Monday, May 21, 2018

What affects food choices in Tanzania?

 

By Lugano Wilson

The notions about feeding tendencies by some of the clients I have attended to, may make your blood curdle. It’s no news, but obesity remains a health burden for many Tanzanians, knowingly or unknowingly. Some say it’s familial, while others think it is a sign of wealth.

Some men gather at social places, staring at obese women rumbling in streets , equating their obese physique with beauty.

Those who are obese are from well-off families, consuming a lot of beer, fats and carbohydrates.

Most of the people are oblivious of the proper food to consume according to age group and their daily activities/occupation.

Moreover those from affluent families consume a lot of kitimoto (pork)/red meat and beer.

Poor food choices

There is a matrix that surrounds the poor choice of food and improper feeding , not surprisingly, that’s ignorance cum poverty.

Needless to say, poverty has a role to play in improper food choices. The low-income families feed just to get their stomach replete consequently succeeding in suppressing the feeling of hunger. Therefore many will eat a huge portion of ugali just to get satiated, amongst the poor urban dwellers others will not access even that ugali, and they simply underfeed.

I would like to insist that the choice of food influences your health/disease status and aging process.

Do you want to be as fit as a fiddle? Just eat well.

Therefore, after observing that trend in my country I resorted not to be restive on the matter. Here are some useful tips for my readers.

Older adults need to eat right

You must understand that sometimes we suffer because we cannot give our bodies the nutrients they require. Food requirements are different as we move through different stages in life.

Today, let me concentrate on older adults, our grandmas and grandpas. I consider elders as vulnerable group of people, threfore I’m going to accord them the priority in today’s article.

With elders, their appetite is low, you might think that they are food faddists, but they are not.

Appetite can vary in older adults and often decrease as you get older, so the interesting thing in such circumstances is eating a variety of foods.

• The elderly require plenty of vegetables, legumes (baked beans, kidney beans and chick beans). These have different naming system in Tanzanian vernacular dialects.

• Do not forget fruits, whole grain cereals, lean meat such as fish and poultry, milk, youghurt and cheese.

• Drink plenty of water. It’s an emphasis that doesn’t age. As we get older, we don’t feel thirsty, even when our bodies want fluids. Therefore, consider suggesting the old to take in a lot of fluids such as water as the most important aspect in their diet.

• Why are proteins important for the elderly? Protein requirement found in eggs, soyabeans and nuts, increases as we reach 70’s. Protein in the body assists in healing of wounds, and this is very important for wound recovery after surgery.

• They need calcium, low fat milk, cheese, yoghurt, for prevention or slowing the progression of osteoporosis.

• Older adults need Vitamin D, which is important in bone health. This is not expensive, one can get it naturally from the sunlight. Just wake up in the morning at sunrise and bask in the graceful morning sunlight.

• Eat low salt, low sugar foods. You know as years go by, sadly our sense of taste can decrease, thus you may add salt to your food that may be more than enough. Do not do that, instead just add spices to add flavour to the food.

According to www.sahealth.sa.gov.au, its recommended to toe the “food guide pyramid.” lt suggests to use fats and oil sparingly. Take 2-3 servings of milk yoghurt, and cheese group, 3-5 servings of vegetable group, 2-3 servings of meat, poultry, fish, dry beans, eggs and nuts group, 2-4 servings of fruit group and 6-11 servings of bread, cereal, rice, pasta group.

The food categories expounded above can also be important to other groups but the emphasis has been particularly made for specific roles in elders.

Keep an eye on the kind of food you choose to consume, otherwise in the end you will be caught between a devil and a deep sea.

If you are your grandparents’ keeper, assist them with best food choices, though remind them to understand that they should live not to eat but they should eat to live.

Again listen to what elders say and suggest whilst constantly guiding them on food choices.

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Monday, May 21, 2018

Watch out for these signs in children that may hint a cancer

 

By Dr Chris Peterson sonchrispeter@gmail.com

Your child has cancer’ - it’s a sentence no parents want to hear.

However, it may be a reality for many, with thousands of new cases expected to be diagnosed every year according to a recent report from the Centers for Disease Control and Prevention (CDC). Apart from lifestyle and genetic factors, the risk factors for certain types of cancers go higher with the age, I always tell people to bear the truth that one is neither too young nor old to be diagnosed with (any type of) cancer at some point in their life and we are not guaranteed to be cancer free forever.

In children, cancer can sometimes be hard to recognise because common illnesses or everyday bumps and bruises can mask the early warning signs. Parents are advised to be vigilant when they notice something abnormal to their kids since some cancers can disguise in such mild conditions.

Well, I have rarely written about childhood cancers, but the recent CDC statistics is worrisome; hence it’s wise to share awareness with the readers on the types of cancers likely to strike children and their symptoms to watch for. These are also known as paediatric cancers.

Lymphoma: This type of cancer starts in certain cells of the immune system called lymphocytes. These cancers affect lymph nodes and other lymph tissues, like the tonsils or thymus. They can also affect the bone marrow and other organs causing different symptoms depending on where the cancer is growing. These cancer are of two types, Hodgkin and non-Hodgkin lymphoma. But the most common in children is non-Hodgkin lymphoma.

These cancers often grow quickly and require intensive treatment, but they also tend to respond better to treatment if caught early. Parents are advised to be attentive on the symptoms of lymphoma that may include; swollen lymph node in the neck, armpit, or groin, unexplained weight loss, fever, sweating profusely and weakness.

Another form of cancer is brain tumour. The World Health Organisation (WHO) has recently reported that brain tumour and other nervous system tumours make up about 32 per cent of childhood cancers. There are many types of brain tumours and the treatment and outlook for each is different. Most brain tumours in children start in the lower parts of the brain, such as the cerebellum or brain stem.

Although brain tumours are typically different in children as opposed to adults, many of the symptoms remain the same. These are; headaches, dizziness, balance problems, vision, hearing or speech problems and frequent vomiting.

Wilms tumour is in the list too. I bet you have rarely heard about it. Wilms tumour starts in the kidneys and is the most common type of paediatric kidney cancer. Wilms tumours usually forms in one kidney, but sometimes both. It accounts for about 5 per cent of all paediatric cancers. This disease is typically found in infants and children from the ages of 0-5. And is not very common in children over 6.

When Wilms tumour strikes, a child may experience several symptoms like swelling or lump in the belly, fever, pain, nausea and poor appetite.

I have been preaching a lot about early cancer detection and how it matters. It really saves a life as I have been saying that’s why it’s important to pay close attention on any unaddressed medical condition and seek medical attention even when they seem not life-threatening.

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Monday, May 21, 2018

Here’s why you need to get your teeth cleaned

 

By Dr Sakina Khanbhai saks.qus@gmail.com

Do I really need to get my teeth cleaned professionally? This is the most frequently asked question that I receive.

Professional cleaning, also known as scaling; is the fastest growing dental prophylaxis, to remove dental plaque and calculus (tartar) which irritate the gums and cause inflammation. Over time, this inflammation puts you at the risk of developing gum disease called gingivitis.

If gingivitis is not treated, the inflammation progresses to the foundation of the tooth causing a periodontal pocket and within the pocket causes more damage. This damage can further breakdown the supporting (bone) structures of the teeth.

Scaling is done to get rid of the bacteria in the pocket and helps the gums adhere more firmly to the teeth.

Scaling if done regularly, that is, every six months to remove calculus, breaks the cycle of gum disease and keeps the teeth and its supporting structures healthy.

This topic hits home for me. I see several patients coming in with periodontal (gum) disease but hesitate at the idea of getting their teeth cleaned professionally, even after having been informed of all the negative impacts it has on their teeth.

Age old wrong notions about scaling of teeth are what stops patients from undertaking this course of treatment.

Let’s look at some of the misconceptions and realities behind them.

Myth 1: Scaling causes tooth mobility

Truth: Have you ever had a tooth extracted? Tooth is the hardest substance in the human body.

A plausible explanation for this myth may be that people with excessive build up of calculus get their teeth cleaned for the first time after very long (say at about 30-40+ years of age). Thus, at that point the only thing holding the teeth in place is the tartar around them. Removing the calculus gives people a feeling that it is the scaling that actually loosens the teeth while in reality it is the progression of the gum disease that eventually leads to destruction of the bone. This explains the tooth’s lose anchorage.

Myth 2: Scaling makes teeth sensitive

Truth: Again this is a misconception. Calculus build up causes the gums to recede and thus exposing the root of a tooth.

That is the part that is susceptible to hot and cold substances as the root does not have protective layer. That is, enamel around it, unlike the crown of the tooth.

Usually teeth sensitivity reduces within a week of scaling as the gums bounce back to good health, provided proper hygiene is maintained. Scaling when done regularly (every 6 months) prevents gum recession which in turn prevents sensitivity in the long run.

Myth 3: Scaling weakens the teeth and removes enamel

Truth: There is absolutely no grinding or cutting of teeth during scaling as the ultrasonic scaler has a non cutting tip.

In fact the scaler works with the pressure of the water-jet and it is a combination of ultrasonic vibrations and water that removes the tartar.

Myth 4: Scaling is not required until your gums bleed

Truth: The sad part about gum diseases is that it is usually not accompanied with pain, thus ignored a lot of times until it reaches very serious stages.

The most common complaints are related to bleeding gums, bad odour and/or pus discharge.

Waiting for your gums to start bleeding will lead to bigger problems afterwards.

Myth 5: Scaling creates gap between the teeth

Truth: What happens is tartar builds up on the sides and backs of the teeth like a collar. It tends to irritate the gums so that it recedes away from it’s normal position.

Tartar builds up even more to fill in the gaps. When the tartar is cleaned off, you see the space that was occupied and where the gum used to be.

It’s never too late to make things right. Visit your dentist and schedule a scaling appointment. Your teeth will thank you.

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

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Monday, May 21, 2018

When the doc is a palm away

 

By Josephat Wangwe

As technology advances, you don’t need to keep nagging doctors at clinics whenever you have simple matters; such as asking one question after the other. A doctor is right there in your palm.

Recently, when I stumbled on a Tanzanian website, www.daktarimkononi.com, I was amazed at how local medical scientists are becoming innovative day by day.

Apparently, medical students and senior doctors in Dar es Salaam have teamed up to create an online platform that can be used in solving several problems that have dogged our health system for many years.

The medics, many of them from Muhimbili University of Health and Allied Sciences (Muhas), do it through a website, dubbed, “Dakari Mkononi,” meaning, a doctor in your palm or hand.

Easing the country’s burden

Tanzania is one of the developing countries with plenty of obstacles to overcome—improving the health system being one of the obstacles.

It’s true that there is a big gap to fill, especially now we, as doctors, strive to empower society through positive behavioural change communication.

But, we shouldn’t forget that the disease burden is growing at the pace that needs much of our creativity, intelligence and commitment in an effort to match with it.

This of medical students and doctors online, comes as one key step and at the right time. Every Tanzanian wants to be on internet these days. What a timing!

The number of internet users in Tanzania rose by 16 per cent at the end of 2017 to 23 million, with the majority of those using their handsets to go online, the Tanzania Communications Regulatory Authority (TCRA) said this year.

Yet, internet penetration in the nation of around 52 million people ticked up to 45 per cent in 2017 from 40 per cent a year before, according TCRA.

So, any healthcare investment that aims at reaching these multitudes of Tanzanians on internet must be lauded.

I am aware that Daktari Mkononi is an initiative of medical students. By the way, these are expected to graduate as doctors in near future.

If they don’t stop at this pace, and perhaps bring other students on board, it means that the army of doctors who will be out there educating society will be growing.

They would work to tackle people’s poor and late health seeking behaviour. But also, this would be a key step in curbing long waiting times on queues at health facilities.

There are a lot of misconceptions about health in Tanzania. Largely, ignorance contributes to this trend.

But also, there are just a few interventions that people can learn to adopt, such as taking preventive measures and challenging situations in-case of emergencies at home, work and other environment that might, at times, cost lives or lead to complications.

How it works

Any internet user, by either cell phone or computer can access DaktariMkononi services through the portal, www.daktarimkononi.com. There are well-researched topics on health, which are posted daily.

They aim to enlighten society and people can ask questions on the comment box concerning the ongoing topic. Then, a panel of doctors, nutritionists or pharmacists or dentists give answers in just a few minutes. To ensure that the information given is real and touches the society, the sources are well established and the messages published are peer-reviewed.

Way forward

I am informed that the initiators are determined to grow the initiative on a bigger scale. The first phase seems to be concentrated on this web portal.

As time goes, they may grow into a bigger institution. Who knows?

There will come a time when discussions and debates on health topics will be held to highlight common myths in the society and address misconceptions that affect preventive behaviour and health seeking behaviour.

These shall be conducted with community icons such as popular artists and other non-health personnel. Internet is beginning to revolutionise health in Tanzania, let’s laud these initiatives.

The author is based at the Catholic University of Health and Allied Health Sciences (Cuhas).

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Monday, May 21, 2018

6 changes fasting brings to your body

 

By Ali Khatau aliKhatau@hotmail.com

Fasting is basically refraining from any food or drink from dawn to dusk. In specific, you would have to stay away from any kind of food and drink from 5:30 a.m in the morning to around 6:30 p.m in the evening.

Since the time period between dawn and evening is different in different countries, the number of hours Muslims fast is also different.

In warmer parts of the world, the days are short and so, people in this part of the world have to fast for fewer hours compared to colder parts of the world where the days are longer.

I was recently having a conversation with a fellow medical professional about the health benefits of fasting on the body.

This was a very interesting topic since fasting has always been regarded as something spiritual and something only Muslims would have to do.

But in reality, fasting has a lot of health benefits as well some of which have also been medically proven and accepted.

Health benefits that may be obtained as a result of fasting may prove beneficial to various body systems and organs including the brain and stomach.

This discussion with my fellow progressed and we came up with specific benefits to the human body:

Control cholesterol levels

One of the main benefits a person can get from regular fasting is reduction of the cholesterol levels in the blood.

This comes as a result of the positive effects of fasting on the lipid profile. Maintaining healthy cholesterol levels in turn leads to great improvement in cardiovascular health and thus, greatly reduces your chances of developing heart disease, heart attacks or strokes.

Detoxifies your system

Regular fasting acts a fabulous and very efficient way of detoxifying your system.

By staying away from food and drinks all day, your body will get a chance to detoxify your digestive system throughout the month.

Since you will be staying away from food for hours at a time, your body will need to burn fat reserves in order to generate energy for different organs and systems.

Harmful toxins may be stored in fat deposits and so, utilization of the fat reserves will also release these harmful toxins which will be excreted from the body.

Boosts brain health

Fasting is believed to boost brain power and can have a positive impact on your mental wellbeing.

According to a popular platform (realbuzz.com), a study conducted by scientists in the US found that the mental focus achieved during fasting increases the level of neurotrophic factor.

This factor causes the body to produce more brain cells, thus improving brain function and making you more alert.

Get rid of bad habits

During fasting, apart from food and drink, you are also not allowed to smoke.

This period is an ideal time to break the addiction of smoking as well as other vices like over indulgence in sweet foods.

As you stay away from these bad habits, your body gradually gets used to their absence to the point where you will be free from the addiction.

The effect of fasting in destroying addiction is so effective that the UK’s National Health Service (NHS) has recommended fasting as the ideal time to quit smoking.

Improves nutrient absorption

Refraining from food and drink throughout the day will make your metabolism more efficient.

This means that you will absorb more nutrients from the same amount of food than before.

This is due to increase in production of certain hormones which allow the muscles to absorb more nutrients.

And in general, it will increase availability of nutrients to all body organs and systems.

Anti-cancer effects

According to canceractive.com, fasting and calorie restriction can slow and even stop cancer progression and tumor growth, kill cancer cells and improve the effectiveness of chemotherapy and radiotherapy.

So one very powerful and efficient thing you can do to save yourself from developing cancer is to fast regularly.

Seeing all these fabulous benefits, you don’t necessarily need to be a Muslim to observe fasts. In fact, in many parts of the world, people of various different faiths and cultures have also adopted regular fasting due to its various health benefits.

The common feeling shared by all individuals who fast regularly is how good and fresh it makes you feel after and this is definitely a very good sign of how beneficial fasting can be.

The author is a Medical Student at Hubert Kairuki Memorial University.

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Monday, May 21, 2018

High blood pressure: not just a matter of the heart

 

Friday May 18 was World Hypertension Day but, interestingly, what was being discussed in the public domain was about the heart.

Well, the heart pumps blood, but when it does its job at high pressure, a condition known as High Blood Pressure (Hypertension) may occur.

There is something to note, however. That in cases of high blood pressure, the problem may not necessarily be about the heart.

Just because you have high blood pressure, certain conditions that are life-threatening; such as heart attacks, stroke and kidney disease may ensue.

Symptoms are rarely noticeable, how can you tell you’ve got it? So, knowing your blood pressure readings, may help you to detect a wide range of health problems whose early manifestation may have come in the form of high blood pressure.

The long-term force of the blood against your artery walls is high enough to eventually cause health problems, including heart disease.

One may have high blood pressure readings because he/she smokes a lot of cigarettes, has mental stress, his/her parents or other close blood relatives have high blood pressure and that means they are at an increased chance that you’ll get it, too, the older you get the greater the risk and so on. The older you are, the more likely you are to get high blood pressure.

Being diabetic, overweight, if you don’t exercise and so on, you increase your risk. But, you have to go the extra mile to check for other problems in case your blood pressure is found to be high.

Three years ago, in our village, a 45-year-old woman complained about frequent headaches and light-headedness for a long time. In our settings, most people tend to believe that headache is mostly caused by malaria and unfortunately, she used to visit a dispensary in our neighbourhood where they often prescribed for her anti-pains and antimalarial drugs. After about a year and a half, she decided to go to a district hospital where doctors took her blood pressure readings and realised she had “High Blood Pressure.”

Unfortunately, she was given drugs to control her blood pressure problem and no further medical investigation was done about it. Guess what. She had already developed kidney failure. This went unnoticed until she was later rushed to a referral hospital in critical condition.

Since then, she has undergone a series of treatment procedures, including kidney transplant surgery.

So, keep an eye on your heart. A small number of high blood pressure cases are caused by another medical condition that was present first. Examples include pregnancy-induced hypertension (PIH), certain heart defects, and kidney disorders, as I said before. Most often, if the condition causing the high blood pressure can be resolved, the individual’s blood pressure will normalise as well.

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Monday, May 21, 2018

Here’s what a high-fibre diet looks like

 

By Devotha John

Did you know that plant-based foods, fruits and vegetables contain fibre that has potential health benefits? When I speak about fibre I always visualise the ‘nyuzinyuzi’ or roughage we see (or not see with our naked eyes) in mostly fruits, vegetables and other plant based food. So just picture out roughage found in a ripe mango, ripe banana or pineapple. This is explained by Neema Shosho, a Nutritionist with the United Nations (UN) World Food Programme.

What is dietary fibre then in a professional language? It is simply a complex carbohydrate found in the cell walls of all plant-based foods.

It is something the body needs but never actually digests. What happens is, while the body converts other carbohydrates such as starch (from say your ugali or rice that you consumed) into simple sugars for energy, it’s not able to fully break down fibre.

Fibre actually passes through most of your body’s digestive system undigested until it reaches the large intestine or colon.

Where can we find fibre?

Neema said dietary fibre is found in fruits, vegetables, whole grains, legumes, nuts and seeds. It should be noted that the list includes our local fruits and vegetables, therefore maximize the consumption!

Health benefits of dietary fibre

Consuming adequate fibre can help you maintain a healthy weight. “Fibre will keep you full and lower the chance of overeating. Just try starting your meals by consuming fruits and vegetables before loading yourself with chips mayai. You will observe that a very small portion of chips mayai will be consumed. This is also a tip for weight loss,” says Ms Shosho.

Lowers cholesterol and prevents cholesterol production, which may prevent chronic diseases such as heart disease.

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Monday, May 14, 2018

Role of nutrition in pregnancy and child's development

 

By Janet Otieno-Prosper @JanetOtieno ajotieno@tz.nationmedia.com

Nancy Kimaro, 27, is drinking water from a yellow plastic tumbler on her desk. She works at a communications company in Tabata Dar es Salaam and her job requires her to report at 8.00 am and update the company’s website and file all reports until 5.00 pm. She looks tired at the time I make my way to her desk. She smiles and welcomes me to take the next seat besides her desk.

Since it is exactly 2.00 o’clock, I ask her if she had any lunch and she smiled pointing to a snack box at the corner of her table. She had French fries for lunch today.

“I was so busy to go for lunch, so I called this guy who delivers chips in the workplaces to bring me some, though I only eat such junks once in a while,” she explained.

This led us to the second question of what her diet looks like in a week.

She says she is very conscious of what she eats since she is aware certain foods like eggs can make the baby really big so she is on a balanced diet.

“I drink plenty of water, eat fruits, vegetables and chicken and include a small portion of carbohydrates as the doctor advised me during the pre-natal clinic visits. He also advised me on what to eat since whatever goes into my body has an impact on my child’s development on the womb and even after birth.” She adds that it is her first pregnancy so she does not want to mess it up by wrong diet.

Adela George, 30, is also expecting her first child. She and her husband George Mtulya operate an Mpesa shop in Mwenge.

She says that her doctor told her what to eat when she visited the clinic last month.

“My doctor is happy with my progress because I eat as he has instructed me. My diet comprises of green leafy vegetables, beans, fish, rice and fresh juice,” she states adding that her husband is very supportive and helps her prepare healthy meals.

“Apart from nutritious foods, I was also told to drink plenty of water to reduce fatigue,” she adds. At this point her husband quips by saying he should be thanked for supplying more than enough food plus waking up dead hours of the night when cravings hit.

What poor diet can do

Not so many women are aware of their prenatal diet like Mrs Kimaro and not all partners are supportive like George.

Some do not know that poor nutrition in the first months of life, during pregnancy can affect the development of the baby’s brain in ways that leave traces into this child’s life through to adulthood. However, not all pregnant women are able to afford balanced diet even if they are willing to eat healthy meals.

Speaking to Your Health, Dr Shafiq Mohammed, the Director of Msasani Peninsula Hospital in Dar es Salaam and a consultant gynaecologist emphasises that nothing can replace a diet as food is extremely important for an expectant mother as what one eats determines the quality of the baby you will have.

“The supplements we give to expectant mothers are very important but should only complement and not replace the food,” he stressed.

Dr Shafiq who is also a lecturer at Muhimbili University of Health and Allied Sciences elaborated on the fact that what an expectant mother eats can have a long lasting impact on the child’s development.

“What an expectant mother eats can also put the child at the risk of developing lower cognitive abilities, mental health disorders and even increased response to stress, so women need to pay attention to their diet and ensure they attend prenatal clinics without fail,” Dr Shafiq adds.

How society can intervene

Dr Shafiq urges all medical practitioners especially gynaecologists to give education to their patients from time to time when they visit about the importance of a healthy diet to the growth and development of a baby.

He says hospitals could also explore outreach programmes to impart knowledge about early childhood development and how nutrition and proper care both at home and at the community level to national level plays a significant role not only to the expectant mother but to early childhood development.

“We as the medical fraternity should give health knowledge to create awareness about this issue,” Dr Shafiq says.

He also urges people to try and attend clinics even before conceiving for advice to prevent issues like miscarriage and many others. He says during these clinics, one is advised on what to eat, what supplements to take and what kind of things to do to ensure their bodies are ready for a healthy baby.

“It is not a custom here for people to come for clinics before conceiving but they are very important. Some people come to clinic very late,” he explains.

Those who have nothing to eat

A report titled “The Impact of Prenatal and Early Postnatal Nutrition on Child Development” by Prof Lise Dubois Published on Encyclopedia on Early Childhood Development reveals that poor families that lack food experience highly stressful situations, which may limit the ability of the parents to respond to the many other stimulation needs of their children.

And for this, they advise that support programs that target poor pregnant women need to address not only their physical and nutritional needs, but the issues of low self-esteem, lack of autonomy and stress that are a day-to-day reality for people who have to beg for food or who live in fear of having nothing to eat.

Effects of hunger on pregnant women

Dr Elisha Osati from Muhimbili National Hospital, Department of Internal medicine issues some warnings about adverse effects of hunger during pregnancy. He says the baby will not get the proper nutrients needed to grow if an expectant mother starves or miss meals plus daily supplements including folic acid.

“The spinal cord and brain of the growing foetus can be damaged easily and requires a daily supply of folic acid. It could also result in effects like spina bifida. For instance lack of calcium rich foods like milk could prevent the baby from forming healthy bones,” Dr Osati points out adding that nutrients play important role in prevention of neurological issues, cardiovascular issues and helps in maturation of cells and body organs.

He warns that a mother might even risk losing the baby or end up with premature delivery depending on the stage of pregnancy and can delay a child from achieving development milestones.

Tips from an expert

Jane Msagati, a nutritionist and Programme Coordinator at Partnership for Nutrition in Tanzania (Panita) encourages men’s involvement during entire period to ensure expectant mothers get nutritious meals.

She says the nutritional support for pregnant women should start at house hold level as there are some women who are unlikely to eat without family support adding that others even forget to take their folic acid tablets.

So when men accompany them to the clinic, they are likely to remind their wives about everything they were advised, such as taking the supplements on time and foods to eat.

“Some women fail to consume the iron supplements they are given and the folic acid so this usually results in low birth weight below the recommended 2.5 kilogramme thus narrowing survival chances of the baby. It could also result into stillbirth,” she explains.

She also advocates for household food security to ensure an expectant mother get nutritious meals, which comprises of carbohydrates, proteins, vitamins, fats and minerals. This ensures they have healthy babies.

“Good food is food which is locally available for instance you can have ugali (for cabohydrates), dagaa (sardines for protein, calcium and vitamin D), mchicha (amaranth leaves for vitamins) and an orange to get all the basic nutrients that you need.”

She adds that the focus should be on locally available food within reach for instance banana, ugali, rice or cassava plus beans and pumkin leaves are also nutrient laden.

You could also get eggs from your chicken at home for your protein and milk for both protein and calcium depending on what is available.

She points out that healthy nutrition should continue even during the breastfeeding period for child’s development.

National policies

So far Tanzania has set up some food security and nutrition systems and mechanisms in place including instituting a separate budget line for nutrition according to Panita.

This is aimed at improving public oversight and accountability for spending and substantial investment in health, thus supporting access to essential services for children and women.

Hopefully this would have positive impact on early childhood development in the country.

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Monday, May 14, 2018

When your immune system fights itself

 

By Nelly Bosire

Gloria is a bold, sassy, stylish and adventurous 28-year-old with an infectious love for life. She is a hardworking professional, who is advancing her career by going to school part-time for her master’s.

This is the image I’ve had for the few years that we’ve been acquainted, so I was taken aback when she casually mentioned that she suffers from multiple sclerosis (MS).

Health system

I may be a doctor, but I am not a physician.

I formed the impression that multiple sclerosis was a condition afflicting people of Caucasian descent. Gloria changed my opinion pretty fast, telling me about her struggle with MS, as it is commonly referred to.

Commonly diagnosed in the twenties, it is shattering to have your doctor look you in the eye and tell you that you have MS just when your life as a young adult is beginning. And then he caps it all by telling you that it has no cure!

We invest tons of money as a country to boost our children’s immunity by ensuring we vaccinate them early in life. And then the greatest irony happens, that in our midst, there are those who will suffer from the opposite.

Immune system

Those whose immune system is overly active, so much so that it attacks the very body housing it.

There are several auto-immune diseases, affecting various body systems and organs. We all probably know someone struggling with rheumatoid arthritis, or childhood diabetes where the insulin-producing cells in the pancreas are under attack.

We may not be aware of conditions such as myasthenia gravis that causes those suffering from it to look sleepy all the time, or scleroderma which destroys the elasticity of the skin, causing the patient to have scarred skin and look older than they are.

In MS, the body’s immune system attacks and destroys this sheath and the end result is much like tampering with electric cables supplying your house. You will end up with a short circuit that may leave you in the dark or damage your electrical appliances.

This is the life of a multiple sclerosis patient.

Unpredictable

Gloria understands what it means to get home from class with an assignment due in three days and when her alarm rings at four o’clock in the morning, her hand cannot reach the clock to turn off the irritating noise.

She knows she is headed to the ward for a while and she is unable to predict when she will be back to normal.

The unpredictability of the condition is probably the worst bit of it all. The disease is characterised by repeated attacks when the system short circuits and organs are rendered functionless because they are all powered by these nerves.

Transmissions from the brain are distorted along the way and suddenly, muscles refuse to coordinate to achieve simple tasks like grasping, walking and even holding a spoon.

Muscle spasms and cramping, pain, visual impairment, constipation, difficulty swallowing, slurred speech, mood swings and anxiety descend on the patient without warning.

These attacks recur, and the condition worsens with age. The disease does not reduce life expectancy by much, but the older one gets, the fewer the good days and the recovery from the attacks is less and less complete, leaving one with chronic symptoms.

I am still trying to figure out how Gloria does it, staying on top of things despite such dark moments in her life.

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Monday, May 14, 2018

Socks that are able to connect to your doc

 

By Your Health Reporter

Physiotherapists can review patients without having to see them, thanks to wearable technology in the form of smart socks.

University of Melbourne PhD candidate Deepti Aggarwal developed the socks to help patients who struggle to travel to appointments.

How it works

The socks are embedded with movement and pressure sensors which provide real-time feedback on the patient’s weight distribution, range of movement and foot orientation, from the patient’s lower limb movements.

The socks could come in handy for physiotherapists, who need to closely observe subtle changes in a patient’s movement, especially in the lower limbs.

“Especially with long-term conditions like chronic pain, it is very difficult for the patient to come in for a face-to-face visit every time,” Ms Aggarwal said.

Such changes would be difficult to detect in video consultation, another alternative to face-to-face care, especially for patients (for example, in rural areas) who don’t live in close proximity to the specialist, and those who have difficulties moving. “This reduces the time and cost for patients travelling to the hospital. However, video consultations are less effective for physiotherapists, as they only provide a two-dimensional view of the patient,” said Ms Aggarwal.

Mark Bradford, a physiotherapist at the Royal Children’s Hospital in Melbourne, noted that the smart socks provide information health workers might not get during video consultations.

He added that the technology’s visual depiction of movement and weight distribution helps patients monitor their progress and encourages them to continue with rehabilitation.

“Putting your foot down on the ground is a really important step in recovery,” he said.

However, Aggarwal said that the innovation is a complement rather than a replacement for face-to-face consultations. The idea is to have a couple of face-to-face consultations, and a couple of video reviews aided by the smart sock technology.

Smart sock technology could also come in handy for patients with foot injuries, elderly people, and pregnant women who may not be able to travel regularly for face-to-face care.

One of the trial’s participants, Poppy Lange, has been suffering from debilitating chronic pain since she injured her knee running four years ago.

The 18-year-old has spent almost all that time on crutches, but said the smart socks had made a big difference to her life.

“Being able to walk as most people take for granted, but it’s a key part of being able to go to Uni, go to work and get to school every day,” Ms Lange said.

“Physio allowed me to do that, which obviously allowed me to get on with the rest of my life.”

The socks which cost about Sh680,000 ($300) to make are not available for sale, but the innovator hopes that companies will come on board to develop smart socks for medical use and drive down the price.

Additional information sourced from abc.net.au

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Monday, May 14, 2018

Here’s how to exercise your memory

 

As we age, especially after we cross the age of 45, there are irreversible changes that take place in our bodies. Memory loss – dementia – is one of those changes. However, as with everything else to do with the body, you only reap what you sow.

In this case, reaping has everything to do with the kind of lifestyle you live now. Treat your body well in your youth, and it will not fail you in your old age.

In December last year, Sam Ojangole, was looking forward to visiting his paternal aunt in the village. “She is my favourite aunt and the only surviving sibling of my late father. We have been really close because she paid my school fees from the time I was in primary school. I arrived at her home carrying a bag of bitengi (African cloth) for her. As I smiled at her, there was an inquisitive look on her face. I asked if she was not happy to see me. She replied, “Please remind me. Who are you?”

Ojangole was shocked. No one had informed him that his aunt was sick. She did not look sick. “She looked well. But her caretaker told me that over the course of the year, her memory had been deteriorating. Now, she does not know me.”

When a loved one begins to lose their memory, it can be frustrating. According to Dr William Ouma, of Serene Medical Centre in Kajjansi on Entebbe Road, there is no research-based evidence that dementia can be prevented.

“However, a healthy lifestyle, full of exercises that stimulate and challenge the brain can go a long way in helping one reduce their risk of suffering memory loss as they grow older,” he advises.

Exercise your mind

Like the body, the brain needs daily workout to keep it alert. If you are not one to be sitting down to read a book, take time off to play cards, scrabble, and snake and ladders with your children, do word searches or try to learn a few words in a new language.

“I always see older people trying to fill out the crossword puzzles in newspapers,” Dr Ouma says, adding, “This is good because it keeps the mind active by continuing to learn new words and phrases and then, trying to remember them.”

Besides crossword puzzles newspapers also carry Sudoku challenges. If you cannot access a newspaper, here is a quick challenge for you – try to say out loud all the 55 countries in Africa.

To begin your journey to creating mental challenges for your brain, ensure you get enough sleep. A tired brain is an inactive brain.

Smart food choices

In this day of limited time and ‘instant everything’ it is only natural that we tend to move towards fast foods. However, a diet high in fats, salt, sugar, and low on green fiber will tip the scales of your health.

Dr Ouma says, “Obesity can increase one’s risk of getting high blood pressure. This, in turn, places them at a risk of suffering a stroke. People who have suffered strokes are at risk of getting dementia.”

A healthy diet should include lots of fruits and vegetables, and white meat such as, fish. Cut down on sugary and refined foods.

“Besides eating smart, keep alcohol to a minimum because excessive alcohol can damage the nervous system and the brain. Every time you reach out for an extra glass of alcohol, consider drinking two glasses of water instead,” Dr Ouma says.

Exercise your body

A sedentary lifestyle is the gateway to all forms of diseases such as, heart disease, obesity, type two diabetes, all of which are risk factors for dementia.

Wilbroad Makumbi, a physiotherapist, advises, “If you have a job that requires you to sit for most of the day, make an effort to get up and move around every 30 minutes. Alternatively, exercise your body for at least 30 minutes a day.”

The exercises can be as basic as taking a walk around your office or neighbourhood at home. Exercises do not only keep you fit; they refresh you mind.

Social engagement important

Experts say that being comfortable with our own company is a commendable effort. However, being alone all the time may graduate into a feeling of loneliness. With friends around you, you can engage in diverse conversations and walk down the memory lane of your past experiences.

Since no one thrives in isolation, increase your engagements with other people. This should not only be restricted to social media; one needs face-to-face conversations as well.

If you are one of those people who do not make friends easily, join a church, clubs or social groups that offer community service. That way, you will always have people around you.

Believe in yourself

Myths about aging can contribute to a failing memory. Middle-aged and older learners do worse on memory tasks when they’re exposed to negative stereotypes about aging and memory, and better when the messages are positive about memory preservation into old age.

People who believe that they are not in control of their memory function are less likely to work at maintaining or improving their memory skills.

If you believe you can improve and you translate that belief into practice, you have a better chance of keeping your mind sharp.

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Monday, May 14, 2018

Here’s why oral hygiene matters when it comes to cancer



Dr. Christopher Peterson

Dr. Christopher Peterson 

By Dr Chris Peterson

You brush your teeth, you see the dentist often. Maybe you don’t floss as much as you should, and sure, your gums seem a little sensitive and prone to bleeding—what’s the big deal?

The one reason our mothers were right about oral hygiene was not only to keep ourselves from gum diseases but also to fight cancers that result from several oral conditions.

One thing people should know is that, gum diseases and oral diseases in general, host a number of cancers including, oesophageal cancer, pancreatic cancer as well as oral cancer that you have probably heard about.

There are these forms of oral conditions known as gingivitis and periodontitis. Gingivitis is the precursor to periodontal disease, it will cause your gum to become red, swollen and can bleed easily. In most cases these conditions may be triggered by not following oral hygiene and in time may lead to oral cancer.

Talking about oral cancer, it might not cross your mind all that often, but it is real. And, no, just because you are young or don’t smoke, does not mean you are not at risk. Oral cancer is on the rise across the world and it makes a lot of sense to look at prevention. Here are a few things you could do to keep this potentially life threatening condition at bay.

Floss regularly

It’s good that you brush twice a day, but when it comes to dental and oral hygiene, this might not be enough. Particles that get deeply lodged in between teeth may need flossing to be cleared. The combination of brushing and flossing may also shield you against the risk of contracting oral cancer through the Human Papilloma Virus (HPV). HPV is the cause of anywhere between 40 per cent and 80 per cent of oropharyngeal cancers.

Conduct self-exams

Once a month, pick up a flashlight that’s bright enough and head to the nearest mirror. For spots that are not easily accessible or seen, use a mouth mirror. Self-exams might not be as precise and as professionally conducted examinations, but they can often spot early indicators, if any. Watch out for tender areas, bumps, lumps and red and white spots. If you notice anything suspicious, talk to your dentist immediately.

Reduce smoking and alcohol use or quit

Do you smoke? If yes, then you fall among those people who face a higher risk of contracting oral cancer.

Smocking tobacco causes 70 per cent of all oral and pharyngeal cancers. Alcohol is the other thing that you should cut down on or better still, give up.

Regular check-ups

Make regular appointments with your dentist or dental hygienist at least every six months and ask for an oral cancer screening to be done.

However, if you go through such symptoms like sore that bleeds and doesn’t heal, difficult and painful chewing, difficult and painful swallowing, sore throat, a growth, lump or thickening of the skin or lining of your mouth, immediately see your doctor especially if these symptoms last for two week and above.

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Monday, May 14, 2018

How to eat right that fits your personality type

 

By Carolyne B Atangaza

How do you choose what you eat and when you eat it? The answer to a successful dieting experience according to nutritionists lies within the answer. Dr Kenneth Dimo, a nutritionist, reveals that what stops people from losing weight is not just food but their attitude toward exercise, low self-esteem and a tendency to procrastinate.

Dr Doreen Kagezi, a private nutritionist, further explains that some people most of the time eat to feed their feelings instead of their bodies.

“So if we cannot identify the individual, we will not give them an effective diet plan. That is why, for example, someone experiencing fatigue or burnout chooses red meat or sugar and chocolate to give an instant energy hit. When people are depressed, fearful, or feeling lonely, they may start craving the soothing effect of fatty foods such as ice cream,” Dr Kagezi explains.

Spontaneous

Dr Kagezi says a person who does not like schedules and lives their lives from day to minute will not work with a strict diet plan. “Instead of focusing on when to eat and what to eat, a spontaneous person should focus on controlling portion size and regulating meal times,” she advises.

The planner

These according to Dr Kagezi will thrive with a step by step plan that gives them exactly what to eat for breakfast, lunch, dinner, and snacks. They are the kind of people who have the commitment to look for particular foods and prepare them ahead of time. All planners need is a system and they will do well.

The caregiver

Dr Kagezi says: “The simplest meal plan possible for people who spend so much time taking care of all the other responsibilities is sticking to healthy options of pre-packaged snacks and meals, and only relying on home cooking for the times when they are relatively free,” she advises.

Trend chaser

These alternate between the spontaneous and planners. One good characteristic of this particular group is their positive response to peer pressure so they will need people they can be accountable to. They need an extensive and diverse menu options.

The cynics

These people refuse to believe anything until they have proven it themselves. They are usually very intelligent and effective, but they tend to think they know better. For them living, in denial is easier than the fact that they may fail at anything. To combat their fear of failure, they should get a plan that gives them success, something more explicit and tangible. Tangible results will motivate them and inspire them not to give up. “Let them look for a meal plan that gives them weekly directives, points of focus, and goals,” explains Dr Doreen Kagezi, a nutritionist, says.

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Monday, May 14, 2018

Is it normal to get moody during your period?

 

By Salome Gregory

Let’s get something straight – menstruating is a natural process and so is getting emotional when your period is about to make an appearance.

There’s nothing wrong with suddenly getting tearful or upset during this time. While others have absolutely no idea about it – to some, it comes as a full package with both emotional and physical symptoms.

This is affirmed by Dr Julius Twoli, a doctor based at Bagamoyo District Hospital. He explains a mood swing as an extreme change in temperament and that they are common and normal around the time of a period. These mood swings are caused by hormonal changes in a woman’s body, which is responsible for temper variation.

Dr Twoli further tells Your Health that during menstruation if a large amount of oestrogen hormone is released, a woman can suffer with not only mood swings but also bloating, cravings, tension and cramps.

This situation contributes to the amount of the mood swings during a period.

Ways to cope with a mood swing

Amina Imran, a primary teacher based in Dar es Salaam confesses to Your Health that before, during and after her menstruation period, she goes through depression. It was never easy for her to understand as to why that happened and what really made her get suddenly tearful and angry.

“It was until I was talking to a schoolmate about two years ago who is currently in the medical field that I got to know about my condition. A friend explained more about mood swings during menstruation and I had a chance to learn about my body,” says Amina.

Adding to that she says, after being told on the mood swings during menstruation cycle, she decided to talk more about it with her gynaecologist.

She was advised to do physical exercise to lift her moods and improve depression.

Commenting on this, Dr Twoli says, during physical exercise, stress and pain can easily be removed and this allows a woman to enjoy her life just like any other woman. Walking, swimming, bicycling and running are part of the physical exercise that can help a woman fight mood swings.

For Beatrice Sagana, a businesswoman based in Kariakoo, mood swings during her menstruation comes with too much anger. During this time, she quarrels with her husband, workmates and even her children.

She fails to contain her emotions and ends up into serious verbal exchange with people around her.

She is currently aware with her situation. Instead of paying attention to her hormones, she tries to manage her temper during her menstruation by exercising and reading different articles on the internet on menstruation issues.

Commenting on Beatrice’s status, Dr Twoli says, to overcome such emotions it is important for a woman to get enough sleep of about 8 hours to support her mood. Lack of sleep can boost your hormones to overact.

What to avoid

Caffeine: According to Dr Twoli, excess usage of caffeine during menstruation can stimulate sympathetic nervous system to initiate the release of adrenaline, which results in pressure of woman’s adrenal glands.

This in turn aggravates extreme mood swing. Therefore, it is advisable to avoid caffeine.

Big meals: Eating small meals rather than big meals helps in controlling mood swings. Normal meals with high consumption of carbohydrates can cause blood sugar levels to rise, in return varying mood swings.

Alcohol: Alcohol is known for being depressant so consuming alcohol during menstruation can result in high levels of depression.

Stress: Managing stress levels also helps to ease the mood swings during your period. To some people, it is not easy to manage stress but it can be done in a very simple way by doing small things in a positive way.

One can create a list of small things she managed to do during her periods like going to work, meeting her deadline, even managing to brush your teeth and do your bed can help one feel better about herself. At the end of the day one has to tick a list of the things she manages to do, despite feeling moody.

sgregory@tz.nationmedia.com

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Monday, May 14, 2018

HIV preventive pill must not be confused with vaccine



Dr Syriacus Buguzi

Dr Syriacus Buguzi 

By Dr Syriacus Buguzi

It’s popularly known as PreP—the way you can protect yourself against HIV infection by taking a pill if you are anticipating that you might be exposed to the risk.

It has already been tried out in Kenya, Botswana, South Africa and some other countries. For Tanzania, this is just the beginning of things.

When news about PreP began to spread in Tanzania recently, many people had a lot of questions. “Doc, how possible is this? That one takes a pill and doesn’t get any HIV infection after an intercourse with an HIV positive individual?”

Some, and unfortunately, the members of the media, referred to it as a vaccine. In Kiswahili, Chanjo.

Well, let’s go back to the main point. It’s possible and science has dictated that it can protect you from HIV. And, as you may know, science relies on tested evidence.

It has been found out that daily PrEP reduces the risk of getting HIV from sex by more than 90 percent. Among people who inject drugs, it reduces the risk by more than 70 percent.

Based on this evidence, in September 2015, World Health Organization (WHO) recommended that people at substantial risk of HIV infection should be offered PrEP as an additional prevention choice, as part of comprehensive prevention.

So, your risk of getting HIV from sex can be even lower if you combine PrEP with condoms and other prevention methods.

What people want to be sure about, I guess, is the fact that the pills, if taken daily for seven days, can help a person not to contract HIV if that person has intercourse with another who is already infected.

But, there is a condition attached to that. The pills should be taken for seven consecutive days ahead of intercourse and then one should continue taking the pills for as long as that person will still be at risk.

It’s at pilot level in 14 regions of the country and when it’s finally found to be effective, it would then rolled out for countrywide coverage.

The challenge we are getting here is how information flows. A friend who read a newspaper recently came to me and asked. “Doc, I just heard that the government is now issuing out vaccines against HIV. I think this government is the best. Look, it has started giving vaccines against cancer, now HIV. Are we almost there is eradicating HIV and cancer?”

“No. This for HIV is not a vaccine,” I had to intervene immediately. This is because, PrEP does not work the same way as a vaccine.

A vaccine teaches your body to fight off infection for several years. For PrEP, you take a pill every day by mouth. This works purely on scientific principles.

The pill, which scientists have found to be safe and can help help block HIV infection is called “Truvada.”

As opposed to a vaccine, if you do not take PrEP every day, there may not be enough medicine in your bloodstream to block the virus.

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Monday, May 7, 2018

When family plans hang on a tight health budget

 

By Rosemary Mirondo rmirondo@tz.nationmedia.com

Everything went as expected for Veronica Joseph (37), a mother of four children, when she embarked on her plans to give birth to the number of children she wanted. However, the future may no longer remain predictable following latest cuts in healthcare spending in Tanzania and continued reduction in foreign aid.

Ms Joseph secures her modern contraception methods through government-run health facilities near her home and according to the 2016 Tanzania Demographic and Malaria Indicator Survey (TDH-MIS), six in 10 modern contraceptive users obtain their methods from government/parastatal suppliers.

“I decided to start using contraceptives and most especially the implant after I had my four children in just eight years and I was in danger of conceiving another if I had not taken action immediately,” says the resident of Tegeta, a suburb in Dar es Salaam.

She tells Your Health that she has been relying on a contraceptive implant, a small flexible plastic rod that’s placed under the skin in the upper arm. Doctors say the implant releases a hormone known as progestogen into the bloodstream to prevent pregnancy and lasts for three years.

So, every after 3 years, she goes to a nearby hospital located at Kibaoni, Tegeta suburb in the city to get the service and, she is due to have another implant in the next one and half years.

Family planning appears now a priority for Ms Joseph and most women in Tanzania. But, is this a current priority for the country’s policymakers?

The Ministry of Health, Community Development, Gender, Elderly and Children has shown the commitment to top up its family planning budget from 14 billion in 2017/18 to 17 billion by 2020. However, challenges still abound in the implementation of the budget commitments.

Far from being ideal

Despite the fact that the government has shown commitment, a health advocacy NGO, Sikika, says that funds from the 2017/18 family planning budget which was pegged at Sh14 billion, haven’t fully been disbursed. Only Sh2 billion had been disbursed by February 2018, says Sikika.

But, the demand for family planning in Tanzania is rising. The number of married women who are using modern contraceptives has increased over the last one decade—from 20 percent in 2004-05 to 32 per cent in 2015-16, says the 2016 DHS-MIS. Yet, the country’s birth rate is one of the highest in the globe ranking 16th out of 225 countries.

Cuts in healthcare spending

Will the government’s drive to increase family planning services remain unaffected by the latest cut in the health budget? The parliament in April approved a Sh893 billion budget for the heath sector for the 2018/19 financial year, cutting it by about 19 percent of the previous budget which was Sh1.1trillion.

According to experts, the decrease in health budget means that the country’s family planning drive takes a hard hit, amid Tanzania’s escalating population.

The National Bureau of Statistics (NBS) Projection Report of 2018 has predicted a 54 million population in 2018, with 44 per cent of this number being the young people, under the age of 15 years.

The young population is, according to family planning stakeholders, driving up the country’s fertility rate even more. Tanzania’s adolescent population currently has three times as many more children than their global counterparts.

This also happens at a time when Tanzania’s unmet need for family planning stands at 22 per cent among married women aged 15–49 years and 23.5 per cent among young women aged 20–24, according to the 2016 TDH-MIS.

Trump factor

The future may appear bleak now, considering that the US President Donald Trump has already proposed a budget cut of 50 per cent in funding for international family planning and reproductive health (FP/RH) programs in developing countries.

Reports from the Reproductive and Child Health Section of the Ministry of Health, Community Development, Gender, Elderly and Children, show that the actual cost for family planning commodities for 2017 were Sh36 billion and for 2018 are Sh33 billion.

But, the Advocacy and Technical Manager for Advance Family Planning (AFP), Mr James Mlali, confirms to Your Health that the demand for contraceptives is still higher than supply. He says that 22 percent of women who need family planning services still do not get them.

According to him, factors behind the situation include stock-outs of the commodities at the facilities, low numbers of skilled family planning providers, and lack of health facilities in rural areas.

Mr Mlali explains that the most used contraceptive method in the country are injectables. He says injectables provide women with confidentiality in cases where their spouses are resistant to family planning use.

“However access is limited due to shortage of skilled family planning providers and lack of health facilities in some rural areas. Also, government does not allow Community Health Workers to provide Injectable Contraceptives,” says Mlali.

He explains that pills are not preferred because they are slightly demanding and one has to be disciplined enough to take them daily, and also don’t provide confidentiality.

He further noted that condoms require mutual consent between partners or spouses, a situation that puts women in a disadvantage due to the male dominant culture, while permanent methods are more dependent on availability of skilled family planning providers.

Regional differences

Currently, married women in Tanzania Mainland are substantially more likely to use modern contraceptive methods than women in Zanzibar (33 per cent versus 1 per cent).

In Zanzibar, married women in Unguja are more likely to use modern methods (16 per cent) than married women in Pemba (9 per cent).

There is a notable difference in contraceptive use across zones and across regions. Modern contraceptive use is highest among currently married in the Southern Zone (51 per cent), followed by the Southern Highlands Zone (44 per cent), and the lowest in Zanzibar (14 percent).

In the regions, modern contraceptive use ranges from a low of 7 per cent among currently married women in Kusini Pemba to a high of 52 per cent of women in Lindi and 51 per cent in Ruvuma.

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Monday, May 7, 2018

Here’s how you can spot fake brown bread

 

By Carolyne B. Atangaza

You might have been told to stop eating white bread for the sake of your well-being. What your advisers failed to explain is that not all brown bread is healthy. Purity Wako, a nutritionist and dietician, says most people confuse brown bread with whole wheat bread. “Some brown bread is just white bread with brown or caramel colouring,” Wako says.

Buying the right bread has become a difficult task with numerous options to choose from. To narrow down the options, we may have to choose between white and whole wheat bread. While we know that white bread is made of refined flour bleached with chemicals such as benzyl peroxide, potassium bromide and fortified with vitamins and minerals through an artificial process unlike brown bread which mostly contains natural elements.

Sheila Karungi, a nutritionist, notes that there is a misconception that one can easily tell the difference between white and whole wheat by the colour of the loaf. She recommends that when looking for a healthy loaf, the keywords to look out for are “whole grain” and “whole wheat” as the first ingredient on the ingredient list. “In case the ingredient list has other things listed first, seek more clarification because chances are that is just white bread with caramel colouring added,” Karungi clarifies.

Why brown ?

According to Wako, fibre is a very important nutrient because not only does it promote health, it also helps reduce the risk for some chronic diseases. It also prevents constipation and hemorrhoids. Fibre is also linked to prevention of some cancers, especially colon and breast cancer. In addition, fibre may help lower the LDL cholesterol (the Bad cholesterol) and the total cholesterol therefore reducing the risk of heart disease. Fibre can also help lower blood sugar and keep you trim since it contains zero calories.

Karungi notes that whole wheat bread is especially good for diabetics because it has a very low glycemic index which helps in lowering sugar levels. The nutritionist cautions against binging on bread however healthy it might be. “Some people tend to do things in extremes which as we all know too much of anything is always bad. Four slices of brown bread a day should provide the recommended calcium intake,” she explains.

John Patrick Lubega, a baker, observes that because of the popularity of brown bread, some bakers will try to pass off enriched wheat flour as whole wheat flour, which is wrong. “Once refined, whole grains lose their essential vitamins, fibre and minerals, only iron is added back to enriched flour,” Lubega explains.

The easiest way to choose healthy bread is reading the ingredient list. “It should have additives that you know and understand. If you find many words that you cannot even pronounce, there is a possibility that they will be as hard for your body to digest. A quick Google search should be able to tell you whether they are healthy or not,” Lubega tips.

What about sugar?

Look for breads with low or no added sugars. Added sugars in processed foods are difficult to track. “Sugars” on Nutrition Facts panels include natural and added sugars. Check the ingredient list for sugar and all its aliases: corn sweetener or syrup, high-fructose corn syrup, honey, invert sugar, malt sugar, molasses, syrup and sugar molecules ending in “ose” (fructose, glucose, sucrose). The closer sugars are to the top of the list, the more the food contains. Also look for bread that does not contain soybean oil, corn oil, cottonseed oil and sunflower oil. These oils are high in omega-6 fats, which compete with healthy omega-3 fats that benefit your heart and brain.

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Monday, May 7, 2018

Unsanitary toilets still remain a health concern

 

By Your Health Reporter

Quality toilets are one of the key requirements that makes a home complete, yet in many homesteads in Tanzania this is not taken into consideration.

The coverage of improved latrines in Tanzania remains low with many homes and public places lacking proper toilets despite the health and sanitation hazard that the situation poses to the community.

To date, five in 10 Tanzanians continue to use unsanitary latrines - the majority being simple pits that are not easy to keep clean.

Whereas they provide limited privacy, they do not break the chain of transmission of germs that cause several serious illnesses such as diarrhoea.

It is also estimated that about 5 million Tanzanians do not use a latrine at all, and practice open defecation which further complicates the entire process.

National Bureau of Statistic findings of 2016 puts the number between 16 – 19 per cent as those who have access to quality toilets in Tanzania whereas some 15 to 30 per cent use soap to wash their hands after easing themselves.

What’s being done

A national campaign that targets to change community behaviour on the use of quality toilets among Tanzanian communities kicks off in Morogoro under the theme ‘Usiichukulie Poa’ (Don’t take it casually), an initiative that brings together several stake holders in the health and sanitation sector.

According to the Programme manager Mr Appolinary Macha the ‘Usiichukulie Poa’ campaign builds on ongoing efforts that address the sanitation and hygiene issue in the Tanzania through the Mtu ni Afya Campaign and the National Sanitation Campaign Phase 1 that was implemented between 2012 and 2016.

Now in its second phase (2017 – 2021) the initiative targets behavioral change towards use of improving toilets in homesteads.

The initiative, therefore, targets the general public to make them appreciate that for a human being’s life and home to be complete he needs a quality toilet, as opposed to the mindset that certain things such as cars, houses, smart phones and dressing as part of modernity.

Sport stadiums deserve improved toilets

Heading toward the launch in Morogoro, the campaign has also targeted improving toilets in two football stadiums (Kinesi and Bandari) in Dar es Salaam which are currently hosting the Ndondo Cup.

Organisers say that these stadiums have been selected as part of their initiative because they represent the state of toilets in most football grounds in Tanzania.

“Many of these grounds in the country do not have toilets, even the ones that are there are rarely cleaned, yet thousands throng these venues to watch popular sports such as soccer,” he said.

He added: Because we are part of the Ndondo Cup tournament it would be quite unbecoming for us to associate ourselves with venues that do not have quality toilets.

The toilets according to him do not mirror the beautiful game and the thousands of the fans that come to these ground in search for entertainment.

“As part of the initiative’s contribution we have decided to uplift the toilets in these grounds, something that we hope that will please the fans who go there to watch the game,” he said.

But as the campaign gets underway authorities admit that there is still a long way to go to achieve the ambitious goal of ending open defecation and ensuring every Tanzanian uses an improved toilet and washes hands with soap thereafter.

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Monday, May 7, 2018

Are you fond of eating too fast? Take this message



Dr Syriacus Buguzi

Dr Syriacus Buguzi 

By Dr Syriacus Buguzi

“Doc, what will happen to me if I continue eating too fast?” This is the question that I was bombarded with recently when a person I was travelling with, in a bus to Dodoma, got to know I am a medic.

Apparently, the bus had stopped somewhere in Morogoro Region so that passengers could attend to their calls of nature, including eating something.

The man we were sharing a seat with went out late to buy some edibles and that means he had to eat very fast so that he could catch up with the bus timetable.

When he returned to the bus, he told me of how he had eaten very fast, but admitted that it was his habit to do so.

“Does this have any effect on my health?,” he asked. Yes. That was my immediate reply to him and in fact, the link between eating quickly and becoming unhealthy has been a long known fact.

What happens is that when a person eats very fast, the body doesn’t get a chance to signal to the brain that one is getting full.

The stomach has what we call receptors which respond upon being stretched by the food, and the hormones that signal to the brain that food-partially digested, is in the small intestines.

Studies done

A study involving 3,000 men and women in Japan found that those who ate quickly and continued until they were full were three times more likely to be overweight than those who ate more slowly.

This was accrued out among the Japanese because speedy eating is popular in that country.

So, faster eaters may also get more acid reflux than slower ones – a study of 10 healthy people asked to eat a 690-calorie meal in either five or 30 minutes found that those who ate faster had 12.5 episodes of reflux compared with 8.5 in those who ate more slowly.

Among the Chinese, another study said that people reduce their calorie intake by more than 10 percent if they chew their food 40 times compared with 15 times. This involved 30 young women.

They were given large plates of pasta and asked to eat quickly. It was later found that while they consumed 649 calories in nine minutes, this fell to 579 when they were told to chew the food up to 20 times.

So, chewing more helps to digest your food well. This is because person’s saliva has enzymes that both lubricate and start digesting what one eats.

Next time, eat more slowly, don’t talk between mouthfuls, reduce your pace to match the slowest eater at the table and don’t wait to be starving before you get food. Take some water too.

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Monday, May 7, 2018

When male breasts are a health risk

 

By Dr Makuhi Ng'ang'a

Man boobs are a very common problem. In most cases, they are not ominous but they can be an embarrassing nuisance.

Male breasts have both glandular and fatty tissue (like female breasts) and both these tissues can enlarge with the correct stimulus.

There are two types of gynecomastia:

True gynecomastia: this is where you get increased breast glandular tissue.

Pseudogynecomastia (False gynecomastia): this is more common as it is associated with weight gain. In this case, you get increased amounts of fatty tissue in your breast. The breasts in this case tend to sag a little bit more than true gynecomastia.

Causes

It is important to understand why you may be developing man boobs.

• Aging: weight gain and testosterone reduction can result in development of man boobs.

• Weight gain: this can lead to pseudogynecomastia

• Liver disease: one of the tell-tale signs of liver disease is male breast enlargement. Usually, by the time gynecomastia occurs when there is some form of established liver destruction. You may also notice redness of the palms, easy bruising and a slight yellow tinge in your eyes.

• Kidney disease: reduction in kidney function result in the development of man boobs. Usually there are associated changes in urine production, blood pressure and fatigue.

•Thyroid problems: an overactive thyroid can result in gynecomastia. This may be accompanied by hand tremors, weight changes and mood swings.

• Tumours: unusual growths in the testes, pituitary (part of the brain) or adrenals (a hormone producing organ located above the kidney) may stimulate the formation of man boobs. This is because these tumours cause abnormal hormone production.

• Low testosterone levels: This can be due to aging, pituitary gland insufficiency or testicular problems.

• Herbal products: Some herbal products have phytoestrogens which cause the body to behave the same way as it would when stimulated by oestrogen produced by the human body. Use of these herbal products can result in development of man boobs.

• Alcohol and substance abuse: use of street drugs such as marijuana, heroin and amphetamines has been associated with development of man boobs. Alcohol abuse can have the same results.

• Steroid use: use of steroid based muscle builders or continuous use of steroid tablets for control of disease such as asthma or inflammatory conditions can lead to formation of man boobs.

• Medication: chemotherapy, HIV therapy, some anti-depressants, some ulcer medication, anti-hypertensives and heart medication can stimulate the formation of man boobs.

• Physiological: this does not apply to you but it is normal for new born and pre-teen boys to have some breast enlargement. In new born boys, it is due to circulating female reproductive hormones from their mother.

Gynecomastia and breast cancer

Gynecomastia usually does not automatically lead to the development of breast cancer. However, men with true gynecomastia have a slightly increased risk of developing breast cancer. This is thought to be due to increased levels of oestrogen in circulation in men with true gynecomastia. For this reason, all men who develop man boobs need to go for a good physical exam to ensure that there are no lumps in your breasts.

What should you do?

You need to go to your doctor for a physical exam. During your check up, your doctor will try and find out the cause of your man boobs. He/she will also check for any other abnormalities that may be in your breast.

If your doctor suspects that your man boobs may be as a result of hormonal problems, you will have several blood tests done. If you are on any medication, make sure you carry it with you so that your doctor can assess and see if it is the cause of your man boobs.

Urgent medical review

If you experience nipple discharge, pain, redness or if your breast swelling is one sided, seek medical review urgently.

The treatment

• Treat underlying problems: if your doctor finds an underlying cause for the development of your man boobs, you need to be initiated on treatment.

• Stop culprit drugs: if your regular medication has contributed to development of your man boobs, ask your doctor to initiate you on alternative drugs (if available).

• Weight loss: if excess body weight is the cause of your gynecomastia, you will have to shed the excess kilos in order to be rid of you man boobs. Combine weight training with cardio to ensure optimal results.

• Hormonal therapy and surgery are other options too.

This article was first published in the Business Daily.

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Monday, May 7, 2018

GUEST COLUMNIST: Don’t take pictures, call 114 to save a life

 

By Dr Marko Hingi

Technology is advancing. But the sad reality is that people are getting more attached to what’s happening on internet than what may be happening in their own lives or going around them. They are so engrossed into the cyberspace.

Let’s look at this scenario, where people taking pictures or videos of accident victims who, at times may be at the point of losing their lives. How is this? Smartphone addicts may not agree with me that this is not acceptable. But, imagine someone taking a selfie during or after an emergency, even with bloodstains right on the face.

Before the era of smartphones, such scenarios were unthinkable but now they are real. A motor traffic accident occurs somewhere in the city, a person is in pain on the road; for almost 20 minutes. But, passers-by are taking photos of the helpless person.

None of them takes the initiative to help until the police arrives. Those currently dealing with emergency care will agree with me that this shouldn’t be happening any more if society decided to embrace technology in a more sensible manner.

Change in mind-set

We, in Mwanza, are taking the step. Through Tanzania Rural Health Movements (TRHM), we are now working to see our society use smartphones to save lives in emergency situations, instead of taking pictures of victims. It requires mind-set change.

In Mwanza city, fire fighters, bodaboda riders and other volunteers are now getting on board with initiatives put in place by TRHM since the year 2015, as the move to ensure proper use of communications technology during emergencies.

We are now in a campaign, with a Kiswahili slogan: “Ukiona tukio la Dharura, Usipige picha, piga simu namba 114 kwa msaada zaidi,” to remind people to use their phones wisely in cases of emergencies such as road crashes, fire outbreaks and abrupt conditions like heart attack.

First responders under the Tanzania Rural Health Movement initiative in Mwanza Region, take part in a simulation exercise.

People are being reminded to call 114 for quick and free help; instead of taking photos with their smartphones to share on their social media pages.

How it works

We are using software. Upon calling 114, the dispatcher receives the call and dispatches emergency as SMS (short messaging service) through Beacon Software which works by relaying SMS from the scene of an emergency to trained first responders throughout the community.

The software enables the nearest available emergency care providers to quickly locate, treat, and transport emergency victims to local hospitals.

TRHM recruited first responders from the community through training on basic first aid, equipping them with medical supplies together with promoting proper use of the 114 through different ways such as posters, advertisement, use of social media and campaigns.

We are seeing some positive results. To a good extent, this technology has managed to save lives of many victims since it was put in place.

The efficiency of the service has increased more from the day when a three wheeler motor bicycle Ambulance (Bajaj) was introduced as it enables the first aid service providers to reach victims within a 15 km radius around Mwanza city.

The service will be more productive when whole of the Mwanza community responds positively towards any emergency incident witnessed.

It’s time now for the society at large to change their perceptions on the ways communication technologies are being used. If we do this, lives will be saved, technology use will make more sense.

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Monday, May 7, 2018

Making meal-time intersting for children

 

By Your Health Reporter

“My child is so skinny.” “My child will not eat anything nutritious; they survive on soda and biscuits.” “My child throws up whenever I force them to finish their meal.” These and more are the challenges parents raising underweight picky eaters understand too well.

Donna Ndamira has been struggling for the past five years with a daughter who has suffered from anaemia simply because she refuses to eat anything that is not junk. Five-year-old Theresa is happiest eating fries and soda. At three she was hospitalised with severe anaemia so, Ndarama started being very cautious about her feeding.

Dr Edward Mugisha, a paediatrician at Kabarole Hospital, says: “A lot of children are naturally thin. They follow a fairly steady growth curve. If you are concerned about their size, it is prudent to see a paediatrician who will measure them using objective tools and confirm whether they are healthy or not.”

Their growth curve

According to Dr Mugisha, children grow a lot during their first 12 months, gaining as much as seven kilogrammes. Between one and five years, children gain about two kilogrammes a year.

After that, weight gain slows down, with most children steadily picking up a couple of kilogrammes each year until puberty. “So do not rely on your eyes, a child can look small in size when their BMI is healthy and that is what matters most,” he explains.

The right foods

Dr Joe Opio, a paediatrician, cautions parents against forcing their children to eat.

“Give them nutritious foods, and make mealtimes enjoyable. It may not seem like your child is eating much, but over the course of a day or a week, it is probably more than you think. Keep in mind that children have small stomachs, and some can only manage a few bites at a time. Because of this, they need to eat more often,” Opio explains.

He urges parents to leave a variety of nutritious snacks such as yoghurt, peanut butter, smoothies, carrot sticks in rooms other than the kitchen where children can easily access them.

Grace Nansamba, a mother, says involving her son in planning the menu and shopping the food makes him more interested in it.

“I explain the role of each food to him, offering alternatives to each type and asking him to choose which ones we should buy. He is always looking forward to tasting them,” Nansamba explains.

Dr Opio observes: “As much as you want the child to eat extra calories, it is unhealthy to do so with fatty foods. Instead, go for protein-rich foods such as dairy and offer foods rich in healthy fats such as nuts and avocados, among others,” he advises.

Wean your child off junk especially if they are underweight because the nutritional value of foods still matters since they eat so little.

Underweight challenges

Underweight leads to anaemia and fatigue, and has been linked to poor attention and difficult behaviour in children.

Low body mass in children can also delay puberty. If your daughter is below the 15th percentile for body weight and has not started showing signs of puberty or menstruating by age 15, consult your paediatrician for further examination.

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Monday, May 7, 2018

There’s no need to fear a prostate cancer screening



Dr. Christopher Peterson

Dr. Christopher Peterson 

By Dr Chris Peterson sonchrispeter@gmail.com

For the past few days, my readers have bombarded me with aggressive questions about prostate cancer, especially on how the disease is screened and how health workers examine patients.

However, all the questions that were directed to me had one thing in common—fear and clear lack of information.

It’s understandable why most men become tense on a mere mention of a prostate exam. This may leave men dreading.

In fact, this feeling can lead to some men putting off that exam or avoiding it altogether. While the disease can be slow-growing, prostate cancer still remains one of the leading cause of cancer deaths in men older than 75 years.

However, knowing what to expect when it’s time for your first prostate exam can help you to prepare, relax and ease your anxiety about the procedure.

So if you’re afraid of a prostate exam, it’s time you move past your fears and protect your prostate health!

At some point in his life, every man will be advised (and not be forced) to have a prostate exam.

Blood test

Prostate exams consists of two different procedures. The first is a blood test that looks for the prostate specific antigen or PSA in the blood, which is an early sign of cancer.

The test measures for the amount of prostate-specific antigen (PSA) in your blood, which is a protein produced by both cancerous and noncancerous tissue in the prostate. Following the completion of the blood test, it may take a few days to get the results.

The test itself is simply withdrawing blood from your arm, which the doctor will send to a laboratory for analysis.

Rectal examination

The second part of the exam is a digital rectal exam (DRE), which doctors usually recommend as part of a routine exam—though it may also be done because of trouble with urination or other symptoms.

Although the procedure only takes a minute or two and is usually painless, many men dread having to have a DRE.

During digital rectal exam, first, your doctor will want to know whether you are experiencing any prostate health-related symptoms, such as a weak urine stream, or straining to urinate.

The next step is the digital rectal exam. Before the doctor performs this exam, let him know if you have hemorrhoids.

During the exam, remember to breathe slowly in and out through your mouth, and don’t hold your breath. A digital rectal exam can be embarrassing for some men, but just detach and try to relax.

Both procedures, the PSA blood test and the DRE exam are important health screening tools for all men.

They are necessary tests performed at regular intervals during a man’s life. If you are a male over the age of 40 and have never been screened for prostate cancer, contact your doctor and make an appointment as soon as possible. It could save your life.

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Monday, May 7, 2018

Apps to help you watch your weight

 

The following apps can help you watch your weight, track what you are eating, measure daily water intake and engage in easy workouts wherever you are to remain fit and healthy.

1. MYFITNESSPAL CALORIE COUNTER

Everyone wants to eat healthy foods, enjoy great diets, transform their habits, remain healthy, toned up and lose as much weight as possible.

This app offers all these and more. With claims of over 88 per cent success among those who have used it, the app is superb for tracking food to ascertain calorie levels, customise your food diary, track water intake, import recipe or access its 6 million plus food database.

2. 30 DAY FITNESS CHALLENGE

Great for virtually anyone, anywhere, the app takes you in a 30-day fitness challenge with a clearly set exercise goal in mind.

The exercises intensity will increase with each step to help you complete the entire 30 days without absconding. No gym is needed.

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Monday, May 7, 2018

ASK THE DOCTOR: How do I treat this body odour?

 

Dear Doc,

I take a shower every morning and evening (after work), but I still have body odour that won’t go away. I have tried using sprays and antiperspirants to no avail. I consulted a dermatologist who gave me bioselenium, but it didn’t work. I even took an HIV test thinking it was the cause of the smell, but I am HIV-negative. I can’t use public transport comfortably and my self-esteem is dented. This problem is giving me sleepless nights. Is it a common problem and what is causing it? Please advise me. Njogu

Dear Njogu,

The bad smell from your body, or body odour, is known as bromhidrosis. Everyone has body odour and it occurs due to the bacteria on the skin breaking down acids in sweat. It becomes significant after puberty due to development of the apocrine sweat glands.

Men tend to have worse body odour than women because they tend to sweat more. If you sweat excessively (hyperhidrosis), you may have more body odour, especially in the feet (bromodosis), or armpits (axillary osmidrosis).

Body odour can be worse if you are obese; you take alcohol, spicy foods or garlic; if you are taking some medications e.g. antidepressants; or if you have some illnesses like diabetes, liver disease, kidney disease, some cancers.

There is a rare genetic disorder called trimethylaminuria which causes someone to have a fishy odour.

You can also apply aluminium chloride solutions or 0.5% glycopyrolate solution on your armpits, preferably in the evening just as you are going to sleep, to reduce how much you sweat the following day.

Some other procedures that can be done to the most affected areas include iontophoresis, which utilises an electric current run through the skin; use of anticholinergic medication; or intra-dermal injection with botulinum. These should be done by a skin specialist.

Dear Doc,

I am 26 years old and single. Since November last year, I noticed that my erection doesn’t happen spontaneously like it used to, especially in the morning, and when it does it is not as strong as it used to be and it lasts for just two to three minutes.

I have never masturbated. I am currently hunting for a job and I find myself stressed all the time. Zakaria

Dear Zakaria,

Having a problem with achieving an erection once in a while is not a cause for concern. However, if it persists, it may be due to either a physical and/or a psychological issue.

You may have a physical problem that is affecting the quality of your erections e.g. reduced testosterone levels, heart disease, high cholesterol levels, blocked blood vessels (atherosclerosis), diabetes mellitus, hypertension, nerve problems, some hypertension medicine, sleep disorders, obesity, alcoholism, smoking or other drug use, injuries to the spinal cord or pelvic region. It may also be due to psychological issues like stress, anxiety, depression, relationship issues, etc.

An urologist can help you figure out the source of the problem and a solution for it. In the meantime, maintain a healthy diet, exercise regularly, get adequate sleep (seven to eight hours a day), and find a way to manage the stress.

You may also benefit from pelvic floor exercises: contract the pelvic muscles as though you are stopping the flow of urine.

You can practise this to identify the specific muscles by stopping the urine mid-flow when you are urinating. Contract these muscles for about 10 seconds, 10 times in one set, six to 10 sets a day.

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Monday, April 30, 2018

Community health workers, a game-changer

 

By Dr Ellen Senkoro

For many years, Community Health Workers (CHWs) are a health cadre that has been building up. Now, it’s formalised. However, it took years of experience to put them on board as community-based healthcare providers.

A lot has been narrated regarding the potential of this growing cadre. A CHW is chosen by community members or organisations to provide basic healthcare to the community. They are capable of providing preventive and health promotional services to these communities. In other settings, such workers have been named village health worker, community health aide, community health promoter, and lay health advisor and so on.

As a leader of an organization that has been working to strengthen rural workforce in Tanzania, through Benjamin W. Mkapa Foundation (BMF), it would be a gross understatement not to appreciate how CHWs can revolutionarise the way we provide primary healthcare.

Bridging the gap

It’s important to note that most parts of the country, especially the rural, badly need health workers and the demand increases year in, year out. That’s why; it was not by coincidence that we, at BMF, decided to direct our resources in supporting this cadre of health workers.

To make sure that they are sustainable and get well established within the healthcare system, we, together with development partners, supported the revision of the CHWs Training Curriculum.

And, as a result, this year, we intend to facilitate recruitment of about 800 of them, whereby we will begin to pilot this plan in May 2018 with the first phase of 215 CHWs.

We believe they are agents of change in promoting prevention, care and treatment of many health conditions, mobilisers for health insurance, and so forth.

Recruiting the CHWs means that we are giving them a chance to prove their worth. With a decade-long experience on strengthening health facilities with qualified health workers, CHWs are a cadre that we continue to uphold dearly.

The government is currently implementing projects to improve maternal and new-born health around the country. We, at BMF, as this May begins, new maternal and new born child health projects are rolling up. The successes of these projects will very much depend on how much has been invested in the Human Resource for Health.

This is our main niche and we understand this is still a grey area which requires innovative approaches to combat the situation.

We are in advanced discussions with the Government and other partners to jointly pilot innovative strategies on HRH to strengthen both public and private health sector. In this same regard, we shall be more engaged in advancing the Community Health Cadre through pilot testing, documentation and knowledge sharing national and internationally.

Our BMF-government collaboration in scaling up CHW through improved frameworks, structure and systems at the central and local government authorities on their production, recruitment and management is key. So far we have managed to harmonise CHW teaching material and teaching aides to 10 Health Training Institutions that the project is supporting.

As of now, a total of 989 students graduated from these Institutions. Apart from the training aspect, BMF support the orientation of 4 Regional Health Management Teams and 34 Council Health Management Teams all these are from the lake zone.

Apart from setting vital training and management structures, BMF is as well expecting to recruit 273 CHW through the support of Irish Aid and place them at village level.

Through this recruitment, we are expecting to reach not less than 273 villages from Chemba District (Dodoma), Itilima (Simiyu) and Misungwi (Mwanza). These, if put together with a network of civil society organizations, can make great advances in reaching out to the people who need healthcare in rural parts of Tanzania.

This is particularly anticipated as we embark into 3 new projects which require community mobilization in addressing HIV/AIDS, maternal health and reinforcing community health prevention and promotion through Community health workers.

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Monday, April 30, 2018

New prostate cancer test developed

Dar es Salaam. Researchers in Scotland have now come up with a new technique of diagnosing prostate cancer by using ultrasound, raising fresh hopes of getting a more accurate and reliable method of identifying disease in patients, compared to the existing tools. Currently, in Tanzania and elsewhere in the world, prostate cancer is diagnosed using a blood test known as Prostate-Specific Antigen (PSA) or through Digital Rectal Examination (DRE); where a healthcare professional inserts a gloved finger into the rectum to check for abnormalities. In other settings, a Magnetic Resonance Imaging (MRI) scan or biopsy could be done. The researchers, from Dundee University, said each of these diagnostic tools being used currently carried “significant problems.”

The new one, known as Shear Wave Electrography (SWE) is touted by the scientists being more accurate, reliable and targets the prostate with ultrasound. Although it may take years before the new test navigates through the long logistical chains and be accessible to Tanzanians, some 1,200 to 1,300 men are diagnosed with prostate cancer every year in Tanzania, according to Prostate Cancer Africa, a website managed by the US-based Prostate Cancer International.

How new technology was developed. Researchers sampled 200 patients and found out that the new technique—the SWE--was able to detect 89 per cent of prostate cancers and could identify more aggressive cancers and those beginning to spread outside the prostate.

The university’s professor of surgical uro-oncology, Ghulam Nabi, said, “Prostate cancer is one of the most difficult to pinpoint.

“We are still in a position where our diagnosis of prostate cancer is extremely inefficient, leading to unnecessary treatments for many patients.”

He said, in a statement, “We can now see with much greater accuracy what tissue is cancerous, where it is and what level of treatment it needs.”

The news of this breakthrough comes at a time when men in Tanzania are being encouraged to take up early screening for the disease. However, the current modes of diagnosis being used—PSA and DRE have either been out of reach for many people or have proved controversial to some, respectively.

Researchers at the Muhimbili University of Health and Allied Sciences (Muhas), carried out a study in Tanzania, in 2012 and realized that the PSA blood test for prostate cancer could not be afforded by most men.

Titled, “Suitability of rapid PSA test for prostate cancer screening in Tanzania,” the study, published in 2012, said, “PSA…currently used in Tanzania is not widely available because it requires expensive equipment, skilled personnel and the test itself is costly.”

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Monday, April 30, 2018

Keeping safe while on the treadmill

 

Most people don’t expect to start a run at the gym and finish it in the hospital. But treadmill-related injuries sent 24,400 people to the emergency room in 2014, according to the Consumer Product Safety Commission (CPSC). Use the safety features. All treadmills come equipped with a safety key you can clip to your clothing. If you do slip, the key pulls out and immediately stops the belt. Use it rather than leaving it twisted around the handrail or hanging down the side. Make use of the “stop” or “pause” buttons to halt the machine if you need to hop off mid-workout. You’re much more likely to lose your footing when stepping back on a moving belt. And if you step away from the machine while it’s running, another runner may step on without realizing the belt is moving—a recipe for disaster.

Check your clearance. Fitness facilities must allow 48 inches. That’s a good guideline to follow with home treadmills, too. Hard concrete or cement flooring could increase your risk for a major injury if you do fall. Consider rubber matting or thin carpet that cushions the blow without interfering with the calibration or balance of the machine.

Stay controlled. You can run a solid speed workout on a treadmill. After all, that’s the whole premise of Henwood’s studio. But sprinting too hard can increase your risk of injury, he notes. Use the rate of perceived exertion scale, where zero is standing still and 10 is an all-out sprint, and try not to exceed nine out of 10.

Keep children away. Some of the most tragic treadmill injuries occur not among runners, but among kids who play on or near the equipment. If you have a home treadmill, keep in it a room where you can lock the door .

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Monday, April 30, 2018

My testimony: Nurses deserve a good turn

 

By Salome Gregory sgregory@thecitizen.co.tz

I was giving birth to my fourth child but I had never had an enjoyable childbirth experience until that day on 15th August 2016 when I was assisted, while in labour, by a nurse at Muhimbili National Hospital (MNH). This day remains in my fond memories to date.

When it was the right time to give birth, this nurse took me through all the steps, as though she knew me well. May be it’s the routine for all nurses but this really felt exceptional. She encouraged me all the time. She assured me that I would make it. She was right. Indeed I did make it!

Just when I acknowledged that I owed her a token, she simply uttered words of thanks and referred me to her block manager where I had to officially submit my appreciation.

But, since then, she has remained a close friend, even when we meet outside the hospital.

In Tanzania, nurses have earned a bad reputation because of what people say about them in the public domain.

However, this is understandable. There are complaints from clients about the standards of customer care services in several sectors across the country.

The health sector has not been spared. However, it should remain clear that nurses are few, just as the doctors are.

Despite working in difficult conditions, the nurses strive to help women in labour wards as they bring another life on earth.

My personal experience with the nurse who took care of me at MNH, has taught me lessons. Through her care, I got a feeling that I had never experienced for the last 11 years; in all the four times I have gone in labour.

The care I once doubted

There is a moment I doubted the kind of care that I got from another nurse. That was five years ago. I still remember every stage as she struggled with me during labour. Was it negligence? I don’t know.

When I was already in labour, she told me not to push so that she could bring gloves, scissors, but it was already too late as the baby was making its way to the world. With gloves off, the nurse had to rupture the placenta using a scissor.

She then quickly put on her gloves and helped me through. I am glad she succeeded. However, until to date, I still have a feeling that I was mishandled. Professionals can help clarify this for me.

I do believe that if I was well handled, my newborn shouldn’t have fallen sick. This is because, the newly born baby got what doctors later told me was sepsis, meaning there was an infection during the birth process. I had to stay in hospital for more days as my baby was undergoing treatment at MNH.

Encounter with my favourite

I was now giving birth to my fourth child. After I had gone through all the antenatal procedures with my Gynecologist, time came for me to be in the hands of the nurses.

Soon as I entered labour ward, I met a nurse named Mugara, with a smiling face, asking me where my bag was. I told her I had only gone there for antenatal purposes, however, she looked at me and smiled again. It turns out that I was now going to deliver.

While helping me with my hand bag and a clinic card, she directed me on to the bed. We had a chat on the history of my former experiences on how long did it take from one child to another, how they weighed, how was the labour and so on.

She explained to me what to expect with the fourth child. She asked me on what could be the right method for me to monitor my labour. However, it is the question I never experienced before I had to choose a method which covered my belly.

She told me generally during fourth pregnancy women tend to bleed more. And assured me it is normal if it happens and there are injections ready to handle the situation.

When strong labour came, she was by my side, taking note of every step. “Take a deep breath, and take it out slowly,’’ she told me. She also told me it was okay to cry if I felt like doing so. However, she insisted I should remain calm and ask anything I wanted to ask.

I felt very much important person that day. I was in labour, yes. But I felt so much secured even with such huge amount of labour. Thanks to this nurse!

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Monday, April 30, 2018

Let’s end the month with testicular cancer awareness

 

By Dr Chris Peterson sonchrispeter@gmail.com

Today, is April 30th. April is recognised as testicular cancer awareness month. During this period, the World Health Organisation (WHO) commemorates the burden of the disease worldwide and, of course, the initiatives being taken to combat it.

It may seem a little bit late to write about this, since it’s the final day of the month. But I really don’t think so. As we know it is better late than never. Testicular cancer is real. Even as statistics show the disease is very rare in Tanzania compared to other forms of cancer, we still have the reasons to remain vigilant.

However, it’s not guaranteed that we will be cancer free forever, that’s why it’s always recommended to be aware about cancer. Especially for men, when it comes to testicular cancer.

The cancer of the testes a malignancy that involves the growth of abnormal cells in the testes. The growth of these malignant cells occurs very slowly and at times it may be hard for a man to spot any abnormal changes that appear in his testicles.

I therefore urge men to never get fooled; but rather check their ‘nuts’ more often. Doing frequent self-examination at least twice a week may help. And doing testicle self-exam can be easy as a,b,c…… and here is my advice on how men can perform their testicular breast exam:

Hold ach testicle one after another at least for two minutes or more between your thumb and fingers and roll it (with slight pressure) between your fingers. If you find any kind of unfamiliar changes like hard lumps, smooth or rounded bumps changes in size, shape or consistency however don’t panic, see your doctor immediately. Sometimes it might be due to other little medical conditions.

However, it is always wise to be familiar with your testicles. Sometimes it might be confusing to know whether the symptoms a man is going through are due to other medical conditions or testicular cancer.

Therefore, if you see a painless lump in either testicle, a feeling of heaviness in the scrotum, a dull ache in the abdomen or groin, a collection of fluid in the scrotum and sometimes back pain. If you notice these symptoms and especially if they have been persistent, please seek immediate medical attention. They could obviously be testicular cancer symptoms.

What are the causes?

The exact cause of testicular cancer still remains unclear and we are yet to know what leads to the growth of cells in the testicles.

However, there are variety of risk factors that may lead a man to fall into testicular cancer, and some of them are family history, if your family members have had a testicular cancer, then you are at increased risk. Age is also risk factor. Testicular cancer rarely affects young men. Due to biological factors, risks are high as a man gets older.

Prevention

When it comes to how we can prevent testicular cancer, men are always recommended to do self-testicular exam frequently. That’s the only way they can detect the disease at its initial stages and that’s when they can successfully be cured.

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Monday, April 30, 2018

Trials and tribulations of doctors in district hospitals

 

By Syriacus Buguzi sbuguzi@thecitizen.co.tz

Dar es Salaam. The challenges of getting quality health services in Tanzania’s rural areas is well documented, however not many put into consideration the difficulties that doctors go through in such places.

A new study has documented the hurdles faced by medical doctors who are posted to work at district hospitals in Tanzania, further unearthing the need for policy reforms in the distribution and retention of health workers in the country.

From the medics’ lack of house rent, unsupportive working environment to lack of career development, the revelations by researchers come at a time when the government is urging medical doctors and specialists to work in rural parts of the country.

In Tanzania, government data show that about 75 per cent of the people live in rural areas (including districts which were surveyed), however, only 26 per cent of the country’s doctors serve in those areas.

For over nine months, the researchers from Muhimbili University of Health and Allied Sciences (Muhas) and those from Umeå University in Sweden went around three selected districts and carried out interviews with doctors and health authorities.

The study, titled: “Retention of medical doctors at the district level: a qualitative study of experiences from Tanzania,” was published about two weeks ago in the BMC Health Services Research Journal.

In one of the districts surveyed, the researchers spoke to some doctors who narrate the bad experiences that they encounter when referring patients to higher-level heath facilities for emergency care, worse still the patients cannot make it.

One of the doctors, whose interview is documented in the study, says, “You give a referral [letter] to a patient but they cannot afford the transport costs…normally it is required that when you refer a patient you must provide a vehicle and an escort nurse… How can we do that in this case?’’

“...The cost of a flight is very high…it is really discouraging… Most of the time we end up witnessing and certifying the death of patients who we referred before but who failed to go..,” the medic reveals.

The study’s Principal Investigator (PI) and Muhas lecturer, Dr Nathanael Sirili, told Your Health that such working environment has been discouraging doctors from working in district hospitals, with most of them opting to leave for greener pastures.

He says, time has come now for policymakers to address the root cause of the problem, by investing in retaining the medics through providing incentives and improving their working environment at district hospitals.

“For many years, the focus was on producing more and more doctors…we did not address the matter holistically…but later we came to realise that we have large numbers[ of doctors] who are jobless, whereas many district hospitals continue to suffer shortages…” says Dr Sirili.

Dr Sirili believes that the government’s efforts to ensure medical doctors work in the underserved areas of the country would bear fruit if a conducive environment is created for the medical staff.

For many years, doctors at the district hospitals have had to grapple with delayed payment of financial incentives, at times going without for a whole year, according to one of the medics who was interviewed by the researchers.

‘When I reported here I was told I would be provided with a housing allowance of Tshs 80,000 per month… I am staying in a house where the rent is Sh 200,000 per month…but since I came here more than a year ago I have not received that 80,000 even for a single month…. If I get another position where I will be valued, I will leave this place…” narrates the doctor.

Confrontation with political leaders

According to the research findings, some political leaders were reported to be at the frontline in complaining about poor health services in district hospitals yet they are fully aware of the financial challenges faced by the health facilities.

One doctor recalls a scenario, saying, “You tell the relatives [of the patient] that we [at the hospital] currently do not have the medicine [he mentions some] needed for the treatment... We advise them to go and buy it…. While you are sitting waiting for the medicine, they come back with the political leader….”

“You [the doctor] are embarrassed, but in the end, the authorities who set low budgets for you…. I am only here because an opportunity to leave has not yet arisen,’’ says the medic.

Knowledge decay

In one of the districts, doctors said the hospital was underequipped with diagnostic equipment. This, according to the researchers, was discouraging to the medics.

“As a trained doctor, I really need to practise what I was trained for… Here I am utilising a very small portion of my knowledge... Imagine I rely on very basic laboratory investigations and X-ray to come to the conclusion of a complicated diagnosis… The chance of false diagnosis is great… Even when you have the right diagnosis, again, the lack of medicine challenges you… I wish to be in a place where I can utilise at least 50 per cent of my knowledge…”

Efforts by authorities

In an efforts to boost the doctors’ career development, two of the three district hospitals prepared written career development plans. This, according to the researchers, helped the districts to budget for their annual implementation.

In an interview, one of the managers said, “You know, MDs are a very fluid cadre…. If you do not show them their career path, be sure they will leave immediately; knowing this, we have the career development plan in the incentive package plan…. This has helped us to retain most of our doctors”

Some other managers have gone the extra mile to create opportunities for the medical doctors to earn extra income but still be retained at the district hospitals.

Realising that some doctors cannot be retained in district hospitals because of lack of extra income, one of the districts surveyed by the researchers came out with an arrangement to open a private practice within all its hospitals but there were no similar arrangements in other hospitals.

“We are planning to create a window for a fast-track clinic (private practice) at our hospitals. This will generate income for our hospitals, but at the same time raise incentives for our health workers and hence retain them...”

Role of stakeholders

For the past 12 years, the Benjamin W Mkapa Foundation (BMF) has been at the fore front in transforming the health workforce in rural parts of the country.

BMF’s CEO, Dr Ellen Senkoro says this has been a complementary role with the government. But, she believes increased investment in districts as well as other lower level hospitals should be top priority.

“To date, we have contributed in increasing the density of skilled health professionals by deploying 1100 health professionals in rural settings, provision of scholarships at diploma and certificate levels to 881 students; construction of 482 low cost houses located in 268 rural primary health care facilities thus ensuring services are functioning at least 24hrs a day,’’ she says.

What other researchers say

Retention of medical doctors and specialists in districts and regional hospitals across the country is top on the agenda of many researchers in Tanzania and beyond.

Two years ago, researchers from the Ifakara Health Institute (IHI) suggested that a centralised monitoring system for the doctors could help to avoid early departures.

In a study, titled: “Explaining retention of healthcare workers in Tanzania: moving on, coming to ‘look, see and go’, or stay?,” published in the Human Resources for Health Journal, the researchers said the system should match workers’ profiles to the most suitable post for them and track their progress and rewards; training managers and holding them accountable.

Researcher said, in addition, priority should be given to workplace safety, late night staff transport, modernised and secure compound housing, and involving the community in reforming health services culture and practices.

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Monday, April 30, 2018

Are you struggling to beat off that foot odor? Read this…



Dr Syriacus Buguzi

Dr Syriacus Buguzi 

By Syriacus Buguzi sbuguzi@thecitizen.co.tz

Do you normally change your socks or shoes? Be informed that proper foot hygiene saves many things—it could as well save you from the bad smell in your foot.

Your foot harbors bacteria. That you have to know. Usually, the bacteria you harbor in your foot could cause the sweat to breakdown and lead to bad odour. At times it could be due to fungus, reacting with the sweat that is left to accumulate in the foot.

The sweat, normally generated from your sweat glands, is itself not odorous. However, when it’s in excess, the bacteria in the feet begin to break it down, leading to that smell.

So, now you know the culprit. You also now know it that in order to maintain proper foot hygiene, you need to wear dry clean shoes and socks all the time.

But also, you need to be weary if shoes that increase sweating, especially the synthetic closed shoes. This is likely to create a favorable environment for the bacteria and fungi.

Well, there are certain people who are genetically predisposed to sweating that is linked to stress and anxiety. The principle remains the same, keep clean and dry all the time.

Do certain foods cause the bad odour in the feet? One may ask. The answer is yes. If you want to keep the smell at bay, just avoid coffee, sodas or even energy drinks.

Scientifically, these contain caffeine, which may increase sweating and therefore foot odour. That’s where the connection comes in.

But also, certain people who are suffering from a rare condition known as trimethylaminuria, need to watt certain things.

If you are one of them and you happen to eat eggs, meat or fish, just know that these have choline, which is converted in our gut into the fishy compound trimethylamine (TMA). This may cause your feet to smell. However, this happens in rare circumstances. The solution for such people is to stop eating these foods.

What else? The design of shoes and socks you wear is important here. Get ones that have ‘room to breathe’ if you are at risk. But also, washing the feet daily with soap and water and keeping them dry is also important.

•Keep the socks and shoes dry.

•Keeping toenails trimmed

•Soaking the feet in salty water or tea for at least 30 minutes

If all this fails, you must arrange to consult your doctor who may prescribe antibacterial or antifungal powders. There are also certain lotions, creams and anti-perspirants that may be given to you.

Stay healthy, make infirmed health choices!

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Monday, April 23, 2018

The heartbreak of false pregnancy

Kenya

Kenya among the 10 most dangerous countries for a woman to give birth in the world. PHOTO | FILE | NATION MEDIA GROUP 

By Esther Kibakaya

Pregnancy is good news for every woman because it confirms that she is going to be a mother.

However, for women who are struggling with infertility or have suffered a miscarriage, pictures of glowing women with healthy bumps can be a very painful reminder.

The inability to bear a child, or the frustration of trying again and again to conceive to no avail, is one of the most trying experiences that couples sometimes have to deal with.

The sensitivities involved are deeply connected to an individual’s identity and self-esteem.

Understandably, when conception is elusive or unsustainable, those affected wonder about the adequacy of their body.

At such points, unhealthy psychological defence mechanisms sometimes kick in to the extent that a woman develops the symptoms of pregnancy despite not having conceived.

The women experience missed periods, enlarged abdomens, the sensations of foetal movement, and even breast secretions which are reasons to be hopeful again after gloom.

This was the case for Martha*32, who spent several years with her husband trying to get a child but all their efforts proved futile even after trying several forms of medication from proven specialists.

On the other hand she was receiving pressure from family members who could not understand whether she had chosen to be childless out of choice or otherwise.

But after several trials she was finally convinced that she was going to be a mother after she started developing a number of symptoms related to pregnancy.

From missing her monthly periods to morning sickness, with her abdomen expanding and even felt her baby moving in the same manner as any pregnant woman would.

Martha looked and felt pregnant and was convinced that it was only a matter of time before she became a mother. This was not to be, for she was never pregnant in the first place.

Dr Living Colman is a gynaecologist and obstetrician at Muhimbili National Hospital (MNH), he was on charge of Martha’s case when she was referred to Muhimbili where she was operated on.

“She was brought to hospital’s emergency room to receive obstetrics and gynaecology services. After she felt ill for a few days, she began to believe that she needed urgent evaluation in preparation for the delivery of her child,” says Dr Colman.

According to the doctor when the woman was referred to the hospital she came with her antenatal clinic card.

As the case is with most women she had not done an ultra sound to rule out the presence of pregnancy because the health centre she attended didn’t have such a facility.

“They just carried out the normal procedure like measuring the size of the baby, her blood pressure and her weight and since her stomach was growing with the assumption that everything was okay,” explains Dr Colman.

According to Dr Colman false pregnancy is clinically termed as pseudocyesis and it comes from belief rather than reality.

“She starts believing that she is expecting a baby when in actual sense she is not really carrying a child. A woman with pseudocyesis may have a number of symptoms that resemble that of a pregnant woman such as vomiting, missing her monthly period, mood swing with an exception that she will not have an actual foetus in her womb,” he says.

“She must have a strong faith or belief with no reasonable doubt that she is pregnant. When a woman feels an intense desire to get pregnant, her body may produce some pregnancy signs of which her brain at that point misinterprets the signals as pregnancy.

The physician says the intense desire can influence her endocrine system and pituitary glands to secrete pregnancy specific hormones specifically oestrogen and Prolactin that lead to actual pregnancy symptoms.

“What makes the stomach look big is an increase of gas inside the womb of woman who is suffering from this condition that’s why most of them will feel that the baby is moving without knowing that it is the gas causing that feeling,” he says.

He adds: If there are no ultra sound tests done, then the stomach will continue to grow. This is what happened to Martha, she never had a chance to do proper test to rule out if she was really pregnant or not.

The gynaecologist says these symptoms can last for just a few weeks, for nine months, or even years.

Some of the women have even gone to hospital with what feels like labour pains only to be turned away with disappointment.

According to him, the condition is said to be common in women who are in their reproductive age and especially in areas where women are pressurized to have children.

To determine whether a woman has a false pregnancy, it is important to carry out some tests to assess the symptoms.

“With modern means of diagnosing pregnancy, including human chorionic gonadotropin (HCG) testing and ultrasound imaging, when no baby is seen on ultrasound, there is an absent heartbeat then it is easy and fair to rule out the presence of pregnancy.”

He says that once it is determined that the woman is not pregnant, what follows is to tell the woman the truth and provide her with psychological support that will help her recover from her disappointment.

“This is because it can be very damaging both emotionally and psychologically when a woman learns that she is actually not pregnant after believing that she was for a certain period of time,”

But this is not a case that is only limited to women because men too experience a related condition that experts have come to term as sympathetic pregnancy.

This according to Dr Colman happens when a man can has extreme desire of becoming a father or he may have sympathy towards his pregnant wife to the point that he may develop many of the same symptoms.

“They develop symptoms such as weight gain and nausea, however this may end soon after his wife,” says Dr Colman

According to Psychology Today, once the woman concerned is confronted with irrefutable evidence, it is usually very difficult for her to digest the news that she is not, in fact, pregnant.

Upon accepting reality, she will abruptly lose the hopeful narrative that was protecting her.

“The situation can be extremely complex; however, when she does finally accept the truth, support is critical. In more extreme cases, unexamined and unresolved issues may result in a future re-awakening of the fantasy that she is again pregnant,” says Monica Starkman who writes for Psychology Today.

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Monday, April 23, 2018

Don’t feel shy, keep asking your Doc these questions (2)



Dr Syriacus Buguzi

Dr Syriacus Buguzi 

By Dr Syriacus Buguzi

This week, I am still on the topic that you and I started off from the previous edition—asking questions. I love this topic, why?

Last Monday, when a piece was published here on the same subject, Dan from Masaki, Dar es Salaam wrote to me, recalling the day he walked into a doctor’s office and felt as though he was on a hot seat.

“I have always assumed it’s the doctor who has to ask me questions and it’s my job to answer them. Thanks for opening up my mind. I didn’t know I had the role to play at this point,’’ he wrote.

Indeed, as we go along seeking healthcare, it’s our health that matters. Your Health is your life. So, when you ask key questions, it’s for your advantage.

Apart from last week’s questions, here is another you could still ask the Doc: “Where would you send your wife or children if they got sick?”

You see, medical doctors are supposed to treat everyone equally, but it’s clear that some people receive better treatment than others.

One thing to note is that doctors who work within a particular system routinely refer patients to specialists within that health-care system.

But, the best doctor or rather surgeon could be somewhere on the other side of town—in another facility. You can bet, that’s where your doctor would send his family for treatment. So, always endeavor to ask.

Yet, it’s not also bad to try and find out about your doctor’s experience. For instance, you can ask him/her: How many surgeries do you perform each per year?”

You could get interesting answers from your doc, and that would teach you many things. There are doctors who may have treated your condition or carried out a procedure 200 times. I mean that same procedure you might have undergone. How does it feel if you get to hear this? You tell me.

Please, don’t feel offended if the doctor turns to you, trying to ask what has been going on in your life.

Visiting the doctor at the hospital/ clinic is not supposed to be a simple discussion about symptoms. Your doctor should know some details about your life. So, he will ask what it’s like: where you live, what you do, if you’re single, how you spend your time, if you smoke or drink, if there were any major, recent changes in your life or lifestyle.

How does that feel, if he/she asks you that? Much as it may feel uncomfortable to reveal at some point, it is still important because it will also provide your doctor with a fuller picture of who you are, so he or she knows what to ask in the future and how to treat you effectively.

Always strive to be healthy by making informed choices!

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Monday, April 23, 2018

What it takes to improve rural health



A rural Medical Clinic in Tanzania

A rural Medical Clinic in Tanzania 

By Dr Ellen M Senkoro

Dealing with rural people, most of who are in the informal sector, without guarantee to medical insurance is a challenging experience that requires commitment.

This has been our experience at Benjamin W. Mkapa Foundation(BMF)for the past 12 years that have seen us work to improve the health of rural people in Tanzania.

Now as the coountry is spearheading the national agenda on Universal Health Coverage, (UHC), it is important to ensure every Tanzanian has access to health insurance.

In reference to the recent 2015/16 Tanzania Demographic Health Survey, it has been reported that 1 out of 10 Tanzanians are covered with health insurance.

Data from the National Health Insurance Fund (NHIF) show that only about 33 per cent of Tanzanians have health insurance which is either in the formal or informal model.

That is (7 percent on NHIF, 25 on CHF and 1 percent other health insurance).

The national target is to reach 50 per cent of Tanzanians with health insurance by 2020.

But there is disaggregation between the urban and rural. Majority of the people having health insurance are in urban settings since they have wider access, financially, to the public and private health insurance.

It is further presumed that more affluent and middle class are the ones with better access and can afford health insurance. Informal sector in rural settings are challenged given the high poverty levels.

Nevertheless, the government has set an affordable health insurance scheme for the rural settings, namely Community Health Fund(CHF) where each household is able to contribute annually an amount ranging from Sh10,000 to Sh30,000/- in the CHF and a co-matching fund is availed by the government.

The annual premium paid will serve the head of the household and 4-6 family members. Best practices exist in some parts of the country which needs to be emulated.

The challenge we see here is the lack of awarness among the rural people on the benefits for CHF as well as practical solutions on how they can obtain the finances to contribute to the CHF.

Furthermore, how we balance demand and supply is another existing challenge which needs to be addressed by all players in this sector.

One will be more motivated to have CHF if he/she is assured of quality health care at the facility end that is, being attended by a skilled health worker, ensuring availability of diagnostic tests and medication when being attended at the public health facility.

To facilitate the poor segment of the population in rural setting access health care, the government has also set an exemption system which caters for vulnerable population such as pregnant women, children under five, people living with HIV/AIDS and tuberculosis, the elderly and so on.

Likewise, those not having health insurance, will be obliged to share the cost share (out of pocket fees) to receive health care which is further challenging to the poor population.

Now that the country is striving to bridge the gaps in healthcare provision through promoting UHC, stakeholders, including Benjamin Mkapa Foundation (BMF) which I lead, have a role to play.

On our part, we believe Tanzania needs to embark comprehensively into UHC. This is the plan that we are part and parcel of, in an effort to attain the goals.

There is need to balance the investment to be made on supply and demand.

Whilst we mobilize the communities to be covered with health insurance, we need to ensure our supply-end are client oriented and well equipped with basic resources such as qualified health staff, functioning diagnostic services with reliable quality results, availability of medications, suitable infrastructures and effective referral systems.

Likewise, on mobilization of community, we have been working with the Local Government Authorities (LGAs) and related structures as well as CSOs. However, we feel the role of Civil Society Organisations(CSOS) in the UHC plan has not been fully optimised. CSOs could be an effective medium to reach community.

There is a pressing need to build a strong network of CSOs countrywide who will mobilise communities. This way, we will help the rural people attain better health via UHC.

Dr Senkoro is CEO of Benjamin W. Mkapa Foundation, Medical Doctor & Public Health Specialist.

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Monday, April 23, 2018

Why early vaccination matters for all children

A young girl gets an HPV jab in Dar es Salaam

A young girl gets an HPV jab in Dar es Salaam recently PHOTO | THE CITIZEN 

Entering a pediatric ward at a local hospital a few weeks ago, one couldn’t help but notice this young child, around two or years old who was covered in red rashes all over her body. She was crying inconsolably and seemed to be in pain. She had fever, on examination and was quite irritable.

The first impression of her condition was that she had measles, which was later confirmed by the mother and the hospital staff. It was surprising to see a child who was suffering from measles; considering the fact that measles is an immunizable disease and most children are given the vaccine at around 9 months and 18 months of life. On questioning the mother, she admitted that she couldn’t manage to take the child to the clinic for her measles shot leading to the child developing the condition.

This incident just goes to show how important vaccinating your child against common conditions can be and how there are many preventable conditions that sadly, can be fatal if not immunised against. Luckily, measles is a self-limiting condition and would only need supportive care before it eventually resolves in 2-3 weeks. It would be extremely saddening if the child missed other important vaccinations.

A vaccine is basically a biological substance designed to produce specific protection against a given disease. Different vaccines have different levels of effectiveness. Some are absolutely protective meaning they offer 100 per cent protection against the disease for example yellow fever vaccine.

Others are highly protective and offer 80-95 per cent protection as in the cases of measles, mumps and tetanus toxoids. And the final class is moderately protective which offer 40-60 per cent protection as in the cases of cholera and influenza vaccines.

A report from the Tanzania Demographic and Health Survey (TDHS) shows that around 75 per cent of children aged 12-23 months received all basic vaccinations including ones for tuberculosis, measles, diphtheria, pertussis and polio. Sadly, the same report mentions that around two per cent of children in the same age range received no vaccines at all, making them very vulnerable to these common and potentially deadly disorders. It also shows that basic vaccination coverage is around 65 per cent among children from poor households compared to 83 per cent among children from wealthier households.

So what exactly are the diseases you need to get your child vaccinated against?

Well, in Tanzania, the Tuberculosis and Oral Polio Vaccines are given immediately after birth. This is followed by the first doses of vaccinations for Polio, Diptheria, Pertussis, Tetanus, Hepatitis B, Influenza, Rotavirus (causes diarrhea) and pneumonia vaccines at 6 weeks of age. The second doses for the same conditions are given at 10 weeks of age followed by the third does at 14 weeks after birth. This is followed by Mumps and Rubella vaccines at 9 months for the first shot and 18 months for the second shot. Though it is not a vaccine, Vitamin A is given in 3 doses at 9, 15 & 21 months of age since it helps to support rapid growth and to combat infections.

Vaccinating your child will be extremely beneficial to both, the child and to you as a parent.

We end with the slogan of the 8th African Vaccination Week – ‘Vaccines work, Do your part!’

This article has been prepared by Ali Khatau, Rahma Baabde, Honest Munishi & Irene Shedura, all medical students of Hubert Kairuki Memorial University.

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Monday, April 23, 2018

Allow your daughters to get the HPV vaccine

Vice President, Samia Suluhu Hassan looks on as

Vice President, Samia Suluhu Hassan looks on as a vaccine is administered on 14 -year-old Hadija Bakari a resident of Kigamboni at Mbagala Zakhem grounds in Dar es Salaam two weeks ago.PHOTO | VICE PRESIDENT”S OFFICE 

By Dr Chris Peterson

For a quite some time now, I have looked at cancer fighting strategies in Tanzania and realized that we still have a huge mountain to climb.

Yet, at times I wonder if the various approaches we have been using so far will enable us to turn victorious in this war against various forms of cancer.

For this reason, it was encouraging to learn recently that Tanzania has for the first time achieved a historical milestone to roll out a Human Papilloma Virus (HPV) vaccine, the type of cancer that occurs and initially grows in the cells of the cervix, the second most common cancer among women globally.

As a medic, I strongly applaud this initiative because more than half a million women around the world are diagnosed with cervical cancer annually.

Over half of them die of the disease. Most of these cases and deaths occur in low- and middle-income countries.

According to the World Health Organisation (WHO), globally, the East African region is the leading burden carrier of cervical cancer and the recent report from WHO even suggest that Tanzania is among the five countries with the highest rates in Africa.

January was cervical cancer awareness month and I wrote about cervical cancer in several publications! But just to remind you, this type of cancer has multiple risk factors such as early sexual activity, multiple sexual partners, multi parity, Sexually Transmitted diseases including HIV and other STIs, like Chlamydia, gonorrhea, or syphilis; tobacco use, vitamin deficiency and HPV infection.

A safe and effective HPV vaccine launched recently when provided to young girls between 9 and 14 years old protects against HPV and therefore cervical cancer.

However, there are few misconceptions that have arisen recently that the vaccine carry health risk or side effects and this has drawn fear among the people that has led to concern that their children might suffer from certain complications from this vaccine.

I want to assure people that there are neither any serious side effects from this type of vaccine nor any permanent health risk; people should therefore send these fears to the garbage bin.

Overall, the effects are usually mild. The most common side effects of HPV vaccines include soreness, swelling or redness at the injection site that heal on its own shortly after vaccination.

Sometimes little dizziness after the injection. Remaining seated for several minutes after the injection can reduce the risk of dizziness.

In addition, headache, nausea, vomiting, fatigue or weakness also may occur. And the health care providers that will be working in this program have gone through relevant trainings to make sure that the safety of these girls during vaccination is guaranteed.

This program intends to reach millions of young girls with the age of below 14 in the country. We have noticed that the group of this age, is by far eligible for this type of vaccination because it is ideal for girls to receive the vaccine before they become sexually active which might expose them to HPV because once someone is infected with the virus, the vaccine might not be effective.

I brand this initiative as the ‘life redeemer’ since it will help to save our future mothers, sisters and wives from cervical cancer deaths.

So it is only down to parents and guardians to pay positive response on this initiative by making sure that their daughters get vaccinated.

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Monday, April 23, 2018

Blended flour: What is the truth behind the myth

It is every parent's desire to see their

It is every parent's desire to see their children live a healthy life.PHOTO|FILE 

By Proscovier Zacchaues

A healthy baby is every parent’s desire. Parental efforts are focused to ensure their kids survive, thrive and excel in all aspects.

However, parents are subjected to all kinds of contradictory advice when it comes to child nutrition.

It is well known that the first year of life is a prime time for growth and changes throughout the body. Babies should be exclusively breast-fed for their first six months of life without giving anything else (water, fruit juice, porridge, other milk, other beverages or food).

Breast milk is the optimal nutrient mix for infants, loaded with good stuff like antibodies, antimicrobial factors, enzymes, and anti-inflammatory factors along with fatty acids which promote optimal brain development.

What happens after six months? Introduction of solid foods apart from breast milk as breast milk alone cannot meet their nutrient requirements.

This is a perfect timing as most of the babies have doubled their birth weight, can hold their heads up, sit in a high chair, open their mouths when food is presented, and swallow.

It should be noted that additional foods do not replace breast milk rather complement, no wonder they’re referred to as complementary foods.

Complementary foods should be soft, liquid like so the baby can easily use. Complementary foods should be nutritious enough to support child’s physical and mental growth.

Blended flour commonly referred to as ‘unga wa lishe’ is a flour containing cereals, grains, vegetables and sometimes whole foods like sardines that is used to make porridge for babies as a complementary food.

The preparation of various combinations to obtain such flour has been carried out without understanding of the correct purpose and balance of the components.

Improper combination and balancing of the components is what causes stomach upsets, constipation and food dislike among babies.

Let’s take an example of ‘unga wa lishe’ with a following combination: maize, millet, rice, sardines, groundnuts and soya beans. Sounds nutritious ha? Wait a minute! Have you imagined being given a plate containing ugali, rice, beans, sardines, millet and groundnuts? Am not in position to say how delicious or disgusting it may taste, I’ll leave it for you to try.

By the way, have you considered cooking time for ugali versus beans? Let’s go back to our porridge which the house help will cook for ten minutes, fill the thermos up as she’ll be rushing to attend other household chores and your precious seven months old will be fed until you come back from work to nurse him.

As said earlier, most food processors do not have sufficient expertise in the nutrient requirement for different groups and so they do not take into account nutritional needs and safety requirements which threaten consumers’ health.

You’ll be asking yourself, what do I do now, and how do I do it? 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.

Foods containing carbohydrates provide the body with energy and strength to perform various functions; all cereals, roots and tubers fall under this group – maize, millet, rice, potatoes, bananas, cassava etc.

Protein containing foods are essential for body building and growth especially for children; all types of meat, dairy and dairy products, poultry, fish, senene, kumbikumbi and legumes such as peas, beans, soybeans, chickpeas, cowpeas and stumbles.

Fat foods provide the body with heat, warmth and softens skin. It also facilitates absorption of vitamins A, D, E and K and improves taste in food, however, they should be taken in small amount. For example butter, sunflower oil, coconut and coconut oil, cotton seed oil, palm oil, cashews and all types of nuts and honey. Vitamins and minerals provide protection against diseases, they are found in almost all fruits and vegetables. Needed in trace amounts but their limitation may cause permanent and irreversible disability. Ever heard of Spinal bifida and hydrocephalus? It’s not witchcraft, lack of certain vitamins and minerals, but we will discuss this in detail some other time.

Proscovier Zacchause is a nutrition specialist.Reach her on proscovier@outlook.com

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Monday, April 16, 2018

Do you ever ask your Doc these questions? Please do!



Syriacus Buguzi

Syriacus Buguzi 

By Dr Syriacus Buguzi

You are at the hospital. A doctor examines you and prescribes medications after you present several complaints about your illness.

Do you ever ask questions about whatever he might have prescribed for you?

Well, doctors usually have good intentions when treating you, however, one fact you can’t dispute is that we are human beings just like the rest.

At times we may not communicate well enough to satisfy your curiosity.

It happens that a doctor and a patient may see different things in a different order of importance.

Doctors are usually committed to solve your problem but that doesn’t mean they will always recognize the greatest need that you have.

That’s why, as a patient, it’s important to take an active role when a doctor is attending you. So, always ask questions.

Such as, hey Doc! Are there different treatment options apart from the one you are giving me? This is so helpful. It helps more if you go the extra mile to reveal to your doctor about your alternatives. He could intervene better at this point.

But, you could also ask: Doc, what should I expect from this kind of treatment? For example, don’t just assume that life will turn to normal after surgery or other treatment, and may be you don’t know that the doctor has a better answer to that.

Yet, doctors almost always have too much on their table to deal with and too little time.

So, it’s important to ask: ‘Do we have to do this now, or can we revisit it later? Is this necessary to do that now?’ This could help your doctor to make a timely decision.

Don’t forget also, that there is always a possibility that medications could hurt a patient.

So, it’s important to ask: “What are the side effects?” Whether the side effects are in form of headaches or skin rashes or mouth blisters, those sorts of side effects are common—and are things patients should understand well.

Ask whether there is anything you can do on your own to improve the condition. This may include lifestyle choices. This plays a big role in your recovery process.

And, this is key: “How much will this cost me, Doc?” In Tanzania, like in the rest of the world, modern medicine is expensive. Sadly, most doctors don’t know the cost of medications they prescribe. Many doctors could help you know it only if the patient pushes them to find that out. If the doctor doesn’t know, he/she could refer you to the administrator.

Don’t forget to ask the Doc, “Should I get a second opinion?” It’s always prudent to seek second opinion because the doctor’s insights because his/her insights into your symptoms and their causes may be very different from another doctor’s, depending on a doctor’s area of expertise.

You need to ask this and much more. Let’s talk more next week. Cheers

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