Tuesday, July 17, 2018

Becoming a father: men’s role in antenatal care


By John Namkwahe @johnteck3 jnamkwahe@tz.nationmedia.com

When it comes to expecting a child and having a healthy pregnancy, the focus has long been on women. Men, rather expectant fathers have not been subjected to preconception care and pregnancy advice while the involvement or role of men during pregnancy is crucial. However, studies show that male participation in Tanzania during pre-pregnancy and post-delivery is still low.  According to a qualitative study, titled, “Perceptions on male involvement in pregnancy and childbirth in Masasi District, Tanzania,” despite the efforts to promote male involvement in maternal and child health, studies in low and middle income countries have reported that male participation is still low.

The findings of the study revealed that women preferred to be accompanied by their partners to the clinic especially on the first antenatal care visit. Men did not wish to be more actively involved in antenatal care and delivery. The study further stated that the society perceived men as being breadwinners and their main role in pregnancy and child birth was primarily to support their partners financially. The key factors which hindered male participation were traditional gender roles at home, fear of HIV testing and unfavourable infrastructure in health facilities.

In this view, when Your Health paid a visit at the maternity block of the Muhimbili National Hospital (MNH) in Dar es Salaam to survey the number of expectant fathers accompanying their partners to the clinic, it was noted that majority of the pregnant women weren’t escorted by their partners. These women looked tired sitting slumped on the bench, while some had fallen asleep waiting for hours for their turn. But there were those who caught Your Health’s attention. Curious to know why their thought process differed from the rest, the expectant fathers who were reached for comments, had a positive mind-set saying that they were keen on following up and knowing their pregnant wives’ health status, urging other fathers in the households to play the same role during the pregnancy. Here are their testimonials.


Couple 1:

Queuing on the hospital bench waiting to see the doctor, while carrying his wife’s handbag on his left shoulder, Richard Mwendilemo, 43, a resident of Mkuranga in the Coast Region told Your Health that he wasn’t shy to escort his pregnant wife to the hospital. He insisted that he religiously accompanied his wife every month during the antenatal classes.

“When we found out that we were going to have a baby, I initially couldn’t understand what she was going through, it was a challenge. Gradually, I began to understand the situation that she is going through. She sometimes yells at me for no reason, but I don’t take it too seriously,” he laughs.

“I sometimes make some jokes to make her laugh when I observe she is not happy. The aim is to make sure her unusual attitudes during the pregnancy doesn’t affect the development of the baby inside her,” he tells.

Commenting on the father’s responsibilities during the pregnancy, Mr Mwendilemo further expounds that the role played by the fathers during pregnancy was fundamental for the growth of the unborn child and the health of the mother-to-be.

“Personally, I understand that pregnancy is not a wife’s weight alone, it is for both husband and wife. It is an obligation for both the parents during pregnancy to ensure that the unborn child’s growth is progressing well,” he says.

Backing up her husband’s opinions, Ms Modesta Machengo, 38, describes her husband as “a good advisor” saying despite her current provocative attitudes against her husband due to pregnancy, her husband still showed her love and support.

 “I thank God for giving me this kind of a man. Apart from his daily parental responsibilities as the head of household, he supports me a lot during this period. The journey of pregnancy, we [expecting mothers] need more love and support from our husbands and he is doing just fine,” she says.


Couple 2:

Sitting next to his wife on the hospital bench awaiting to consult the doctor on the same day, Calvin Chezi, 36, a resident of Chang’ombe here in Dar es Salaam states, “I decided to come with my wife here to the hospital so that I can know the health status of my wife and the unborn child.”

On the new experiences that he was going through during his wife’s pregnancy, Mr Chezi said, “To be honest, she has not been showing any new attitudes during her pregnancy. Her condition is progressing very well.”

“I feel very relaxed when I see my husband sitting besides me whenever we come here at the hospital for maternal health services. It makes me believe that he is ready to help me and the child in case anything happens,” says [in a low tone] Mr Chezi’s wife, Hasia Bitigo when she was reached by Your Health for comments.


Couple 3:

Holding hands while walking towards the entrance door of the Maternity block in MNH, Vincent Balenge, 28, and his wife, Sarah Atanas, 27, both residents of Kimara in Dar es Salaam, were received by a nurse at the reception, and later they were directed to sit on the hospital bench awaiting their turn to see the doctor.

“As a father-to-be, I am here to escort my wife for the prenatal clinics. Despite having fixed daily routines, I always escort her whenever she is scheduled for her clinics,” says Mr Balenge.

When asked to explain whether he was subjected to difficulties during his wife’s pregnancy, Mr Balenge states, “Of course since she got pregnant, I have been experiencing some changes in her attitudes, but I can handle them because I know it is temporal.”

“She sometimes wants me to take her to a place where we have never been there before. I therefore now take her to different places for exposure. But before pregnancy, she had never asked me to do so,” he adds.

For her part, Ms Atanas says that she enjoys her husband’s support, saying it is a great pleasure to see her husband escorting her to the hospital during her monthly clinics.

“It always feels good to see him sitting beside me on the bench. More interesting is when he carefully listens to the doctor’s instructions on the proper use of medicines and other instructions,” she expresses.

“When we are home, he also reminds me to take the medication as per the doctor’s instructions. I urge other men to do the same because pregnancy comes along with a variety of health complications; this is why it is very important to escort pregnant women to the hospital,” Ms Atanas urges.


A call upon all expectant fathers

Speaking to Your Health during the interview on the same day, the MNH Manager of Maternity Block B, Ms Stella Medadi, established that according to her office’s observation and records, only a few male parents were escorting their pregnant wives to the hospital for maternal health services during pregnancy.

“Honestly, most of the pregnant women come here without their men. Majority of them are being escorted by their relatives. To us, this is a challenge because we sometimes need to speak to the responsible father about the progress of the unborn child and the health of the mother,” she says.

“But we fail to do so because majority of them do not come with their wives to the hospital,” she adds.

She mentions about the urban lifestyle as one of the factors that influences majority of men’s failure to escort their women to the hospital for maternal health, calling on male parents to be there for their wives at the health facilities.

“Pregnant women need to eat healthy food with a view to ensuring the unborn child grows healthy. Therefore it is very important for men to be there while we are giving the instructions to the pregnant women about the type of food and other issues to be highly considered during the pregnancy,” she informs.

Explaining on the maternal health services that are offered in the national hospital, Ms Medadi states, “Here at the maternity block, we offer maternal health services to women, men and children.

Therefore we normally expect to see men escorting their pregnant women for clinic services. The move helps the fathers to be aware of their wives’ health status during pregnancy.”

She further expounds that her office was committed to help the fathers through comprehensive reproductive health counselling programmes on how they can deal with various changes that occur during pregnancy.

“Speaking of experience, it is easier to tell that a pregnant woman feels more comfortable when she sees her man sitting beside her while awaiting to see a doctor at the hospital,” she reveals. “It becomes easier to help a pregnant woman when her man is around. I also encourage the government to enhance public awareness campaigns on the importance of supporting pregnant women by their men,” Ms Medadi suggests.


Men, too , go through ‘pregnancy’

Moreover, fathers not only have an important role to play during pregnancy, but they too are subjected to changes, physically, emotionally, to mention a few, from the time the mother gets pregnant to post-delivery.

According to the study titled “Fathers’ experiences of being in change during pregnancy and early parenthood in a context of intimate partner violence,” published by the US National Library of Medicine in 2016, indicated that the transition to fatherhood can be experienced by men as being very stressful.

It also involves a number of different emotional reactions, including a need to identify with the role of father and a redefining of self and the relationship with the partner, according to the study.

Speaking to Your Health via telephone, the Emergency Medicine Resident at Muhimbili University of Health and Allied Science, Dr Deus Kitapondya states, “When a women delivers everything changes inside the house! So there are lot of things a husband has to conform! This may bring a kind of panic and sometimes psychological tension.”

He further adds, “There is also an increased family expenditure during pregnancy and delivery, all these add up to bring about psychological discomfort to a husband (stress), fatigue and nervousness.”

Meanwhile, White Ribbon Alliance [an organisation, through its vast network of National Alliances, WRA is activating the global movement for reproductive, maternal and newborn health and rights] and partners are calling upon all current and prospective fathers to get involved in the “What Women Want” campaign.

For far too long, reproductive and maternal health is seen as primarily women’s responsibility.

But the fact is, fathers occupy a special position of influence with the women and girls in their families.


Monday, July 16, 2018

Let’s talk about our body image


By Nelly Bosire

Few weeks ago, the public was left in shock when a young woman lost her life following a plastic surgery procedure.

It was very sad to see a young family go through such loss, robbing such young babies of a mother.

In the ensuing public discussions on mainstream and social media, the expertise of the surgeon was questioned, as was the post-operative care and management of complications.

Many wondered why a beautiful young woman would go under the knife to alter her body and viewed it as assimilation of Western culture, which may be accompanied by unexpected negative outcomes.

Plastic and reconstructive surgery as a medical specialty is not new. It may have had a limited number of specialists for many years, but it has always existed.

It is now gaining visibility because of increased demand for cosmetic procedures and the increased number of specialists.

Many patients have undergone plastic surgery for various reasons.

Some are patients with physical defects such as cleft lip and others undergo mammoplasties for gigantomastia (abnormally large breasts) that cause back problems.

Most are patients requiring reconstruction following tragic disfigurement from traumatic accidents, burns and explosive injuries.

In the face of such a heavy burden, it is only humane to go the extra mile to restore function and aesthetics to one who has already suffered so much.

Increased demand

However, over the last decade, there has been a marked increase in the demand for cosmetic surgery.

The demand for breast augmentation surgery, facelifts, chin lifts and tummy tucks are no longer the preserve of the elite.

The advent of complete body transformation is evident in the cropping up of “socialites” who have gone all out to alter their bodies to conform to what is perceived to be perfection.

The skin bleaching, hip and breast augmentation, lip enhancement and cheekbone enhancement has been taken to a whole new level.

Suppliers of pharmaceutical and non-pharmaceutical products used in plastic surgery have also had to up their game. Weekly Botox is here with us.

While every person has a right to seek plastic surgery purely for cosmetic reasons, it is important to know where we draw the line.

Body dysmorphic disorder is a well-recognised mental illness categorised using the criteria in the 5th Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

A person with body dysmorphic disorder is obsessed with one or more aspects of their own body, deeming it severely flawed and warranting exceptional measures to hide or fix it. This is a condition that most patients will never discuss with their doctors. This is not to say that every person opting to get a hip enhancement surgery is mentally ill.

However, when one is preoccupied with one or more non-existent or slight defects or flaws in their physical appearance; is repetitively and compulsively responding to this perception to change it; and their preoccupation is interfering with their capacity to function normally, then a diagnosis of body dysmorphic disorder may be considered.

The disorder requires treatment as it has a great impact on the quality of life of the patient.

Medication and psychotherapy are the mainstay of therapy, but it is difficult to institute treatment when the patient fails to understand that they have a problem.

There is need for public awareness on the condition so that we are better able to support those in our midst who are suffering.

Therefore, before we judge the neighbourhood college student who is constantly bothered by her dark skin, or call the office administrator a “slay queen” for perennially wearing huge wigs because she is convinced she has a massively prominent forehead, it is important to remember that their self-esteem may not be only issue taking a beating. Their mental health may be in distress too.

In the same vein, our plastic surgeons must always remember that they may be the safety net for our patients, diagnosing those who may need to see the psychiatrist instead of heading to the operating table.


Monday, July 16, 2018

A guide to soluble and insoluble fibre


By Carolyne B Atangaza

Dr Paul Kasenene, a nutritionist at Bugolobi Wellness Center, describes fibre as a form of carbohydrate found in plants that, unlike starch, cannot be digested by the body. Fibre plays a significant role in helping to lower cholesterol, keeping blood sugars stable and aiding in weight loss.

However, there are different types of fibres and each has particular benefits. The two classes of fibre are soluble and insoluble. Soluble fibre has the capacity to absorb water and so it tends to swell when it comes in contact with water and forms a gel-like substance.

Soluble fibre is hyped for its potential role in improving heart health by helping to lower total cholesterol levels and regulating blood sugar levels.

Insoluble fibre speeds up the passage of materials through the digestive tract. Increasing your intake of foods high in total fibre will provide you with ample amounts of both types.

A well-balanced diet should include both soluble and insoluble fibre.


“Soluble fibre swells in your stomach, provides bulk to foods, and keeps you feeling full.

This makes soluble fibre very useful in digestion mainly by helping to make fecal matter (stool) soft, making elimination easier.

Soluble fibre also helps the digestive system retain food longer, which helps to promote satiety and therefore can mean eating less. This is very important for weight loss,” Dr Kasenene explains. It also ensures that nutrients have the opportunity to be fully absorbed in the intestines.

Soluble fibre also helps to regulate blood sugar levels; it has been consistently shown to be related to the reduction of blood cholesterol and unhealthy fat absorption by binding to it.


Nutritionist Sheila Karungi notes that soluble fibre called the lignans, mostly found in flax seeds, wheat and legumes, is known to possess anticancer, antibacterial, and antiviral properties. “Ligans have the ability to bind to oestrogen receptors in the body, which reduces the rate of cancer cell multiplication,” Karungi explains.

Another extremely useful soluble fibre is the inulin. It is low in calories, stimulates the growth of beneficial bacteria, and does not lead to a rise in serum glucose or stimulate insulin secretion.

Inulin has been used to improve the taste of low fat foods.

Some form of inulin known as probiotics helps the body stimulate the growth of beneficial bacteria. “The body needs good bacteria in order to digest substances that it cannot break down such as many carbohydrates and chain fatty acids.

Good bacteria also protects the body, especially the bowels from infections by allowing in the desirable nutrients and blocking the dangerous viruses and the bad bacteria,” Karungi says.

Soluble fibre also helps to delay the absorption of glucose and increases insulin sensitivity, resulting in improved glucose metabolism, ultimately helping to lower the risk of type 2 diabetes.

How much soluble fibre do I need?

According to www.unlockfood.ca, there is no specific amount of soluble fibre that you should have in your diet. Instead, focus on total fibre (soluble and insoluble).

Adult men should get 38 grams of total fibre and adult women should get 25 grams of fibre every day. If you need to lower your cholesterol, aim for at least 10 grams of soluble per day.

Regardless of the type of fibre one consumes, it is always important to take in sufficient water, to keep the bowels moving.

High fibre foods

According to Dr Kasenene, foods with soluble fibre include:

• Some fruits such as apples and citrus fruits such as oranges and lemons

• Legumes such as beans, peas, lentils

• Seeds such as chia and pumpkin seeds

• Nuts, oats, mushrooms

• Some vegetables such as cabbage and sweet potatoes.


Monday, July 16, 2018

Are herbs effective in family planning?


Dear Doc,

I am 45 years old and for five years I have been using herbs in family planning and they have worked. Other women have also been helped. Should I continue?

It is true that many drugs are made from herbs and that herbs can be effective in treating humans but unfortunately for many, the appropriate dosage, purity, effectiveness, contents, or even short or long-term side effects may never be known.

A woman’s fertility largely depends on her age. Women are born with all the eggs they will ever have but as they age their eggs diminish in quantity and quality hence negating fertility.

A woman’s fertility starts to decline in her early 30s, with the decline speeding up after 35.

It is likely that you are not getting pregnant because of diminished fertility rather than the effectiveness of the herb in family planning. This has also been helped by having sex less often as happens when a woman nears or gets into menopause.

Dear Doc,

Is it true that saunas cause impotence? Do they have any health benefits?

A sauna is a heated room in which people relax in dry heat.

Many Ugandans flock saunas thinking they will burn fat and reduce weight just like when one has done a strenuous physical exercise, which is untrue. Sweating in saunas happens to cool one down.

That said, saunas are said to have heart and blood vessel benefits including preventing stroke, reducing stress, and relieving soreness of muscles and joints including chronic arthritis.

It is advised that if a man has problems of fertility, he should avoid saunas.

Also, if a woman is pregnant or anybody who has a cardiovascular problem, they should avoid saunas. Drinking alcohol before and after saunas should also be avoided.

Thirty five per cent of fertility problems that couples experience are caused by a problem with male fertility usually resulting from low sperm motility, low or no sperm count and abnormal sperms.

In normal couples, saunas may cause no fertility problems. Those with fertility problems, high sauna temperatures are likely to increase them.

Sauna high temperatures can affect the testes with a likelihood of worsening low sperm count and sperm motility hindering fertility. Impotence, which refers to erection problems, is not usually caused by saunas.

Dear Doc,

I get flu every morning. Is it the cause of my failure to taste anything?

The smell sense may contribute up to 80 per cent of the taste sense (flavour) and as such anything interfering with the smell sense, including allergies in the nose and a common cold may interfere with the sense of taste.

What you call morning flu could be an allergy in the nose called allergic rhinitis (but could be non-allergic rhinitis), which produces too much mucus that swamps the smell sense nerve endings, hence making you fail to smell and therefore fail to taste.

Proper treatment or management of the nasal symptoms will most likely improve both the smell and taste sense.


Monday, July 16, 2018

Six leading causes of child obesity

By Your Health Reporter

Obesity is tightening its grip with the rise of urbanisation and rapid dietary changes.

Far gone are the days when people would trek to get from one point to another. Now we have tarmacked roads and where those are lacking, or the roads are narrow, motorbikes save the day.

Water pollution in rivers and other water sources has made us hesitant to buy vegetables and fruits in towns. Many times, we opt for processed food believing that it is the safest bet as far as food hygiene and sanitation is concerned.

But at what cost?

In 2016, the World Health Organisation (WHO) reported that an estimated 41 million children under the age of five years were overweight or obese globally. The report further stated that in Africa alone, the number of children under five years who were overweight had increased by nearly 50 per cent since 2000.

Here are the six leading causes of child obesity:

1. Overconsumption of processed food: This happens while failing to meet the required fruit and vegetable portions per day. WHO recommends at least 400g (5 servings) of fruits and vegetables per day.

While treats are good once in a while, they should not replace the children’s staple meals.

2. Inadequate physical activity. Children today are adopting a rather sedentary lifestyle eternally glued to the screens of their phones, computers and such like devices. Outdoor games and house chores would help a great deal to eliminate child obesity.

3. Mother’s diet during pregnancy. An article published in 2016 by Daily Nation of a study in the Journal of the American Medical Association (JAMA) Paediatrics stated that mothers who ate too much fish -- more than thrice a week -- increased the risk of children being overweight once they reached ages four and six years. It was observed that this effect was greater in girls than boys.

4. Genetic influences. Children can become obese due to gene factors affecting their metabolism, body-fat distribution, appetite, satiety and and the tendency to use eating as a way to cope with stress.

According to an article published by Harvard Health in April 2017, “Why people become overweight”, genes may account for 25-80 per cent of the predisposition to be overweight depending on the individual.

Does your child keep eating even after they are full? Do they turn to food for comfort when stressed? Do they have an extremely high metabolism rate?

Making such observations can give you a rough idea of the extent of genetic influences on your child’s weight . This can inform best on how to help the child stay healthy.

5. Creating an enabling environment. Children tend to learn by example. If they have access to unhealthy food or watch other adult family members engaging in unhealthy habits of poor diet and inactivity, they will succumb to this tempting environment regardless of how much broccoli you place on their plate. Processed food is mostly colourful and enticing.

6. Lack of adequate sleep. Sleep is crucial for healthy growth and development of children.

Sleep deprivation has the potential to alter the normal functioning of body hormones including ghrelin, which is the hormone responsible for increased food appetite.

Sources: World Health Organisation (WHO), Daily Nation, Harvard Health


Monday, July 16, 2018

Dental health emergencies while travelling


By Dr Sakina Khanbhai

Travel! Oh, how everyone loves this word.

But with the highs of travel, come the lows of dental health emergencies that may create a huge hole in your wallet and/or may force you to cut short a trip; be it leisure, business or work related.

Not only does this affect the intended purpose of travel but it may also leave you feeling exasperated.

So what should one do if such a situation arises? Before this question can be answered, it is important to know what conditions fall under dental health emergencies.

There are numerous dental emergencies that one may encounter while on travel. Accidents, sports related injuries, tooth decay and infection are to name a few.

The most common dental health emergencies to have been reported are:

• Knocked out tooth

• Chipped / broken tooth

• Object caught between teeth

• Bitten lip / tongue

• Toothache

• Abscess

It is very crucial to get professional help when one of the above situations arises but it is also equally important for one to do their part especially if one has limited access to a dental facility.

Tips for common dental emergencies

•For knocked out permanent tooth, rinse the tooth immediately with water.

If you can, try placing it back in the socket without touching the root. If not, then place it in a container of cow’s milk and see a dentist.

The chances of saving a knocked out tooth are greatly increased if it is placed back in its socket within an hour.

• For a chipped or broken tooth, immediately rinse the mouth with warm water to clean the area. Cold compresses on the face using ice are very helpful to keep any swelling down.

• If an object is caught between the teeth, try removing it gently with a dental floss.

Avoid using sharp objects or pointed instruments as these may cut your gum or scratch the tooth surface.

• In case of a bitten lip / tongue, it is very important to control the bleeding first by applying pressure with a clean gauze.

Cold compresses with an icepack will help to reduce swelling on the outside.

• Toothache is usually caused when the nerve of a tooth is irritated. This could be due to an infection or tooth decay. Warm saline rinses usually help to relieve the pain to some extent. Never put any painkiller against the gums near an aching tooth as it may burn the gum tissue.

• Abscess is an infection that occurs around the root of a tooth or in the spaces between the teeth and gums. If left untreated, it can damage tissue and the surrounding teeth, with infection possibly spreading to other parts of the body.

This is a serious condition and requires immediate medical attention.

A note for travellers

Phew! The above information may be terrifying for all those that are in the midst of packing their bags for an upcoming trip, but it is for reasons like these that travel insurance was introduced.

Travel insurance covers emergency dental conditions and is restricted to treatment of pain, infection and removal of the affected tooth / teeth.

The premium may vary depending on which part of the WorId you’re travelling to and the age of the person. In addition to the above, it is recommended to see your dentist for a routine checkup before you leave; whether you’re planning to travel out of the country or going on an extended vacation. T

his ensures that problems can be fixed easily before they become emergencies.

On that note, keep calm and travel on! Life is short and the world is huge.

The author is a dentist based at Ebrahim Haji Charitable Health Centre


Monday, July 16, 2018

Keep safe while on treadmill


Unlike most workout outfits, what you wear on a treadmill can make a difference between a safe session or a trip to the emergency room.

It is easy for pieces to get trapped in the belt or to trip on account of the wrong footwear.

One needs shoes that will offer sufficient protection against problems such as shin splints, knee pain and stress of the ankle.

Never wear sandals, slippers on the treadmill.

Another important step one can take to keep safe on a treadmill is familiarising themselves with the machine. If you are installing the machine at your home, take time to read the manual and educate yourself on how it works. Before you use the one at the gym, ask your instructors how it works.

Treadmills come with features that are meant to keep you safe. The stop or pause buttons are meant to halt the machine so you can get off safely instead of trying to jump off a moving belt.


Monday, July 16, 2018

Lessons from this patient who found calm in the face of cancer


By Dr Chris Peterson sonchrispeter@gmail.com

Being diagnosed with any type of disease is one thing. But accepting the results and coping with it, is another, especially when it comes to cancer.

This is what I have learnt from my experience as a doctor. Different emotions surface when patients get to know that they have been diagnosed with cancer; from anger, hopelessness to depression. Few months ago, I met 37-year-old Joyce*, a cancer patient. She was referred to me, presenting with untreated, prolonged, irregular menstruation and persistent vaginal discharge. She showed up at the hospital early in the morning on the day we proposed to perform tests, and that gave me a chance to talk to her for few hours before we stepped into the examination room.

We then went into the examination room for her pap smear test [a screening procedure for cervical cancer] and allowed her to go back home to rest. A week later when she returned, her results confirmed that she has stage 2 cervical cancer.

Unlike other patients, I was really surprised at how she reacted to her diagnosis. She took a deep breath, pulled out a note book from her handbag and placed it on my table.

While I waited for a ‘real’ reaction, she stayed put and opened her book where neatly written notes were on it.

Still surprised by her composed nature, she said, “Well doctor, what happened has happened and we can’t overturn it.

Here in the notebook are the questions that I wrote for you to guide me in the new life as a cancer patient and survivor.”

Taking a close look at her notebook, I saw a list of questions for which the answers would be a great aid in her journey towards combating the deadly disease. It is something I didn’t expect from this patient. I was impressed at how Joyce* gave herself the room for emotional preparation on her test results and prepared those questions for me. She was one among the hundreds of patients I have attended to that grabbed my attention.

Learning from Joyce

When you are diagnosed with cancer, you need answers to important questions from your doctor. But this is a time when emotions can interfere with getting that information unless you come prepared. Receiving a cancer diagnosis can make you feel a great amount of anger, frustration and confusion. Since many thoughts cloud your mind, it is easy to forget important questions and concerns that are vital in making important decisions about your care.

Like what Joyce did, we doctors expect to be asked some important questions from our patients’ right after their diagnosis. The answers to these questions might be helpful tips to them as cancer patients. Some of the questions to be asked are:

• What treatment options are available?

• What is the right way to take care of myself pre and post treatment?

• How long will my treatment last and what are some of the expected complications?

• Would you advise me to go for a second opinion?

• What will happen if I choose not to have the suggested treatment?

*not her real name


Monday, July 16, 2018

Some foods can put you at risk of falling ill, here’s why

Some of the street foods displayed. Food

Some of the street foods displayed. Food preparation is one of the important aspects of food safety. PHOTO | FILE 

By Gladys Mbwiga @gladysmbwiga

We depend on the food we consume to survive but we must question ourselves, ‘how do we ensure that this basic need doesn’t become the cause of our illness?’

Food safety, a discipline that involves handling, preparation and storage of foods in a way to prevent food-borne illness falls under this. One must ensure that the food is well processed before consuming it and that the environment it is prepared in is also clean.

According to nidirect.gov.uk, it’s very important to prepare food safely to help stop harmful bacteria from spreading and growing. You can take some steps to help protect yourself and your family from the spread of harmful bacteria. This includes, washing your hands, keep worktops clean, separate raw foods from already-prepared foods, check expiry dates etc.

If all this is not followed well, it may lead to contamination of food, which eventually leads to food borne diseases.

What is food contamination?

Food contamination according to Pazi Mwinyimvua, a nutritionist based in Dar es Salaam, is the presence of a harmful chemical or physical substance or micro organism in the food, which can cause a person to fall ill.

Food contamination can either be biological, physical or chemical depending on the factors or circumstance that leads to the food becoming harmful.

“Biological food contamination are at a large per cent is caused by presence of bacteria and virus in the food we consume as well as rodent, micro organisms and wastes,” explains Mr Pazi.

Unlike biological, physical contamination is associated with the presence of foreign objects in the food we consume.

Mr Pazi tells Your Health, “Physical objects such as hair and micro organism are carriers of pathogens which are leading cause of diseases.”

In addition, Mr Pazi explains that food contamination can also be caused by chemical substances which can either be natural or artificial.

“Natural substances are chemicals such as those from poisonous mushroom, which are are there naturally. Artificial are those chemical that are used to preserve crops. If not washed away properly before eating, it can cause food born disease,” he states.

Eating unclean foods

Furthermore, Mr Pazi explains that food poisoning can either be caused by food infection caused by eating food with micro organisms or food intoxication caused by consumed poison produced by micro organisms before eating.

Several diseases can be associated with eating contaminated foods and according to Mr Pazi, diseases differs with the kind of contamination. One among is food poisoning.

The leading cause of food poisoning is Staphylococcus aureus bacteria which occur when food is left at a low temperature that causes micro organisms to multiply at a high speed and produce toxic substances.

“That is why we cook food to kill micro organisms, although they don’t die completely but by eating warm food they don’t multiply but once the food cools the micro organisms then multiplies,” he explains.

These bacteria can cause boils in the body and the symptoms such as vomiting and diarrhoea normally happens six hours after eating.

In addition to that is Salmonella bacteria, this normally occurs due to eating raw red meat or undercooked eggs and meat.

“The symptoms for this bacteria normally happens 16 to 48 hours after eating and the symptoms are normally abdominal pain, diarrhoea and vomiting.”

Another bacteria is E-coli that is caused by eating contaminated food or drinking contaminated water and prolonged suffering from this can lead to death.

And last but not the least is Clostridium botulinum, it is very rare but very dangerous caused by bacteria that grows in canned foods. It is also present in unprocessed honey and this is the reason why honey is never allowed to give a child under 12 months of age.

“This bacteria attacks the nervous system causing double vision, muscle pain, difficult breathing, diarrhoea and vomiting.

Symptoms occurs 18 to 36 hours after food consumption and lasts for up to a month and can lead to death.”

How to preserve food safety

This all can be prevented if personal hygiene is considered during preparation of food and also during eating of the food.

“A sick person should avoid preparing food especially one with flu. Someone with a wound should always wear gloves. Avoid using plastic containers to store hot food because they produce chemicals which may cause cancer,” Mr Pazi advises.

Food selection especially canned foods should be bought diligently. If you notice that the can has expanded, then take note that the food inside is contaminated since micro organisms produce wastes.

“Cross contamination that is mixing raw and cooked food in a fridge should be avoided as micro organisms move from raw food ton contaminated,” Mr Pazi cautions.

Once a person knows that he or she has food poisoning, they must drink a lot of water/fluids since vomiting and diarrhoea causes the body to lose a lot of water.

One should avoid self medication and instead visit a doctor for the right treatment.


Monday, July 16, 2018

What institutions can do to boost human resources for health


A strong health system needs adequate and quality healthcare workers. The gap towards achieving the standards set by the World Health Organisation remains significant, with many patients unable to access quality healthcare services, particularly in rural areas.

Although universities have increased admissions to training programmes, the infrastructure and human resources in the universities have not grown in tandem with the growth of the student body, resulting in diminishing opportunities for hands-on exposure required for effective pre-service medical training.

Further, new training programmes have been introduced to meet specific needs of pre-service and post-service training for health workers and other personnel in the health sector.

We have adopted many approaches towards addressing these needs, but resources have remained a challenge and opportunities for increasing the number and quality of staff working in county health facilities are needed to meet county-specific needs.

The University of Nairobi, the oldest institution of higher learning in Kenya, has made a significant contribution towards boosting human resources for health, that other medical institutions can learn from. These efforts include:

Flexible learning to retain workers in their duty stations: By extending training opportunities to healthcare workers in all areas through open/distance and e-learning, health workers have been able to access training while continuing to offer much needed clinical services to the population, where they are most needed.

Clinical research: Due to the dynamic nature of the health sector and the emerging and re-emerging diseases, there is need to continue investing in research to have capacity to address emerging health needs.

Universities conduct high-level research led by local scholars who collaborate with local and international partners, and contribute significantly to building the capacity of faculty and health workers across the country.

Orphaned skill sets: While it is critical that health workers attain world-class clinical training, the need to equip them with other skills necessary for proper functioning of the health system is largely ignored.

Several training programmes have been set up to offer skills in health programme management, communication and technology, monitoring and evaluation, health economics, epidemiology and biostatistics, among others.

These are offered at various levels of complexity to suit the needs of all cadres of personnel.

Institutional capacity building: By partnering with local organisations implementing health programmes, capacity gaps in health systems of these organisations are determined.

They can be bridged by collaboratively implementing collective measures. This in turn means that the organisations are better able to support the personnel working for them to provide better services to the populations they serve.

There is need to mobilise and ring-fence resources to sustainably address challenges faced by personnel working in the health sector.

The author is a Professor, Principal at College of Health Sciences, University of Nairobi


Monday, July 9, 2018

Blended flour as first foods: The mistakes to avoid


Parents are subjected to all kinds of contradictory advice when it comes to child nutrition or the first complementary foods for your baby.

Breast milk is the optimal nutrient mix for infants but what happens after six months?

Yes, introduction of solid foods. One of the common complementary food we give is blended flour commonly referred to as ‘unga wa lishe’ that containing cereals, grains, vegetables and sometimes whole foods like sardines that is used to make porridge for babies. The preparation of various combinations of such flour has been carried out without understanding of the correct purpose and balance. Improper combination and balancing of the components is what causes stomach upsets, constipation and food dislike among babies.

Well, the idea of blended flour is built on the philosophy of balanced diet; a diet consisting of a variety of different types of food which provide adequate amount of nutrients necessary to maintain good health.

Foods containing proteins, carbohydrates, fats, vitamins and minerals in right amount makes up a balanced diet.

Now you know the food groups, contents and functions, let’s go back to our flour composition.

Simple math: mixture of maize, millet, rice, potatoes equals single nutrient – carbohydrates, soybeans, groundnuts, sardines equals protein. So, you’re mixing five food groups to obtain only two nutrients, and call that nutritious?

Sadly, the child will be fed such crap for months and you’ll be complaining my child won’t eat, my child doesn’t like food! Oh really? I dare you to drink that uji from morning till dawn and let me hear how you loved it!

Right combination

Before I tell you the right combination, let me take you back on preparation because most people think it’s just mixing and milling of the grains.

Effective processing begins with the best exploration of raw materials (here referred to as ingredients) from the field or marketplace.

The ingredients should be harvested in due time, kept in proper storage conditions, clean and not damaged by insects. Before processing, ingredients should be properly cleaned to remove any dirt and water used for cleaning should not be re used for other ingredients.

Further processing of ingredients before mixing differ significantly between the grains. Unfortunately, most food producers do not take into account the proper steps which is crucial for food safety to optimise consumers health.

The goal of making blended flour is nutrient enrichment to a grain source type of food.

Targeted nutrients are proteins, vitamins and minerals, so the additional ingredients should aim at complementation and not just quantification.

For instance, food containing very little amount of protein like maize should be mixed with high protein food like soy, beans, peas or peanuts.

Let’s take a mixture of maize (81%) and soy (19%), from 100g of flour; a child will get 422 total Kcal, out of which, 15% Kcal from protein, 75 per cent Kcal from carbohydrates. (Those who ditched mathematics, I can see your faces).

Okay, don’t get confused, the point here is mixing should consider correct ratio of ingredients and their nutrient content. But again, even with correct balance of ingredients, quantity of cereals is important, the more the merrier does not apply here. Blended flour containing nuts is not recommended for children aged between six months and one year to prevent allergies and the risk of aflatoxins.

Even though the idea of having blended flour is to meet nutrition needs of the infant is vital to consider implication of each of the elements in the combination.

There is an important and urgent need to reevaluate the combination formulas used and design appropriate modifications that will meet local and international nutritional standards.

Infant feeding isn’t rocket science, seek correct information mix with a bit of common sense, you’ll be safe.


Monday, July 9, 2018

Dear doc, can prostate cancer come back?


Dear Doc,

Due to urination complications, my prostate was removed 16 years ago. Recently, the problem returned and another doctor says I have prostate cancer. How is this possible?

A prostate is a sexual gland that produces about 30 per cent of seminal fluid that carries sperms and because it surrounds the upper part of the urethra, it may interfere with urine passage when it grows bigger as happens when men get older.

When the urinary flow is obstructed, a man will find it difficult to pass urine requiring surgery as a relief and to prevent other urinary tract complications, especially those affecting the kidneys.

Surgery may then be done to remove all (if it is due to cancer) or part (if it is BPH) of the prostate gland in what is called prostatectomy.

Removing part of the prostate rather than the whole of it helps in preservation of urinary and sexual function and minimises the side effects of removing the whole prostate.

So, the doctor was right to treat your prostate enlargement, the reason you could urinate well after the operation and most likely your sexual function was preserved.

Unfortunately, as you grew older, you got cancer in the part that was left after the operation because it was previously not diseased.

Dear Doc,

I am 23 and my right breast produces milk when pressed. I gave birth in 2014 and stopped breastfeeding in 2016. Both breasts were producing milk when pressed long after I stopped breastfeeding; now it is just the right one. Is this normal?

It is possible to induce production of milk through repeated stimulation, either with the hands, by sucking or by using a breast pump, even without pregnancy or normal lactation and even in someone who has never been pregnant.

For someone who has been pregnant, as long as you keep stimulating the breasts, by pressing or sucking, milk will be produced.

About six weeks after breastfeeding stops, most people stop producing milk. In a few people this does not happen, but as long as there are no additional issues like pain or breast lump, there is no need to worry.

To avoid milk production, avoid breast stimulation (pulling, pinching, and sucking) and do not wear clothes that have a lot of friction between your nipples and the fabric.

Visit a doctor for a physical breast exam. You may have tests done to find out if you have high prolactin levels (the hormone that causes milk production), and if you have other disorders.


Monday, July 9, 2018

Foods to keep your kidneys healthy


Kidneys help remove extra water and toxins from the blood. But sadly, most of us take these vital organs for granted, leading to many cases of kidney disease. Here is a list of foods you should add to your diet for a healthy kidney.

Kidneys are one of the body’s biggest natural detoxifying components. Keeping your blood pressure under control can protect your kidneys and prevent kidney failure. Watching what you eat and drink will help you stay healthier.


Paul Lutaakome, a nutritionist at Jinja Referral Hospital, says water is the best ingredient for overall water balance in the body. You need to aim for six to eight glasses a day, depending on your body weight and how often you feel thirsty.

“Water helps flush out toxins that can lead to bacterial infection or kidney stones, along with harmful particles in the blood. Water is absolutely the best cleanser and if you drink enough of it, you may not get frustrated about detoxifying,” he says.


Apples are a low potassium fruit that act as a natural cleanser for the body. They keep the kidneys cleansed without causing frequent urination. “They are a good source of pectin fibre that removes excess cholesterol and regulates blood sugar levels,” Lutaakome says.


Cruciferous vegetables such as brussels sprouts, cauliflower, broccoli, kale, cabbage and mustard greens are known for their high fibre content and distinctive taste. They are also high in beneficial plant compounds and may increase the liver’s natural detoxification enzymes, help protect it from damage and improve blood levels of liver enzymes.

“Kale is an important source of vitamins A and C that prevent inflammation and protect the immune system. It has lower potassium content than some vegetables and contains a large amount of iron. Iron is important for healthy kidney function since many people with kidney disease have an iron deficiency,” Lutaakome says.


Berries are good for people with chronic kidney disease and those on dialysis. Beyond the daily boost, berries such as blueberries, raspberries and strawberries contain less Potassium per serving.

“Berries are a great option for maintaining healthy kidneys, because they provide flavonoid antioxidants which help to rid the body of free radicals. An excess of free radicals is thought to trigger a number of kidney conditions,” says Lutaakome.

Blueberries also maintain the vascular function of kidneys, and raise the antioxidant defenses in the kidneys. Other healthy foods for the kidneys include seeds and nuts, pumpkins, beetroot juice, garlic and onions, grapes and fish.


To keep your kidneys healthy, you must avoid consuming too many protein-loaded foods or foods that are, in general, not good for health. You should also go for walks or run to keep your body functioning properly.

Finally, always keep your doctor informed about your food habits if you are suffering from kidney disease.

Sodium (salt) is found in almost all foods. If your sodium intake is high, you will get too thirsty, which can lead to swelling and escalating of your blood pressure. This often damages your kidneys. Limiting the amount of salt you eat is therefore one of the healthiest ways to keep your kidneys healthy.

Too much potassium can be dangerous if you have kidney disease. Work with your dietitian to find foods that are low in sodium and potassium.

“High protein diets should be avoided, especially if they are animal-based foods. This is because processed meats such as sausages and bacon and other animal foods contribute to inflammation while high phosphorus-containing foods can cause kidney stones,” he warns.


Monday, July 9, 2018

Autonomous agencies: A cure for African medical security


By Christophe Bazivamo and David Mukanga

When Ebola struck in West Africa in 2014, more cases and deaths were recorded than in all other outbreaks combined. Spreading across borders to kill tens of thousands, destroy communities and leave survivors in anguish, the epidemic was the largest and most complex since the virus was discovered.

Such devastation roused the international community and local actors into action, necessitating a coordinated response.

But at the same time, medicines were brought in and tested on patients by some groups without going through appropriate regulatory and ethical approvals by the responsible institutions.

There are a number of anecdotal stories of regulators being pressured to approve medical products and manufacturing sites without due processes being undertaken, and this could result into poor health outcomes.

On the other side, there are firsthand accounts of autonomous regulatory agencies withstanding this pressure. These are government agencies mandated by force of law to exercise independence in decision making over medicine regulation, with their autonomy guaranteeing independence from undue influence. This means agencies can make decisions on the basis of science and public health, and nothing else.

This is important because medicines are not ordinary consumer goods, and citizens are not able, alone, to determine if a medicine is safe, efficacious and of quality. So to mitigate such risks in Africa, it is of paramount importance that countries regulate medicines effectively.

To do this each country must have an autonomous regulatory agency. Yet a recent survey by the World Health Organization (WHO) shows that only 40 per cent of countries in the WHO Africa Region have an autonomous or semi-autonomous Medicines Regulatory Agency

Without said agencies, nations stand the risk of failing in their duty to protect their citizens’ public health, as well as their national security by allowing the illegal manufacturing and trade of drugs to go undetected.

While working together regulators can achieve high standards through work-sharing with other agencies, there are vital functions that each country must undertake alone.

These functions require a strong, autonomous, but right-sized agency so that access to medicines is not hindered by unjustified regulatory work.

Economically, without an autonomous agency, a country cannot provide the regulatory oversight necessary to ensure medicines produced locally are of quality for both the local and external markets.

This means external markets will be reluctant to buy products from countries in which the regulator’s competency and independence are in doubt.

Therefore, by maintaining high regulatory standards, national regulatory authorities allow their national manufacturers to participate in global commerce.

It also affords access to the World Health Organisation’s prequalification program and improves global supplies for the benefit of those most in need.

Take Kenya, where manufacturers are exporting across East Africa with one local manufacturer, Universal, selling WHO prequalified products. Or Uganda, where one manufacturer, QC Cipla, is selling WHO prequalified products for HIV and malaria that are exported across Africa, for the benefit of Africans and the Uganda’s economy.

An autonomous agency is also able to generate its own revenue through fees for services that allow it to hire and retain competent staff. These staff play not only a public health function, but advance national security through the agency’s regulatory mandate. Just imagine an entity that intentionally produces a falsified “drugs” with the intention to cause harm.

Fortunately, great steps have been taken in the East African Community in recent years.

Since 2012, when the East African Community Medicines Regulatory Harmonization Initiative was launched, the goal of making more medicines available to more people across the region has been centre stage.

The initiative sought to reduce the amount of time taken to register essential medicines to treat priority diseases. More than that, it aimed to harmonise requirements across countries to increase collaboration, strengthen the regulatory capacity of partner states, and ensure the efficient evaluation of high-quality, safe health technologies.

How has this work-sharing and reliance been done?

Each country contributes its expertise towards joint assessment of medicines, ensuring that even those that may be constrained with certain expertise benefit from the regional pool of experts, while their own capacity is built through this engagement.

And it has been successful: more drugs have been submitted for review under joint assessments; expertise is pooled; optimisation has brought efficiencies and cost savings that accrue to the health care system, taxpayer and patient. Yet, without autonomous agencies, progress will remain incomplete and frustrated.

Fortunately, within the EAC region, four of the six countries have an autonomous or semi-autonomous agency, with Rwanda and Burundi, the remaining two, close to setting up their own.

In February, the Rwandan parliament passed into law a bill to establish the Rwanda Food and Drugs Authority.

A month later, the National Legislative Assembly of Burundi considered legislation establishing the Autorité Burundaise de Régulation des Médicaments et des Aliments (ABREMA).

Such progress across the East African Community is not just necessary, it is welcome and encouraging. Because while developments in medicine should always be celebrated, so too should these regulatory steps that will ensure safe access for millions of Africans.

Dr David Mukanga is a Senior Program Officer in Global Health for the Bill and Melinda Gates Foundation and Hon Christophe Bazivamo is Deputy Secretary General for Social and Productive Sectors for the East African Community (EAC).


Monday, July 9, 2018

Health conditions your teeth can reveal


By Dr Sakina Khanbhai

You’ve probably heard or read time and again that you should visit your dentist at least once in every six months.

Now you may insist that you follow a meticulous oral hygiene regime, have never ever experienced a toothache, bleeding gums, sensitivity or any other sort of other dental issue that may warrant a visit to the dentist.

In spite of all that, do you ever wonder why we stress on the same so often?

Well, this may come as a bit of a surprise but in fact, your dentist may be the first person to notice non-dental medical issues in your mouth during an examination. Some of the most common diseases that manifest as oral conditions are:


Dry mouth, receding gums, bleeding gums and loose teeth are all warning signs that indicate a diagnosis of diabetes. Diabetic patients also experienced delayed healing in oral wounds and gum line infections due to poor immunity. However, these signs are not only limited to diabetes.


Stress not only takes a toll on your mental wellbeing, but may also manifest in the mouth. One of the most obvious manifestations of stress in the oral cavity is worn out occlusal surfaces of the teeth. This is due to a condition called bruxism, or in other words grinding of teeth.

You should also look for other ways to free your mind and body of stress, be it exercise, playing some sort of sports, yoga and meditation.

Oral Cancer

Oral cancer is one of the most aggressive types of cancer. Your dentist may perform an oral screening if he/she notices red or white lesions on the tongue, palate, floor of the mouth or insides of the cheeks. Major risk factors are alcohol consumption, smoking and tobacco chewing.


Severe pain, swelling, redness around the affected area, an area that feels hot to touch, fever and pus in or around the tooth are all signs of infection. If left untreated, infections may spread to other parts of the body. Therefore it is of utmost importance that an oral infection is treated in a timely manner.


White, red, purple or brown spots in the mouth and especially on the tongue are common signs manifested in adult patients with HIV. Some may also develop oral warts.

Children infected with HIV may have salivary gland swelling that results in a dry mouth and due to severe immunosuppression, they are more prone to viral infections like herpes and fungal infections like oral candidiasis.

Having the above symptoms do not necessarily mean that one has HIV but may raise a red flag and your dentist may advise you to get a blood work up done to rule it out.

Poor Nutrition

You may try to hide your eating disorder from everyone but your dentist will figure it out as soon as he/she sees your oral cavity. Cases of bulimia usually present with bleeding gums, dry mouth, and erosion on the insides of front teeth. Forced vomiting causes the gastric acid to wear off the enamel of teeth and also leads to sensitivity.


This is a condition in which the body loses bone or makes too little bone. Thus, leading to bone weakness. Although this can happen to pretty much anyone, it is more common in post menopausal women.

Mobile teeth and receding gum line are tell tale signs of an underlying bone disease as the teeth lose support from the jaw bone due to changes in density of the bone.

The dentist may refer you to a physician for bone density and other relevant tests.

So the next time when someone refers to a dentist as a doctor, don’t say ‘oh but they only deal with teeth’. There are ceratin health problems your dentist can catch at an early stage. Regular dental care may save you from developing life threatening conditions and give you a chance at a better prognosis.

The author is a dentist based at the Ebrahim Haji Charitable Health Centre.


Monday, July 9, 2018

Obesity a major cause for infertility in men, experts say


By Devotha John @johnteck3 djohn@tz.nationmedia.com

Overweight and obesity are two health challenges tied together, though in our societies when a person looks flabby, it is usually associated with prosperity.

“It is now very common to hear couples struggle to conceive. We also hear lots of factors contributing to infertility but many of us are not aware that unhealthy eating habits and lifestyle play a huge role in this,” notes Neema Shosho, a nutritionist based in Dar es Salaam.

A diagnosis of male infertility can be one of the hardest challenges a man can face. Not being able to father can make a man feel like he has failed in life.

Jacob Moses, 38, a Dar-es Salaam based businessman, says he has been in marriage for over six years now without a child.

Moses originally blamed his wife before he realised that he had fertility issues.

“In my lifetime, I didn’t know that I was the source of the problem. My wife has been asking me to go for check-up after she had done so but I was not ready for I knew I was fertile,” he says.

Jacob says being a businessperson, he had to travel upcountry regularly and had no much attachment with his family.

He says he was tired of being blamed by family members for the wife’s failure to bear children, because they all believed that she was the source.

“I remember two or three times when my sister accused my wife of being barren. She ordered her to leave the house and let another woman come and bear children,” he says.

Jacob had always had weight issues something that he says even his mother was concerned about as she always advised him to lose weight,

“The day I accepted to go for a medical check-up it was like opening a can of worms. My doctor said my weight was to blame for my infertility. I was weighing 190 kgs,” says Jacob.

How body-weight affects fertility

“Obesity is strongly linked with hormonal imbalance in male, chronic elevation of insulin hormone a condition known as hyperinsulinaemia affects testosterone (male hormone) , which is supposed to be low (in balanced state), when affected becomes predominant in male,” says Dr Boaz Mkumbo, a medical doctor and founder of Healthy Eating Academy.

Dr Boaz explains that insulin is a hormone made by the pancreas that allows your body to use sugar (glucose) from carbohydrates in the food that you eat for energy or to store glucose for future use. Insulin helps to keep your blood sugar level from getting too high (hyperglycemia) or too low (hypoglycemia.The cells in your body need sugar for energy.

He however, explains that, the main disruptor of hormones in male is sugar when taken from simple sugars (drinks, table sugar and juices) and refined carbohydrates such as wheat bread can affect your body from normal utilisation of insulin hormone a condition known as insulin resistance which is characterised by excessive insulin in the body.

“It is scientifically known that sugar in your blood should range 5gram-10gram in 5-7 liters of blood in an adult, which can be converted to 4.6mmol/L to 5.0mmol/L. In our normal daily life, sugar in our blood is supposed to be one teaspoon to two teaspoon in 5 to 7 liters of blood,” he says.

Because the normal blood sugar range is a fixed value, whatever the amount of sugar you have taken as your diet, the body will need only 1 to 2 tablespoon of sugar to circulate in your blood and the rest will be pushed to storage tanks (fats and glycogen).

For example, you have taken a sugary drink with an average blood sugar of 30 gram. This is equivalent to 6 teaspoon whereby the body will need only maximum of 10 grams, the remaining 20 grams will be stored as fat in large amount for future energy use.

“Your pancreas will keep on helping you use sugar normally throughout your life, therefore excessive sugar consumptions puts you at risk of developing insulin resistance, the main cause of obesity, hypertension, diabetes, heart diseases, erectile dysfunction - all linked to male infertility,” Dr Boaz explains.

Insulin resistance is the chronic condition whereby the body cells cannot use insulin properly and therefore the signal of insulin to body cells is ignored and your body loses ability to use sugar and carbohydrates normally.

He says testosterone is the male hormone, which controls male secondary sexual characteristics including enlargement of male genitals, body power, vitality and desire to have sex. Testosterone is the key male sex hormone that regulates fertility.

He notes that, when levels of testosterone drop below normal levels, they can lead to conditions like hypogonadism characterised by small male genital organs, impotence and mostly of male secondary sexual characteristics are impaired.

There are, however, sources from which people with low testosterone can boost their levels.

Dr Boaz says high or low levels of testosterone can lead to dysfunction in the parts of the body normally regulated by the hormone.

He says when a man has low testosterone or hypogonadism, he may experience reduced sex drive, erectile dysfunction and low sperm count and therefore may become infertile unless treated.

The effects of insulin

When you are overweight or obese, your body is exposed to excessive insulin that’s why you experience difficult in losing weight whatever you struggle because insulin prevents your body from using the stored fat.

This condition may affect the production of testosterone and hence have low sperm count, low sexual drives and body power.

Apart from that excessive insulin exposure may also cause oestrogen hormone, predominant in male which is not supposed to be detected high in male since it controls female secondary sexual characteristics such as breast and hips enlargements, menstruation cycles etc. This condition is linked to central obesity in male, low male sex hormones, enlargements of breast in male and small genitalia.

Generally, most of undiagnosed causes of infertility in males are hormonal related.

Dr Boaz says sometimes when a man weighs extra kilograms, he will always experience chronic body fatigue sometimes accompanied with pain, a situation that will lead him lose desire for sexual intercourse.

Healthy lifestyle

Here are some of the lifestyle changes Dr Boaz suggests:

• Get involved in healthy eating lifestyle, to boost your testosterone level and avoid excessive sugar and refined carbohydrates consumption.

This will help you sensitise your body and lose your extra pounds without struggle. Losing weight will not only make you lighter but also increases your fertility.

He argues that making these changes, a man will get other health benefits as well, explaining that he may lower his risk of other diseases, and will probably feel better and have more energy.

They should also eat a variety of foods from each food group, including whole grains, fruits with low sugar value such as avocado, cucumbers, strawberry and blueberries and vegetables.

In addition, research has shown that excessive omega 6 ratio compared to omega 3 drives insulin resistance a condition linked to infertility.

Therefore avoiding Omega 6 rich seed oils and fats loaded with free radicals such as margarine [blueband] which should go concurrently by increasing omega 3 rich foods such as a handful of tree nuts, cashew nuts, almond seeds, Chia seeds as well as eggs, grass fed beef, free range fish so that to boost your testosterone level.

• Exercise has many health benefits, including helping one to lose weight and lower their blood sugar levels. Also helps to boost testosterone level to people with condition of infertility.

• Smoking can contribute to insulin resistance, which can lead to type 2 diabetes. If one already smokes, one should try to quit.

The exercise should go with taking balanced diet because exercising makes testosterone hormone high.

• Avoid stress, when you are chronically stressed, cortisol hormones (Stress hormones) lower your testosterone and may cause infertility. Apart from that, chronic stress is linked to obesity, chronic fatigue accompanied with generalised body pain.

• Engage in Yoga and meditation, which are the main tools for stress management as compared to aerobics, cardiac and resistance exercises.

Not a woman’s problem only

Dr Boaz advises men not to think, ‘there is a magic pill or herb that can cure infertility’. The permanent and definitive solution to conquer your problem is to adopt healthy lifestyle changes, healthy foods can help you reclaim your health by dealing with your body as whole.

However talking about why most men fear to seek medical check-up, the expert says most of them feel that they are superior to their wives, thus seeking medication would be akin to losing dominance.

“Most men can stay with healthy problems without wanting to inform their wives. They mostly think by divulging secretes they would destabilise their families and conjugal affairs,” says Dr Boaz.

He notes that in the past infertility was a problem that was associated with women, the situation that caused family separation but now days a few men seek medical advice in case infertility persists.

Most Tanzanian men don’t realise that the problem might start with them.

A nutritionist’s take

On her part, Ms Neema Shosho, a nutritionist says, it is now very common to hear couples struggle to conceive.

“If not done in a healthy way, unhealthy eating and lifestyle can highly damage your reproductive system so precautions should be taken. For men specifically, studies have proven that young men of reproductive age have low sperm count than their fathers and grandfathers had at this age,” says Ms Shosho.

What is contributing to this then?

Ms Shosho sheds light to some of the other contributing habits to male infertility:

• Alcohol consumption: excessive consumption of alcohol is named to be toxic and can affect sperm production as well as causing hormonal imbalance.

Ms Shosho says alcohol not only leads to erectile dysfunction, it can also affect the quality of your semen and the production of sperm through abnormal hormone fluctuations.

• Same effects are observed in men who smoke. Smoking is linked to damaged sperm.

• She notes that weight gain has tremendous effects to a man’s reproductive health. It affects men’s hormonal balance, throwing sperm production off. There’s also evidence that being overweight can make it difficult to achieve an erection or even want to have sex.

“We know this is sensitive so if a man wants to keep his virility, he should make sure that his BMI is ideal,” she says.

• In addition to the above two key factors, the following factors are also named to play part to male infertility;

Tight pants and underwear. This increases the scrotal temperature which can result in a decrease in sperm production as sperms survive better at low temperature. This is important for those wearing very tight pants and underwear. Let it free.

• “Excessive stress although correlation between stress and infertility is not that clear, researchers did suggest the sperm could be harmed by stress-related hormone changes, or an increase of stress-related free radicals that harm cells”.

Key message

“Eat balanced diet, manage your weight, maintain ideal BMI, drink alcohol in moderation and smoking should be a No No to them, avoid stress, remember to exercise and keep fit,” Dr Boz advises.


Monday, July 9, 2018

New mother: Taking care of yourself post delivery


During pregnancy most women tend to ask family members and those close to them who have children on what to expect after giving birth, but the truth is not all people have the same experience.

Some of the changes that women experince might seem alarming especially for first time mothers. There are things that once they occur they need quick medical attention but others can be overcomed with time.

What to expect

Speaking to Your Health, Dr Emmanuel Mduma, a medical doctor at Arusha Lutheran Medical Centre (ALMC) said there are changes that occurs during the first six weeks after giving birth, which are very common and that a new mother should not be worried.

According to him, for a woman who has just given birth, one thing to expect is vaginal discharge, commonly known as ‘lochia’ which contains blood mucus and uterine tissue.

“During the first few days the discharge is normally redish and as days pass it gets thinner and becomes brownish or pinkish and finally at the end it turns to yellowish white, this is perfectly normal and should be expected.

Another thing Dr Mduma explains is vaginal soreness and sometime a tear, which might either require stitches or if very minimal, left alone to heal with time, adding that antibiotic will be provided for those with stitches.

“Most women tend to use ice or warm water to reduce soreness but those with stiches should avoid this. The most important thing is to maintain cleanliness to avoid bacterial infections,” he said.

Afterbirth or adnominal pain should also be expected because after carrying the baby for nine month the uterus will need to contract and return to its normal size.

Tenderness of the breasts and painful nipples are something the first time mother will have to expect and bear.

In addition, Dr Mduma further explained that for those women who experience hormonal changes during pregnancy that cause dark spots, they tend to disappear during the postpartum period.

Kegel exercises

Some women also experience urine incontinence. This urine leakage occurs when one sneezes, laughs or jumps and this happens during child birth when pushing the baby, which weakens the pelvic floor muscle due to the use of force.

“The pelvic floor muscles tends to strengthen with time and give a better bladder control. Kegel exercises should be done to give the muscle better strength,” explained Dr Mduma.

Kegel exercises, according to Mayo Clinic, can help you prevent or control urinary incontinence and other pelvic floor problems. These exercises strengthen the pelvic floor muscles, which support the uterus, bladder, small intestine and rectum.

To identify your pelvic floor muscles, stop urination in midstream. If you succeed, you’ve got the right muscles. Tighten your pelvic floor muscles, hold the contraction for five seconds, and then relax for five seconds.

Try it four or five times in a row. Work up to keeping the muscles contracted for 10 seconds at a time, relaxing for 10 seconds between contractions.

What not to overlook

One of the issues that is overlooked is postpartum depression or mood change causing a woman to be emotional, depressed and anxious.

Dr Mduma says, “Mothers suffering from postpartum depression need a lot of support from family members and those close to them to help them not to feel isolated”.

This all should be expected by any women after birth, says Dr Mduma.

But there are things that once they occur, immediate medical attention is normally required.

“One major cause of concern is postpartum haemorrhage, which is an excessive loss of blood within the 24 hours after delivering, as well as puss discharge for those with stitches and caesarian section,”,he said.

Furthermore he also cautioned of postpartum preeclampsia a pregnancy complication characterised by high blood pressure and signs of damage to another organ system, most often the liver and kidneys, the signs for this are severe headache, pressure as well as dizziness.

“If not treated earlier it develops to postpartum eclampsia and seizures which can permanently damage the brain, eyes, kidney and liver,” Dr Mduma cautions.

The right nutrition

Postpartum care does not only involve body and mind, but also healthy eating habits should be adapted.

Doreen Kasubi a nutritionist based in Dar es Salaam tells Your Health that the most important thing after giving birth is eating a balanced diet to regain nutrients as well as being able to produce enough milk for the baby.

“Whatever the mother eats determines what the baby will be receiving in his milk, failure to eat enough food, the mother will not be able to produce enough milk to sustain the baby,” says Doreen.

Lack of balanced diet can cause the mother to have low blood count and hence lowers the immunity making the mother prone to diseases.

“During this period, a large consumption of sugar and fats should be avoided, but light exercise should be encouraged to strengthen the body,” she said.

Speaking of exercises, Buneventure Prosperia, a fitness and nutrition consultant based in Dar es Salaam says during the 40 first days after giving birth, heavy lifting should be avoided and the body should be allowed to rest.

“The body requires rest because it has undergone stress. All that needs to be done are light exercise sand progress as the days go on to tighten the body,” Prosperia advises.


Monday, July 2, 2018

Caring for people with life threatening illness


By Zainab Sachak @TheCitizenTz zainabsachak@gmail.com

How difficult is it for someone to just wait for death lying on the bed doing nothing? Very devastating for somebody like the 65-year-old Julie*.

I met her son at a community gathering where he was sad and worried about his mother who after being diagnosed with cancer had become totally bedridden.

She was fed and dressed by the house help, wouldn’t talk to anyone and was constantly crying. She was in that state for two months now.

I volunteered taking a look at her. Upon assessment, I found out that she had fully functioning arms and legs, just a little weakness and no will to live anymore.

Julie was a very jolly person according to her family members and seeing her like that, was heartbreaking.

When life takes an unexpected turn, such as the case of Julie, some people prohibit themselves from doing meaningful things that they want to do.

This is where occupational therapy comes in. Julie needed that push to help her do the things she wanted and needed to do.

Her therapy

In the therapeutic programme formulated, I started off by visiting her and conversing with her about her life achievements, her interests and how important she is. Gradually introducing light exercises to build up her endurance and ensure that blood circulation is improved. We also incorporated walking and self dressing in her routine.

Her interests lied in cooking for her family and picking her grandchildren up from school. When she was strong enough, we incorporated cooking as a therapeutic activity and started with making simple tea and progressing to making pilau for her family.

This improved her body function and brought back her self-confidence and motivation to live. Furthermore with the help of her son, I created a safe and comfortable environment for her to accompany the driver in picking up her grandchildren, which helped her to socialise.

In four weeks of therapy, she was slowly returning to her jolly self. She began attending family gatherings and community events. She could also dress, eat and bath on her own again.

Part of the therapy process is having to meet with the family members to know about the patient’s progress and what more do they require from the therapy process. In my routine meeting with Julie’s son, he mentioned that before his mother was hit by cancer, she always hosted family and friends for gatherings and she would cook delicious meals for the dinner guests and how much he misses that. So Julie and I decided to surprise her son with that. We invited the family and neighbours for dinner one night. I planned the cooking activity for her taking into consideration her endurance level, safety and rest periods. She was able to prepare the meal and enjoy a fun night of gathering with the people she is close to.

Unfortunately cancer got the best of her, in her final days of life, we worked for her to be comfortable and managing pain by appropriate positioning. We made cards for her children and fun videos for her grandchildren. She passed away leaving a lifetime treasured memory for her family. Most importantly she died having lived happily even during her final days.

Final thoughts

Life is not over when one is debilitated. Terminal illness, ageing or a permanent disability does not limit one living to their full potential.

Don’t let yourself or your loved one suffer alone in silence. With appropriate help, life can be meaningful.

Quick notes

• Due to certain life circumstances, people’s normal functionality is compromised

• Medical approach can only help you to a certain extent

• Appropriate rehabilitation services will help the person recover and reintegrate back to their daily activities

• Disability is not inability


Monday, July 9, 2018

Walk 100 steps a minute for good health, here’s how


Most of us know that we should walk briskly for the sake of our health. But how fast is brisk?

A helpful new study of walking speed and health concludes that the answer seems to be about 100 steps per minute, a number that is probably lower than many of us might expect.

Current exercise guidelines almost always state that we should walk at a brisk pace rather than stroll leisurely. But the recommendations do not always define what brisk walking means and, when they do, can deploy daunting terminology or technicalities.

They may say, for instance, that brisk walking requires three metabolic equivalents of task, or METs, meaning that it uses about three times as much energy as sitting still.

Even the simplest, often-cited description of brisk walking can be vague and confusing. Used by the Centers for Disease Control and Prevention and other agencies in their guidelines, it defines brisk walking (and other moderate-intensity activities) as occurring at a pace at which people can talk but not sing.


That definition seemed impractical to Catrine Tudor-Locke, a professor of kinesiology at the University of Massachusetts in Amherst, who has long studied how much exercise might be needed or sufficient for health.

“Who wants to sing when they walk?” she asks.

So, for the new study, which was published in June in a special issue of the British Journal of Sports Medicine devoted to the topic of walking, she and her colleagues decided to see whether there was enough data already available to develop a more precise and useful definition of brisk walking.

They began by looking for recent, good-quality published studies that had tracked people’s walking pace and cadence, which is the number of steps they take per minute, as well as other measures of their effort, such as heart rate or increases in respiration.

They wanted to see if there were consistencies between an easy-to-use number, such as steps per minute, and more technical determinations of intensity, such as respiration.

They wound up with 38 studies that had included hundreds of men and women ranging in age from 18 to elderly and of many different BMIs.

But despite the differences in the participants, the data about what made their walking brisk, or “moderate,” was consistent across all of the studies, Tudor-Locke and her colleagues found.

Brisk walking involved a pace of about 2.7 miles per hour. Or put more simply, it required about 100 steps per minute.

“This is a number that is very easy for any of us to measure on our own,” she says. “You do not need special equipment or expertise.”

Just count how many steps you take in 10 seconds and multiply that number by six, she says. Or count how many steps you take in six seconds and multiply by 10. Or count how many steps you take in a single minute and skip the multiplication altogether.

“The good news is that this pace will probably not feel strenuous to most healthy people,” she says.

Vigorous walking requires about 130 steps per minute, she and her colleagues determined, a pace at which you still are walking.


Monday, July 2, 2018

Emerging concerns: Cardiovascular disease in HIV patients


By Gerald Yonga

As the World Aids Day was observed last month, cardiovascular diseases — particularly stroke and coronary heart disease — were highlighted as emerging areas of concern for HIV patients.

According to the UNAIDS 2016 report, 1.1 million people worldwide died of Aids-related illnesses in 2015. By the end of that year, an estimated 36.7 million people around the world were living with HIV.

Since 1996, when antiretroviral therapy (ART) became available, people with HIV have been living longer and healthier lives.

However, as individuals with HIV age, they are more likely to be diagnosed with chronic illnesses and research has named cardiovascular disease as a common occurrence in people over 40 living with HIV.

A number of factors combine to make them more vulnerable to cardiovascular diseases. The virus causes chronic inflammation, which leads to plaque build-up and eventual blockage in the arteries that can cause cardiovascular disease.

Additionally, some ART medications used to treat HIV can raise the risk of heart disease by causing insulin resistance which may lead to diabetes. Researchers have revealed that some kinds of HIV drugs such as protease inhibitors are associated with development of high levels of fat in the blood. Both of these may lead to blockage of blood vessel in various parts of the body. If untreated, this heightens the risk of heart, gall bladder, and pancreatitis diseases.

Also HIV patients who smoke are at higher risk of cardiovascular disease.

HIV itself can further increase the risk of cardiovascular disease. Untreated HIV with its high viral loads has been linked to heart diseases and experts now recommend starting treatment earlier to avoid such cardiovascular damage.

Not only does HIV related inflammation damage the immune and other organ systems, it also accelerates the ageing of blood vessels. The use of ART greatly decreases HIV-related inflammation. Indeed, studies have found that people who stop taking ART have a greatly increased risk for heart attacks and stroke. Nevertheless, low, or un-detectable viral load, low-level inflammation triggered by HIV infection may continue to slowly affect organs and blood vessels, but at a much lower level than before.

But there are steps to prevent and manage this fear.

To begin with, lifestyle changes such as diet, exercise and quitting smoking can greatly reduce the risk of cardiovascular disease. When lifestyle changes are not enough, a number of effective medications and other medical approaches are available. It is also important to take cardiovascular risk factors into account when making crucial HIV treatment decisions, such as when to start, or switch treatment and which medications to use.

But the benefits of ART have been shown to greatly outweigh the dangers and researchers warn against stopping HIV drugs to protect the heart.

Regular monitoring of the levels of cholesterol and triglycerides in the blood and other cardiovascular risk factors in the HIV treatment factors and adoption of prevention, early detection and control can help to control the problem.

Researchers are currently pursuing ways to address the problem of cardiovascular disease among people living with HIV.

Prof Yonga is a consultant cardiologist at Aga Khan University Hospital.


Monday, July 2, 2018

Don’t ignore cleaning your tongue, here’s why


By Dr Sakina Khanbhai

Whenever I ask my patients whether they follow good oral hygiene practices, they are quick to respond with an enthusiastic YES! They even give me an elaborate explanation of how they floss each and every tooth, brush all the different surfaces of the teeth, twice or sometimes thrice a day and even use a mouth wash to keep all plaque at bay.

As soon as I mention the cleaning of the tongue as part of routine oral hygiene, I see the colour and excitement of believing that they are doing everything perfectly draining from their face.

Cleaning of the tongue is one of the most commonly left out areas in the oral cavity.

The mouth comprises of more than 600 strains of different bacteria that stick to both hard and soft tissues of our oral cavity, including our gums, insides of cheeks and mostly the tongue.

Bad breath

Bacteria adhere very easily to the tongue due to the tiny bumps on its surface known as papillae. These grooves collect food debris, bacteria and dead skin cells. With accumulation of all these debris, the tongue starts having a whitish appearance and also causes one to develop bad breath.

Not only that, this plaque may redeposit from the tongue on to the teeth, causing plaque buildup, calculus (tartar) and tooth decay. Which means, however meticulously you may clean the teeth, if the tongue is left out from cleaning, the bacteria makes its way back to the teeth and gums.

Most people firmly believe that mouthwash is the best way to keep bad breath (halitosis) at bay. But what it actually does in reality is to just take off the superficial layer of plaque from the tongue. This is because the swishing movement of mouthwash is not enough to remove the deeply seated debris in the papillae of the tongue.

If the film of plaque is not removed by physical cleaning of the tongue, bad breath will prevail.

Right way to clean your tongue

Now that I’ve stressed enough on the importance of cleaning the tongue as part of routine oral hygiene practice, I’ll give an overview of how this may be achieved by one and all.

The two most commonly used ways of cleaning the tongue are by brushing with a regular tooth brush or by scraping using a tongue scraper.

Although both methods work well, a tongue scraper is more effective.

This is how it is done: Stick your tongue out and place the scraper (or toothbrush) at the far end of the tongue and slide it towards the tip of the tongue with uniform pressure.

Make sure that you start at the back of the tongue and move towards the tip so as not to push plaque towards the throat and accidentally end up ingesting the bacteria.

Rinse the scraper (or toothbrush) well and repeat. Once you’ve ensured that the entire surface of the tongue has been cleaned, clean the scraper (or toothbrush) well.

After this, brush and floss your teeth as per your usual routine.

Tongue cleaning should be done twice a day just as you do brushing and flossing.

It is advisable that children are also encouraged to do the same from their early years so that they develop a habit to clean their tongue as part of their routine oral hygiene practice.

So what are you waiting for? Grab your tongue scraper today and reap the benefits of it.


Monday, July 2, 2018

Let’s talk about health anxiety in the internet age


By Piamaria Ngole

“I know I am fine, but my subconscious mind will have the best of me if I do not confirm this,” –Khalid explains why he decided to get a full body checkup as he battles paranoia from looking up disease symptoms on the internet.

After surviving a fatal traffic accident about a year ago, with help from the internet, he diagnosed himself with Post Traumatic Stress Disorder and a futile attempt to self-medicate redirected him to a specialist. The specialist’s diagnosis and prescription were consistent with Khalid’s preconceptions and this grew his confidence in both the internet and his abilities to peruse through the wild wild web.

For a while, the internet was his immediate and often final voice of reason whenever he needed medical advice. His preference for the internet he says, is founded on the tardy access to professionals in hospital settings and points out how the internet tides that over.

He is not alone on this. One US study on ‘Access to health care and internet search for health information’ revealed that, people who experienced trouble accessing health care services are more likely to report using the internet to obtain health information.

Lately, he has been feeling a little sick and a lot more worried as all internet roads lead him to a cardiac situation. His medical and family histories suggest an unlikelihood but his trust on the internet tips the scale when he tries not to worry. He has decided to dismiss these worries -or confirm them- with a full body checkup.

I met Khalid at Kairuki Memorial Hospital where we were both waiting to see a cardiologist. Between fidgeting with his keys and googling terms on his result sheet, his anxiety was made obvious by his time to time heavy sighs. Sharing this story with a total stranger might have been a way to distract himself and I was a happy listener.

Searching for health information is one of the most popular activities online and cyberchondriac is an actual term for someone who suffers a state of web induced medical anxiety after using the internet to self-diagnose an ailment.

Health concerns seem to escalate often when a search of seemingly benign symptoms suggest the possibility of a serious illness. On contrasting instances, people have been reassured when their worries over what they imagined to be terminal symptoms were dismissed with possibilities of milder conditions.

Google is the most preferred search engine and several studies have been done to analyse the accuracy of its results in relation to search content. The findings of these studies suggest that in the cyber world, fruits can and very often do fall very far from their trees. Results of searching a rash could go as far as suggesting a psoriasis, eczema and even worse meningitis. Searchers can arrive to constipation from searching abdominal pain when they actually have gallstones or misdiagnose a headache as a brain tumour.

Health professionals report patients who refused treatment while quoting the internet and concerns are growing as internet use increases. The positive influence that the internet has had in improving life and health cannot be denied but it’s wild nature makes experts question users’ ability to extract accurate information off of it.

Suggestions have been made to improve access to and reliability of resources that are publicly available online. Readers are also called to be very critical when browsing for health information online.

Here are a few tips to help improve reliability of information from the internet;

Check the website and the author’s reputation and then check the date it was published. Reputable sources and recent findings make better references. As you read, pay more attention to peer reviews rather than testimonials and wether the information petrifies you or reassures you. Always remember that even the most comprehensive internet search can never replace a trained eye.

Most importantly, because the content is potentially hazardous, ‘caveat quaeror’ -let searchers be warned: the internet is a dangerous tool for self-diagnosis and this may increase anxiety for people who lack training in the health profession.


Monday, July 2, 2018

Foods that promote good digestive health


By Your Health Reporter

Occasional gas, bloating and irregular bowel movements are signs that the food you are eating is not friendly to your digestive system. However, paying attention and making a few changes in your diet can ease these digestive problems.

Sesame seeds

According to Bridget Kezaabu, a freelance nutritionist, sesame seeds contain a high amount of protein, which is broken down and reassembled from its component parts into usable proteins for the human body. This adds to overall strength, healthy cellular growth, mobility, energy levels, and a boosted metabolic function.

“Sesame seeds are rich in fibre, an important element in healthy digestion. It bulks up bowel movements and stimulates peristaltic motion as food moves through the intestine smoothly. This reduces the risk of constipation and diarrhoea and protects your colon. It also reduces the chances of gastrointestinal diseases and cancer,” she says.


Jamiiru Mpiima, a nutritionist at Victoria University Wellness Centre, says carrots are not only good for your eyes but also stimulate the gum to produce more saliva, which kills bacteria and foreign bodies in the mouth thereby reducing oral health problems.

“Carrots also contain dietary fibre which is important in maintaining good digestive health. Carrot juice reduces the severity of constipation and protects the colon and stomach from cancer,” he says.

The juice of fresh raw cabbage has been proven to heal stomach ulcers and is rich in iron, iodine, calcium, potassium, sulfur, phosphorus. Broccoli contains a fibre which supports and checks the speed that food travels through intestines, the consistency and bacterial populations in our intestine thereby aiding digestion.

Kezaabu says, “Broccoli contains omega-3 fats and phytonutrients which have the ability to lessen the impact of allergy-related substances and the risk of chronic inflammation of the digestive tract,” she says.


Pineapples contain dietary fibre which is essential for keeping intestines healthy and preventing conditions such a constipation, diarrhoea, irritable bowel syndrome.

“Bananas stimulate the growth of friendly bacteria in the bowel. They also produce digestive enzymes to assist in absorbing nutrients. High fibre in bananas can help normalise bowel movement for people who usually get constipated. They also soothe the digestive tract and help restore lost electrolytes after diarrhoea,” Kezaabu says.

The astringent properties in guavas help treat digestive disorders such as diarrhoea and dysentery. “Guava seeds are equally important because they help with gastrointestinal problems, such as constipation. This is because there is a lot of dietary fibre in these seeds. The fibre adds bulk to stool and will pass through system without any problem.”


Whole grains such as millet are very rich in fibre which helps in healing gastrointestinal disorders.

“Regularly making millet a part of your diet will help maintain a healthy gut and prevent peptic ulcers and colon cancer. It can eliminate problems like constipation, excess gas, bloating, and cramping,” Mpiima says.


Jamiiru Mpiima, a nutritionist at Victoria University Wellness Centre, says sometimes when you develop a digestion problem, you are probably not drinking enough fluids. Drinking water before or after a meal aids digestion. Water and other liquids help break down food so that your body can absorb the nutrients easily.

Drinking warm water in the morning on an empty stomach improves bowel movement and softens stool, which prevents constipation. Lemon juice acts as a stimulant to the digestive system and can help flush toxins from your body. A cup of warm water with lemon juice or honey acts as a natural laxative that stimulates the colon. Ginger is known for digestive problems, preventing nausea as well as increasing blood circulation. It can be eaten raw or added to food.


Monday, July 2, 2018

You can ward off certain types of cancers by quitting smoking today

Dr. Christopher Peterson

Dr. Christopher Peterson 

By Chris Peterson sonchrispeter@gmail.com

The exact reason why people develop cancer is yet to be known. But we do know some of things that cause or influence the risk of developing cancer. We call them risk factors.

You can reduce your risk of getting cancer by making positive lifestyle choices. For instance, abstain from smoking, eat a healthy diet and keep physically active are some of the ways you can do.

Smoking-related cancers

It is no news to everyone that smoking is the main risk factor for lung cancer. Smoking hosts a number of cancers apart from just lung cancer. When we think of smoking-related cancers, lung cancer is often our first thought.

I understand that cancer is tricky! At times you can’t avoid it by maintaining just one or two healthy lifestyle habits, but at least it helps a lot! There are several cancers which have been fairly conclusively linked to smoking for many of these, smoking is the leading risk factor for the disease.

Today therefore, let’s take a look at the types of cancers that we can ward off by simply quitting or never smoking.

Lung cancer: While lung cancer is one of the deadliest cancers, it is also one of the most preventable one.

Since cigarette smoking is the cause of over 90 per cent of lung cancer cases, avoiding smoking or quitting smoking can significantly lower a person’s risk of developing this disease.

A smoker’s risk of lung cancer is 15 to 25 times more that of a non-smoker and the risk increases with the number of cigarettes smoked each day and the number of years of smoking. Quitting at any age will significantly lower the risk.

Oesophageal cancer: This is another type of cancer that you can avoid by never smoking. This type of cancer occurs in the oesophagus, a long, hollow tube that runs from your throat to your stomach.

Your oesophagus helps move the food you swallow from the back of your throat to your stomach to be digested. Oesophageal cancer is one of the cancers, that in few cases is triggered by a number of chemicals that are present in cigarette.

The good news is that, oesophageal cancer rarely affects Tanzanians, but people are at higher risk of acquiring this disease at some point in their lives due to smoking habits.

Leukemia: Yes. it is in the list too! This is blood cancer that grows in the bone marrow. Although statistics are yet to be actualised, the rate of this disease in Tanzania is alarming. Hundreds of Tanzanians fall victim to this disease and apart from other risk factors, smoking and alcohol is confirmed to be one of its leading causes.

I understand that smoking is very hard to quit among the majority. But rather than dying of smoking-related cancers, it’s better to try to quit it. You can’t win it by your own, but doctors, psychologists and spiritual leaders will be a great help for you!

Tip: One of the most important things to keep in mind when you’re trying to give up cancer sticks is that you really shouldn’t go on a diet. Depriving yourself of your favorite foods could cause you to lose focus. Instead, eat what you want, but keep in mind that certain foods and drinks are more likely to send you reaching for a cigarette, such as glucose. So try to stay away from foods that contain a lot of sugar.


Monday, July 2, 2018

Bladder cancer: why Tanzanians can fall victim to this disease


By Dr Lugano Wilson

An old woman [Bibi], peasant with her tall lithe figure reported at the hospital in Dar es salaam where I am stationed. She was referred from Nachingwea district hospital with main complaint of passing blood in urine for about a month since she first visited the hospital.

The Bibi insisted, “Najisikia vibaya, sina raha mjukuu nisaidie.” [I am feeling unwell my grandson, please help me].

I assured her that her recovery will be smooth.

What was the cause?

A string of preliminary tests revealed that this elderly woman had tumour of the bladder; therefore she was scheduled for a diagnostic surgical procedure known as cystoscopy whereby a doctor can visualise her bladder lining and take some tissues/biopsy for medical tests in order to confirm the type of bladder tumour. Meaning, whether cancerous or not.

Bibi is a widow, her husband died in 2007 and she has been living with her daughter since then.

She has 5 living children among 10, 5 children passed away.

When I asked her about her smoking and alcohol usage, she replied, “Kusema ukweli, mwanangu pombe nakunywa hizi za kienyeji, navuta ugoro sio sigara.” [Honestly my grandson, I do take local liquours and I just chew on tobacco but I don’t smoke cigarettes]. Of course I didn’t pin-point accusing her of the choices, which made her more comfortable and open. Blood in Bibi’s urine, is the main symptom of the bladder tumour, thus that means a bunch of abnormal tissues grew on her bladder lining. It can swiftly go even to the bladder muscle, and when it goes there it’s called ‘muscle invasive’, this is an egregious type since it can spread to other parts of the body. The non-invasive type rarely kills.

So if you notice blood in your urine, even if it comes and goes, you ought to visit a nearby hospital.

What really caused Bibi’s bladder tumour? In all probabilities, it could be due to her tobacco chewing behavior, but generally bladder tumour is caused by any exposure to harmful substances that may destroy bladder cells over years. Tobacco smoking is the most common cause of bladder tumour, according to www.nhs.uk, it is estimated that more than 1 in 3 cases of bladder cancer are caused by smoking and about 10,000 people are diagnosed with bladder cancer in the United Kingdom (UK) per annum.

How is it treated?

Treatment may include surgery to remove the cancerous lesion and chemotherapy to cut down the risk of recurrence. But most patients may opt for either surgery or radiotherapy. Bibi was subjected to a procedure known as cystoscopy, which was in essence diagnostic rather than a treatment at which a biopsy was also taken.

Who is at risk?

It is said that the condition is more common in older adults with most cases being diagnosed over the age of 60. But from my encounter with bladder tumour victims, some of them are somewhere around the age of 40-50, though this Bibi is in her 80’s.

In addition to this, there is a greater association between bladder cancer and schistomiasis [a disease caused by infection with freshwater parasitic worms, usually found in snails] in Tanzania. Schistomiasis is famously known by most Tanzanians as ‘kuhara damu’, this is underpinned by a study done in Tanzania by Peter F. Rambau, and others, that looked into the ineffable burden of bladder cancer in North-Western Tanzania whereby 185 patients were reviewed. The study concluded that the majority of bladder cancers seen in Lake region were associated with schistomiasis, the cancers showed aggressive behaviour ommonly seen in younger age groups.. Looking at Bibi’s case, she comes from Sourthen part of Tanzania, in Lindi region which is a low schistomiasis endemic area, undoubtedly her bladder tumour was not caused by schistomiasis rather by Tobacco smoking as alluded to above.

The key issue to the bladder cancer victims is to take up the gauntlet and staying optimistic about the situation after being well informed about the possible treatment options.

To the family members, they should wholeheartedly support the bladder tumour victims in all aspects of life. The small courtesies, sweeten lives of bladder tumour survivors, as Bibi’s daughters did. They brought her to hospital and accompanied her everywhere she sought help.


Monday, July 2, 2018

Please help, I can’t stop scratching my scalp


Dear Doc,

I was diagnosed with scalp psoriasis 10 years ago. I have tried all prescribed remedies including tar-based shampoos and soaps, elocom, salycilic acid ointments and others, but nothing has helped. What’s the best treatment available?

Psoriasis is a condition where the immune system makes the skin cells grow faster than the old ones can be shed off.

This causes cells to pile up leading to raised scaly patches. It can affect any part of the body, including the scalp, and cause itching, a burning sensation and hair loss.

Psoriasis should be managed by a dermatologist. The first line of treatment is topical medications like coal tar, medicated shampoos, topical steroids, salicylic acid, and antibacterial and antifungal medications for secondary infection.

Other medications include vitamin A derivative e.g. tazarotene, soriatane, vita-min D derivatives e.g. calcipotriene and anthralin cream. The skin overgrowth is triggered by your immune system, so the disease cannot be completely cured.

Medication helps with the symptoms or to soften the scales, or to suppress the immune system and reduce the overgrowth of skin cells.

Avoid scratching your scalp, shampoo gently, use a scale softener (salicylic acid) and remove the scales gently.

Dear Doc,

My wife suffers from hormonal imbalance. She has irregular periods which make conception difficult. A gynaecologist prescribed some medication and her period came once and then stopped. Which is the best treatment and medication for this condition?

Hormones are chemical messengers that are produced by organs and glands and they influence specific cells, causing an effect on many processes in the body. The level of the hormones can be affected by other hormones, by glands and organs, and by feedback loops.

The menstrual cycle occurs due to changes in the levels of the hormones oestrogen and progesterone, causing the different phases of the cycle. If something causes a problem with these hormones, then there is a hormonal imbalance and the cycle is disturbed.

Hormonal imbalance means that there is too little or too much of one or several hormones.

The menstrual cycle is different for every woman, but menses can occur every 21 to 42 days, and can last from two to eight days. Menses are considered irregular if the time between one period and the next changes significantly, if the number of days when you are on your period changes a lot or if the amount of bleeding changes a lot.

Irregular periods usually mean that there is no ovulation. Hormonal changes affecting the menstrual cycle can happen due to pregnancy, breastfeeding, menopause, using hormonal medication, stress, too much exercise, severe weight change (losing or adding a lot of weight), thyroid disease, polycystic ovarian syndrome, diabetes, diseases of the adrenal or pituitary glands, and tumours.

In some cases, the problem can be rectified permanently, but in many cases, there is no permanent solution. In most women, the cause of imbalance is polycystic ovarian syndrome, which cannot be cured completely.

You need to visit a gynaecologist so that she can be examined.


Monday, June 25, 2018

Third-hand smoke residues a health risk, here’s why


By Adrams Mulama

Chemicals from tobacco smoke that get trapped in clothes, furniture and carpets can become airborne again and be circulated through office blocks, schools or other nominally smoke-free buildings.

Laboratory tests have shown that indirect exposure to tobacco residues, common on skin, clothes or surfaces, can detrimentally affect growth and immunity in mice.

Unlike direct smoking, or passive “second-hand” smoke – from being in a room or vehicle where someone is smoking – the health risks of third-hand smoke on surfaces and in the air is less well-established.

“In an empty classroom, where smoking has not been allowed for some time, we found that 29 per cent of the entire indoor air particles contained third-hand smoke chemicals,” said study author Dr Anita Avery, raising questions on how much third-hand smoke could be lingering in a non-smoking, ventilated room.

Researchers also ran laboratory trials using sealed containers, one of which was filled with cigarette smoke, and then subsequently flushed with air from outdoors.

The following day they pumped in filtered air to mimic a draft or ventilation system and measured the particle content and found that it was 13 per cent higher in the air that had passed through the smoking container.

The humid circulating air, common in communal buildings with air conditioning and heating, allows these potentially harmful chemicals to get airborne again, instead of being fixed on the surfaces of the room where smoking took place.

This could be a concern for babies in homes where a smoker sits or sleeps on furniture or carpets where these particles have settled. Moreover, third-hand smoke was found in surprising places, such as neonatal intensive care unit incubators.

“Many public areas have restrictions on smoking, including distance from doorways, non-smoking buildings and even full smoking bans,” said Dr Michael Waring. “However, these limitations only protect non-smoking populations from second-hand smoke, yet, third-hand smoke, can be as harmful, and is much more difficult to avoid,” he added.

The health risks of third-hand smoke remain unclear, but the potentially harmful chemicals associated with it could spread widely, causing harm. The findings were published in the journal Science Advances.


Monday, June 25, 2018

Even non-smokers should be aware of lung cancer, here’s why

Dr. Christopher Peterson

Dr. Christopher Peterson 

By Dr Chris Peterson sonchrispeter@gmail.com

It is no news that smoking is detrimental to your health regardless of age or fitness level.

Cigarette smoking harms nearly every organ of the body, exposing one to many diseases and worsening the health of smokers in general.

Even the cigarette pack has a warning in bold stating, “cigarette smoking is harmful to your health”. Smoking hosts a number of serious medical complications such as heart diseases, stroke, aneurysm, tuberculosis, lung cancer, oesophageal and throat cancers.

According to the Center for Disease Control and Prevention (CDC), cigarette smoking causes more than 700,000 deaths each year in the world. This is nearly one in five deaths.

When it comes to lung cancer in particular, smoking appears as the number one risk factor. The recent report from the World Health Organisation (WHO) shows that over 70 per cent of all lung cancer deaths have been due to cigarette smoking for the past few years.

Non-smokers are at a risk too

However, do not be fooled by the concept that only smokers get lung cancer. If you think you’re safe from lung cancer because you’ve never smoked, think again. Being a non-smoker doesn’t mean you cannot get lung cancer. Yes, smoking is the main cause of lung cancer, but non-smokers can get it too. Here are a few reasons why.

1. Secondhand smoke: Few cases of lung cancers in non-smokers may be caused by secondhand smoke or passive smoke.

There are two different types of secondhand smoke. Sidestream smoke is when a non-smoker inhales smoke from the lighted end of a person’s cigarette or cigar . Mainstream smoke is when a non-smoker inhales the exhaled smoke from the smoker. And this is more toxic. Some groups are more susceptible to getting lung cancer from secondhand smoke, including people exposed to it in childhood and those living in poverty.

2. Air pollution: This is another risk factor for non-smokers to acquire lung cancer. When you think of risk factors for lung cancer, what comes to mind? Most of us think about the risk associated with smoking cigarettes, but did you know that air pollution can also cause lung cancer? Overwhelming evidence shows that particle pollution in the outdoor air we breathe—like that coming from vehicle exhaust, coal-fired power plants and other industrial sources—can cause lung cancer. Particle pollution increases the risk of early death, heart disease and asthma attacks, and it can also interfere with the growth and function of the lungs. The World Health Organisation estimates that up to 2,000 lung cancer deaths per year may be attributable to breathing polluted air, and it’s medically proven that prolonged exposure to highly polluted air can carry a risk for the development of lung cancer similar to that of passive smoking.

Like the rest forms of cancers, lung cancer is a very tricky diseases. It has so many risk factors and some of them, we can’t even control. you can abstain from smoking, or being exposed from polluted environment, but still you may fall victim to this disease due to other risk factors for instance hereditary factors, which are totally out of control. That’s why regular screening is always advised for smokers and non-smokers too. If the disease is caught earlier, the treatment can be more effective.


Monday, June 25, 2018

Low iodine intake in children can have a negative impact


By Dr Lugano Wilson

Two months ago, I saw a 36-year-old patient who was referred from Lindi for further management of her condition. Her complaints included front neck swelling. The neck swelling started as a small mass on the right side of the neck that progressively increased in size, it was associated with protrusion of the eyes and heat intolerance, she also reported history of weight loss and lower limb swelling.

A lot of tests were done, which later revealed that the patient had ‘goitre’, with symptoms of what doctors described as ‘thyrotoxicosis’.

The woman told to me that she became nonplussed after hearing that even her high blood pressure was due to the that swelling.

“I didn’t know that this swelling could bring on all of these troubles,” she added as her face was slowly being flooded with tears since she thought that her cruel illness insinuated the twilight point of her life on earth.

Many Tanzanians have incidentally been diagnosed with such swelling especially in their childhood. People are not aware that such swelling might point to something more serious, thus I advise my esteemed readers do not take any palpable or noticeable neck swelling for granted.

What is the swelling?

Goitre is an enlarged thyroid gland, this gives a lump at the front of your neck, it produces hormones called thyroid hormones, you either have overactive (hyperthyroidism) or underactive (hypothyroidism)thyroid gland, and that means you make too much or too little thyroid hormone respectively. The case of the woman from Lindi was making too much thyroid hormone.

When you go the hospital, doctors will try to look for the cause of the problem, although goitre can be painless but when it’s enlarged it may cause symptoms like difficulty in breathing, swallowing and sensation of choking.

What exactly causes goitre?

The causes may be due to Iodine deficiency as expounded hereunder, others include thyroid cancer and autoimmune diseases of the thyroid gland.

The most common type of goitre is endemic goitre, which is due to iodine deficiency. Iodine is an essential nutrient that is required for production of thyroid hormone.

The so called endemic goitre is said to be more common in female than in male, it occurs most commonly in inland and mountainous regions where the natural iodine content of water and soil is very low, thus it can easily be prevented by the use of salt or food to which iodine has been added.

It may regress with increasing iodine intake especially in young people, however the likelihood of regression diminishes with age, thus surgery may be required if the swelling causes further complications like difficulty in breathing or swallowing.

In one of the study published in PubMed done by Assey in 2009 that received the limelight among some endocrinologists, titled , “Tanzania national survey on Iodine deficiency, impact after 12 years of salt Iodine”, it was revealed that there was a significant improvement in iodine nutrition in Tanzania 12 years after initiation of salt iodination program in Tanzania.

In addition, my second biggest concern apart from the case of the woman narrated above is about children who become victims of iodine deficiency, you must know this, that the maturation of brain desperately requires thyroid hormone in the perinatal period.

In many low income countries, children are at greater risk of iodine deficiency disorders, including brain damage as expounded above.Thus, I think it’s imperative that policy makers in Africa must endorse that screening for neonatal/newborn hyperthyroidism should be mandatory with a view to cutting down the number of mentally retarded children.


Monday, June 25, 2018

Why is my urine yellow?


Dear Doc,

I drink lots of water but my urine is still yellowish.

The body is able to regulate the amount of water it has so that if it is short on water it conserves water by producing more concentrated urine, which will appear dark yellow.

When one takes lots of fluids, one passes more urine, which may then be lighter hence it may be straw or light yellow in colour, though in some cases it may be colourless. So urine being straw-coloured or light yellow means you are taking enough fluids.

Using the colour of urine to know how much water or fluids to take is useful since water loss depends on the surrounding, temperature or humidity apart from the body activity, all which may never be the same always. This therefore means one cannot rely on eight glasses a day with different water loss situations.

Dear Doc,

My girlfriend is three months pregnant but she gets her period. When I asked her to visit a doctor she said the same happens to her sisters. Is this normal or is she aborting?

Many times, when a woman misses periods even without tests to confirm pregnancy, she may be deemed pregnant. Sometimes a woman can miss periods when she is not pregnant and bleeding may be thought to be due to a miscarriage when in some cases it is not.

Bleeding in early pregnancy might mean the womb is threatening to miscarry or has already miscarried but some pregnancy pieces remain or if bleeding and abdominal pain have eased or stopped the products of pregnancy may have all been expelled.

When there is bleeding in pregnancy, an ultrasound scan should be done to make sure the baby is still alive. If the baby is alive, there are good chances even after repeated bleeding that the baby will survive. Bleeding in pregnancy requires visiting an antenatal clinic for help because it can result in serious problems including bleeding to death or infections among many others.

You need to go with your girlfriend for antenatal visits where tests will be carried out to determine what is wrong.

Dear Doc,

There are times when there is pus on my penis. What causes this?

Pus indicates an ongoing infection. You may also have pain or irritation when passing urine, urethral itchiness or abdominal pain. It may be due to gonorrhoea, chlamydia, trichomonas, or other bacterial infections.

If not treated, the symptoms may reduce with time, though the infection is still present. The danger with this is that the infection can spread to the testicles and the rest of the reproductive tract and lead to infertility; or spread to the rest of the body, causing serious illness.

You need to see a doctor who will examine you and take urine and discharge samples for analysis and culture.

You also need a chlamydia test and a HIV test. You will be given antibiotics to treat the infection, depending on the results. Abstain from sex until you have completed treatment, been re-tested and found to be cured.


Monday, June 25, 2018

Caring for your baby’s gum and first teeth


By Dr Sakina Khanbhai

More often than not, people believe that since deciduous (milk) teeth will eventually exfoliate (shed off), there is no reason to spend valuable time and money to save them or rather in taking care of them.

Come to think of it, they eventually end up under fluffy pillows providing ample of business to the tooth fairy.

This is an age old notion that needs to be broken.

Since parents are the caregivers of children and make decisions on behalf of them, it is highly important they understand the importance of good oral hygiene and the need to seek professional help if a problem arises.

Would you as parents leave out on treating a disease that your child is diagnosed with? If not, then why should dental diseases like caries be left untreated and cause unnecessary pain and discomfort to your child.

Primary (milk) teeth play a vital role in various functions and well being of a child. Eating/chewing, speech, aesthetics and maintaining space for permanent teeth; to name a few. Maintaining good oral health means overall good health and development of a child.

Bursting baby teeth myths

Myth 1: Baby teeth don’t need to be brushed or flossed.

Reality: Be it milk or permanent teeth, they must be brushed twice a day. This ensures that all plaque is removed from the teeth and it also strengthens the enamel.

Flossing helps to remove plaque in hard to reach areas like in between the teeth, where toothbrush bristles cannot reach.

Myth 2: Babies do not need to see a dentist until their milk teeth start falling off.

Reality: It is recommended that as soon as the first tooth erupts in your child’s mouth, you visit a dentist. This not only helps the parents to know what are the dos and don’ts for them to maintain good oral hygiene of the children but also creates a positive introduction of the dental clinic.

Children have a better chance to familiarise with the sounds and sights of a dental set up which are generally very daunting.

Myth 3: Children can brush their own teeth.

Reality: Dentists greatly encourage parents to brush their children’s teeth until they’re at least 7-8 years of age. This is because at an earlier age, children have not fully developed their fine motor skills to adequately brush and floss their teeth.

This not only cultivates good oral hygiene practice from a young age but is also a good bonding time with the kids.

Electric toothbrushes are great tools for children. The fascination of the product itself paired with controlled movement of the brush helps effectively clean teeth.

Myth 4: Cavities are hereditary.

Reality: This is untrue! With a few exceptions, cavities are preventable majority of times. Genetics play a very small role in dental health.

Most cases of caries (decay) are due to poor oral hygiene and if left untreated, can worsen the damage both to the milk tooth as well the underlying permanent tooth bud.

Few pointers to take care of that gorgeous smile of your baby

• Run a damp cloth over your baby’s gums after feeding to prevent plaque build up

• Once the child has his or her first tooth, cleaning it with a damp cotton wool/gauze helps to keep the bacteria at bay

• A soft toothbrush may be used once your child has a few teeth in his oral cavity

• Opt for a tootbrush with a small head and a long handle to make it easy to reach all areas

• Replace your baby’s toothbrush every 3 months or as soon as you see signs of wear (fraying of bristles)

• Do not put your baby to sleep with a bottle or breast nipple in his/her mouth. This may seem an easy way of soothing the baby.

The sugars from the milk may remain on the baby’s teeth for hours and cause the enamel to be eaten away with time

Regular dental care is important for every individual and children should be no exception. After all, they’re our future leaders.

The author is a dentist based at Ebrahim Haji Charitable Health Centre in Dar es Salaam.


Monday, June 25, 2018

Why is my urine yellow?


Dear Doc,

I drink lots of water but my urine is still yellowish.

The body is able to regulate the amount of water it has so that if it is short on water it conserves water by producing more concentrated urine, which will appear dark yellow.

When one takes lots of fluids, one passes more urine, which may then be lighter hence it may be straw or light yellow in colour, though in some cases it may be colourless. So urine being straw-coloured or light yellow means you are taking enough fluids.

Using the colour of urine to know how much water or fluids to take is useful since water loss depends on the surrounding, temperature or humidity apart from the body activity, all which may never be the same always. This therefore means one cannot rely on eight glasses a day with different water loss situations.

Dear Doc,

My girlfriend is three months pregnant but she gets her period. When I asked her to visit a doctor she said the same happens to her sisters. Is this normal or is she aborting?

Many times, when a woman misses periods even without tests to confirm pregnancy, she may be deemed pregnant. Sometimes a woman can miss periods when she is not pregnant and bleeding may be thought to be due to a miscarriage when in some cases it is not.

Bleeding in early pregnancy might mean the womb is threatening to miscarry or has already miscarried but some pregnancy pieces remain or if bleeding and abdominal pain have eased or stopped the products of pregnancy may have all been expelled.

When there is bleeding in pregnancy, an ultrasound scan should be done to make sure the baby is still alive. If the baby is alive, there are good chances even after repeated bleeding that the baby will survive. Bleeding in pregnancy requires visiting an antenatal clinic for help because it can result in serious problems including bleeding to death or infections among many others.

You need to go with your girlfriend for antenatal visits where tests will be carried out to determine what is wrong.

Dear Doc,

There are times when there is pus on my penis. What causes this?

Pus indicates an ongoing infection. You may also have pain or irritation when passing urine, urethral itchiness or abdominal pain. It may be due to gonorrhoea, chlamydia, trichomonas, or other bacterial infections.

If not treated, the symptoms may reduce with time, though the infection is still present. The danger with this is that the infection can spread to the testicles and the rest of the reproductive tract and lead to infertility; or spread to the rest of the body, causing serious illness.

You need to see a doctor who will examine you and take urine and discharge samples for analysis and culture.

You also need a chlamydia test and a HIV test. You will be given antibiotics to treat the infection, depending on the results. Abstain from sex until you have completed treatment, been re-tested and found to be cured.


Monday, June 25, 2018

Battling childhood cancer


By Gladys Mbwiga @gladysmbwiga

There is no greater joy to a parent like seeing their child start standard one, this normally marks the beginning of one of the first independent chapters of their child’s life.

But for Ms Zainab Issah, a resident of Buza in Temeke, her joy was short lived when her son Ismail, now 8 years old started getting sick a few months before beginning his standard one journey.

When speaking to Your Health, Ms Zainab said it all started around November 2016, when a then 6 years old Ismail started complaining of severe leg and joint pain, which she first suspected as an injury caused by playing around with other children.

After taking him to a nearby dispensary, the doctor said he had a fractured leg and that he had to get injections. Little did Ms Zainab know, the jabs made her son’s situation even worse.

“Before he was in pain and so he was limping but after visiting the dispensary and getting injections, his legs became swollen and he could not even walk,” explained Ms Zainab.

6-year-old Ismail was taken to a health centre where he was diagnosed with oedema, a condition that leads to excess water or fluid collecting in the cavities or tissues of the body. He received medication the second time, but again this did not make Ismail’s condition any better.

Here’s when Ms Zainab decided to seek further medical help at Temeke Referral Hospital. He was given medication without further tests or scans.

He at least did start walking but what Ms Zainab noticed was that he got tired after a very short time of playing and that he had fever from time to time.

The bad news

In December the same year, Ismail was hospitalised at Temeke Referral Hospital with a low blood count which caused the doctors to suspect he had sickle cells but after several test the results came out negative.

“Every time they added blood for him, his blood count would still be low the following day, this made the doctors to give us referral to seek further treatment at Muhimbili National Hospital (MNH),” Ms Zainab said.

Upon arriving at MNH, Ismail was bleeding from the mouth, this is when the doctors told Ms Zainab that they suspect her son was suffering from lack of fluid in the bone marrow.

Ismail was undergoing tests and scans and was hospitalised for several days. The day that changed her life and that of her son was after hearing the dreadful news that she never expected.

“Your son has leukemia.” These are the words that Ms Zainab remembers hearing from the doctors and could not recall the rest because her mind had become blur for several seconds after the news.

After being diagnosed, Ismail was admitted at MNH’s children ward where he stayed receiving medical treatment for six months.

Dedicated her life in taking care of her sick son

Ms Zainab had to give up her job of selling clothes for six months so that she could be by Ismail’s side to care for him because he was too young to be alone in the hospital.

“This dreadful disease did not only affect me but also my son because all of his friends started standard one, leaving him behind,” Ms Zainab confronts.

Talking about Ismail’s father, Ms Zainab said that he could not visit them often because he had to find extra work to be able to provide for them, given that he was the sole provider since she had to spend days and nights at the hospital.

What is leukemia?

According to Dr Regina Kabona, a pediatrician from MNH children’s ward, leukemia is a cancer that starts in blood-forming cells. Most often, it is a cancer of the white blood cells that starts from the lymphoid cells in the bone marrow, but some types of leukemia start in other blood cell types. Any of the cells from the bone marrow can turn into a leukemia cell.

“Leukemia cells reproduce quickly, and don’t die when they should, instead they survive and build up in the bone marrow, crowding out normal cells. In most cases, the leukemia cells spill into the bloodstream fairly quickly. From there it can go to other parts of the body where they can intrude other cells from functioning normally,” Dr Kabona explains.

She further said that the symptoms of leukemia are mostly not specific, they depend on how much the cancer has affected the body.

“Most common symptoms of leukemia are frequent fever caused by abnormal or lack of white blood cells, low blood count and cell plates which leads to bleeding from the mouth and nose accompanied by body aches,” Dr Kabona talks about the symptoms.

There are three types of leukemia, with Acute lymphocytic leukemia (ALL) being the most common among children, with the remaining cases being acute myeloid leukemia (AML). Chronic leukemia is rare in children.

Ismail was diagnosed with acute lymphocytic leukemia.

When describing a disease as acute, it denotes that it is of short duration, meaning that the symptoms are of a short period and progresses very quickly, Dr Kabona informs.

“Late diagnosis can lead to death because it takes a very short period after the symptoms for the cancer to progress,” Dr Kabona cautions, adding that most of the times late diagnosis is caused by failure to identify the symptoms as cancer at an early stage.

Most children with leukemia before being diagnosed will have symptoms that may lead to parents believing that it’s a normal fever of anaemia [a condition where you have less haemoglobin than normal in each red blood cell].

In order to identify if the symptoms are of leukemia, tests are normally conducted through blood test or through testing the bone marrow.

For Ismail, a blood sample was taken and tested and the result showed that he had leukemia.

How was Ismail treated?

If a child is discovered to have leukemia, medication starts immediately with having different phases. The initial phase is called pre-phase - to discover how the patient responds to medication because normally patients respond differently to treatment.

“In all diseases, take a good example of malaria, there are others who can get treated by one medication while the same medication would respond differently with another person,” Dr Kabona explained.

For one week, a patient is given a drug called prednisolone, which helps the doctor to determine who will need a much stronger dose and who will respond quickly.

After pre phase, the first phase is elevation and induction which is for 35 days - afterwards the patient is tested again to see if the disease is still present in the bone marrow.

After 35 days if a child responds well to the medication, then the doctors continue administering other treatment and for those who do not respond well then the treatments are cut short meaning that the case is severe and there is no cure.

For females the treatment takes 2 and a half years, while for males it is 3 and a half years and intensive treatment can take 6 to 8 months.

“But this does not mean it is the end of the road for them, what happens next is counselling and terminal care to the child to help them live the rest of their days with care,” Dr Kabona said.

This happens when the required medication fails to work on the child because their condition was already critical when diagnosed.

Dr Kabona also informs that leukemia has a cure rate of more than 95 per cent and it is one of the leading curable cancers.

But the challenging thing is that most leukemia patients suffer from low blood count - so it happens that a child might die not because of the disease but due to shortage of blood.

“And sometimes patients with leukemia can suffer from an infection which might lead to their death,” she said.

Ismail’s progress

After being admitted for six months undergoing chemotherapy, Ismail was released from the hospital after his condition got better.

For Ismail the journey with battling leukemia has now ended. He no longer undergoes chemotherapy but visits the clinic regularly for medication and checkups. Ismail joined standard one this year.

Free cancer treatment

The proportion of people with leukemia that are cured by treatment has since improved from at least 30 per cent when the children’s cancer unit was at Ocean Road Cancer Institute only to 60 per cent now that MNH is also taking in cancer patients.

MNH offers free treatment to children with any cancer, which now provides a wide survival chances for children and support for families who could not afford the treatment.

MNH and Ocean Road Cancer Institute and other partnering government facilities and NGOs offer free treatment to all children with cancer under the age of 18.

Dr Kabona says that mostly the treatment for cancer is not a one day thing, it takes several months for a patient to get better which could have been very hard for patients to afford.

But for a patient who is given referral to MNH from other regions, they normally have to make a small contribution of Sh4800 for blood test per week.

“And for those who cannot afford to pay there are social workers in the ward who deal with such cases by helping them,” Dr Kabona said, adding that there is no case of a patient failing to get treatment due to lack of funds.

For Ismail being cancer free means he can now play for a long period without getting tired or feeling pain in his joints and he can now open a new chapter in his life while looking forward to a bright future.

Ms Zainab was able to return to her previous job and is now supporting her husband to provide for the family.

As a mother, Ms Zainab says that there is no joy like seeing your child overcome a sickness that might have killed him if he was not diagnosed at an early stage.


Monday, June 25, 2018

Stress can be harmful: here’s how to fight back

Exam stress can be detrimental in a long term,

Exam stress can be detrimental in a long term, worsening health conditions and exposing them to non-communicable diseaes. PHOTO | FILE 

By Ali Khatau alikhatau@hotmail.com

Recently, I sat for my final examinations and I’ve been experiencing extreme stress from all the pressure, late-night studying and sleep deprivation.

I had been drinking tons of coffee and energy drinks to keep me awake and alert enough to be able to study for my exams. I wasn’t the only one in this situation and that many students all around the world at different levels of education have similar experiences ahead of their exams.

This got me thinking on how stress can be detrimental to my progress now and later on. I thus decided to do a short research, which also involved talking to few medical students on how damaging stress can be.

Harmful behaviours due to stress

Stress is one of the most common things most of us experience throughout our lives. Many different aspects of life can be the sources of stress including financial problems, marriage and relationship issues and work-related problems. Apart from the psychological aspect, stress can also give rise to many other physical problems and may even worsen health conditions that you may already be having.

I have had many friends fall into depression and risky habits after experiencing long periods of stress without relief. During our conversation, one of my colleagues narrated a story about how one of her friends suffered from severe migraines and regular headaches due to constant work-related stress. The friend would always choose the easy way out by taking short term medications like Panadol to relieve the headaches but in fact, what she really needed was a break and stress-relief therapy in order to de-stress her.

She went on to mention how her friend was eventually diagnosed with depression due to all the stress and needed medications and therapy to manage the migraines and depression.

Another fellow pointed out how people suffering from stress become victims of risky behaviour like binge-eating and thus an increased risk of obesity.

These individuals are constantly seeking ways to relieve the stress and in turn, can engage in wrong practices, which can worsen their conditions and cause irreversible harm. Excess stress causes a rise in the levels of a certain body hormone called cortisol, which increases the amount of fat that’s deposited in the abdomen.

Stress can expose us to chronic diseases

Other risky methods of stress release practiced by these individuals may be smoking and alcoholism. One common experience shared during the conversation was how these individuals would confidently mention that smoking and drinking helped them release their stress while in reality, it worsened their condition by making them more vulnerable to conditions like heart disease, asthma, diabetes and lung cancer among others.

Long-term stress in itself would also significantly increase an individual’s risk of developing conditions like heart disease, asthma and diabetes. Stress causes the heart to beat faster and also causes the release of cholesterol and triglycerides into the blood stream. Cholesterol, as we are all aware may lead to blockage of the heart vessels and eventually may cause a heart attack.

Research suggests that stress appears to directly raise the glucose levels in diabetics, thus worsening their condition. Many different studies have also shown that stress can worsen asthma. Surprisingly, certain studies suggest that stress in parents can increase the risk of their children developing asthma. The condition won’t only affect you, but also your child.

Researchers found that mothers caring for chronically ill children accelerated their aging process by 9-17 years according to a recent study.

Fight back the stress

Seeing the above mentioned effects of stress, one can realise just how much damage stress can do to a person and how much damage it has already done to long-term sufferers in the past. The condition affects almost every aspect of life including your social life, financial condition, work performance and even family life. It is highly advisable to keep your stress levels in check in order to avoid these disorders. It is advisable to indulge in stress management techniques and focus on long-term stress management.

The most appropriate stress-management technique one can use and agreed on was exercise.

Exercising, whether you decide to walk and jog, hit the gym or play sports can reduce stress rapidly by releasing certain hormones called endorphins, making you feel better. This was followed by yoga and meditation since it combines physical and psychological aspects by involving physical activity as well as mental relaxation through meditating.

Music is also one of the top anti-stress techniques since playing calm music has shown to have a positive effect on the body and mind, can lower blood pressure and release off stress-linked hormones.

So the next time you feel stressed for whatever reason, make it a point to take a break from your busy life and play some sports or hit the gym, attend yoga classes and listen to some soothing classical music.


Monday, June 25, 2018

Watch out for eating disorders in children


By Your Health Reporter

Every parent’s pride is to see their children eat well. However, some children over do it which can lead to weight gain that may result into other serious health problems such as diabetes, high blood pressure, high cholesterol, asthma, sleep apnea among others. Then there are those who refuse to eat.

According to Julius Kusemererwa, a medical practitioner, there are three main types of eating disorders.

Binge eating is a condition where a child eats a lot. Children with binge eating disorder feel hungry more often and will take food in large quantities. A child or person consumes large amounts of food in a short time frame.

Like other eating disorders, binge-eating disorder is life-threatening and it often occurs with other disorders, such as depression and substance abuse.

“Children /people with binge eating disorders cannot control the urge to eat large amounts of food and they tend to become overweight or obese,” he adds.


Anorexia, Kusemererwa says, is where a child refuses food especially that with high levels calories for fear of gaining weight. He notes that this may lead to malnutrition and hence poor health.

“Bulimia is where a child eats abnormally too much and for fear to gain weight, they decide to force it out by intentional vomiting. This is the worst act where a child may develop a disorder of vomiting each time they take food,” he says.

According to Gorreti Betty Mbabazi, a nurse and mother, most children have seasons when their appetite is high; this should not be mistaken for over eating unless they do it abnormally.

“Just as their appetite shoots up it wanes with time. This happens and should not be a cause for worry unless it is continuous and to the extreme,” Mbabazi advises.

Kusemererwa notes that eating disorders mostly develop during adolescence or early adulthood but can start during childhood too.

He says depression could be one of the causes of over eating in children, he/she might eat as a way to forget what is troubling them, and he notes that parents should always be cautious as this could lead to obesity.

Fighting disorders

Annet Nakazibwe, a teacher, notes that as a parent, you should be a good role model for your children by choosing to eat healthy meals and in appropriate portions.

She adds that you should also teach your child to make healthy choices for school lunch.

“Have healthy snacks in your home such as fruits, bananas raw vegetables or nuts that a child can feed on and have no effect on the body but rather keeps it fit. These foods should have plenty of low fat proteins, vegetables, whole grains,” she adds.

What to do if it persists

Kusemererwa cautions parents against drastic measures such as denying children food or forcing them to go on a diet.

“If you notice a problem with your child’s eating habits, seek medical advice. Children need certain amount of calories and nutrients to grow, develop and learn so denying them food might tamper with this process which a doctor should be able to tell which foods and in what proportions are enough for the child,” Kusemererwa notes.

Also, talking to your child in a manner that is neither judgmental nor confrontational can be of a help.


Monday, June 25, 2018

Six steps to take for preventing falls in elderly


By Dr Priyank Punatar

Falls can happen to anyone, anytime, anywhere, and as we grow older, falls become more common especially, in the elderly. While some falls may not cause much harm, some can leave long term detrimental effects on people.

Many physiological and impaired health factors make falls a common problem in elderly people.

Impaired vision, problems with balance, medical diseases like - osteoporosis, lack of strength in muscles, neuropathy due to chronic illnesses like diabetes, medicinal side effects and environmental hazards are some of the several reasons causing elderly people to being more prone to falls and thus, gruesome injuries.

Falls are the leading cause of death, injury and and hospital admissions among the elderly population. The Center for Disease Control (CDC) reports that one in five falls causes a serious injury such as a broken bone or head injury. Fear of falling can also seriously affect an aging adult’s quality of life and sadly, can keep a person from being active and thriving.

How can we prevent falls in the elderly

Since, most elderly people spend most of their time at home, the worrisome part is that most falls happen at homes. These falls lead to cuts, bruises, head injuries, fractures of already soft and brittle bones and in more severe cases even death!

There are many different ways and strategies that we can employ in homes to reduce and prevent falls in the elderly people living with us. Some of these include:

1. Equipping our homes with fall-preventing instruments: grab bars in restrooms, non-slip mats in the shower area, plastic shower stools, hand rails in the corridors and stairs. The above can assist in allowing the elderly to hold on to something when they get off balance or are about to fall.

2. Regular eye check-ups: 6-monthly eye checks are what is advised for elderly people in order to ensure that their vision is good, which can play a major role in preventing them from experiencing any falls at home or outdoors.

3. Educate ourselves with their medications and illnesses: Almost all elderly people have their medicinal cabinet which may contain over-the-counter supplements and also prescribed medications for chronic illnesses.

It is highly advised for all elderly people’s caretakers to be aware of their medications and possible adverse effects like - hypotension, dizziness, vertigo and other balance disorders.

The people around should also be aware of their medical conditions, such as diabetes, neuropathy, sciatica, which make senior citizens highly vulnerable to impending falls.

4. Removal of potential environmental falling hazards: One should keep the walking areas in the homes as empty and clear as possible by not having unnecessary wires, cords, small furniture (stools, tables, etc) in line of movement.

Banging onto these furnitures or entangling into floor wires and cords can easily cause someone to fall, especially the elderly.

5. Ensure proper bright lighting: In order to make obstacles more visible and also to support elderly’s poor vision, it is very important to have bright lighting in homes to prevent falls.

6. Proper clothing and footwear: Long robes, dresses and loose clothing may increase the chances of elderly to fall in homes by tripping over their own clothes or by having sleeves stuck up on doorknobs.

Similarly, elderly people should wear low-heeled shoes with rubber soles that can provide good grip on flooring.

Falls in elderly people which mostly occur in homes can be very dangerous and with fatal complications.

As parents or our elders, they made all efforts to make sure we did not fall as children or protected us before we hit the ground.

Now, it’s our time to give back to them and keep our loved ones safe and healthy by modifying and ensuring our homes are safe and by modifying their lifestyle to prevent fall-related injuries.

Let’s lend our young hand to hold our elderly and not let them fall.


Monday, June 18, 2018

Jenifer’s story: from a life of prostitution to hope


Jenifer Manyanga, a resident of Sembaki village in Moshi District, Kilimanjaro Region was gang raped at the age of 18 by six giant men.

Now at 24 , she recounts her story to Your Health in an exclusive interview.

She recalls her controversial life with relatives in Manyara Region and how she ended up in a troubled life, soon after she had completed her ordinary level education at Changalika Secondary School in Pwani Region in 2012.

“When I completed secondary school, I moved to Manyara to stay with my brother. My brother was married. His wife didn’t like me,’’ she says.

Didn’t pass exams

Results for the National Form Four Examinations were released and Jenifer didn’t pass. Her dreams to join advanced level studies were suddenly blacked out.

“My dream was to continue with studies so I was keen on re-taking the exams as a repeater. But, I did not have the fees,” she says.

Fateful day

Jenifer doesn’t remember the exact day when she was raped but what she can recall is that the incident happened at night.

Thereafter, she says, “I started experiencing vaginal discharge and bleeding from the rectum. I told my brother and we reported the incident to police. Then, I was rushed to the hospital for diagnosis.”

Doctors revealed to her that she was HIV negative and she was asked to report back at the hospital after three months for the second test.

“It is hard to forget what happened. I was depressed and I lost hope. I had no interest to continue with school,” recalls Jenifer.

Did police investigate the incident?

Jennifer says until today, police have not been able to produce a report of the perpetrators.

The report aside. “Because I wasn’t in good terms with my brother’s wife, I had to leave my brother’s house. I moved to my sister’s place in another district-Ushetu.”

Pushed into child prostitution

At a young age, Jenifer felt so desperate and didn’t have any income to sustain her life. She couldn’t resist the temptation to become a sex worker.

“We were just two of us in the house. I didn’t have a job to earn income. I therefore decided to look for the job. Life was difficult, that’s when I started to engage in sex work,” says Jenifer.

“I ended up joining a sex workers’ group ‘Live Band’ in Kahama urban. I was involved with sex work for two years from 2014 to 2016.”

On a bad day, she recalls, “I could earn up to 70,000 but on a good day, it could go up to Sh 200,000.” My clients were businessmen and I could serve up to 10 men on a day.”

“Sex work was the only option I had.”

Not everyone is as safe as Jenifer

Though Jenifer was tested HIV negative, many Tanzanians still find themselves in circumstances that expose them to new HIV infections—sex workers are among the high risk groups.

Earlier last month, the Minister of Health, Community Development, Gender, Elderly and Children, Ms Ummy Mwalimu described new HIV infections as ‘a huge threat’ to the country’s social and economic development.

She blamed the new infections on poverty, low literacy levels among parents, peer pressure and harmful cultural practices that expose children to sex early in life.

She reaffirmed her commitment to fighting the infections through implementing strategic plan IV which aims to combat new HIV transmissions, particularly among the youth.

But, the government can’t do it all alone. Through the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), has set out plans to collaborate with the government.

And, according to the minister, the government is banking on self-testing programmes to achieve the plans.

“We will introduce HIV self-testing. We aim to enable people use devices that will be available at public health facilities free of charge to motivate people to know their HIV status,” she said.

Her story continues, with renewed hope

In 2016, Jennifer found her way into HIV outreach programmes.

She joined ‘Sauti Project,” implemented by an international, non-profit health organisation affiliated with The Johns Hopkins University—Jhpiego.

The fire that still burnt inside Jenifer as to what happened to her in the past could only be put off by helping other girls who are exposed to abuse and violence.

“Many girls face abuse and violence. Most of them were abandoned by their families due to poverty,” says Jhpiego’s Director of Sauti Project, Mr Albert Komba.

“I have talked to some young women who left their families due to lack of financial support. They said they ended up in prostitution in order to survive and support themselves and their children,” he said.

He also said there had been a large increase in the number of children forced into prostitution.

“Most girls are aged 14 to 22 years, but I have come across some as young as nine.”

Mr Komba says the government and stakeholders have to now double efforts to address the root cause of child prostitution and put in place tougher legislations.

“Through Sauti Programme, at least 32, 410 people were linked and enrolled into care and treatment clinics. We also reached over 63, 000 women of reproductive age between 15 to 49 years,” he said.

Through the outreach programme, at least $13, 269 equal to over Sh29 million loans were disbursed as loans to groups of vulnerable women.

“Since I joined the programme, my life has changed completely. I can now feed and clothe myself. I quit sex work. I applied for a loan and opened a small business,” says Jennifer who is one of the beneficiaries of the project.

According to Mr Komba, over 17, 000 sex workers were reached with periodic presumptive treatment of sexually transmitted infections, an important service to minimize risk of acquiring and transmitting HIV to their partners.

“When our initiative, ‘Diagnose One, Link One’ was implemented, majority of the people who were tested were HIV positive,” says Mr Komba. For her part, Sauti Program Officer Adolescent Girls and Young Women Sexual Reproductive Health, Ms Agnes Junga says individuals who were HIV positive or recent survivors of gender-based violence have received peer-escorted referrals to treatment services.

She says now the effort is being directed in conducting community dialogues to address stigma, discrimination and gender-inequitable social-norms.

The HIV prevalence in the general population (Adults aged 15-49) in Tanzania has in the last decade (2003-2012) declined from 7.0 per cent to 5.1 per cent, the recent reports indicate.

However, in hotspots across the country and key and vulnerable populations such as adolescent girls and young women, female sex workers and their partners still face a high risk.

They are at risk of acquiring new HIV infection by 25 per cent and men who have sex with men by 26 per cent, drugs addicts by 36 per cent whereas, the HIV incidence remains unacceptably high.

In Tanzania HIV/AIDS prevalence remains ‘a huge threat’, according to recent 2016-2017 (THIS). HIV prevalence rate in Tanzania has declined from 5.1 per cent to 4.7 per cent indicated in research 2011-2012.

US government steps in

The US government currently provides more than 80 percent of all finding for HIV programmes in Tanzania in which through PEPFAR, the USG has spent about Sh9 trillion.

Between 1990 and 2003, the year PEPFAR began, at least 871, 000 Tanzanians died of AIDS related causes.


Monday, June 18, 2018

Speaking health in defense of a father’s territory

Syriacus Buguzi

Syriacus Buguzi 

By Syriacus Buguzi

“What’s the point of going if you just have to wait outside?” is one of the questions men raise when it comes to matters of accompanying their spouses to antenatal clinics.

However, on the other end, healthcare workers and researchers on maternal health insist, “Men will hear the advice together [with their spouses], making them able to collaborate in pregnancy.”

And, “husbands will be less ignorant of advice given by healthcare workers, knowing reduction of activities by their wives is not laziness’, ‘HIV testing involves both of them.”

These are key quotes I borrowed from some studies and another survey done in Tanzania by the African Woman Foundation in a rural district of Tanzania, Magu, which aimed to answer the question: Why don’t men in Tanzania attend antenatal clinics?

Just recently, I was involved in antenatal clinics as a potential father. I drew lessons. But, for the many years I have been interacting with fellow men, especially when it comes to this matter, it dawned on me that a raft of measures need to be taken to enable the men appreciate the value of antenatal clinics and why they should accompany their spouses, fiancées or rather girlfriends.

There has been a lot of finger pointing at men—that they aren’t proactive, that men don’t care, that they don’t know their responsibilities, however, a closer look at this matter reveals that more men could get involved, if key issues are addressed.

Some years back, one thing drew my attention. A nurse told a pregnant woman at a clinic. “Hatukupokei hapa kama bwana wako hayupo. Kama umeiba mume wa mtu shauri yako.”

This means the nurse was determined to attend to this woman until her man showed up. The nurse became even harsh, saying if she was carrying a child for a man who had an extramarital affair, it was even going to be worse.

It must have been a very bad day for the pregnant woman. Anyway, personal matters need to be treated as indeed personal. But for the sake of what we celebrated yesterday—Father’s Day, I am trying to look at what can be done to help more men attend ANCs.

Look at this study from Uganda, titled: Male involvement during pregnancy and childbirth: men’s perceptions, practices and experiences during the care for women who developed childbirth complications in Mulago Hospital, Uganda. It says it out: What exactly has to be done, and this should continue being applied in Tanzania. Not threats and name-calling.

It suggested, clearly that there is pressing need to improve men’s involvement by creating more awareness for fathers, male-targeted antenatal education and support, and changing provider attitudes. Simply that!


Monday, June 18, 2018

Here’s why playing with your child is important


By Mkama Mwijarubi

“Playing with children is a childish thing, that is what I knew,” says Magreth Shija, grandmother to two year old twins: Agripina and Aggrey says about her experience with child stimulation.

Her opinion is not only popular but, it is a way of life for many communities in Tanzania believing that playing is for children. They should play with children and, their mothers. They should not bring play to adults.

Now science raise fundamental questions on the traditionally culture that directs caregivers in Tanzania to keep children at bay (except occasionally) contented that feeding, medicating and keeping them safe is superbly enough. Caregivers are an inclusive term that includes biological parents and guardians.

According to the World Health Organisation, Early Childhood Development that include playing and communicating purposely with infants and children stimulates their brain. According to research 80 per cent of human brain develops during the first 1000 days of their lifetime. In this time one activity that children do seriously is play.

The question is do you want your child brain to develop alongside his/her physical health that they reach their potential and fulfill their dreams, probably your dreams too?

“If we need to develop our children to their fullness, we need to purposefully stimulate their brains to grow. We cannot evade or downplay playing with our children if we want to impart confidence, cognitive excellence and building personality,” says Josephine Ferla, a program manager for Malezi, a project by Elizabeth Glaser Pediatric Aids Foundation that facilitate early childhood development activities, including early stimulation.

Early stimulation becomes even more important in Tanzania that is home to estimate 1.3 million are AIDS orphans and where women’s low level of education weakens family care and educational environments for young children.

The importance of an excellent foundational knowledge and confidence for a success in later stages of education and eventually career cannot be overstated. While in Tanzania, the government has designated one year of pre-primary education compulsory, only a small minority of children under three in urban areas attend a daycare center, meaning that home is still the primary source of development for young children.

Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) with funding from Conrad Hilton Foundation worked with the Ministry of Health, Community Development Gender, Elderly and Children to bring information and counselling about early child development (ECD), including child stimulation closer to caregivers at an outlet that is readily accessible to parents and children- the health facility.

“Information and counseling regarding ECD will typically only reach the family through the health systems. Pregnant mothers visit antenatal clinics, and lactating mothers visit post-natal clinics. Men also visit health facilities accompanying their partners. Therefore awareness about early stimulation at health facilities is likely reach the community and be emphasised through repeated visits, says Josephine.

Having worked in prevention of HIV from mother to their children since 2003 in Tanzania, EGPAF was positioned to observe how HIV/AIDS slowed development of children. Apart from its severity in HIV affected children the problem generalized in the population.

Malezi’s baseline study, conducted prior program implementation pointed that parents do significantly less in child stimulation particularly in playing and singing with their children.

Is it a surprise then, that there are children higher classes of primary school who lack basic literacy, language comprehension and numeracy skills?

“My children have more confidence in asking what they need and talking with me,” says Eliwaza Simon, a mother of four at Mbagala locality in Igunga.

Probably, these poor children would have known better and asked their teacher to help them, had they been brought with assertive communication environment.

Malezi, for two years, trained health care workers and community health care workers, who in turn counselled caregivers about how to stimulate their children and ECD in general.

A total of 69,260 caregivers were reached through home visits, group counselling and individual counselling at health facilities.

Endline data after two years show a story of change. That there are more locally made play materials in the households during endline 60 per cent in comparison to the baseline 24 per cent. Children are more encouraged to play with households objects such as cups whereas the improvement is at 82 per cent in comparison to 67 per cent.

Although the results at the end still trace around the baseline reflection change has taken place.

“I see that there is improvement from the feedback I get in repeat visits. Gradually, more caregivers appreciate the value of stimulation to their children,” says Fikira Abdallah, a community health worker in Tabora Municipal.

Eliwaza sits with Sarah under a cool shade of an acacia in the middle of open yard. Her house is on the left and another smaller house on the left. Her three children play with three others from the neighbourhood on a heap of sand beside the tree.

She is content that their play is not just play; it is for their good.

The author is a communications, outreach and advocacy manager at EGPAF Tanzania.


Monday, June 18, 2018

Foods that lower high blood pressure


By Beatrice Nakibuuka

High blood pressure is associated with diabetes, stroke, heart disease, kidney failure and death.

However, it can be controlled with healthy eating and a healthy lifestyle, says Dr Levi Kwarisiima, a cardiologist at Braakline Medical Centre in Bwaise. Besides reducing your sodium intake, it is important to watch what you eat.


The dried red flowers of the hibiscus plant contain antioxidants that fight free radical damage caused by poor diet and constant exposure to dangerous chemicals. Dr Kwarisiima says, “Hibiscus has a number of health benefits including fighting bacteria and aiding weight loss. Hibiscus tea can be made by soaking hibiscus flowers in boiling water for five minutes.”

Hibiscus has the potential to lower blood pressure, thus contributing greatly to improving cardiovascular health. Be careful however not to take it if you have low blood pressure.

Sunflower seeds

Sunflower seeds are rich in vitamin E, folic acid, protein and fibre. They help to lower blood pressure and promote your heart health. Paul Lutaakome, a nutritionist at Jinja Referral Hospital, says, “They are a nutritious snack because they contain a lot of magnesium, folic acid, protein and are a good source of fibre. Ensure you buy unsalted sunflower seeds to minimise your sodium intake.”


Tomatoes are rich in lycopene, which reduces blood pressure. They are more beneficial when eaten raw. However, because they are a versatile vegetable, they can also be incorporated into several meals as part of salads or into your cooking. However, do not overcook or deep fry them because their nutrient value diminishes with increased temperatures.


Watermelon contains an amino acid called L-citrulline which helps improve circulation and lowers systolic blood pressure. A drop in aortic systolic blood pressure is important in mitigating cardiovascular disease risk.


Carrots are high in potassium and beta-carotene which have a great impact in reducing high blood pressure. Carrot juice also helps maintain normal blood pressure by regulating heart and kidney functions.

Green vegetables

For example, spinach is low in calories, high in fibre and contains potassium, folate and magnesium. These are key ingredients for lowering and maintaining blood pressure levels. Celery contains phthalides that relax the muscle tissue in the artery walls, enabling increased blood flow and, in turn, lowering blood pressure.


“Bananas are rich in potassium which boosts kidney function, thereby helping them flush sodium out of the body. They also help in relaxing artery walls which boosts heart health,” says Lutaakome.

Tit bits

Other things you must be watchful about while keeping your pressure normal include;

Eat less salt because too much salt can cause a spike in blood pressure. A drop in sodium consumption may lead to a drop in your blood pressure.

Stress elevates your blood pressure and for those suffering from hypertension, stress can also cause some kind of cardiovascular damage. Sleep deprivation can also lead to hypertension and other health related problems.

“It is important that you exercise to stay fit and keep the pressure at a recommended level. Belly fat may trigger high blood pressure. Reduce your alcohol intake, quit smoking because nicotine is said to increase blood pressure,” says Dr Kwarisiima.


Monday, June 18, 2018

Dear patients, don’t hesitate to ask questions


By Piamaria Ngole

Imagine ‘A Tanzania’ where quality health care is available, accessible and affordable to all 55.57 million -or at least a vast majority of us and we all have a health insurance plan. As of 2015, about 13 per cent of under-five years of age were underweight. Imagine improving that ratio significantly.

Imagine a “one mother one bed” Tanzania where there are no 398 martenal deaths for every 100,000 live births. Imagine free health care for every under five and elderly above 65. Imagine a nation eradicated off of communicable diseases and with great management resources for non-communicable diseases.

Imagine the physician density is better than 0.003 doctors for 1000 people and we shift from the current 1:33,864 to the WHO suggested 1:1000 pharmacist to patient ratio.

Imagine having all your medical needs met at your local region without the need to be transferred half way across the country or abroad.

Well, we could go further on this cerebral adventure to the future, but I’d rather we pause and live in the moment.

Yes, there are strategies in place to make sure we move forward but spending too much time in the future is another reason we fail to make effective use of the resources at hand.

Health care information

One of the most wasted resources in the health sector is health care information which can go a long way in prevention, control and management of diseases.

It is less than exemplary that health care providers have not always made the initiative to inform patients thoroughly regarding their conditions or management and it is unfortunate that patients have very often not been in the positions to claim this vital information. A fault not of their own.

As torch bearers, health care providers need to make habit of communicating thoroughly and in their best patient language, all information regarding patient health status, medications, options and the goal of treatment.

Patients, take note

On the other side, patients should make sure they are on the same page with their experts, asking questions and -well I’m usually on the other side of the counter so it’s hard to come up with too many patient stuff- But, if you don’t know what to ask, then here are a few questions you can ask your pharmacist next time before you leave the counter.

Most important, ask about the dose and dosage. How much of the med should you take, when and for how long? This is important because it significantly reduces chances of overdose or under-dose.

Not every pill that looks like a tablet is meant to be dropped to the throat and flushed down the guts with water. Some are lozenges, to be put under the tongue and left to dissolve there and some are strictly to be chewed. In this matter, I cannot imagine a bigger tragedy than taking orally what’s meant to go through the other end of the alimentary canal.

It can be challenging for first timers to use aerosols and so before you leave the pharmacy make sure you know exactly how to. Most people never think to ask this but it is quite valid to inquire about what to do with left over medication. There are standard procedures for disposal of unfit or unsafe medications and you will be surprised to learn that most of our disposal techniques are not environmentally safe.

Many people believe that left over medications still carry both their economic and therapeutic values and so find it hard to dispose them and instead keep them for future use. That is not entirely false for some medicines but before you choose to do so, get your pharmacist’s opinion.

It is also very important to ask about possible side effects and interactions. I have heard many people quit a certain medication just because it made them worse not knowing that their experiences were merely tolerable side effects. Talking to your pharmacist about this will not only improve your compliance but it will tell you when you actually need to stop taking the medication.

These are just few questions to guide you in getting importatant information from your pharmacist. If you have other concerns, do not hesitate to raise them because it’s safer not to assume knowledge when clarity is just a question away.


Monday, June 18, 2018

Blood in the stool isn’t always colon cancer: here’s when to worry

Dr. Christopher Peterson

Dr. Christopher Peterson 

By Dr Chris sonchrisoeter@gmail.com

Dear readers, I hope you’re on the right track in reducing your risk factors for cancer; you’ve been eating high fibre and low fat foods, you’re maintaining body fitness and weight is under control and that you’re regularly attending your cancer screening. Good! Kudos to you all for always staying informed by making sure that you do not miss cancer information that I always pin on this column. It’s encouraging to witness that this space has played a huge role in raising cancer awareness.

Yet everyone still dreads that “blood in the stool” scenario. The concept that a bloody stool that lasts for a time is cancer, is one of the most common colon cancer myths, probably arising from fear and lack of information.

Well, early last year in this column I talked about key cancer warnings that should NEVER be ignored and when it comes to colon cancer particulary, we see a blood in the stool is a one of the KEY colon cancer warnings. Yes it is! But if you experience persistent blood in the stool that doesn’t quit however, don’t panic.

The good news is that while blood in the stool may be one early symptom, as lower as only 2 per cent of patients who present with bloody stool turn out to have colon cancer.

Whenever you discover you’re bleeding, it gets your attention. And it’s often easy to find the source of the blood. But when it’s rectal bleeding the source isn’t so easy to pinpoint. And this can make anyone worry. However, rectal bleeding comes in various forms that are quite different from cancer.

In most cases, colon cancer does not cause any symptoms and is found incidentally during a routine colonoscopy. If a person with colon cancer does have symptoms, those symptoms will depend on the location of the tumour in the large intestine. That’s why regular check-ups always matter.

The very common factor that can trigger bloody stool is what we call hemorrhoids. It’s obvious that any one can have hemorrhoids inside and outside of the anus. Sometimes they get irritated due to some reasons; so if you notice blood in the stool, plenty of factors may lie behind that may include; constipation, severe diarrhoea, diet with low fibre, heavy lifting, and hard stools.

Apart from hemorrhoids and cancer itself, bloody stool can be caused by anal fissures. An anal fissure is a small tear in the thin, moist tissue (mucosa) that lines the anus. An anal fissure may occur when you pass hard or large stools during a bowel movement. Anal fissures typically cause pain and bleeding with bowel movements. You also may experience spasms in the ring of muscle at the end of your anus (anal sphincter).

Anal fissures are very common in young infants but can affect people of any age. Most anal fissures get better with simple treatments, such as increased fibre intake or prescription. Some people with anal fissure may need medication or occasionally surgery.

However, it is helpful if you can make a note of how long you have been experiencing rectal bleeding. And your doctor will always want to know some other important information from you such as pain, colour of blood and family history.

Like I always say, when it comes to cancer, early detection saves life. Plan to start regular colon cancer screening especially if you are above 30.