chemicals may be a cause

But, in principle, the causes of liver cirrhosis include hepatitis B and C, abuse of some medicines and exposure to certain chemicals.

Currently, health care workers are being vaccinated against hepatitis since it easily spread through fluid contacts and doctors are more prone to the occupational risk.

I still remember very well one of the young doctors who died of hepatitis B in 2015 at one of the district hospitals in Tanzania. It was a sad moment.

Before that, vaccination against hepatitis B was mainly given to infants, in combination with other vaccines abbreviated altogether as “PENTAVALENT” vaccines.

Liver cirrhosis can cause general body weakness, loss of appetite, yellowish coloration of the eyes sometimes the whole body, easy bruising, sometimes itching, and swelling of the abdomen.

Occasionally, the person may experience bleeding from esophagus due to complications plus long standing liver disease symptoms, such as muscle wasting, redness of the palms, small spider like veins in the skin, breast enlargement and shrinking of testes.

Is it diagnosed properly in Tanzania?

This condition can be diagnosed by using an ultrasound, however, it is suggested that a definitive diagnosis be made through microscopic examination of tissue. This, unfortunately is not done in rural hospitals in Tanzania.

In the management of liver cirrhosis, good nutrition is vital plus alcohol abstinence, but most of the clients are not willing to abide by that. Most of them usually blame their illness to witchcraft so they don’t seek modern medical care. They simply go to traditional healers.

Due to economic challenges, most people cannot afford buying medications.

During treatment of this condition doctors do sometimes require to removal of fluid from the body in a procedure called “paracentesis.”

The procedure involves replacement of lost proteins /albumins in the body. This is because, liver cirrhosis may cause the body to have reduced amount of albumins/proteins. This requires replacement.

But the infusion of the proteins is very expensive and unavailable in most upcountry regional health facilities, including Dodoma. I have seen some in Dar es Salaam, at an exorbitant price of more than Sh50,000 for a single infusion. A patient has to undergo several infusions.

There is also the lack of endoscopic tests that are needed to diagnose the patient, especially when he/she is bleeding, however, all tertiary hospitals in Tanzania can offer this endoscopic test.

Sadly, there is no complete cure for liver cirrhosis. However, liver transplantation may help the patient.

The good news is that if detected early, it could be arrested in the early stages, if one stops taking alcohol.

advertisement

Tuesday, January 9, 2018

Why bus drivers face higher TB risk than passengers

 

By Syriacus Buguzi, sbuguzi@thecitizen.co.tz

Drivers of public vehicles such as buses in Dar es Salaam are eight times more likely to catch Tuberculosis (TB) in a period of one year compared to the  passengers they carry; a new study has shown in part.

However, compared to all city dwellers, it does not mean that the drivers face the highest risk of catching the bacterial disease. Their risk only stands at 20.3 per cent, the study reveals.

Prison inmates are the most at risk group, carrying 41.6 per cent, according to findings in the study titled: “Tuberculosis transmission in public locations in Tanzania” published in the Journal of Infection.

Scientists now urge the authorities to target public health interventions against TB transmission on those locations that the study has focussed on.

Through the study, the researchers from Ifakara Health Institute (IHI) adapted a method for identifying tuberculosis (TB) transmission hotpots in Dar es Salaam by using a new technique.

They collected data in form of carbon dioxide, one of the gases in the air that people breathe. This data was used to estimate the proportion of re-breathed air from other people in confined spaces, such as cars and rooms.

The Principal Investigator of the study, Jerry Hella, believes this approach can guide the identification of TB transmission hotspots and targeted interventions to reach World Health Organization’s ambitious End TB targets.

Being an airborne disease, TB is transmitted from one person to another through small air droplets (droplet nuclei) which can remain suspended in air from few minutes to two hours.

These droplets, according to Hella, are produced in massive amounts when a potentially infective patient (not yet on TB treatment) coughs and sneezes.

“Locations with poor ventilation increase the time for the TB particles suspended in the air – resulting in increased probability of being re-breathed in by the next person in the room,’’ he says.

In public transport, TB transmission is highly likely but not many people ever thought that drivers of public vehicles, such as those popular in Dar es Salaam as daladala, are at a higher risk compared to their passengers.

Your Health posed a question to travellers at various bus stops: Between you and the driver, who do you think is safe from catching TB? None of those who responded believed the driver was more at risk.

“Look at that bus, look at how congested it is. There are too many people in there. I think they can’t even breathe well and freely!’’ said Mr Sadik Mussa, “…but see where the driver is seated,’’ he went on as he described a minibus plying Mbagala-Mwenge route which had just made a stop at Tabata Relini to pick more passengers.

“I think the driver is enjoying his seat and he is safe, right? I don’t think he is at risk,’’ says Mussa. That’s what most people like him thought as Your Health interviewed them.

To most of them, congestion of the passengers is the main reason. However, during the study, the scientists from IHI found a different reality in Dar es Salaam

“From our point of view – congestion alone is not a problem as long as there is an adequate system to support good ventilation i.e, air exchange between the indoor location and the “air outside”…’’ says Hella.

Hella and his team went around the city, collecting the carbon dioxide data from public transport facilities as well as markets, prisons, night clubs, schools, religious and social halls.

When asked why drivers faced a higher risk than their passengers, he explains “…passengers [in public transport] are less at risk because they spend less amount of time in the bus on a day compared to drivers. So, this puts the drivers at higher risk.

“If you model this relationship during one year, the risk of TB transmission is higher among drivers,’’ he tells Your Health. “For example,’’ he further explains, “The probability of a passenger to be in a bus with one TB patient during one route is the same for the passenger and the driver.”

“However the driver will have many trips, increasing his/her probability [of getting exposed to more patients with TB] during the day and the year,’’ says the researcher.

What about prison inmates?

“…Most people who end up in jail,’’ he says, “…are from a low socio-economic status, succumb to poor nutrition while in jail and prisons are mostly overcrowded making TB transmission rates higher than in the general population.”

The researchers believe that policies which address both congestion in public locations, with clean air quality systems will result into better control of TB by reducing significantly the transmission from such locations.

Why focus on Dar es Salaam?

“We decided to carry out the study in Dar es Salaam as it’s the city with the highest population in the country and it’s the fastest growing city in Africa as per World Bank Reports.

“But also, it is the leading in TB notification each year, accounting for about of 22 per cent of all TB patients notified…but also…because our research activities are mainly based in the urban.”

“We are currently conducting a similar study in the rural setting at Ifakara, Morogoro, so that we can have a rural to urban comparison of our findings,’’ he hinted.

Low risk areas for TB in Dar es Salaam

The researchers found that other areas in the city have lower risk of transmission. They include central markets, where the risk was 4.8 per cent and 0.5 per cent for traders and their customers, respectively.

For passengers on public transport, the risk was 2.4 per cent while in public schools it was at 4.0 per cent. In night clubs, it was 1.7 per cent and religious buildings (0.13 per cent) and social halls (0.12 per cent).

Tanzania is the 15th among 22 countries with the highest TB burden, says the WHO.

Global efforts to combat TB have saved an estimated 53 million lives since 2000 and reduced the TB mortality rate by 37 per cent according to the Global TB Report 2017.

“While the world has committed to ending the TB epidemic by 2030, actions and investments don’t match the political rhetoric. We need a dynamic, global, multispectral approach.” said Dr Tedros Ghebreyesus, Director-General of WHO when commenting on the report.

advertisement

Tuesday, January 9, 2018

Why self-identity is very healthy

 

By Rocky Amini rockyamini94@gmail.com

Students, just like any other human beings, have the intellect that helps each one, individually to define and understand oneself as complete person. This is how to stay healthy mentally.

I am addressing secondary school level students, although this could also somehow apply in tertiary education.

Psychologists will tell you that those who have failed in life are only those who define and understand themselves negatively.

Negative attitudes to any individual largely create failures to an individual psychologically and are unhealthy.

And, today, I want to pose a challenge: What do teachers in schools do in order create an enabling environment for students to be aware of their identity and shape their attitudes for the sake of their academic progress?

A school is a place where students need to get the backup for happiness and get all that can enrich their livelihood through teachers and other educational experts.

In a real sense, there is a need for the students to get better self definition of their positive attitudes in the grounds of building their psychology.

Things to tackle

Untreated psychological problems that students face in schools can damage their attitudes in undertaking their studies.

How would the educational specialists determine whether students are already affected psychologically?

“What if I fail to answer the question asked by the teacher?”, “What if they laugh at me?” and many questions of this form, are signs of inferiority complex, that must be addressed immediately.

Most students affected psychologically, would possibly create growing habit of interfering with other students’ courage’s to keep moving on.

In helping students affected negatively by the attitude perceptions, let’s chip in with some kind of a disciplinary approach and help in vocational educational guidance towards giving better psychological affection.

Empowering the student with self-discipline would mean the kind of training expected to produce a specific character or pattern of behavior, especially training in producing moral and functioning results.

A better student should be self-disciplined in terms of action, reaction and in decision making. This largely facilitates their understanding of things, the world in school and elsewhere.

It is very important for students to know that discipline is the mother of all disciplines and thus for them to reach their potential, they need self-discipline in shaping the educational progress.

But also, in most cases, students who achieve vocational guidance, in a large extent won’t be found in many disciplinary cases. Such students ought to be obedient, listeners and responsible for their school’s daily routine.

What both students and educational specialists need to do cooperatively?

In this matter, every student and educational specialist has great personal responsibilities towards making positive changes. The journey of learning to students possibly involves both obstacles and challenges.

The role of the teacher here is to find out the suitable psychological approaches and solutions while the students must also help speak out on the challenges encountered. Yet, students need to build up and strengthens good relationship with their teachers. Guidance strengthens students in their educational system by providing motivation.

in education. It is the same reason that helps students to act in their human nature, self awareness, freedom and responsibilities accordingly.

This helps the educational specialists to know how well students have understood the lesson in the bounds of performance in comparison with others or in comparison with the domain of performance task given to students in school’s environment

Since educational vocational guidance is a long life process to students, teachers need to be aware of, and alerted on how to bring students together in recognizing themselves and re-diagnose their capabilities in matching with what the school’s environments offers.

Thus, in a great manner, educational vocational guidance is meant to help students determine themselves in building the kind of psychological attitudes that fosters the academic progress in school.

The author is an expert in Education.

advertisement

Tuesday, January 9, 2018

Surround yourself with positive people to stick to resolutions

 

On January 1, a friend told me that he had given up on setting New Year resolutions. Why? I asked him.

And the answer he gave me was not surprising: “It’s too difficult to achieve them,” he said.

But as we talked further, I realised that each time he was trying to blame some of his failures on bad company.

Then, a topic cropped up: Should we choose who to associate with if we want to achieve our resolutions?

I will be speaking about health resolutions particularly and here, it has dawned on me that the people we often associate with, could make or break us.

If you surround yourself with negative or destructive people, there are always likely chances that you will end up being like them.

For instance if they are taking drugs, you may become a drug addict as well. On the other hand, surrounding yourself with optimistic minded people has a number of benefits including health, emotional, spiritually and psychological.

For instance, if you are trying to lose weight, befriend people who will be positive and give advice especially when you want to go off track.

This is much so if one is trying to deal with harmful use of alcohol, for instance, or smoking as well as having more than one sexual partner.

At times, these habits may seem mild and easy to beat off but without the right mindset, they become too difficult to tackle. And, this can be determined by who advises you.

In case you are already engaged in any of the harmful habits, seek help; including professional counselling, treatment and rehabilitation but make sure you watch your company.

May be your friends have made several whispers about you gaining weight.

Well, the friends’ remarks about you could mean a lot. Be careful with this and don’t be put off the course.

As the year begins, you have the opportunity to redeem your image, habits and other achievements in the next 12 months.

But above all, be mindful of what goes into your body. There is an old adage that says: “you are what you eat,” which means that our bodies reflect the kind of food we consume.

Think about choosing foods and drinks that are good for health, in the modest portions that will help control weight.

But, there are so many types of foods and drinks, and so much information about nutrition and diet plans that we find it difficult to make the right choices.

And, may be friend X or Y is advising you to choose one against the other. Well, my honest advice to you is that you should stay focused.

A book on nutrition would also help. Through it, you can know quite a bit of what to eat and drink-and what not to eat and drink to prevent chronic diseases. And since nutrients are found in foods, all one needs are a few guidelines on maintaining their health and well-being.

advertisement

Tuesday, January 9, 2018

Let’s talk about HPV vaccine and its link to cancer prevention

 

By Dr Chris Peterson sonchrispeter@gmail.com

A few months ago, I received a referral case of a patient from one of the major hospitals in Mwanza Region.

It was a 50 year old woman, a patient who was initially experiencing prolonged menstrual bleeding but later developed some complications.

She reported feeling pain in her pelvis and during intercourse. She had been advised to take antibiotics when she visited a walk-in clinic near her home.

But the pain didn’t stop. Her situation got even worse. She spotted watery, blood vaginal discharge that was heavy and had a foul odour.

That was before she was referred to our hospital in Dar es Salaam for further check-ups; after the basic care she had received seemed not to solve her problem.

After examining her and taking an HPV DNA test, pap test and biopsy, I finally confirmed that she had abnormal cells in the cervix and the HPV DNA test clearly showed it was caused by the Human Papillomavirus (HPV).

And the pain in her pelvis and during intercourse were actually a result of a cancer that had moved to the lower portion of the vagina and internally to the pelvic wall.

To treat her cancer, my patient had to go through 33 daily rounds of radiation and six weeks of chemotherapy and she finally finished after three months and that’s when I got chance to sit down with her and discuss the exact cause of her cancer.

She was surprised when I told her that she would have avoided the cancer if she had a shot of an HPV vaccine at a young age.

According to Centre of Disease Control (CDC), cervical cancer still remains the leading cause of death among women. Here in Tanzania it’s also a major problem.

The main solution, according to stakeholders in the cancer fight and researchers, is vaccination.

If you have sex now, had sex in the past or will have sex in the future, especially if it’s unsafe, there is a likely chance you‘ve had, have or may someday get human papillomavirus (HPV).

It’s a sexually transmitted virus that is linked to several cancers including cancer of the cervix.

However, the good news is that, the next generation and young adults may not face these odds, thanks to HPV vaccine.

So what is HPV vaccine? This is a type of vaccination that helps to prevent infection among people of high risk to get HPV, that can lead to cervical cancer and low risk types that cause genital warts.

HPV vaccines are recommended for both girls and young women aged 0-26.

To prevent the risks of other types of cancers however, boys are also recommended to get this vaccination since HPV may cause many forms of cancer in both men and women.

I therefore, urge all parents and guardians to have their children vaccinated. A cervical cancer free generation is possible if we invest our efforts in prevention rather than cure.

advertisement

Tuesday, January 9, 2018

Childbirth conditions defining future growth

 

By Keneth Kammu kenethkammu@gmail.com

During a ward round at the hospital last week, I came across a one year and six months old boy who, at that age, was incapable of controlling his neck and head.

It dawned on me that something wasn’t right, and perhaps, this had to do with a long history of how the boy developed.

I also realised that he was unable to sit unless supported by his mother on the bed beside. He could neither stand nor walk, although by that age, he should have been able to do so.

The first impression I got, as I tried to analyse his condition was: “He has delayed developmental milestones.” However, I had to delve into the details of his progress since birth.

Tracing the problem

As I tried to obtain a brief history from his mother, I was informed that on the day the boy was born, he did not cry immediately; like other new born children do.

Usually, if the new-born baby does not cry immediately after birth, it signals something that needs closer follow up, monitoring or rather closer attention.

In this case, I was told that, as a new-born baby, the boy “cried two hours later,” after delivery. Apart from that, I learnt that he was admitted for four days at the hospital after birth. Why?

He had what we call neonatal jaundice—a liver condition that causes yellowing of a new-born baby’s skin and eyes.

But, he was also found to have hypoglycaemia (low blood sugar) for 2 weeks in hospital. That was his history at birth.

Well, last week, when I examined him, one diagnosis stood out—cerebral palsy (CP)—a permanent disorder of posture and movement that results to activity limitation.

Who can suffer from CP?

It is important to know that CP does not just happen. Depending on what happened around the child during pregnancy, childbirth and 28 days after delivery, it can be determined whether the born child will develop cerebral palsy or not.

These are the conditions to watch out during pregnancy: Sexually Transmitted Infections (STIs), HIV/AIDs, conditions linked to high blood pressure such as preeclampsia and eclampsia.

This also includes defects of the placenta which may impair the transfer of nutrients and gaseous exchange between the mother and foetus.

Cases of CP have also been reported among women who abuse drugs during pregnancy.

There is a risk of premature delivery which often leads to low birth weight, low blood glucose level and neonatal jaundice, conditions that may account for cerebral palsy. After delivery, inability to breathe, inflammatory conditions like encephalitis and meningitis, seizures, any birth trauma may lead to cerebral palsy.

With this piece of information, I would like call upon women to always abide by simple preventive measures such as screening for Venereal diseases, HIV/AIDs and attending regular for clinic as scheduled when they are pregnant.

These are among the ways they can be able to monitor for safe and health delivery.

Our role as medical practitioners

On the other hand, it’s our role as medical practitioners to pay close attention during the childbirth so that we can do away with circumstances that can lead to CP.

Children with CP in our country have been a burden as most of families are facing economic hardships.

This means that most of the families fail to take care of the children, in terms of treatment and psychosocial support.

These children are part of the society we live in, unlike people who never think the opposite of this.

I know institutions that have instituted key interventions. The Comprehensive Community Based Rehabilitation in Tanzania (CCBRT) has played a big role in dealing with such disabilities.

This is where the rights of the affected are protected; by assuring affordable quality medical and rehabilitative services, educating the community on the rights of disabled, together with facilitating the disabled to live their full potential.

advertisement

Monday, January 1, 2018

Snoring ruined my marriages

Mark Mukuza posing near his residential area at

Mark Mukuza posing near his residential area at Mabatini, Mwanza.  PHOTO | JONATHAN MUSA 

Mark Makuza snores so loudly while asleep but for many years he did not realise it was a problem until he got married. Doctors say his parents should have intervened when he was still child.

“I got to know that I was abnormal when I got my first wife,’’ says the 36-year-old resident of Misungwi District in Mwanza Region. 

“My wife could poke me several times at night, complaining of how I was making her uncomfortable with the loud noise. She could not sleep peacefully. Later she abandoned me,” he tells Your Health.

As Makuza narrates his ordeal, he recalls his teenage days when some of his relatives and friends appeared curious about his breathing pattern.

None of his parents, says Mukuza, had thought it was a problem that required medical attention.

Not even at school, that Makuza’s problem was detected. “Whenever I dozed off in class, my fellow students just made fun of me. Personally, I thought it was funny too and had nothing to do with my health,’’ said Mukuza.

Months and years passed, he says. The problem became more serious. Then, he got another woman to marry.

In 2009, he courted and married Suzan from Tabora Region.

“I believed Suzan was going to be my life partner,’’ says Mukuza, “But I was wrong. Soon, she started complaining of the snoring too and tried to find ways of coping.”

“At one moment, she had to find a coping mechanism. She could sleep during the entire daytime to compensate for the lost night sleep,’’ he recalls. “Suzan was a nice person to me but she didn’t like my snoring habit. I never took action. I didn’t know it was a problem.”

Mukuza re-married the third time

“I had to remarry in 2011. I felt I couldn’t stay without a wife,’’ he says. “I got Aisha from Tanga Region, but she did not last long in the relationship. She left me. At that point, my mother got so concerned about this,” Mukuza adds.

Parents had to chip in

Mukuza’s parents began realising that something had to be done. However, their decision was to take him to a herbalist in Nzega District, Tabora region, where he was introduced to a herbal concoction of green grounded leaves. This, he says did not help.

Later in the year 2010 Mukuza went to another herbalist in Mabuki ward, about 30 kilometers from his home village. But he did not get any relief.

“I had to pay Sh150,000 and the herbalist convinced me that the problem would be resolved within days,’’ he says.

Hospital admission, then, strange coping mechanisms “Finally, I had to go to the hospital,’’ he says. Mukuza was admitted at Nyamagana District Hospital in Mwanza where he was diagnosed and given instructions on how to sleep at night.

“But this has not helped. It reached a point I thought I was bewitched. I became worried, I feared even to sleep in a lodge because I would disrupt other people’s sleep,” he narrates.

“I later got a single room at Mabatini Street where most buildings are set on hilly areas. I knew that since houses were far apart, my snoring would not disturb the neighbours,” he says.

In 2015, Mukuza found another woman to live with, her name was Monica. With her, he thought of a new technique that would help maintain his relationship.

He found a job as a night guard so that he would use this as an excuse to spend his nights at work. He made all these efforts to ensure he bears a child with Monica.

But, Monica couldn’t cope and left him within a month.  She was always mad at him due to the noise he was making whenever he would be resting after a night at the job.

“I would come early in the morning and have a rest. The moment I slept, I could make a lot of noise. This made Monica frustrated. She believed I could infect her with the problem,’’ says Mukuza, a trained mechanic.

The drama continues

Recently, he tried out another way of living with a woman. “I now stay with another woman, Eunice. But we live in a funny way. After she realised that I have this snoring problem, she tried some ways of coping with me.  She comes in the morning and leaves in the evening,” Mukuza explains his current relationship ordeal.

Did medics treat his problem?

Later, he says, he went to a private health facility at Igoma in Mwanza where again he was introduced to new drugs such as syrups but they did not work.

Mukuza says that during his various visits at the hospitals, he was advised by medics on how to sleep at night and how to reduce his body weight.

“I wondered when one medic told me to change pillows on my bed while I had no pillows,” he says. He admits that, since he began looking for a solution to his poor breathing mechanism, he has never found a reliable one.

Doctors speak out

According to Tabora Regional Medical officer, Dr Gunini Kamba, snoring can be treated but that depends on the extent of the problem.

“One of the basic remedies for people who snore is physical exercises. By practicing this, they will easily lose weight and keep their airways and postures right,’’ he told Your Health.

Dr Leonard Subi, Mwanza Regional Medical Officer, explains how one could end up snoring. As one reaches middle age and beyond, he says, one’s throat becomes narrower. “The muscle tone in the throat decreases. When it’s too late for one to intervene, lifestyle changes, new bedtime routines, and throat exercises can all help to prevent snoring.”

He says that fatty tissue and poor muscle tone contribute to snoring. Even if one is not overweight in general, carrying excess weight just around the neck or throat can cause snoring.

“Men have narrower air passages than women and are more likely to snore. A narrow throat, a cleft palate, enlarged adenoids, and other physical attributes that contribute to snoring are often genetic. Again, while you have no control over your build or gender, you can control your snoring with the right lifestyle changes, bedtime routines, and throat exercises,” says.

Another medic, Dr Baraka Maginga of Pasiansi Sabbath Health Centre in Mwanza, the blocked airways or a stuffy nose make inhalation difficult and create a vacuum in the throat, leading to snoring.

“At times sleeping flat on your back causes the flesh of your throat to relax and block the airway. Changing your sleep position can help to reduce snoring,” he says.

Mukuza is currently working in a motor-vehicle garage in the city as a day worker.

advertisement

Monday, December 11, 2017

Uturo village in Tanzania : Where maternal death is a ‘taboo’

 

By Syriacus Buguzi
More by this Author

Memories of graves—small and large—still linger on the mind of Mr Wilson Chotamganga, as he recalls the days he first arrived at Uturo village, Mbarali district, Mbeya region in 1993.

“To me, those were dark days,’’ says the 60-year-old medic who will soon be retiring from his job at the village dispensary he has served for the past 24 years.

“In the 90s, when I was posted by the government to work here [at Uturo Dispensary], I was stunned by the graves that I witnessed at the homes I visited in the neighbourhoods. I later learnt that almost each grave meant the life of a woman or child lost,” he recalls.

“But there was no real data. No proper records of the deaths. All that people were doing was bury the dead—that’s all. We could just count—one, two, three deaths…up to five in a year,’’ he says.

When a woman died with her unborn child, you could hear people say, ‘siyo riziki,’ meaning, ‘It was God’s plan.’That amounted to giving up."

When a child died during birth, at times it was kept as a family’s top a secret. It was believed to be a curse for the family.

“For yet another four years, I witnessed more women dying for reasons that could have been avoided. People here could mourn for so long whenever a pregnant woman died. But then, something struck me. I said to myself; come on!! Pregnancy is not a disease, why then, should this continue to happen?’’ he told Your Health.

After a storm, comes a calm

Behind this sad tale of Uturo memories, lies a success story. One told by Mr Chotamganga and other villagers. That no woman in Uturo has died due to pregnancy-related complications in the past 18 years, as far as the community can recall.

To them, death of a pregnant woman has almost become a taboo. “We don’t want awoman to die in this village,’’ insists Chotamganga.

For over 18 years, no maternal death

In 1998, the residents of Uturo and neighbouring hamlets, covering a population of over 5,000 people, decided to “wage war” on maternal deaths. This was under the co-ordination of the village government, inspired by Mr Chotamganga, a clinical officer.

At that time, a special team of peole who now comprise of 36 members was formed to complete the task. “We named them commandos. They were going to face an enemy of the village—the maternal deaths,’’ says the Village chairman, Mr Charles Mtambalike.

One of the members, Ms Josephina Sakarani, now aged 50, says, “We realised that pregnant women risked their lives by giving birth at home; without assistance from a skilled personnel.”

“The only thing women knew was to endure labour pains and push the baby out of the womb at the time of delivery,” says Ms Sakarani, a midwife who has been working in the community for the past 20 years.

“Women could simply push. It did not matter whether the unborn child was lying in the right position or not. Clinic visits were just a foreign concept. Men didn’t know they had a role to play. But today, all that, is history. The community has changed, male involvement is so high,’’ she says.

“We had to educate the community. We first underwent training. The village health team, led by Chotamganga, sounded a warning to the village. That it was against the village’s norms for a woman to deliver at home.”

Ms Mariam Kipangule, the village health secretary, says the special team—the commandos—were tasked to ensure close monitoring of all pregnant women, fast response for all women carrying risky pregnancies for referrals and mass public health education campaigns to the residents.

This has been going on for years. The village health workers and local authorities are keen on village principles. A family that, for instance, doesn’t adhere to the principles could be fined up to Sh50,000 for a pregnant woman who doesn’t attend antenatal clinic visits.

Today, arriving at the dispensary, one doesn’t have to ask the hospital authorities to provide data—it’s all placed on the walls of the building.

Although, supplied with electricity, most of the information is kept in files. A United States-funded program, Walter Reed, donated a desktop computer which is only used to store data for HIV patients at the Care and Treatment Centre (CTC).

Not privileged, as could be thought to be

However, Uturo is not a privileged dispensary. Mr Allence Mvili, a clinical officer who is now in transition to succeed Chotamganga, says, “Here, we face the same challenges as any other public health facility.” But, there is no waiting for donor support to work on pressing issues, he adds.

“In cases of an emergency, we have to call for an ambulance over 100 kilometers away from here. If it doesn’t come, we, as a community raise funds for a private vehicle,” Mr Mvili says.

“Another big challenge is, the road from this dispensary to where we refer patients in Mlangali ward is in bad shape. As we wait for the municipal authorities to help, we have decided to work on it,’’ he says.

“Residents here have already raised contributions to kick-start the construction of a maternity ward. Currently, delivery is done in an improvised room,’’ he says. It is estimated that the ward‘s construction will cost about Sh300million.

“We could have waited for the higher authorities to come and help build it but, ---until when? Whatever the government brings here, or donor support we get, will be considered as top-up and we will just thank them for it,” he reveals.

Painting a picture of the village

Last week, when Your Health arrived at Uturo village, almost every community member was at work, women carrying stone aggregates and men filling up pot-holes along the 5-kilometre road that heads to the village dispensary.

Led by the village chairman, Mr Mtambalike, Uturo villagers joined forces with the neighboring villages of Mtamba and Ukwama in repairing the road.

“This road was causing delays whenever we wanted to transfer a pregnant woman to the district hospital in cases of emergency. We have decided to act,’’ said Ms Rose Jackson, one of the residents, panting and sweating as she hauled stone aggregates into a truck.

In Tanzania, about 8,000 women die every year due to pregnancy-related complications. Maternal mortality ratio has risen from 432 to 556 per 100,000 live births, according to the 2015/2016 Demographic Health Survey (TDHS).

For many years, communities are still glued on the receiving end of the maternal health services in Tanzania’s struggle to improve maternal health, says Dr Dismas Matovelo, a specialist at the Catholic University of Health and Allied Sciences (Cuhas).

Uturo village has been described by high profile government officials as a learning example as experts say the power of communities is key to dealing with maternal mortality.

The Permanent Secretary of the Ministry of Health, Community Development, Gender, Elderly and Children, Dr Mpoki Ulisubisya, recently asked regional authorities across the country to borrow a leaf from Uturo’s success story.     

advertisement

Tuesday, December 19, 2017

Challenges of dealing with molar pregnancy in Tanzania

 

By Salome Gregory

Amina Salumu, 35, was two months pregnant but her belly grew big, as if she was in her second trimester. With this, she had severe nausea and severe abdominal pain including high blood pressure. She sensed something wasn’t right.
Upon attending her first clinic at the Muhimbili National Hospital (MNH), the gynaecologist advised she does an ultrasound [a type of safe and painless scanning that produces pictures of the inside of the body using sound waves] to know what the problem might be or to rule out any concerns.
That day, Amina sat in the queue for more than four hours, but she was not one among the lucky ones to get the scan done.
The following day, the case was no different. The queue and unbearable pain made her resort to a plan B. Amina decided to look for another clinic, outside the gates of MNH. She was successful to get the ultrasound done. When she took the results back to her gynaecologist, Amina was told that she had ‘molar pregnancy’, a condition she wasn’t familiar with and that daunted her.
“I was very worried about the condition. To make it worse, when I googled about the condition soon after I left the doctor’s room, I learnt that it can result to cancer and I was about to collapse. I had to wait for my husband to come for me as I couldn’t manage to go back home alone,” she recalls the four-month back incident.
Dr Living Colman, a gynaecologist based at MNH explains to Your Health that a molar pregnancy occurs when something goes wrong during the initial fertilisation process and the placenta or the foetus do not develop properly. It appears as a grape-like cluster.
“There are usually two types of molar pregnancies, complete and partial. With complete molar pregnancy, there is no baby in the uterus but only parts of the placenta are formed after the fertilisation of an empty egg.
Partial happens when the abnormal cell and embryo has birth defects. The condition is curable if there is early treatment; However, it has serious complications if not well taken care of and can result to the formation of a rare form of cancer,” Dr Colman tells.    

What steps did Amina take?
A week later, Amina went through vacuum aspiration [a suction method to remove tissues from the uterus which cost her between Sh150,000-Sh200,000. After that process she went on methotrexate medication for four weeks. Single dose went between Sh35,000-Sh70,000. And currently she is on a follow-up procedure to monitor the human chorionic gonadotrophin (hCG) levels.
“You can just imagine how expensive it is. The hCG test goes for Sh40,000. In a month I had to do four of them to ensure the mole tissue were completely removed and the blood remained clean,” says Amina.
Dr Colman adds to this. He says that it is important for the hCG levels to be monitored as it is the only way to trace if the condition has completely cured. If traces of mole remains, it can begin to grow again and create cancerous-type threat to other parts of the body.
“After the removal of the molar pregnancy, one should avoid trying to conceive at least for a year. A woman can use any birth control except intrauterine device,” Dr Colman gives a tip.
Treating molar pregnancy is very expensive and has a lot of stages to follow. If not treated on time, it can result to cancer (choriocarcinoma).
“Molar pregnancy treatment starts from diagnosis to its treatment. The pregnancy has to be removed if not miscarry as in most cases they don’t go up to five months.
If it happens there is no miscarry, a patient has to go through some medication to help the uterus release the pregnancy,” Dr Colman says.
According to Dr Colman, vacuum aspiration has to be done to remove molar pregnancy by opening the uterus and have it checked to make sure all molar tissues have been removed. After this process a woman has to go through a medication called methotrexate.

When molar pregnancy turned cancerous
Maria Joseph, 32, also experienced molar pregnancy just a month ago. With her, it took four months exactly to diagnose. She had a very big belly and sometimes would see vaginal spotting, yet she was under assumption that it was normal.
“I never took it seriously, however, the pain would come and go. When the pain was severe, I decided to go to the hospital. Though I was treated with extra care, my doctor was not happy with me for staying at home for so long without consulting him,” says Maria.
She says, same day through the ultrasound they realised it has extended to chronic molar pregnancy that left my life into a cancer stage.  I went through the vacuum aspiration. And currently I am on three types of medication, including methotrexate.
Maria regrets taking the decision late, “ I feel guilty of ignoring the early signs to a point that led to putting my life in danger.”
Maria’s single dose of medication goes for Sh100,000-Sh200,000. Each follow up check-up to observe whether molar pregnancy is successfully removed, cost her up to Sh135,000 per visit excluding other basic expenses like transportation. The hCG test, as aforementioned by Amina goes for Sh40,000. Full blood picture for Sh15,000  and other tests to check the status of vulnerable organs like liver and kidneys goes for Sh80,000.
Commenting on her treatment, Dr Colman says that if she follows doctor’s advice, she will be completely cured. The type of cancer resulted from molar pregnancy is curable only if a patient will follow treatment procedures.
“It is important for all women to attend their maternity clinics soon after they realise they are pregnant. This will help them know if they are in a good condition or not,” says Colman.

sgregory@tz.nationmedia.com

advertisement

Tuesday, December 19, 2017

Here’s why vitamin D matters for good health

Fatty fish is a good source of Vitamin D. PHOTO

Fatty fish is a good source of Vitamin D. PHOTO | WEB 

By Devotha John

Vitamin D is a nutrient that falls under a group of fat soluble vitamins, the kind that are stored in the body for long periods of time. Other vitamins in the same group are A, E and K.
Such kind of vitamins are absorbed along with fats in the diet, explains Neema Shosho, a Nutritionist based in Dar es Salaam.

Do I need vitamin D?
Yes. Our bodies need vitamin D. Some of the key functions of Vitamin D is to boost immune system of our bodies (fight off invading bacteria and viruses) and to maintain strong bones.
 Vitamin D helps the body to absorb calcium (one of bone’s main building blocks) from food and supplements.
People who get too little vitamin D may develop soft, thin, and brittle bones, a condition known as rickets in children and osteomalacia in adults.
Children with rickets experience delayed growth, pain in the spine, pelvis and legs, muscle weakness and skeletal deformities such as bowed legs or knock knees. Vitamin D is also needed by nerves to carry messages between the brain and every part of the body.

In which foods can one get vitamin D?
Vitamin D is naturally present in very few foods. Good sources of vitamin D is fatty fish while small amount of vitamin D can be found in beef liver, cheese, mushrooms and egg yolks. It can also be found in some fortified foods, so read the labels carefully when you are buying such foods. 

Does the sun provide vitamin D?
When skin is directly exposed to the sun, the body makes vitamin D. This way, it has helped most of us to get vitamin D naturally.
 So yes, the sun is important for vitamin D synthesis.
However, we need to be careful not to be exposing ourselves to too much sunlight in order to lower the risk for skin cancer.
That is why I always advise people to go for ‘jua la asubuhi’ (early morning sun) and not waiting till the sunlight and heat is unbearable.
Remember that people who avoid the sun or who cover their bodies with sunscreen or clothing should include good sources of vitamin D in their diets or take a supplement.

Is there anything like too much vitamin D?
Yes, too much of anything is harmful, Ms Neema says. Vitamin D becomes too much when the amounts in the blood become too high and mostly occurs to people who overuse supplements. 
As a result, you might experience nausea, vomiting, poor appetite, constipation, weakness, and weight loss.

Key take-aways
• Vitamin D is naturally present in very few foods.
• Exposure to sunlight is a good source of vitamin D; other sources are supplements and fortified foods.
• Vitamin D deficiency causes rickets, where the bones become soft and bent in children and osteomalacia in adults, causing bone pain and muscle weakness in adults.
• The amount of vitamin D you need each day depends on your age.
• Remember that Vitamin D is needed more as we age.

yourhealth@tz.nationmedia.com

advertisement

Tuesday, December 19, 2017

Four golden rules to follow to cut the risk of getting cancer



Dr. Christopher Peterson

Dr. Christopher Peterson 

By Dr Chris Peterson

I admit that awareness on cancer still needs to be spread evenly in our societies especially when it comes to how people can avoid cancer risks mainly related to lifestyle habits.
Cancer is not entirely genetic and it can be highly avoided by only maintaining daily lifestyle habits like what to feed in and other environmental factors.
First of all I would like to write about my heart-felt appreciation in today’s column that goes out to my readers for positive feedback on my article  titled and published in this column, “You are what you eat; What does this mean in the language of cancer?”
In the aforementioned article, I highlighted on eating habits that may put you in the risk of getting cancer.
It is my pleasure to know that the article was informative for you.
Today, however, apart from eating habits, I would like to go an extra mile to share with you other tips that may help you, my dear reader to avoid cancer risks.


• Get a regular cancer screening done including the screening test that can help detect cancer before it causes any symptoms. For men aged between 15-35, a periodic testicular exam along with regular self-exams should be done. All men older than 50 should have regular screening for colon cancer, and should make an informed decision about testing for prostate cancer.


• Avoid exposures to cancer-causing substances. Radiation exposures and some chemicals are known to cause cancer. Get medical imaging only when you are recommended to them.
Protect yourself from ultraviolet radiation in sunlight, which increases the risk of melanomas, and other skin cancer.


• Keep your alcohol consumption low or better quit it if possible. Keeping alcohol intake to the minimum daily level doesn’t mean that you can “save up” all your drinks for a week  and binge on Friday night with your weekly “allotment.” Excess alcohol increases the risk of cancers of the mouth, larynx (voice box), oesophagus (food pipe), liver and colon; it also increases women’s risk of breast cancer.


• Avoid use of tobacco products, including smoking. If you have tried to quit before, don’t give up. Eventually something will work. Smoking also increases the risk of many  alcohol-induced malignancies.

sonchrispeter@gmail.com

advertisement

Tuesday, December 19, 2017

A virus responsible for many cancer cases

Illustration showing how HPV is responsible for

Illustration showing how HPV is responsible for causing various types of cancer and to what extent. INGOGRAPHIC | CANADIAN CANCER SOCIETY 

By Jonathan Musa

There are growing concerns about the Human Papilloma Virus (HPV), a sexually transmitted virus threatening Tanzanian women.
The disease, which is still unknown to many Tanzanians, has become the most common sexually transmitted virus, putting many women at high risk of developing cervical cancer.
According to Dr Nestory Masalu, an Oncologist at Bugando Medical Center (BMC), the virus has no cure yet and is spread through vaginal, oral and anal sex.
Without giving figures on patients admitted with HPV complications at the facility, he said the virus has become so common that nearly all sexually active women get it at some point in their lives.
“The HIV agenda has been pushed so much that we may have forgotten about other equally deadly sexually-transmitted viruses such as HPV,” says Dr Masalu.
On her part, Nyamagana district hospital’s doctor in charge, Agnes Mwita explained that HPV also causes non-cancerous, nipple-like bumps called warts on the skin in the genital area or in other parts of the body as well as ulcerations.
She said the ulcerations may make women more vulnerable to other sexual transmitted diseases (STI’s) such as HIV.
“Unlike other STIs, HPV infection causes havoc silently. It does not produce any symptoms until at advanced stages when it has caused cervical cancer. Men often carry the virus, and transmit it to women during sex. In men, the infection is linked to penile, anal and throat cancers, though cases are still rare in Tanzania,” said Dr Mwita.

An alien virus
Despite the huge dangers posed by HPV, an overwhelming majority of Tanzanians remain unaware of the virus and how to protect themselves.
Dr Mwita, however, said that due to exposure to early sexual intercourses on youth, the pace has on HPV infections has multiplied especially on young ladies.
“A patient with HPV virus will automatically have a very low immunity and thus the mechanism to fight against other diseases will be very weak,” she informed.
One of the health experts in Mwanza regional hospital, who claimed for anonymity, said the facility admits about five to ten patients with HPV cases daily.
He added that it has become more challenging to discover the virus because of its symptoms which are related to other sexual transmitted diseases. This is more serious in rural parts.
“HPV, I can say is a new disease to many people, so getting to differentiate it from other related diseases become so tricky,” he said.

Victim’s testimony
Mwajuma Jafariah, 36, a mother of four was detected with the virus, the symptoms in certain cases might delay to be noted unless diagnosed by a specialist.
“I had some genital warts which appeared as small bump. They could appear and disappear, it reached a situation where I started feeling pain in my genitals and hence seeked for treatment at Bugando,” she tells.
Mwajuma further reveals in the interview that doctors advised her to use salicylic acid to treat some warts developed in private parts but generally, there is no treatment for the virus and instead symptoms can be treated.
Dr Masalu sheds light into Mwajuma’s signs and symptoms. He says that it is also important to note that, although warts and cellular changes may be removed or resolved, the virus can remain in the body and can be passed to others. There is no treatment to remove the virus from the body.
“Common symptoms of some types of HPV are warts, especially genital warts. Genital warts may appear as a small bump, cluster of bumps, or stem-like protrusions. They commonly affect the vulva in women, or possibly the cervix, and the penis or scrotum in men. They may also appear around the anus and in the groin,” Dr Masalu.
Other types of HPV can increase the risk of developing cancer. These cancers include cancer of the cervix, vulva, vagina, penis, anus, and oropharynx, or the base of the tongue and tonsils. It may take years or decades for cancer to develop.

yourhealth@tz.nationmedia.com

advertisement

Tuesday, December 19, 2017

Dear doc, can stress make me catch diseases so easily?



Syriacus Buguzi

Syriacus Buguzi 

By Dr Syriacus Buguzi

I  was confronted with a question last week when I met with Mr  Zuberi, an avid reader of Your Health and a resident of Kijitonayama in Dar es Salaam.
“Hey! What’s up doc, I have always heard that stress can cause someone to have low body immunity. That someone who is always stressed, is prone to minor illnesses, such as flue. How does that come about?”
Well, behind Zuberi’s thirst to know, lies a health problem that people have been grappling with, unknowingly.
“A healthy mind, means a healthy body,” so the saying goes and that’s why depression, one of the mental health disorders, is referred to as a ‘whole-body disorder.’
But, before going into the Why’s and How’s as per Zuberi’s question, it’s important to know that the immune system is the body’s defense mechanism for keeping us protected and safe from germs, such as the bacteria and viruses.
But, stress alone cannot make you catch a cold or flu virus.What it does, is weakens the immune system’s ability to respond to invaders, such as the bacteria I mentioned, leaving your body more vulnerable to infection.
It’s a complex interaction that scientists tend to refer to as psychoneuroimmunology. Don’t worry about the big word. It can be simply put.
Here is what really happens.
When a stressor attacks your body, there is usually a feeling that you are “under attack.” Then, stress hormones cortisol rise in response to the perceived attack. The rise of the hormones shouldn’t be a problem.
However, if this feeling persists for a long time, the body may be over-exposed to the cortisol and other stress hormones.
This affects cells of the immune system, making it unable to respond normally and thus increases the risk of further health problems.
 But, the problem may not be direct.
Stressed people may resort to unhealthy coping strategies, such as smoking cigarettes or drinking too much alcohol.
They may also eat too much sugar. Worse still, is when they don’t sleep properly and give up on exercising and healthy social activities. This takes a big toll on their health.
So, when stressed, eat healthy foods. Choose natural foods, such as fruits, vegetables, whole grains, beans, seeds, and nuts.  
Limit refined sugars that are known to weaken immunity, such as caffeine, alcohol and processed foods.
Exercise regularly. Exercise is known to improve immune system and helps the body release “feel good hormones” that help in combating stress.It is advised that you take 30 minutes of aerobic exercise and 5 to 10 minutes of passive stretching daily. But don’t overdo it, since too much intensity without adequate breaks will suppress immune function and increase stress, instead.

six.buguzi@gmail.com

advertisement

Tuesday, December 19, 2017

Secrets to keeping kidneys healthy



Dr Punatar

Dr Punatar 

By Dr Priyank Punatar

Don’t we all want to live a good and healthy life? And if we could do so by taking care of a specific organ in our body, how easy would that be? I am talking about kidneys, the most fundamental organs of the human body.Mostly functioning in a pair, our kidneys are constantly working to ensure smooth and efficient functioning of the human body.
Kidneys are such an important part of the human body that the blood flow in the kidneys is higher than the blood flow in heart, liver and brain.
Before we look into the basic steps of how to keep our kidneys healthy, we first need to understand why it is important to have healthy kidneys.


The 5 most important and major functions of the kidneys include:
1. Regulation of fluid volume: Excreting excessive fluid in the body through the urine. Hence, poor functioning of the kidneys lead to swelling of the legs and face due to accumulation of excess water in the body.
 2. Excretion of toxins and waste products: Nitrogenous wastes (urea) is excreted by the kidneys in the urine which accumulates in the body from different foods we eat.
 3. Manufacture of Vit D: That is important for the regulation of calcium levels in the body. It is vitamin D that enables us to absorb calcium from our foods and dairy products making our bones and teeth strong.
 4. Manufacture of red blood cells and blood: Kidneys are known to produce an important hormone called Erythropoietin which is used for manufacturing blood cells in the body and to keep our haemoglobin levels within the normal range.
 5. Regulation of blood pressure: High BP can affect the kidneys and as a vicious cycle, damaged kidneys can negatively affect the BP and cause it to rise. Kidneys play an extremely important role in regulating our BP.

How do we keep our kidneys healthy?
• First and foremost, by regularly getting urine and kidney function tests done in order to ensure that everything is running smoothly in our body and if not, to catch kidney damage in early stages.
• By maintaining our blood pressure and blood sugar levels under control in order to avoid constant damage to our kidneys. According to World Health Organisation, by 2030, 2 out of every 5 people (i.e. 40 per cent) suffering from Hypertension or Diabetes or both would also be suffering from irreversible kidney damage.
• By avoiding long-term use of strong self-prescribed pain killers i.e. NSAIDs (Non-steroidal anti-inflammatory drugs) like: Diclofenac, Ibuprofen, Naproxen, for mild to moderately bearable pains, unless prescribed by a doctor and antibiotics like: Gentamycin, Amikacin, etc.
• By making good and healthy dietary decisions of drinking plenty of water during the day in order to facilitate the filtration of toxins and waste products in the body by the kidneys, by reducing salt intake and by avoiding daily over-consumption of red meats (beef, mutton), which tend to have a damaging effect on the kidneys.
 Kidneys are amongst the most integral part and organ of the human body because long-term damage done to them is irreversible and comes with major health complications and very poor quality of life.
Treat your relationship with your kidneys as a marriage – do not take them for granted; you look after them and in return your kidneys will take care of you.

priyank.punatar@gmail.com

advertisement

Monday, December 11, 2017

Here’s what should go on a diabetic’s meal plate

A photo illustrating the plate method. PHOTO |

A photo illustrating the plate method. PHOTO | DIABETES FORECAST 

By Lugano Wilson

Edwin*, a 29-year-old man from Chemba district was referred to Benjamin Mkapa Hospital. He was a known diabetic on insulin treatment irregularly for past three years whose blood glucose was swinging/unstable.
Doctors diagnose diabetes mellitus  using the World Health Organisation’s criteria, which include symptoms of high blood glucose such as polyuria - excessive urination, polydipsia - excessive drinking/thirst, unexplained weight loss, visual blurring, genital thrush and lethargy.

A diabetic meal plan
Edwin’s main problem was poor choices of food he made that wasn’t compatible with his condition. He represents one among the many diabetes patients in Tanzania who don’t have the right information on how to plan their meals.
Thus, in today’s article, I will grossly focus on diabetic meal planning.
Edwin, as I mentioned earlier had swinging glucose levels, yet he found himself eating rice and at times bread frequently since he said that he felt hungry often.
Thus I advised him to focus on food from all groups with fewer calories about the same amount of carbohydrate at each meal/snacks and eating healthy fats.
I sketched out for him a diabetic meal plan using Plate Method. This method advices the following:
Half a plate to be portion of non-starchy vegetables with quarter a plate moderate portion of proteins and quarter a plate of starch (low carbohydrate foods).
I had to allude to some groups of the aforementioned foods.

1. Vegetables
Go for fresh or frozen vegetables without added fats/salts. Non-starchy vegetables include dark green and deep-yellow vegetables such as spinach, broccoli, lettuce  and cabbage.

2. Fruits
Choose fresh or frozen without added sugar or dried fruits. Try apples, grapes,  water melon, pawpaw and drink juices that are 100 per cent fruit with no added sweeteners or syrup.


3. Grains
Whole grains or refined grains? Here I insisted to Edwin that “Dona ni nzuri kuliko Sembe” (maize whole grains are better than maize refined grains). Whole grains are unprocessed and have entire grain kernel and have lots of fibres; fibers in diet keep your blood sugar from rising too fast.
So whole grains are preferred to refined grains.

4. Proteins
Protein food includes meat, poultry, seafood, eggs, beans, peas, nuts, seeds, and processed soy beans.
Eat fish and poultry more often, but remove the skin from chicken and turkey. It’s wise to trim all the visible fats from the meat (what an arduous task !).
Do note that the meat should be baked, roasted, broiled, grilled or boiled instead of frying. Select lean cuts of beef, pork.

5. Dairy
Choose low fat or non-fatty dairy products. Beware that milk, yogurt and other dairy foods have natural sugars even when they do not contain sugars.

6. Oil and Fats
Avoid or limit bad fats/saturated fats such as hamburgers, beef-fried food, bacon, and butter. Instead choose foods that are high in unsaturated fats such as fish, nuts and vegetable oil.
It’s important to know that oil can raise sugar but not as fast as starch.

7. Alcohol
Most diabetic patients do ask this question whether they should stop alcohol or not.
If  you choose to drink alcohol, limit the amount and have it with a meal instead of empty stomach.
*Not his real name

The author is a Medical Doctor and a public health activist now based in Dar es Salaam.

advertisement

Monday, December 11, 2017

Five major causes of child death in TZ

Data showing neonatal deaths. INFOGRAPHIC |

Data showing neonatal deaths. INFOGRAPHIC | WORLD HEALTH ORGANISATION 

By Ali Khatau

High rate of child mortality is a major problem in most low and middle income countries around the world, including Tanzania.
The United Nations Children’s Fund (UNICEF) reports that the under-five mortality rates in Tanzania dropped from 112 deaths per 1000 live births in 2005 to 81 deaths per 1000 live births in 2010.
Deaths of infants less than one year also decreased from 68 to 51 per 1000 live births over the same period according to UNICEF but these are still quite significant numbers.
The ministries responsible have already taken and still continue taking steps to ensure the reduction of the child death rates in their respective countries.
The steps taken include ensuring extensive immunization programs for children against common diseases, providing vitamin supplements, encouraging use of treated mosquito nets and better anti-malarial drugs.
Sadly, UNICEF mentions that despite improvements, close to 400 children less than five years die every day of preventable and treatable conditions. Around 8000 women die annually during childbirth and pregnancy from treatable and preventable conditions.
The following are the top causes of deaths in children in Tanzania:
• Neonatal conditions
The neonatal period includes only the first 28 days of life but accounts for 40 per cent of all under 5 child deaths according to the data from World Health Organisation (WHO).
Among the various different neonatal conditions that can possibly occur, there are three, which according to WHO are the major contributors to the global burden of disease and includes premature birth, birth asphyxia and neonatal infections. WHO defines premature birth as all births before completing 37 weeks of gestation.
• Pneumonia
Pneumonia is an infection of the lungs that can be caused by various micro-organisms including viruses, bacteria and fungi. Symptoms of this condition include cough, fever, chest pain and difficult breathing. WHO reports that worldwide, this condition was responsible for deaths of more than 920,000 children in 2015. The best ways to prevent pneumonia according is by immunization and ensuring adequate nutrition so the child can develop a strong immunity.
• Diarrhoea
According to webmd.com, viruses are the most common cause of loose-watery stool in children. Diarrhoea is very dangerous particularly because it can easily lead to dehydration due to excessive fluid loss. UNICEF mentions that diarrhoea is the leading cause of death in children under 5 accounting for 1,400 child deaths a day or more than 520,000 child deaths a year globally.
• Malaria
Malaria, as we all very well know, is one of the deadliest diseases not only in Tanzania, but also on the African Continent. A 2015/16 Tanzania Demographic and Health Survey and Malaria Indicator Survey (TDHS-MIS) report shows the prevalance of malaria has increased in children under 5. The report attributes the drastic increase to decline in use of mosquito nets and lack of distribution of the nets to households.
• AIDS
The condition is an advanced level of infection with the HIV virus is affects millions of people worldwide. UNICEF mentions that around 99,000 HIV positive women give birth annually in Tanzania and around 160,000 children under 15 years are living with HIV. Around 2 million children have been orphaned due to the disease.
Local and international organisations are working tirelessly to ensure a significant reduction in the diseases that lead to the deaths of the future of our continent.

 alikhatau@hotmail.com

advertisement

Monday, December 11, 2017

Government should cast special eye on cost of cancer treatment



Dr. Christopher Peterson

Dr. Christopher Peterson 

By Dr Chris Peterson

Over the past decade, our knowledge of the genetic aspects of cancer has dramatically grown. There are now new forms of targeted remedies that are leading to clinical progress for thousands of patients with cancer.
Additionally, our knowledge of complexities of cancer treatment has dramatically increased, and new immunological therapies for cancer are generating surprisingly strong results. My special thanks to our dear government for this initiative.
However, on the other side of the coin, the rising healthcare costs leave a growing number of cancer patients - both uninsured or with insurance without the financial coverage they need.
Thousands of people are diagnosed with cancer each year in Tanzania and it’s one of the five most costly medical conditions. This forces many patients to make decisions about their healthcare and cancer treatment based on the finances and not on what is the best for their health.
Once diagnosed with cancer, whether insured or not, people face significant and sometimes devastating hurdles to receive timely, affordable treatment in our health care system.
Cancer patients require a lot of services: infusion therapy, medication, surgery and ongoing care from doctors.
I spend a lot of time with my patients talking about options on what they can and can’t afford. As doctors, we are constantly juggling for what is best for patients, versus what they can afford. Whether or not, healthcare reform will help fix this problem remain to be seen.

The cost keeps rising
I therefore argue the government to rationalise the cost of cancer treatment. One of the biggest challenges in clinical cancer care, especially in Tanzania, is the cost of new drugs. Over the past ten years, the cost of cancer therapy has dramatically risen.
Dr Syriacus Buguzi in his article ‘Cancer patients dig deeper to pay for treatment at ORCI’, published in The Citizen, shows vividly how the cost of cancer treatment is a burden to low income earners.
Dr Buguzi points out in his article that 75 per cent of cancer patients at the ORCI (Ocean Road Cancer Institute) reported in the advanced stages of their disease condition, and more are frustrated by high cost of cancer treatment.

Many of the medical advances that allow cancer patients to live longer come at higher cost. Some of the newer drugs cost upwards of millions of money for a single cycle of chemotherapy, prices most uninsured people can’t afford.
Even patients who do have insurance often have to pay more than 50 per cent of the recommended cancer treatment.

sonchrispeter@gmail.com

advertisement

Monday, December 11, 2017

Recognising warning signs of suicide

 

By Kammu Keneth

Many people posses fleeting thoughts of death. Fleeting thoughts of death are less of a problem and are much different from actively planning to attempt a suicide [the act of intentionally causing one’s own death]. Your risk of suicide is increased if you think about death and killing yourself often.
Most people who seriously consider suicide do not want to die. Rather, they see suicide as a solution to a problem and a way to end their pain. People who seriously consider suicide feel hopeless, helpless and worthless. A person who feels hopeless believes that no one can help with a particular event or problem. A person who feels helpless is immobilised and unable to take steps to solve problems. A person who feels worthless is overwhelmed with a sense of personal failure.
According to the 2015 World Health Organisation (WHO) data, close to 800,000 people die due to suicide every year, this is one person every 40 seconds. Suicide is the second leading cause of death among 15-29 year olds globally.
Suicide has now been defined as a global phenomenon. WHO further suggests that 78 per cent of suicidal cases occur in the low and middle-Income countries. There are indications that for each adult who died of suicide there may have been more than 20 others attempting suicide.

Warning signs
Talking about wanting to die or to kill oneself, feeling hopeless or having no purpose, feeling trapped or being in unbearable pain, talking about being a burden to others, increasing the use of alcohol or drugs, acting anxious, agitated or reckless, sleeping too little or too much, withdrawing or feeling isolated, showing rage or talking about seeking revenge, displaying extreme mood swings and looking for a way to kill oneself.

Causes for increased suicide risk
Many factors increase the risk for suicide. These factors are separated into three categories:

• Bio psychosocial factors
Bio psychosocial causes account for most suicides and attempted suicides. These causes include mental health disorders such as depression, bipolar disorder, schizophrenia, anxiety disorders and personality disorders.
Additional bio psychosocial causes include, substance abuse, childhood abuse or trauma, family history of suicide, previous suicide attempts, having a chronic disease.

• Environmental factors
Environmental factors that increase the risk for suicide often occur due to a stressful life event. This may include the loss of a person, pet, or job. Other causes include, social loss, such as the loss of a significant relationship, access to lethal means, including firearms and drugs being exposed to suicide, being a victim of harassment, bullying, or physical abuse

• Sociocultural factors
One of the main sociocultural causes of suicide is the feeling of being isolated or of not being accepted by others. Feelings of isolation can be caused by sexual orientation, religious beliefs, and gender identity.
Other possible suicide catalysts in this category include, difficulty seeking help or support, lack of access to mental health or substance abuse treatment, following belief systems that accept suicide as a solution to personal problem exposure to suicidal behavior

Protective factors that help reduce suicidal behaviour
Strong, positive relationships with parents and guardians – feeling secure and supported, connections to other non-parental adults, closeness to caring friends, academic achievement, school safety, feeling a sense of belonging to something bigger than themselves – community, culture, religion, sports team, neighbourhood safety, awareness of and access to local health services.

The author is based at Hubert Kairuki Memorial University.

advertisement

Monday, December 11, 2017

Why antenatal care shouldn’t be taken for granted



Syriacus Buguzi

Syriacus Buguzi 

By Dr Syriacus Buguzi

Last week, I travelled to a village in Southern Tanzania where, at one point in history, women didn’t believe in going to a clinic for antenatal care [the care you get from health professionals during your pregnancy].  It was until they were educated about it, that they had to reform and realise how a visit to a clinician during pregnancy can greatly reduce the risk of maternal death.
It is recommended that care during pregnancy should start as soon as a woman finds out that she is expecting.
This is because, having a healthy pregnancy is one of the best ways to promote a healthy birth.
It even becomes more important when a woman and her husband are fully engaged—this, I realised, during the same tour I made in Uturo village, Mbarali District, in Mbeya.
Men and women are committed, and, this has come with a lot of successes. Coupled with other public health interventions, the community has been able to cut down maternal mortality to ‘zero’ for over 18 years.
When a woman and her partner make a clinic visit together, it’s a time when both can ask questions to the  health workers, make regular check-ups, meet other expecting parents and make new friends but above all, share experiences on what to expect.
In Tanzania, four antenatal visits are recommended, for the sake of improving pregnancy outcomes by identifying and managing pregnancy related complications early. However, attendance is not enough—sticking to appointments is essential to determine if the unborn baby is healthy and whether the pregnancy is progressing well.

Benefits of antenatal care:
• Minority of pregnant women develop complications such as hypertension and diabetes. Early diagnosis means they can be properly monitored and treated.
• Provides caregivers with an opportunity to explain the importance of proper nutrition during pregnancy and breastfeeding to the expecting mothers.
• It’s a time when expecting parents gain insight and get fact-based information on pregnancy, birthing options, how to care for a newborn baby so that they can make informed choices.
• Antennal care is a package for comprehensive care. The World Health Organisation (WHO) recommends that women should receive tetanus toxoid immunization, intermittent preventive treatment of malaria, deworming, iron and folic acid, and insecticide treated bed nets.
• In HIV-endemic countries, such as Tanzania, antenatal care includes HIV testing and is an entry point for prevention of mother-to-child transmission services.
• Antenatal care attendance is also associated with an increase in facility based deliveries and use of postnatal services.
Make informed choices.

six.buguzi@gmail.com

advertisement

Monday, December 4, 2017

Dispelling the fear of being HIV positive

Melania Mrema in her office in Rungwe. Photo |

Melania Mrema in her office in Rungwe. Photo | Roger Braun 

By Roger Braun

Recalling that day back in September 2007, Melania Mrema was sitting in the church, gathering all her courage. She had known for three years that she was HIV-positive, but had kept it to herself. But on that day, everything changed.
She went up to the pulpit and addressed the congregation at the Moravian church in Rungwe district in Mbeya.
She told them about the death of her HIV-positive husband, about how she found out that she was infected too and about her daily medicine that prevents the virus to spread in her body. When Ms Mrema finished saying the words, some people were in tears, fearing that their fellow Christian would die.
Today when Ms Mrema tells this story to Your Health, she is seated in her office at the Moravian church in Rungwe.
“I was fed up of hiding that I had HIV,” the 56-year-old says. “And I wanted to offer help to those who are affected as well.” And indeed, coming forward inspired others to do the same.

Soon after, seven people – including Ms Mrema, initiated the first self-help group of the church. Since then, Ms Mrema has not only become an HIV activist, but also created the HIV department of the Moravian church in Mbeya region, counting on the support of the Protestant charity Mission21, based in Switzerland.
The goal of the program is two-fold: supporting people living with HIV and stopping the spread of the disease in the three districts Rungwe, Kyela and Ileja in and around Mbeya. Despite some progress in the last years, HIV is still widely spread in Tanzania.
According to the recent UNAIDS 2017 data, there are 1.4 million people currently living with HIV, which equals 4.7 per cent of the total adult population. The virus is especially widespread in the south of the country, reaching prevalence rates of 15 per cent.

Encouraging one another
In the course of the last years, six more self-help groups have been created by the church. The biggest and oldest one is the group called ‘Lusubilo’, which means ‘hope’ in the local language Nyakyusa.
That day when Your Health visited the group in Rungwe, 30 of the 65 HIV positive members convened in a modest concrete building. On a small wooden table, a white candle marked with a cross is burning.
The participants are lined up along the wall, sitting on small wooden benches. “The aim of our group is to sensitise other HIV-positive people to be as open as us,” the acting chairman Frank Lwaga speaks.
To promote this idea, the group would go to funerals or churches. “And when we go there we don’t stay silent, but we sing,” Mr Lwaga says. The group stands up, lining up in rows and starts performing their signature song in the local language Nyakyusa.
The main idea of the song is that a person with HIV doesn’t suffer from a disease, but simply has a weak immune system. “By this we want to dispel the fear of being HIV-positive,” Mr Lwaga says.
He goes on to say that the discovery of the antiretroviral therapy [combination of antiretroviral (ARV) drugs to maximally suppress the HIV virus and stop the progression of HIV disease] and the covering of the costs by the government, enabled HIV-positive people a life without major health problems. He also stresses the importance of the group in caring for each other. “Since we are not alone anymore with the virus, we are not afraid of it anymore.”

Meanwhile, in Kyela district
At another group meeting, this time in Kyela district, it becomes clear that a lot of people still struggle to talk openly about their infection. It is the smallest and latest group, having been built only in February this year. Ten members are present, nine women and one man. This uneven representation of sexes is common. Men are still reluctant to be open about their infection, Ms Mrema says. When asked in the group why there are so many women in the group, the answer is unequivocal. “Most infected men want to carry on having sex with multiple partners,”one woman says. Another woman nods. “For us the health of our family is paramount, that’s why we act more responsible than men,” she says.
Everybody in the room knows people in the community who are HIV-positive, but hide it. It is obvious that they are afraid of losing sexual appeal, if they were to be open about it.
Though some of the members were targets of stigma, they confess that the community with being more aware of the disease and the better understanding have now embraced people with HIV positive as part of them. “There is no discrimination anymore,” a woman who has been living with HIV/Aids for 15 years says. She feels perfectly accepted, while in former times she was called “dead person” in the street. Another woman recalls a funeral where everybody ate from the same big plate while she was given a separate meal. It also happened that other people left the room when she entered. Ms Mrema says people are much better educated about HIV today than in the past. Since they know that the disease can only be transmitted by specific body fluids like blood or semen, they are stress-free when they meet people with HIV.
 To further encourage openness, the church pays every participant of a self-help group a basic health insurance of Sh10,000. They also help them to generate income by establishing Village Community Banks, a cooperative that enables the members to save money and take out loans when they need it.

The innocent ones
 Not every HIV-positive person has contracted the virus in the course of the life. Every year about 10000 babies in Tanzania are born with it. That’s why the church has a special program addressing children. Two of the beneficiaries is the four-year-old Aziza and her grandmother Grace Sunkusa from Rungwe. Aziza had often been sick after her birth. Nobody quite knew why. Then when her mother died, they tested her blood for HIV – and the test turned out positive. Since Aziza takes antiretroviral medicine, her health clearly improved. What remains is the daily struggle for food. Ms Sunkusa is a widow and too old to work, her children don’t have jobs either. “I sometimes struggle to buy even salt or sugar,” she says. It is her main worry that Aziza won’t get enough food to develop properly, given his weak immune system. Thanks to the church, she can afford the transportation to the hospital to get the antiretroviral medicine once a month. When Aziza gets older, the church will also pay for the school material.
 In need of support are also Grina Kapalila and Aniyimike Misasi in Rungwe. Their daughter was only thirteen years old when she became pregnant. One year after she gave birth to little Arun, she left. It was only after her getaway, when the grandparents found out, why Arun had often been sick. He was HIV-positive. As Ms Sunkusa, they are struggling to make a living in general, and on top of that, Arun needs special care.
Before the Moravian church stepped in, Mr Kapalila walked for four hours every month to the hospital and back again to get his antiretroviral medicine. Asked for the future of her two-year-old grandson, she just shrugs her shoulders. “I don’t think about the future,” she says. “I just hope he finds his way in life.”

rogerbraun@gmx.net

advertisement

Monday, December 4, 2017

Here’s what should go in your child’s lunch box

 

By Devotha John

Good food habits set early in childhood can last a lifetime. Lunches provide around one third of our daily nutritional needs, so it’s important to put some thought and planning into them.
Neema Shosho, a Nutritionist based in Dar es Salaam tells Your Health that selecting foods to pack for your school children is always a challenge to many. “I get a lot of questions from mothers and caregivers on what they should include in a lunchbox for their children. Many complain that it is hectic and tiresome to do food/snacks selection and to even understand healthy choices for their children,” reveals Ms Neema.
As a result, most parents opt for easy options such as sausages, chips, andazi, bread plus a bottle of fizzy drink. Ms Neema has also come across parents who pack for their children candies, chocolates and high-sugar snacks almost every day.
“This really saddens me. Yes we go for easy, quick and unhealthy ways but we jeopardise our child’s growth, development and learning,” says Ms Neema.

The right things to pack
Make sure you select foods from different groups:
• Carbs - Your child needs carbs preferably wholegrain for energy and fibre. Include a small portion of brown rice, brown bread etc.
• Include protein rich foods- Your child needs protein for physical and cognitive (brain) growth. Protein builds, maintains, and repairs the tissues in our body. Include a piece of fish or legumes such as beans and peas etc.
• Include plenty of vegetables and fruits. These provides fibre, minerals and vitamins-very crucial for the immunity system and optimum growth of your child. Remember to use fruits and vegetables of different colours as different colours stands for different essential nutrients.
• Include dairy products such as reduced fat milks, cheese or homemade maziwa mgando (yoghurt). These are excellent sources of calcium, which is important for strong, healthy bones.
• Use water as the main drink- it is the healthiest choice. Just make sure it is safe and clean. Water has a lot of health advantages, from digestion of the food to detoxifying the body.
Make sure you involve your child during shopping and preparation of healthy foods and nutritious snacks. They should learn while young that healthy meal is the way to go!

The nutritionist’s message to parents and caregivers
Preparing healthy foods isn’t hard and doesn’t require lots of money. It just needs commitment. What is missing is the knowledge.
 As parents, we also forget that we lead by examples and that our children copy and follow our eating habits. This means we should also adopt healthy eating habits.
Remember to include locally available foods - kiazi, muhogo, ndizi etc. Stop sweating and googling for foods that aren’t even grown in your country. Here is to my fellow parents and caregivers who kept asking where they can get asparagus and the alike for their child: “Explore local choices first, they are actually the best!”
If your child receives meals from school, make sure you have visited school canteen to get a sense of what is been provided to your child.
If we aspire to raise a healthy individual, you should invest carefully in the meals consumed while they are still children.

djohn@tz.nationmedia.com

advertisement

Monday, December 4, 2017

Why the youth still resists condom use

 

By Lugano Wilson

HIV/AIDS and unwanted pregnancy among young people are urgent public health problems still faced in Tanzania.
For instance, the use of condom in Tanzania is met with daunting challenges including inconsistent usage and from my own experience many of the youths don’t use condoms at all.
I recall a university student once telling me that she would rather get HIV than become pregnant, owing to the fact that she might be rusticated/ expelled from studies if she gets pregnant. But if she gets HIV she will not meet the wrath of the law and it will be her own secret.

Here’s the explanation
It seems like the young adults are being coerced to use condoms, simply put they do not like them even though they are aware to the perils of practicing unsafe sex.
A survey published in avert.org, revealed that condom use is still inadequate, with only 34.1 per cent of young men, and 41.5 per cent of young women using a condom in the same year in Tanzania.
I was so flabbergasted when my co-worker admitted that he never uses condoms. When questioned why, the much-touted reason for not using condom is the Swahili assertion that, “huwezi kula pipi na ganda lake” [meaning, you cannot consume candy with its cover altogether], which points out to the fact that there is reduced sensation of sexual pleasure when you use condom.
Of course when viewing the matter from social prism of sexual act, pleasure is an important aspect of sex. Anything that interferes with it can be viewed in a negative way; it’s only natural to want to maximise pleasure during sex. It’s no wonder that many use this as an excuse for not wearing condom.
Nevertheless, a number of research papers disapprove this claim with surveys revealing that both women and men consistently rate sex arousing and pleasurable without a condom.
Further research shows that any reduction of pleasure is usually due to using a condom that’s imperfectly sized.
In one of the incidences, I heard my friend saying that, “mwanamke huyu  anavyooekana hawezi kuwa na ngoma, siwezi kutumia kondomu” [meaning, from the way this woman looks, she must be HIV free, there is no need to use a condom].
Though many Tanzanians are aware of sexually transmitted diseases (STDs), the general public’s understanding of symptoms, effect on the quality of life and the risk of transmission is questionable.
It’s important to recall that many STDs  including HIV/AIDS may be asymptomatic. Rather than taking a gamble on the status of a new partner’s sexual health, why don’t you just use a condom to cut down 98 per cent  of the risk?
So we ought to be aware of the jeopardy associated with the practice of unsafe sex, it is weird that people are still willing to take the risk and not use condom.

Condoms has nothing to do with trust
You might also hear someone say, “you want me to wear a  condom, don’t you trust me?”
Condoms do not represent trust. Lovers always mistake intimacy and trust for safety, it must be construed that trust and intimacy are essential ingredients in any sexual relationship but so is the safety.
Lastly, do not accept to be dragged into unsafe sex for whatever reason, your safety should always come first.
Looking for a way to maximise sexual pleasure with condoms or at least change our thinking  about pleasure is important.
This could be as simple as improving genuine sensation with condoms from suggesting thinner designs to contemporary safe materials. Moreover people should know that safe sex can be good sex for a secured future.

The author is a Medical Doctor and a public health activist now based in Dar es Salaam.

advertisement

Monday, December 4, 2017

Here’s why your child’s teeth might be conditioned to minor colour changes

Dr Emeria Mugonzibwa  is a lecturer of

Dr Emeria Mugonzibwa  is a lecturer of Dentistry at Muhimbili University of health and Allied Sciences 

By Emeria Mugonzibwa

Have you ever come across appearance of faint white lines, streaks or sometimes a brown discolouration on the tooth? If yes, then that’s a common condition that we refer to as fluorosis.
It occurs when younger children consume too much fluoride, from any source such as tap water or artificial sweeteners, over long periods when teeth are developing under the gums.
For instance, you might have noticed that most people who are born and brought up in Arusha, have slight brown stains on their teeth – this is the very same condition that we speak of today.
In moderate to severe dental fluorosis, teeth are physically damaged.

The condition and how it affects people
Intake of excess fluoride, most commonly in drinking-water, can cause fluorosis which affects the teeth, sometimes bones. The severity of the condition is dependent on the dose, duration, and age of the individual during the contact with fluoride.
Strangely enough, low levels of fluoride intake help to prevent dental decay. The control of drinking-water quality is therefore, critical in preventing fluorosis.
Visible teeth fluorosis is characterised by staining and pitting of the teeth. In more severe situations, all the tooth may be damaged. However, fluoride may not be the only cause of teeth enamel defects.
Teeth enamel malformations similar to fluorosis are associated with other conditions, such as malnutrition with deficiency of vitamins D and A or a low protein-energy diet. Eating and/or drinking of fluoride after six years of age will not cause permanent teeth fluorosis.

How does it happen?
People affected by fluorosis are often exposed to multiple sources of fluoride, such as in food, water, air (due to gaseous industrial waste), and excessive use of fluoridated toothpaste.
However, drinking water is typically the most significant source. A person’s diet, general state of health and the body’s ability to get rid of fluoride all determine how the exposure to fluoride manifests itself.

Scope of the Problem
Teeth fluorosis are quite common and it is believed that fluorosis affects millions of people around the world.
People with fluorosis are relatively resistant to tooth decay caused by bacteria, although they may be of cosmetic concern. In moderate to severe fluorosis, teeth are physically damaged.

The author is a lecturer of Dentistry at Muhimbili University of Health and Allied Sciences (MUHAS).

advertisement

Monday, December 4, 2017

Stop asking ‘Dr Google’ if you’re depressed



Dr Punatar

Dr Punatar 

By Dr Priyank Punatar

When was the last time you ‘googled’ your symptoms and thought you had a medical problem suggested by its search results?
It is inevitably tempting for people to nowadays self-diagnose themselves and others with information and medical knowledge when it is just a phone away.
The most common self-diagnosed condition is depression.  
In my practice, over a period of time, I have at numerous occasions come across patients and people who misuse and overuse the term ‘depression’.
Even in our day to day lives, we often hear people say - “I am so depressed”, “oh, this is so depressing” etc.
Is it really depression? Or is it just sadness? Is it just feeling low or sad temporarily? It’s always important to answer these simple questions before labelling someone or something as depressed or depressing.

Depression vs sadness
There is more than a fine line between feeling sad and being depressed and more often than not, people aren’t able to see that line clearly and a lot of emotions and situations are overlapped.
Depression is often misconceived as a symptom; Rather, it is a common and serious mood disorder. It’s not a single symptom, but in fact it causes severe symptoms that affect how one feels, thinks and handles daily activities - such as sleeping, eating or working.
According to the International Classification of Disease (ICD), there is a set criteria put aside to uniformly and accurately diagnose depression.
These criteria is a combination of symptoms and duration of symptoms, which enables a clinician to conclude whether someone is depressed or is he/she simply in a temporary phase of sadness or low mood.

The outlined criteria include:
Persistent sadness and/or low mood, loss of interests or pleasure in activities and hobbies that was exciting and pleasurable previously and fatigue and/or low energy
At least one of the above three main symptoms lasts for two weeks or more, along with any of the following seven associated symptoms:
Low self-confidence, feeling of hopelessness, poor and disturbed sleep, guilt or self-blame, worthlessness and helplessness, suicidal thoughts or acts, poor concentration, focus and indecisiveness, poor or increased appetite and agitation or slowing of movements.
The next time you don’t get a movie ticket, or your favourite restaurant is closed when you plan to have a meal there, take a moment to think about the above before claiming that you are “depressed”.
There are many people out there battling with depression and all they need is some understanding, assurance and empathy.  By self-diagnosing, you may be missing something or you may think there is something wrong with you than what the reality might tell.
Hence, self-diagnosis can have tremendous negative repercussions on a person.
While reading is helpful and informative, it is always best to discuss your impressions with a doctor before you conclude on a particular medical diagnosis for yourself and also before you decide on the kind of treatment you want.

priyank.punatar@gmail.com

advertisement

Monday, December 4, 2017

While battling with cancer, here’s how you can keep stress at bay



Dr. Christopher Peterson

Dr. Christopher Peterson 

By Dr Chris Peterson

Cancer can be among the most stressful life events. The good news is that there is always help and ways to cope with the tension and feelings one goes through.
Sometimes one might not know that he/she is under stress, so it is important to pay attention to the body and the cues it might be sending out. Tight muscles, aching neck, clenched teeth and irritability, stress really does show itself physically. Here are some ways you can lower stressful feelings as you move through cancer treatment.

•Get in touch more often with loved ones
The most common misstep we see is when cancer patients do not communicate their needs or their feelings to their loved ones. I advise cancer patients to be honest and open to their families and friends.
Tell them what you need even if it is a wish for solitude and rest. The same goes for your doctors, nurses, social workers, and other healthcare providers. They have a deep and broad understanding of cancer treatments and are valuable sources of practical information and perspective.

• Get yourself to rely on others
Manier times, people want to remain strong and keep things as they were before the diagnosis. But, difficult as it may seem, this is a time for you to let people take care of you. Ask yourself: if your friend was the patient, wouldn’t you want to show your concern by helping in some way?
So let people do things for you and take comfort in the fact that you are not alone.

• Get spiritual help
Many cancer patients find that revisiting their spiritual or religious beliefs and practices help them to cope with their disease. Revisiting your spirituality might mean reading inspiring stories or poetry, going to services, or simply enjoying and appreciating the being outdoors.

• Engage yourself in mind-blowing activities
Cancer treatment is serious, but you don’t have to give every moment of your day over to the disease. Some people find light exercises like a walk outside, helpful. Continue to take time out for interests such as cooking, wood working, gardening or even gaming. You may even consider to start a new hobby.
These creative outlets helps to turn our thoughts elsewhere and to experience a sense of joy and accomplishements.

sonchrispeter@gmail.com

advertisement

Monday, December 4, 2017

Aiming for a malaria-free generation begins with you



Syriacus Buguzi

Syriacus Buguzi 

By Dr Syriacus Buguzi

The saying, “an HIV-free generation begins with you,” seems to have paid off because combating the disease depends largely on the adherence of people to the prescribed methods of prevention.
This campaign, coupled with what governments and other stakeholders have been investing, clearly explains why between 2000 and 2016, new HIV infections fell by 39 per cent globally, according to data from the World Health Organisation (WHO).
If the same campaign was promoted for malaria, there could be huge improvement in curbing the deaths related to the mosquito-borne disease, which still occur in Tanzania and other countries.
It’s the individual who will decide whether to use the insecticide treated net or not, go for test and treatment or not, clear the bushes and stagnant water around the home or not—it is all about people’s willingness to prevent, which of course comes after years of sensitisation.
In Zanzibar, the Zanzibar Malaria Elimination Program (ZAMEP) has managed to keep the prevalence of the disease as low as less than 1 per cent since 2010, reaching up to 0.003 percent in recent years.
ZAMEP owes this success to community sensitisation, household surveillance of the disease, coupled with the treatment of all cases, emphasis on use of insecticide treated nets and indoor residual spraying. But above all, individuals were willing enough to deal with the disease.
Currently in Tanzania, 90 per cent of the population live in areas that carry a high risk of Malaria transmission, says the National Malaria Control Program (NMCP). If everyone takes it as a responsibility, great achievements can be attained; borrowing a leaf from the Isles—our closest neighbours.
At global level, stakeholders worry that the unprecedented global progress in fighting malaria since 2000 is at stake unless countries redouble their efforts, according to the latest figures released by WHO on Tuesday last week.
The report shows a growing gap between high-burden countries, those lagging behind and those on the path towards malaria elimination.
Rwanda has seen the greatest increase in malaria cases since last year — around 1 million, while Madagascar has the greatest decrease of more than 800,000.
Whereas Senegal and Sri Lanka are showing that beating malaria is possible. Sri Lanka was certified as malaria-free by WHO in 2016, a milestone largely achieved through domestic financing.
Senegal has seen its malaria cases decrease by more than 250,000 since last year.
A nationwide malaria campaign “Zero malaria starts with me” is engaging Senegalese citizens to keep malaria high on the agenda.
So, why should such a campaign not start today in Tanzania?

six.buguzi@gmail.com

advertisement

Monday, November 27, 2017

When babies arrive before time



A mother holding a preterm baby. Photo | Web

A mother holding a preterm baby. Photo | Web 

By Mpoki Thomson

Most mothers dream of the moment of holding their child only seconds after the birth. But for Ruby Kimondo, it was a very long time before she snuggled or gently caressed her first born.
Mother of three and founder of Preemie Love Foundation, Ruby’s first baby was born early, premature. “My baby came at 28 weeks. I had to stay at the hospital for a month and a half after birth,” she tells Your Health.  From the simplest questions about clothing to the tough medical treatments, Ruby was overwhelmed as she never expected to see her child breathe life through a machine.
Due to the struggles she went through with her first birth, Ruby was encouraged to champion the cause of helping mothers who give birth preterm through her foundation.
Preterm birth, also known as premature birth, is when the baby is born too early, before 37 weeks of pregnancy have been completed.
These babies are known as preemies. Ruby started the foundation at the clinic where she was being nursed, by providing psychosocial support to mothers of preterm babies.
Today, working together with volunteers of her foundation based in Kenya, she visits different hospitals such as Kenyatta National Hospital (KNH) and Pumwani. She also connects with mothers with similar cases through social media including home visits. Ruby has so far reached out to more than a thousand mothers, helping them know more about handling their preemies.

Numbers don’t lie
Premature birth is the leading cause of death in children under the age of five worldwide. Babies born too early may have more health issues than babies born on time, and may face long-term health problems that affect the brain, the lungs, hearing or vision.
As the world marked Prematurity Day earlier this month with the theme ‘March of Dimes’, let’s take a look at the state of preterm births in Tanzania.
According to United Nations Children’s Fund (UNICEF), Tanzania has made laudable progress in reducing child mortality over the past decades.
Data from Muhimbili National Hospital (MNH) shows that there has been significant improvement in the death rate of children born premature especially in the last five years (2012-2017). However, neonatal mortality has stagnated, remaining at 29 per 1000 births between 2005 and 2010. Yet the number is too high and unacceptable. No child should die during birth.
Neonatal causes account for 40 per cent of all under-five deaths and are intimately linked to the conditions of the mother, as well as the quality of care received during pregnancy and delivery. Most of the deaths are from birth asphyxia, preterm birth complications, and infections such as sepsis.
Dr Jose Hernandez, an obstetrician-gynaecologist working at the Kangaroo Unit at MNH tells Your Health that 80 per cent of the causes of preterm births are preventable only if the mother of the child plans for the pregnancy six months prior to conceiving and is taken good care of throughout the pregnancy.
The health experts further cautions against the use of unprescribed medicine, intake of alcoholic beverages and using other forms of illegal substances. These all contribute to the increased rate of preterm births. 
Head Nurse at MNH special unit for premature babies, Cleopatra Mtei says that eclampsia is the major reason for preterm births, a condition that Ruby also suffered.
 The nurse also attributes frequent abortions by women as a factor leading  to babies being born preterm due to the weakening of the cervix.
Other possible causes include short intervals between pregnancies, malaria and malnutrition.

Low weight and age of the mother also plays a role as causes of preterm birth.
According to the Director of Nursing at MNH, Agnes Mtau, 20 to 25 per cent of children at the new-born unit at MNH were born premature or with low birth weight in 2016.
Mtau adds that health data in Tanzania indicates 13 per cent of children are born with low birth weight, accounting for 86 per cent of premature deaths. This is due to the fact that babies born premature are more susceptible to health complications which deter their growth.

What’s our situation?
Preterm babies need specialised treatment until they are stable - above two kilogrammes - and healthy enough to go home. But the availability of superior care is a mere reality in Tanzania, mostly existing in top private hospitals.
One infant incubator [a rigid box-like enclosure in which an infant, mostly premature, can be kept in a controlled environment for observation and care]  is meant to house one baby, but because of the shortage, babies spend less than the normal amount of time in the incubators to make room for new arrivals.
The acute shortage of incubators in public hospitals in Tanzania has led to the risky practice of babies sharing this medical equipment. As a result, new-borns are put at risk of contracting deadly infections.
MNH also faces an acute shortage of incubators. As a result, due to the rising number of preterm births, the new-born unit at MNH has been modified to be conducive to them. This has been done through increase of room temperature to the same level as that found in incubators.
According to World Health Organisation (WHO), preterm babies in Tanzania can be saved in large numbers if there’s better handling of mother and child during delivery and during the post-natal period.
Mortality due to prematurity and low birth weight can be reduced significantly through low cost high impact interventions.

Skin to skin contact, a miracle
Tanzania adopted a low cost intervention method as an alternative approach for premature baby-care.
Kangaroo Mother Care (KMC) which was initiated in Tanzania in 2011 is an effective way to meet baby’s needs for warmth, breast feeding, protection from infection, stimulation, safety and love. Thanks to KMC, mothers who can’t afford private health care treatment are able to take care of their preterm babies through skin-to-skin contact.
This is one of the things that Ruby and her foundation do as well, helping the mothers know more about KMC and how it helps with their babies born preterm.
KMC is an idea that was born out of desperation back in Colombia in 1978. It is early, prolonged continuous skin-to-skin contact between a mother/surrogate and her preterm baby. It should be done for a minimum of 20 hours per day. It is a key component of care for preterm and low-birth-weight babies and was introduced to deal with overcrowding in new-born units and inadequate incubators.
Dr Sudha Sharma, Chief of the UNICEF Tanzania Health and Nutrition programme tells Your Health that KMC is the safest place for babies to be nursed in close contact with their mothers – in a similar way to a kangaroo nursing her baby in a pouch.
According to Tanzania Ministry of Health’s Kangaroo Mother Care guideline, KMC for preterm and low birth weight babies is one of the evidence-based and cost-effective child health interventions that contribute to reduction in neonatal morbidity and mortality when implemented at high coverage.
Kangaroo unit at MNH houses preterm babies weighing 500 grams to 1.5kg, even though the number of premature births is very high.

Key elements of kangaroo care
• Positioning: The baby is placed on the mother’s chest between the breasts in an upright position.
• Nutrition: The baby is fed through exclusive breastfeeding. This enhances weight gain.
• Release: The baby is discharged only if she/he meets set criteria, and KMC is continued at home, follow up is done at a nearby hospital.


 mthomson@tz.nationmedia.com

advertisement

Monday, November 27, 2017

Don’t make medication changes on your own



Dr Lugano

Dr Lugano 

By Lugano Wilson

A man aged 54 arrived at the medical outpatient department straight from work with the main complaints of severe headache and blurred vision. He came from Ng’ong’ona village, which is nearby the hospital I worked at in Dodoma.
He appeared sick. His blood pressure was measured and found to be 200/110 mmHg; this reading indicated that the blood pressure was very high. His preliminary diagnosis was hypertension.
Thus, just at the outset I told him that most of the time hypertension comes with no obvious symptoms, so regular checkups is necessary and that he doesn’t have to wait for symptomatic phase of complications.

He wasn’t a fan of medicines
Then after briefing him about the findings, and the consequent plan upon the condition, he asked, “What can I do to get it lowered without taking medicines?” After a lengthy conversation, he at least seemed to be more willing to adhere to lifestyle changes rather than to start taking the medication.
But I told him that he has to do both, start taking medicines and adhere to lifestyle changes.
From his facial expression, I knew that the man was not going to adhere to taking medicines since he insisted, “Don’t give me many pills.” Additionally I advised him to get his blood pressure measured for consecutive five days and to record it somewhere whereby he agreed to do so.
But I made sure that he makes a well informed decision, however he kept on asking, “kwani hizi dawa natumia kwa muda gani?” [ Meaning, for how long do I take these medicines? ]  I told him that it’s for life, I humbly insisted “Hypertension is not malaria, henceforth you have to take them every day unless your doctor tells you otherwise but do not stop taking them on your own.”
In order to alley his fears, I gave him a little comfort. “in case you progress well, your doctor may decide to reduce the number of medicines or cut down the dose or frequency whenever possible.”

But what is hypertension?
Hypertension refers to sustained elevation of blood pressure above normal range, but according to World Health Organisation (WHO), it is defined as blood pressure (BP) readings higher than 140/90 mmHg.
The known risk factors so far are family history, overweight, smoking and increasing age.
There are two types of hypertension, ‘secondary hypertension’ for which there are known causes such as kidney diseases, hormonal/endocrine diseases, some blood vessel diseases and others but in ‘essential hypertension’ there are no known primary causes.
It’s said that secondary hypertension makes about 5 per cent of the general population whilst essential hypertension makes about 95 per cent.
Treatment modality depends on the level of your BP and your risk of developing cardiovascular diseases. If you are having secondary hypertension where there are underlying causes, your BP will be controlled by removing the cause.
In general, lifestyle modification such as exercising  regularly, quitting smoking, reducing the intake of alcohol and having a healthier diet is good for your blood pressure, however, medicines may also be needed especially when your BP is much higher than normal and if your risk of cardiovascular diseases is high.
My advice to you is that do not stop medication without your doctor’s instructions, take them regularly as prescribed to you, know the name and the dose of the medicines you are taking and importantly report any side effect like dizziness, drowsiness, persistent cough and headache among others.
Moreover, the penalty of poor adherence will be high but by the same token the reward for strict adherence will be great, just endure.  
 I know it’s not easy to embark on that journey of taking life-long medicines, but do talk to your doctor about it and I’m sure he/she will find a better way to make it bearable and friendly.

The author is a Medical Doctor and a Public Health Activist now based in Dar es Salaam.

advertisement

Monday, November 27, 2017

Dear men, know when to worry about the lump on your testis



Dr. Christopher Peterson

Dr. Christopher Peterson 

By Dr Chris Peterson

In this column, I’ve once talked about key cancer warning signs that should NEVER be ignored. And when it comes to testicular cancer particularly, a lump on a testicle is seen as one of the key warnings. Of course it is! But don’t panic.
According to a recent research done by the American Cancer Society (ACS),  four out of five testicular lump examinations are benign, meaning they are harmless and certainly not testicular cancer and this resembles the same graph in Tanzania. However, if you notice a lump on the testicle, precaution should be taken.

Let’s look at the symptoms
The most common symptom of testicular cancer is a painless lump on or in a testicle. If your lump is painful, it is good news. But few of the testicular tumours might cause pain. Men with testicular cancer may also have a heavy arching feeling in the lower belly or scrotum.
There are actually a lot of possible explanations for lumps on or in your testicle(s) beside cancer. Because it is hard to figure out the cause based on symptoms alone; it is important to have changes checked by a healthcare provider.

Conditions that can cause a testicle lump, swelling, and/or pain:
• One of the very common condition that can cause testicular lump is ‘torsion’ of the testicle. In testicular torsion, one of the testicles gets twisted inside the scrotum. This cuts off the blood supply to the testicle and other structures, leading to sudden, severe pain in the scrotum along with swelling and redness. Torsion is a medical emergency that needs to be treated right away.
• Physical injury and infection may also trigger testicle lump and pain. Injury to the scrotum or testicle, can cause pain right away.
It may also cause gradual pain and swelling later on. A testicular injury can be painful but it does not cause cancer.
• Certain infections in the scrotum can sometimes cause lump and painful sensation in or on the testicle. And these are usually caused by bacteria or viruses.
This is not to say that finding a lump, thickening or change in or on your testicle is not serious.  I reiterate once again that any such changes should be checked by your doctor right away.

sonchrispeter@gmail.com

advertisement

Monday, November 27, 2017

Why diabetics need to take care of their feet

This is how a diabetic foot ulcer looks like.

This is how a diabetic foot ulcer looks like. Photo | Courtesy 

By Insiyah Amiji

Working in the field of medicine, I had the privilege to be supervised by one of the renowned endocrinologists of the country, Dr Kaushik Ramaiya. When you are facing a diagnosis of a hormonal condition, like diabetes or thyroid disease, you may be suggested to see an endocrinologist who specialises in such hormone-related diseases.  
Speaking of diabetes, the condition can cause nerve damage and poor blood flow, which can lead to serious foot problems. Working alongside Dr Ramaiya, I got to witness a vast number of diabetic foot complications.

My case
To understand this topic better, I would like to share a case of a 53-year-old man (name withheld for ethical reasons) who is a known case of  Type 2 diabetes for the past 8 years and overtime developed foot complications.
When the diabetic came in for diagnosis, he narrated, “It all began with blister which was discharging clear fluid from right foot after I hurt myself unknowingly.”
A few days later, as he further narrated, he experienced severe pain and foul smell from the same leg. His sugar levels were out of control despite of the strict diet and medication, which increased his worry. He then decided to seek medical help. Unfortunately the infection had risen to a great extent above the foot and had spread to the deep tissues that involved the bones. Simply, it was too late.
Upon admission, the diabetic was reviewed by a multidisciplinary team of physicians, vascular and an orthopaedic surgeon. Due to the poor condition of the foot, the solution was to amputate [cut off] the limb. After explaining to him about his condition and thorough counselling, he agreed and underwent above knee amputation which was successful. Currently, this man walks with a prosthetic leg and manages to do his daily activities.
Think for a second, if this patient had noticed the wound earlier, would he be able to save his limb?

The burden
According to the World Journal of Diabetes, diabetic foot ulcer (DFU) is the most costly and devastating complication of diabetes, which affects 15 per cent of diabetic patients during their lifetime, just like the aforementioned case.
It is associated with major morbidity, mortality and reduced quality of life and therefore early detection and prompt effective management is crucial.
Diabetes is the most common non-communicable chronic disease globally. According to World Health Organisation (WHO), the number of people with diabetes has risen from 108 million in 1980 to 422 million in 2014.
It poses a therapeutic challenge to surgeons, especially in developing countries where health care resources are limited and the vast majority of patients report to health facilities late with advanced foot.

What should be done?
Patient education plays a central role. Here’s what needs to be done:
1. Ensure during your monthly follow up at the clinic, instructions are given on foot hygiene.
2. Emphasis is made on daily inspection of your foot.
3. Pressure relieving methods include use of proper footwear which is closed shoes with pressure relieving insoles, clutches and wheelchair ambulation if need be.
4. Look out for new lesions,  example fungal lesions of the skin or toe nail and any ingrowth or abnormal nail growth. This should be handled by your doctor.
5. General lifestyle modification - smoking cessation and reducing fatty diet.
6. Last but the most important, have a good control over your glucose level.
Diabetic foot disease is a preventable medical condition. Spread the awareness, save your limb!


The author is a Medical Doctor pursuing post-graduate studies in Paediatrics and Child Health at Muhimbili University of Health and Allied Sciences.

advertisement

Monday, November 27, 2017

Here's why pregnant women should have good intake of fluids



Syriacus Buguzi

Syriacus Buguzi 

By Dr Syriacus Buguzi

Last week marked the ninth week of pregnancy for Jane*, a 27-year-old accountant in Dar es Salaam. She had been grappling with nausea and vomiting, feeling fatigued and very sick almost all the time. It’s her first pregnancy.


She told me her situation wasn’t getting any better. Water couldn’t pass past her throat. She could vomit everything. She was relying on anti-emetic tablets in keeping the nausea and vomiting at bay. She was getting weaker day by day.
However, the one thing she forgot to do—and in fact the most important, was to find alternative ways of rehydrating herself. She took the first step to narrate her ordeal to me only after it kept getting worse. By that time, her urine was deeply coloured and she could urinate little.
It was obvious she needed help and the first thing was to quickly rehydrate her with intravenous fluids but encourage her to continue taking plenty of fluids.


Upon being rehydrated, she felt so relieved and her nausea was already disappearing. But it took me some hours to convince her there was the psychological aspect of the nausea that she had to fight off, followed with a big lesson about the importance of water or staying hydrated during pregnancy.


During pregnancy, water or fluid intake is very key for the body, so it’s important for them to make that extra special effort to keep hydrated. Staying properly hydrated greatly improves chances of having a safe and normal pregnancy and a healthy baby after delivery.
In case of morning sickness that’s causing the vomiting, it’s important to try drinking plenty of fluids every moment the pregnant women doesn’t feel nauseated.
In cases of extreme morning sickness that make it impossible to keep any fluids down, a doctor’s intervention is needed, refer to what Jane did.

If not avoided, dehydration during pregnancy can prompt what we call Braxton-Hicks contractions—the tightening of the uterus that usually only lasts a minute or two, especially in the second or third trimester.


Apart from making effort to rehydrate, a pregnant woman should keep away these issues that are likely to cause dehydration:
• Vigorous exercise, particularly if the weather is warm.
• Intense diarrhoea, vomiting, fever, excessive sweating.
 In case of symptoms such as dry, sticky mouth, sleepiness, feeling thirsty, decreased need to urinate, headache, constipation and dizziness, visit the doctor.


 If the urine turns dark yellow, it’s another sign you should worry about. Clear urine means you are hydrating well.
Therefore, during pregnancy, dehydration can be a worrisome thing. Water is used to form the placenta, which passes nutrients to your growing baby. It’s also used in the amniotic sac.
[* Not her real name]

advertisement

Monday, November 27, 2017

Lessons learnt abroad on healthcare



Dr Fazel

Dr Fazel 

By Sajjad Sherally Fazel

Public Private Partnerships can change the face of healthcare in Africa’ – this was a bold and apt statement made by Dr Amit Thakker, Chairman of Kenya Healthcare Federation during the Tanzania Health Summit in 2016.
The public private partnership system he proposed echoes the principal of an integrated health system that is at the heart of Ontario’s Local Health Integration Network (LHIN) in Canada.
While Tanzania and Ontario have grossly different health systems, both rely on health service provided by privately owned entities.

The lessons
There’s a lot that Tanzania can learn from their Canadian counterparts. The Local Health Integrated Network (LHIN) plan, integrate and fund local health care, improving access and patient experience. This is done by bringing together a variety of stakeholders to achieve the common goal of improving access to healthcare for all.


• In Ontario, each region has a LHIN which is further divided into smaller sub-regions having their own respective sub-LHINs. This enables each sub-region to focus more on their target population and the diseases affecting them.
 For example; some sub-regions of the province have older people, hence the incidence of ischemic heart disease would be more. The LHIN system allows different regions to implement the vision of the ministry of health at a local level.
This new system reduced unnecessary bureaucracy and in turn helped many sub-regions save up to 8 per cent of their allocated budget. This is an important lesson for Tanzania.


• The establishment of the LHIN system also created a better sense of responsibility in terms of using the allocated health budget. Numerous sub-regions used their budget well and self-funded a lot of the health initiatives without creating an extra deficit for the federal government.


• Another benefit of the LHIN system is community engagement. It involves the public and takes feedback from the community regarding primary care, mental health and much more. They then use this feedback to improve the health services in the area.


• The LHIN system facilitates coordinated care where health facilities communicate with each other in case a patient gets services from different health centers.
This creates a harmonious relationship between healthcare workers and leaders of different health institutions unlike in Tanzania, where competition and profit are in most cases considered a priority.


Today, a year after Dr Thakker’s speech, Tanzania is still lacking a robust Public Private Partnership (PPP).
Private facilities near each other continue to invest in the same resources competing for the same demographic. Often, patients would have to repeat medical tests when shifting from one facility to another as patient records are not always shared between healthcare providers causing delays due to repetitive history taking.
The lack of understanding between private and public entities is one main problem in Tanzania. The current status quo of ‘public vs private’, a competition that exists in the minds of various health stakeholders hinders the effectiveness of better healthcare for the Tanzanians.
This is reflected by a statement from the CEO of Sanitas Hospital, Mr Murthy Venkateswaran, “The public sector does not trust the private sector and until this is overcome, an integrated health system in Tanzania will only be a dream.”

The author is a Tanzanian health professional pursuing post-graduate studies in Public Health at Western University, Canada.

advertisement

Monday, November 20, 2017

Strong warning for pregnant women

A woman addicted to eating rock/soil. PHOTO |

A woman addicted to eating rock/soil. PHOTO | WEB 

By Syriacus Buguzi and Hellen Nachilongo

Pregnant women who crave for soil-like materials sold on street market may have to rethink this habit after researchers confirmed that the practice, known as geophagy, carries health risks to them and their unborn babies.
In a study carried out in 12 regions across Tanzania, the researchers found abnormally higher levels of the toxic chemical elements such as Lead, Arsenic, Nickel, Cadmium and Aluminum, which were present in the commercialised soils.
“We took soil samples from sources of production in 12 regions and analysed the contents through laboratory techniques,’’ said Mr Elias Nyanza from the Catholic University of Health and Allied Sciences (CUHAS), as he described how the study was done.
“We have no problem with eating the commercialised soil but we are concerned about how it is processed and the sources,’’ he said.
“The practice should be discouraged until safety is guaranteed,” said Mr Nyanza, an environmental health scientist who collaborated with a team of researchers from the Universities of Colorado Denver in United States and Calgary in Canada.

Soil craving among women
Ms Sarah Kawira, a resident of Dar es Salaam, says she has refrained from eating the soil because her doctor said it was unhealthy to do so. “I also fear suffering from stomach problems. The doctor made me believe it’s bad to eat the soil,’’ she said.
“I know women who believe that they are addicted to munching the soil because it has an attractive smell,” she says.
“I have come to learn that eating soil is like smoking cigarettes because a person who smokes enjoys a certain flavour or smell. This is not necessarily good,’’ she points out. Some women eat the soil even when they are not pregnant.  A petty trader, at Ubungo in the city, nick-named Mama Mchaga said the that most of her customers are pregnant women.
“There are also women who are not pregnant but they also like eating the soil. That’s’ why I continue to sell,’’ says Mama Mchaga who buys soil at wholesale price in Ilala Market to sell at retail price in her neighbourhood.
In Dar es Salaam, women who spoke to Your Health, admitted to have been consuming the soils without knowing if there were any health risks.
On the contrary, they believe eating the soil helps treat some of the problems they face during pregnancy. Some couldn’t explain why they were eating the soils, though.
When Mama Lucy got her first pregnancy, eight years ago, that was the first time she learnt that soil can be eaten, and to her, seeing women munching earth, chalk-like clay, had become a normal thing.
“I could see expectant women at antenatal clinics carrying packets of soil. One of them told me the soil increased her food appetite. Another one told me it helped her stop nausea. I didn’t buy the idea at that time,’’ she says.
“Later, when I got my second pregnancy, six years ago, I tried it out.  Slowly, I started eating it and got addicted,” said the 35-year-old petty trader, a resident of Dar es Salaam.
But according to Dr Latifa Kalinga, a medical officer based in Songwe Regional Hospital, pregnancy is a period when women crave for many things, soil-eating being one if them.
Although some pregnant women eat the soils with the hope of treating anaemia, Dr Kalinga says, “There are those who eat stones even if they don’t have anaemia.”
“I think it’s important to educate the pregnant women that there is a higher risk of being infested with worms in the soils. The worms may later cause anaemia in pregnancy instead.”

The craving proven dangerous
Mr Nyanza further revealed that some chemicals such as Lead, Cadmium and Arsenic have been documented in the United States Agency for Toxic substances and Diseases registry, and are known to affect health and birth outcomes even at very low levels.
“Most of the chemical elements found in the soils popular as Pemba, are far above the recommended safe levels as per World Health Organisation chemical exposure guidelines ,’’ said Mr Nyanza.
“We found women eating soil containing 50 to 60 microgram/litre levels of some of the substances while the WHO recommended level is 10 micrograms/ litre,’’ he says.
“Consuming this, increases the chances for stillbirths, low birth weight, preterm birth and in some cases could lead to birth-defects including increasing the risk of infant mortality,’ he further warned.
The Chief Government Chemist, Professor Samuel Manyere has proposed that the researchers take the samples collected during the study to the Government Chemist Laboratory Agency (GCLA) so that further steps and possible interventions can be taken.
“We at GCLA haven’t per se carried out a study on that. However, it would have been appropriate if they submit the samples they have collected so that we can assess what they claim. We have the technology to be able to establish the contents in their samples,’’ he told Your Health in an interview at his office.
The study, titled: “Assessment of health risks of chemical element content for commercialised sikor in Tanzania,” was carried out in regions: Kilimanjaro, Lindi, Kigoma, Mara, Southern Pemba, Morogoro, Rukwa as well as Dar es Salaam, Singida Coast and Ruvuma.
“The health risk is very high in the women who eat the soils made in areas where there is small scale gold mining activities,’’ said Nyanza.
Another 2014 study done among small scale gold mining communities revealed that out of 155 pregnant women involved in the study, 69 per cent bought the soils in form of stones (pemba) from local shops and 31 per cent consumed ground soil (kichuguu).
“Arsenic, chromium, copper, iron, manganese, nickel and zinc levels were found in both pemba and kichuguu samples. Cadmium and mercury were found only in the kichuguu samples,’’ said the study titled, Geophagy practices and the content of chemical elements in the soil eaten by pregnant women in artisanal and small scale gold mining communities in Tanzania.
“…in artisanal mining settings, culturally appropriate and sensitive policies and programs should be developed that directly address a reduction of exposure to contaminants from geophagy,’’ suggested the study.
The researchers said the existing beliefs expressed by the women about eating soil should be explored further and public health education is key to preventing the health risks.
yourhealth@thecitizen.co.tz

advertisement

Monday, November 20, 2017

Long-term back pain shouldn't be ignored

The physical appearance of Pott Disease of the

The physical appearance of Pott Disease of the spine. Photo | Internet 

By Lugano Wilson

A widow from Singida arrived few weeks ago at the hospital I was stationed at in Dodoma with excruciating back pain and lower limb numbness.
The 67-year-old could hardly stand tall or walk, she was living with this discomfort for a year now.
The tests revealed that the woman had tuberculosis (TB) of the spine, or what we term as ‘pott’s disease’ [a form of tuberculosis that occurs outside the lungs whereby disease is seen in the vertebrae, such as the case of the widow.]
Interestingly the widow was brought in by her long-serving concubine who not only settled all her hospital bills but also has been taking care of her since she lost her husband 20 years ago.
The woman’s back pain never got assuaged by anti-pains and she could barely support herself; she was eventually confined to complete bedrest. She was put on anti-TB medication, mind you early diagnosis and management is vital in preventing complications like paralysis. Many patients seek medical help when it becomes unbearable and this delays initiation of early treatment.
The widow wasn’t my first ‘spinal TB’ patient that week, I encountered four patients diagnosed with the same.
Spinal TB is one of the forms of extra pulmonary tuberculosis (EPTB), at the outset it’s important to know what it is. EPTB is an infection caused by TB bacteria that has spread beyond the lungs.
Her concubine requested I cast light on his patient’s diagnosis. I explained to him that spinal TB is simply the TB of the backbone, often referred to TB ya mgongo or TB ya Mifupa in Swahili.  
He wondered aloud how this was possible. Then right off the bat, I responded by explaining him that when a person breathes in TB bacteria, the bacteria can settle in the lungs and begin to grow. From there they can move through the blood to other parts of the body including the spine.
Globally, between 10-15 per cent of the TB occur in extra pulmonary sites outside the lung. Apart from spine, other sites include lymph nodes, brain, larynx, abdomen and urinary system to mention a few.

Is TB of the spine contagious?
Spinal TB is not contagious but TB occurring in the lungs (PTB-Pulmonary TB) and larynx can be infectious.
Then, her concubine questioned, “mbona hata hakohoi, hii TB kaipata lini?” [How comes she isn’t coughing, when did she really get this?]
Most of the time when we are affected with TB, the disease is so mild that they do not even know they have it, hence difficult to diagnose.
Patients with latent TB do not have symptom unless the disease becomes active. Spinal TB patients can have same symptoms as people with TB in the lungs such as fever, night sweats, fatigue, weight loss and loss of appetite.
In addition, patients often have other symptoms specific to the body site, such as the widow who complained of back pain. Some doctors say that TB can either cause pulmonary symptoms or none at all.

Yes, it can be cured
The good news is that TB can be prevented, treated and cured. Treatment is often a success but it’s a long process – can take at least six months but EPTB are treated beyond that duration.
In Tanzania, TB is diagnosed through either sputum or chest x-ray. Other specific tests are not  available in most health centres.
When you have TB, you have to take medicine the right way as the doctor advises. If you are not wearing a mask, cover your mouth and nose with a handkerchief or tissue. Keep your house well-ventilated by opening the windows.
The author is a medical doctor and a public health activist now based in Dar es Salaam.

advertisement

Monday, November 20, 2017

Here’s how a patient can cope with cancer related fatigue



Dr. Christopher Peterson

Dr. Christopher Peterson 

By Dr Chris Peterson

Although fatigue is common and one of the expected side effects of cancer and its treatment, patients should talk about such feelings with their health care team. There are times when fatigue may be a sign to an underlying medical problem. Other times, there may be a need for a medical intervention to assist in controlling some causes of fatigue.
Do note that cancer related fatigue is different from being tired. Sleep or getting rest most often heals tiredness unlike cancer-related fatigue that can persist despite getting good hours of sleep.

What’s the best way to cope?
The best way to combat fatigue is dealing with the underlying cause. Unfortunately, the exact cause may be unknown, or there may be multiple causes. So, when I talk to patients about cancer related fatigue, I focus on self-care and how patients can help themselves and it is my hope that these tips will benefit my readers too.
• Cancer patients should do (moderate) body work out: It may seem counterintuitive, but physical activity can actually reduce your fatigue. Studies done on cancer patients conclude that a little movement such as walking for at least 30 minutes three to five times a week, can reduce fatigue.
• Mind what and how you eat: Almost all types of cancer treatments may cause a patient to lose appetite while during this time, a patient needs good nutritious food the most. Therefore, control the loss of appetite and eat a well-balanced diet. At times, your diet may need to include extra calories or protein, such as milk, cheese and eggs.
• Making plan and priorities on what you do on daily basis: Some people may need to continue to work while on treatment, so they need to have energy for their jobs. After that, it is important to engage in activities that can be rejuvenating. This is very much up to the individual and could include activities than can be domestic such as light gardening. As much as possible, keep the activities that are enjoyable. Cut out the rest.
• Staying well hydrated also matters: Ask your health care team how much water you should drink. Plain water is best, but if you dislike plain water, try drinking flavoured water or adding a slice of acidic fruits like lemon or a fruit that has a taste you like.
Other decaffeinated, non-alcoholic fluids, such as milk, juice and tea, can also keep you hydrated. Try avoiding caffeine as it may contribute to dehydration, especially if you are not used to it.

sonchrispeter@gmail.com

advertisement

Monday, November 20, 2017

Right ways to cook food to retain nutritious value



Steamed broccoli PHOTO | FILE

Steamed broccoli PHOTO | FILE 

By Devotha John

Faustina Msula, a mother of three loves cooking for her family and ensures her children eat healthy. Mrs Msula believes that eating nutritious keeps her family shielded from contracting diseases.  She tells Your Health, “I stopped buying junk or processed foods, which I think may not be well prepared.”
Mrs Msula gets fresh fruits and vegetables from a nearby market and has also made an effort in planting few vegetables in her home garden to help her save cost and eat organic.
Some of us might be regular buyers of fresh vegetables, like Mrs Msula, but for instance mushrooms that are deep fried or broccoli that are cooked in cheese sauce doesn’t really offer a host of nutritious benefits. An example is echoed by Mrs Msula herself, “Breading meats and veggies is completely unnecessary and a terrible cooking habit. Breading is usually full of simple carbohydrates and provides you little nutrition. If you do bread a cutlet, swap out the white crumbs and flour for whole-wheat bread crumbs.”

What is healthy cooking?
Attaining a healthy lifestyle involves eating healthy and being physically active, reiterated by nutritionist Neema Shosho. She adds that people need to always to strike the balance between the two otherwise we will continue seeing ourselves struggling with obesity, overweight, diabetic, hypertension and many other diet related non communicable diseases
“When we talk about healthy eating it is important to also consider healthy cooking methods. One might ask so what is that all about, cooking is just cooking! It is worth noting that cooking methods can change your healthy food to unhealthy one and yes cooking methods can affect nutrients of your food and torment your health,” adds Ms Shosho.  Depending on the cooking methods, vitamin C and D, vitamin A, D, E, K and minerals such as sodium, potassium, magnesium and calcium are often affected.  Let’s look at some of the healthy and unhealthy cooking methods explained by Ms Shosho.


Frying – Locally known as ‘kukaanga’, this involves cooking food in a large amount of fat, usually oil, at a high temperature. Although fried foods taste yummy, it is important to note that when oil is heated to a high temperature for a long period of time, toxic substances called aldehydes that have been linked to increase risk of cancer and other diseases are formed.


Boiling – A quick and easy method, commonly practiced in both urban and rural areas. Boiling is a safe way of persevering some nutrients but it can dissolve vitamins and minerals in some foods such as vegetables.


Steaming – This method of cooking keeps vitamin C and D in your food and is named as one of the best cooking methods for preserving nutrients. The only issue with steaming method is on the taste, most people don’t find steamed food tasty. You’ll often hear, ‘steamed food is for sick people, tastes like medicine.’


Grilling and broiling - Although this method provides great flavour to the food, it reduces B vitamins. Grilling also just like frying generates possible cancer causing substances. There are people who never miss nyamachoma and other choma foods hence be watchful!


Take away from the nutritionist
1. Select cooking methods carefully depending on the type of the food you intend to cook.
2. Mix different cooking methods, don’t stick to one over and over again.
3. Avoid cooking methods that involves cooking for very long time, using high temperature and lots of fats and oil.
4. If possible opt for cooking methods that requires shorter periods at lower temperatures.
5. Remember there is no one cooking method that retains all the nutrients. However, don’t opt for methods with tremendous effects on the nutrients and cancer causing potential.
djohn@tz.nationmedia.com

advertisement

Monday, November 20, 2017

If you crave soil when pregnant, then take this message



Syriacus Buguzi

Syriacus Buguzi 

By Dr Syriacus Buguzi

During early pregnancy, women face tough moments, more so due to what is known as morning sickness.
It’s a time when they are likely to make certain decisions about their health—informed or uninformed.
In today’s main story, we get to hear this of women who crave for soil in Tanzania—a habit that researchers now say exposes them and their unborn babies to health risks.
If you are a woman and crave for soil, today should be the right moment to decide whether to continue or to stop habit.
Just to make sure you get a well-guided decision—straight from Horse’s mouth—I decided to involve Dr Latifa Kalinga, a general practitioner and a mother in this conversation about soil-eating during pregnancy. Being a medic and a mother with experience, Dr Kalinga, from Songwe Regional Hospital has come across pregnant women eating soil—a habit known as geophagy.
Through both experiences, she suggests that the challenges that pregnant women face would be resolved through being informed correctly and thinking rightly.
Dr Kalinga says, “Pregnancy comes with cravings. There are common obsessions like eating soil, ice in the freezer or uncooked rice, but this may not cure anything.”
“If it’s anaemia that they believe such edibles may treat, it’s not true. I know a number of women who decide to eat such things but their heamoglobin level is normal. They don’t usually have anaemia.”
“It’s important that we advise these women that there is a risk of causing other health problems through eating the soil. There is a risk of worm infestation. Worms are likely to cause anaemia to these women instead.”
The reasons cited by the women for eating soil, as narrated in today’s main story, have been that they do it to avoid nausea and vomiting.
However, the following health tips, as per webmd.com are touted by medics as the right ways of minimising nausea and vomiting during pregnancy.
• Keep food in your stomach but not too much. An empty stomach can make nausea worse. Eat several small meals every day instead of three large meals.
• For morning nausea, eat a small snack (like crackers) before you get out of bed. Allow a few minutes for the snack to digest, then get out of bed slowly.
• Stay hydrated. Drink a lot of fluids. Try a sports hydration drink, as well as water, broth or juice.
• Eat more protein, and cut your fatty food intake.
• Avoid smells and foods that make you feel nauseated. Citrus juice, milk, coffee, and caffeinated tea commonly make nausea worse.
• If you are taking iron supplements, ask your doctor if they are necessary. Iron can make nausea worse.
Make informed health choices.
E-mail: six.buguzi@gmail.com

advertisement