There is a common misbelief that being circumcised is a sin since circumcision would change God’s creation—but numerous studies have demonstrated that male circumcision (MC) has a number of health benefits.
Joseph Anthony, from Mgaza village in Morogoro narrates to Your Health how he got motivated to be circumcised after living with the foreskin for 21 years.
Just like many other circumcised men, Joseph recalls that peer-influence triggered his decision to get circumcised.
He further recalls that it was back in July 20 this year when he first heard about the AIDS Free Tanzania-Voluntary Medical Male Circumcision (VMMC) programme offering the male circumcision services at no cost to clients, implemented by Jhpiego.
“There’s a friend of mine (Samadu Abdul) who advised me to go for circumcision. I did not talk to my parents about my decision. I did it alone by going to the mobile clinic and afterwards I returned home,” says Joseph.
Male circumcision is the surgical removal of the foreskin, the tissue covering the head (glans) of the penis. The procedure becomes more complicated and riskier in older babies, children, and men, according to medical sources.
Joseph who lives with his parents and his young brothers, belongs to a group of young men at the village who have found a way to put food on their families’ tables: making mud bricks.
He makes about Sh240,000 from the bricks, he says, depending on how good business is, and for the rest the family, they depend on agriculture.
Why the low turnout?
In many Tanzanian communities, older men (over 25 years of age) have not come forward for VMMC services. Reasons for low demand among this group of men may vary across geographic, cultural contexts and influence of circumcision related stigma.
Such barriers to MC uptake include: a long distance to the health facility, a decrease in male and female sexual satisfaction and peer influence against MC.
But for Joseph, a long distance to the health facility was not a factor that prompted him to delay for 21 years to undergo circumcision, but the economic hardship.
According to Dr Kanisiusy Ngonyani, a registered medical doctor working with Jhpiego, the circumcision cost in the public and private hospitals in the region varies between Sh20,000 and Sh100,000.
“I missed on undergoing circumcision at a younger age because my parents did not have the money to afford the hospital costs,” Joseph tells Your Health in an interview during a recent visit at the village.
But through the VMMC programme, Joseph who is the ninth child in a family that consists of 9 children (eight boys and two girls) has been circumcised, becoming the fifth male child in the family to be circumcised--the remaining two male children are set to be circumcised in the near future, according to Joseph’s father Anthony Abili, 55.
“Prior to the circumcision, I was not comfortable to take bath in the presence of my colleagues in the river because they used to say that uncircumcised men are dirtier. But I am no longer stigmatised,” says Joseph.
Jhpiego launched the AIDSFree Tanzania VMMC program in October 2015, in collaboration with the National AIDS Control Program (NACP), funded by USAID aimed to provide male circumcision services of which under the program the organisation has provided over 800,000 VMMCs in over 500 health facilities across the five regions: Iringa, Njombe, Tabora, Morogoro and Singida at no cost to clients.
In tandem with the program objectives, Jhpiego on July 23 launched a mobile health clinic (MHC) in a truck aimed to rapidly expand the provision of high-quality, client-centered circumcision services as a core component of comprehensive HIV prevention in Morogoro region.
The clinic serves to offer other health-related services including Tuberculosis (TB) treatment, sexually transmitted diseases (STDs) and HIV/AIDS counseling and testing and family planning education.
“The plan is to circumcise 80 per cent of men aged above 10 years old in the selected five regions,” says Dr Ngonyani.
Mgaza village where Joseph is currently living is one of the villages targeted by the VMMC programme in Morogoro region because the rates of HIV and STDs transmission are slightly high.
According to the 2016-2017 Tanzania HIV Impact Survey (THIS), HIV prevalence among adults 15 years and older in Morogoro is 4.2 per cent.
Is circumcision necessary?
The use of circumcision for medical or health reasons is an issue that continues to be debated. The medical sources indicate that the health benefits of newborn male circumcision outweigh the risks, but the benefits are not great enough to recommend universal newborn circumcision.
The procedure may be recommended in older boys and men to treat phimosis (the inability to retract the foreskin) or to treat an infection of the penis.
The right age
Circumcision occurs at a wide range of ages, and neonatal and child male circumcision is routinely practised in many countries for religious and cultural reasons.
According to a report titled ‘Neonatal and child male circumcision: a global review’ by World Health Organisation, there are several advantages of circumcising males at a younger versus older age, including a lower risk of complications, faster healing and a lower cost. However, some parents may wish to wait for an older age for religious or cultural reasons, or have a preference to wait until the child can give consent for the procedure.
“Although male circumcision is frequently performed in children, there is no consensus about the age at which it should be performed,” says Dr Ngonyani.
He adds, “If you were not circumcised as a baby boy, you may choose to have it done later for personal or medical reasons.” Moreover, the medical sources suggest that the necessity of circumcision varies depending on religious beliefs and social structures in society.
Numerous studies have demonstrated that male circumcision (MC) reduces the risk of urinary tract infections, also reduces risk of some sexually transmitted diseases in men, to mention but a few.
Dr Ngonyani further reveals that the primary reasons why men choose to undergo circumcision is for protection against HIV and STDs, improved hygiene, decreased risk of penile cancer and improved sexual satisfaction with their sex partner.
“The primary reasons prompting men to choose not to be circumcised are pain during and after the procedure, long healing period, culture or religion, and time away from work,” says Dr Ngonyani.
Speaking to Your Health, Dr Zainab Chaula, the Permanent Secretary in the Ministry of Health, Community Development, Gender, Elderly and Children said, “The Government recommends male circumcision for HIV prevention. This remains an important recommendation in scaling-up MC services throughout Tanzania.”
Medical vs traditional snipping method
Medical sources indicate that male circumcision performed in a medical facility protects against HIV. There are several other important differences between traditional circumcision procedures and clinical procedures. These include differences in equipment used and counselling provided to the men before and after surgery.
Another difference is how much of the foreskin is removed. Some traditional circumcision involves only a partial removal of the foreskin, while the medical procedure removes sufficient foreskin that the glans remains fully exposed even on a non-erect penis. The sources further explain that it is not known exactly how much foreskin should be removed to reduce the risk of HIV infection in men, but complete removal seems to be the norm.
The practice of partial removal of the skin may help explain why some cultures that practise traditional circumcision still have high rates of HIV prevalence.
One of my 50-year-old patient with history of obstructive lung diseases, a respiratory disease that makes breathing difficult by narrowing airways, decided to take matter in his own hands. The consequence wasn’t too fruitful. In fact, made his condition from better to worse.
This man had a positive history of smoking for almost 20 years before he quit recently. Since his diagnosis, he was doing well with regular medication and other factors. And we have always had productive doctor-to-patient communication during his regular check-ups.
One fine day, he asks, “Can I take other medication?”
“It depends. What kind?” I ask.
“I would like to try vitamin and herbal supplements that someone suggested. Especially at this very stage when I recently quit smoking, they are believed to be effective for that,” he says
I was clear to him that it wasn’t a wise thing to do, “Unfortunately, the protocol does not allow you to take alternative or integrative therapies. We do not know about the safety of other medication, especially with a drug that is still being tested.”
When things went wrong
I presumed I had resolved his query but one day he calls in the middle of the night complaining of profound shortness of breath, coughing up blood, night sweats and increased weight loss. I was alarmed and called him to come to the hospital for tests where a chest x-ray showed diffuse interstitial infiltrates consistent with pneumonitis. I tried to run further investigations, which came to a conclusion that he had tuberculosis too.
Surprisingly, this was not known toxicity, not even among “rare” side effects. I asked him if anything had been different in the past month; had he started taking any medication?
He responds, “I did start taking those herbal supplements last month.”
“What kind of supplements?” I ask.
He named 15 supplements, many of which I had never heard of. I was furious not just because he took those supplements despite being warned but also because he did so without even trying to figure out what could be the side effects.
“It’s possible that the interaction between your drugs and supplements [not prescribed] has compromised your immune system, eventually causing all this to happen” I inform.
With regrets, he says, “I never imagined that my supplements could cause a problem. They’re natural, and I didn’t need a prescription for them. Their marketing campaign showed real people with real improvements and I was sold by that.”
I asked him to stop taking those supplements and arranged weekly consultations with him to improve his condition.
‘Herbal’, ‘all natural’ - these are labels that make most of us feel like whatever product they are associated with can do us no harm.
Unfortunately, that is not always the case, and some pure natural supplements can be potent enough to cause serious harm or even death.
Many people shun prescription drugs in favour of remedies that are more aligned with nature, and while many of those natural remedies are effective, and may be less dangerous than pharmaceuticals, we cannot afford to assume that all of them are harmless, and can be used without any restrictions.
Be aware of supplements. They can be hazardous to your health, and always check with a doctor or other qualified medical practitioner before you use any medication, whether it is natural or not.
My dear reader, I bet you have never thought that hepatitis is real and serious until you find out that at least 40 per cent of our general population is at a higher risk to acquire the disease.
It was on July 28 last month, on World Hepatitis Day, when I came across one of the studies that was done by International Association for Medical Assistance to Travelers (IAMAT).
Their study on ‘Hepatitis Prevalence’ came to a conclusion that in Sub-Saharan region particularly around East Africa, at least four out of ten people are believed to be infected with hepatitis at some point in their lives.
Ignorance, poor awareness and inadequate access to medical care remained the leading factor.
These statistics are worrisome! Aren’t they?
What is hepatitis?
Liver is one of the delicate organs in our body, which some of its major functions are detoxifying the blood, storing vitamins and producing hormones.
In some occasions, liver can be invaded by different medical conditions leading to its dysfunction and even death. And one of the major medical conditions which can attack the liver is hepatitis.
Hepatitis is the condition that causes the inflammation of the liver cells and damage it. Hepatitis is majorly and commonly caused by viral infection.
Though in some rare chances it can be caused by some other factors for instance autoimmune disorders, a condition where by your antibodies attacks your own liver tissue. But this is very rare so let’s talk about viral hepatitis.
As I said, hepatitis is commonly caused by a viral infection. These viruses are medically known as hepatitis viruses.
These viruses are classified in A, B, C, D and E categories. But in Tanzania, the most common type of viruses is hepatitis B followed by hepatitis C.
Causes and symptoms
Like any other viral diseases, there are plenty of risk factors and causes leading to one being infected with the hepatitis virus.
Hepatitis can be contracted through body contact with an infected person, and this body contact can involve blood or any body fluids.
In other words, one can get hepatitis infection through having unprotected sexual intercourse with infected person, sharing personal items such as a toothbrush or razor with an infected person, being bitten by someone who is infected, sharing a needle with an infected person, often for illegal drug or steroid use, or even infected mother can pass the virus on to her infant when breastfeeding.
Infact, the risk factors for hepatitis are quite similar to those of HIV/AIDS.
In many cases, hepatitis infection is asymptomatic. It sometimes takes 30 days or even months for symptoms to show up after infection.
You should therefore, pay attention to its symptoms that includes fatigue, malaise, nausea, abdominal pain, dark urine and jaundice. All these symptoms are on and off and can last for even up to a month or two.
It is preventable
The bad news is, unless treated in its initial stages, in severe cases hepatitis kills. But the good news is, hepatitis is preventable. And this prevention comes through vaccination.
The only thing you need to do is to firstly get screened, if your results will turn out positive, then it’s a good thing, it’s diagnosed in its earliest stages that it will be easy for you to pull through treatment and get healed.
And if your results appear negative, you will start routine vaccination for full prevention as you will be directed by your health care provider. Being fully vaccinated means you will never get hepatitis infection ever in your life.
Everyone is reminded to abstain from its risk factors, mostly unprotected sexual activities. Let’s control what we can, and lastly; hepatitis vaccination services are available at almost any of your walk-in hospital. So, be kind to your liver and get vaccinated today.
As the world marks breastfeeding week to celebrate each woman’s breastfeeding journey, many women out there are still struggling to juggle it with work and other responsibilities. Various studies have provided insight for the nutritional and health benefits of breastfeeding and its impact on lowering rates of childhood diseases and deaths. Globally, only 2 out of 5 women are able to begin breastfeeding within an hour of birth and practice exclusive breastfeeding up to six months. And in Tanzania, The United Nations Children’s Fund (Unicef) reported in May last year that 700,000 children are not breastfed every year, as women fear their breasts will sag. It went further to point out that in 2014, 85,000 child deaths were linked to lack of breastfeeding related complications.
Inadequate breastfeeding therefore leads to unfavourable impact on neonatal, infant and young child health and development according to the World Breastfeeding Trends initiative. The World Health Organisation (WHO) has also outlined how breastfeeding provides major benefits to women health and is valuable to national productivity and economy. Due to information gap on breastfeeding benefits, there are women out there who have been body shamed because of their postpartum weight therefore they abandon breastfeeding and embark on slimming diet and products putting their babies’ health at risk. I simply ignore when someone tries to either body shame me or tell me to stop breastfeeding and embark on a slimming journey. And for these reasons, I have decided to share my breastfeeding experience to inspire other women on their journey
Related story: Just give them breast milk Many years ago, I would never have imagined that I would be able to breastfeed in public. But here I am, exclusively breastfeeding and pumping breast milk for the baby’s use when I am at work. I remember four years ago when I had my first baby, through caesarian section (CS). He made his way to the world at 35 weeks so I was advised that exclusive breastfeeding was the best for the baby to grow healthy. I managed to exclusively breastfeed for six months as per the WHO recommendation though it was not easy. Here I was, with fresh CS wound and nothing had prepared me for this, let alone breastfeeding. The following morning during ward rounds, Dr Kaguta Munawar, a senior gynaecologist and obstetrician at Aga Khan Hospital (AKH) comes with his team and finds me struggling to force the baby’s mouth to my breast. He then instructed the nurses to teach me how to breastfeed, which they did for the better part of the day. By the time I was leaving the hospital, I was trying my best. As a new mother, I had challenges with positioning the baby, had issues with getting him to latch on as sometimes I would wake up with engorged breasts, which are rock hard. At times he would breastfeed well and for long but another time, he would just snack on the breast milk and leave it. It was also a learning experience as I noticed that babies are born with a suckling reflex because the moment they latch on well, they just suckle. And nothing is more fulfilling than your little baby looking into your eyes for assurance that you will give them the best – it creates a lasting bond between the mother and the baby.
Supporting breastfeeding makes a great difference by keeping mothers on track especially when they leave the hospital and go home and when they resume work. I got support from my spouse who would make me soups and porridge besides refilling my water bottle to ensure I am not hungry and remain hydrated.
I would also wake up in the wee hours of the night to pump after Dr Mariam Noorani, a paediatrician and lactation expert at AKH introduced me to the world of pumping and storing breast milk to ensure the baby has enough supply when I resume work after 84 days of maternity leave.
She was always on the standby answering questions anytime of the day and night about breastfeeding challenges including reflux and colic. She indeed walked with me through the journey until the baby’s digestive system matured. She also educated me on supply and demand of breastmilk. I also got massive support from Breastfeeding Support and Help for Kenyan mums – a Facebook group where you ask any question when you are stuck and you get responses and messages of encouragement. They kept me going as you are in a group with mums either experiencing the same challenges or have faced them and are ready to share success tips with you on how to tackle the problem.
With constant pumping, I had enough stock but one day someone accidentally switched off the power connection to the milk freezer and the stock got spoilt. I had to start pumping again all night long just a day before resuming work. So I would restock everyday while I was working. It was tough journey but I kept my eyes on the prize – benefits of exclusive breastfeeding to ensure the baby is healthy.
There was also a day I got a call from the nanny that the stock had run dry so I had to pump at work and send milk home. At work, there was no space to pump so would squat under my desk or use a hidden corner in the library where I would cover myself and pump. A tip I would give to any mum to overcome this challenge is to either express or pump and do a few trials giving it to the baby through the bottle during maternity leave so that the baby gets used to this feeding method as well as to reduce many episodes of crying when one resumes work. It is noteworthy to mention that one should have enough feeding bottles to take the baby throughout the time one is at work. And ensure that you emphasise the issue of hygiene to the person taking care of the baby so that they constantly wash their hands and ensure all is clean before each feed. In as much as you may have a trusted nanny, it always make a difference when you wash and sterilise the bottles and the pump by yourself.
With my second baby in April this year, I was all set to breastfeed and had told the nurse just before my CS procedure that my baby should not be given formula. I requested that the baby be put on my chest so that he breastfeeds in the first hour of birth but this was not to be the case as anesthesia had not worn off completely besides the baby had been taken to the nursery for monitoring as he was big. So I had to wait until the following day to be able to breastfeed.
But the doctor later on explained to me why observation in the first 24 hours is important for the baby.
The following day at night, I made my way to the nursery and breastfed. This time round, I was better off as I had learnt from my first-born and this time round AKH prepared us so well for breastfeeding as they used videos to educate us during antenatal sessions and the nurses emphasised on it as well. I also discussed with Dr Kaguta during my clinic visits and he provided a lot pre-natal education on breastfeeding.
The transition to work from maternity leave is a very difficult phase as most babies reject the bottle when you give them, however, they later get used to it. I still pump milk at work though this time I approached the management and requested for a safe room to breastfeed, they also read my articles on breastfeeding and I was given a pantry to use for pumping milk during lunch break which I think is an achievement towards making exclusive breastfeeding for working mothers possible. I would pump milk, store it in a cooler bag at work then take it home later on. I have medela double electric pump for use at home since it needs a power source to plug it in and alternate between an Avent or Tommee Tippee hand pumps for use while at work.
Then comes another challenge in the name of erratic power supply for those of us this sides of the Sahara. For instance, there was a day power was cut for 72 hours in our area so some milk got spoilt while I managed to save a few which I took to a friend who had a standby generator at least 22 kilometers away (Goba to Mikocheni) for safe storage until the power in our area was restored. So this journey of exclusive breastfeeding is not a walk in the park. Another major challenge, which I think many working mothers also experience, is that the workload remains the same even while you exclusively breastfeed. For instance, I mostly work until 3.30pm before leaving to go and breastfeed as the supply I leave in the morning usually runs dry by this time. By the time I reach home, it is already 5.00pm. Some of my colleagues are very supportive though to some male colleagues, it doesn’t make sense why I have to leave to go and either pump or breastfeed. They wonder why I don’t give the baby cow milk.
For instance, in one meeting, I requested to be excused to go and pump and avoid leakage. The men (they are the majority at the meeting) burst into fits of laughter. An indication of knowledge gap on importance maintaining a pumping schedule for breastfeeding working mothers.
Breastfeeding in public is also a challenge since at home, I have a luxury of pillows and couches but in public places like church and restaurants, this is a bit challenging so you have to know how to position yourself and the baby to latch on well. And of course there are preying eyes as many people still objectify breasts, which should not be the case. The primary purpose for breast is to feed the babies. An indication that there is still a need of creating awareness on breastfeeding.
Related story: Breastfeeding: how we can break through barriers I was also encouraged by Dr Noorani and Dr Yassir Abdallah Aljaidi, a neonatologist and consultant paeditrician at AKH to create a breastfeeding support group where I encourage mothers and share with them tips on exclusive breastfeeding. In case they have any technical questions, Dr Noorani is always on standby to tackle them. I get many calls even in the middle of the night with mothers wanting tips on breastfeeding. It is so fullfilling reaching out to other mothers who are breastfeeding and giving them emotional support through calls and WhatsApp chats.
I also learnt a lot more about breastfeeding when I met lactation experts at the WHO’s headquarters in Geneva during the 71st World Health Assembly.
This is my parting shot; exclusive breastfeeding for six months is possible though a mother needs support from the family, community, the government (on policies and programmes) employer and healthcare giver to make this journey successful and dramatically increase breastfeeding rates in Tanzania thereby improving children’s health and development. There is also a need for breast milk bank in major health faccilities in the country, this would ensure no child is left out when it comes to giving them a level ground when they are born.
Expert tips on exclusive breastfeeding
In an earlier interview with Your Health, Jane Msagati, a nutritionist and programme coordinator at Partnership for Nutrition in Tanzania (Panita) asserts that breast milk is the first food of every child that comes into this world.
“Every child should be exclusively breastfed for six months and breastfeeding should continue to 2 years. This is because breast milk is the complete food that has essential nutrients that a child needs for the first six months of life,” Ms Msagati said.
“By exclusive, no water, glucose or formula should be given,” she firmly states.
According to her, the positive impacts of breastfeeding can be seen not only on the baby, but also on the mother as well.
On the benefits of breastfeeding, Ms Msagati says breast milk is not only the most nutritious food for babies but also boosts their immunity thus protects them from infections, allergies, some chronic diseases and even childhood cancers plus it is also seen as a good protection against obesity in later life.
“It also strengthens close bond especially eye-to-eye contact and physical closeness between the child and mother,” she explains.
Dr Richard Rumanyika, a senior gynaecologist and obstetrician at Bugando Hospital, a top referral in the Lake Zone Region says that the impact of breastfeeding can be seen in a child’s emotional, cognitive and psychosocial development even long after stopping breastfeeding and that is why as a medical facility they are paying attention to breastfeeding trends and helping mothers achieve optimal feeding for their babies. Dr Rumanyika also said, “We must disseminate accurate information on the value of breastfeeding as a powerful intervention for health and development, benefitting both children and women.”
Dr Mariam Noorani a paediatrician at AKH, said milk production declines if a mother does not breastfeed enough.
“Mothers should express milk even at work to stimulate milk production. By not breastfeeding or pumping, it can cause milk supply to run dry. Those mothers who do not have place for storage should carry cooler bags to work if possible. For working mothers to achieve exclusive breastfeeding for 6 months,support is required from the employer. A space for her to pump, storage facilities in a fridge and adequate time for pumping breaks are needed. Working mothers should plan for pumping and engage employer to organise the logistics,” she states.
“Breastfeeding should be assesed at every clinic visit and special attention should be paid at three months when most mothers return to work. Investing in human milk bank will help save lives of sick and premature babies who need breast milk.” Dr Mariam points out.
On his part, Dr Kaguta Munawar, a lead gynaecologist at AKH said, as healthcare providers they advocate breastfeeding as the safest milk for newborn.
“For those women who have undergone Caeserian Section, we usually keep the baby in the recovery room with the mother and encourage them to start breastfeeding. We totally discourage artificial milk,” he states.
Dr Elisha Osati, President of the Medical Association of Tanzania (MAT) and Internal Medicine physician at Muhimbili National Hospital, recommends scaling up awareness programmes, especially on the right way to express, store and handle breast milk.
“As health practitioners, we have a big role to play in giving mothers the right information,” Dr Osati stated, adding that comprehensive post-natal care would go a long way in reinforcing breastfeeding.
Janet is the Features Editor of The Citizen and an Early Childhood Development and Health Fellow with the International Centre For Journalists
There is a global diet shift with animal rights activists advocating for a meatless based meal plan and a complete boot of meat from the menu. However, many Tanzanians have just decided to completely drop red meat from their menu or reduce it significantly. With red meat toping the list of the most controversial foods in the history of nutrition, healthy lifestyle champions have argued that the body becomes more acidic when red meat is consumed thus creating a perfect environment for disease.
While nutritionists have pointed out that beef is very nutritious if it comes from naturally fed animals, several groups have come up on social media rooting for a complete shift to plant-based diet .
Anne Masawe*, 42, a journalist based in Dar es Salaam is not such a fan of red meat. She cut down her beef intake from five to two times in a week. She says her love for beef is no longer the same as researchers keep on linking the same to all kinds of disgusting illnesses.
“ I started loving beans more as many researchers kept on advocating for plant based proteins which starve off the bad bacteria living in our gut,” she states adding that what she reads in the media about red meat is even more scary.
Just recently, the Daily Nation, our sister publication in Kenya, carried a story titled ”Red alert” which investigated how supermarkets inject all sorts of meat with dangerous chemicals to give it a fresh look. This even made the warning about red meat get louder without people knowing exactly what next healthy choice to put on their dinner tables.
But no matter what the headlines in the media read about meat, Tanzanians celebreate food with nyamachoma and one can find barbeque spots in almost every corner of the street. Food culture in Tanzania and meat are two things you cannot separate. But how do we ensure our choices are the healthy when it comes to consuming meat?
As an average consumer, you probably have a vague awareness of the nutritional value of your meats - fish being better than red meat, for example. The issue can be complicated, because all meats have pros and cons, research can come up with conflicting results, and studies can surprise us. For example, research suggests that in terms of cholesterol alone, eating white meat chicken is as bad for you as eating beef.
Still, there’s a generally agreed upon hierarchy of nutritional value when it comes to meat, and small shifts in your diet might have greater effects than you realise.
In a study of the Danish population, researchers found that Danes could gain more than 7,000 years of healthy life annually if they ate the recommended quantity (12 ounces per week) of fish while replacing red and processed meats in their diet.
“It’s important to note that there is no one-size-fits-all healthier diet or meat per se,” said Janese Laster, a physician nutrition specialist. Also crucial? “There are differences in farming practices, so throughout the country, each person is getting different risks and benefits from the meats.”
Keeping that in mind, here are some conclusions that can be made about different categories of meat, starting with the good.
A cut above: Fish and poultry
Poultry and fish are considered the best meats you can load your diet with, Laster said. Fish is hailed for its omega-3 fatty acids, which can protect against cardiovascular disease.
Fish is also rich in vitamin D, selenium and protein. “A healthy diet would entail a great diversity of fish consumption, rather than the same fish every day, along with fish that is wild-caught rather than farmed,” Laster said.
Because there’s some risk of ingesting “mercury, polychlorinated biphenyls, microplastic due to our polluted water supply,” try to avoid species such as swordfish or king mackerel and opt for cod or salmon instead.
Poultry, such as chicken and turkey, is also great protein source, low in calories and saturated fat. Keri Gans, registered dietitian and author of “The Small Change Diet,” used to recommend light meat over dark, but the fat difference is actually quite minimal.
“Eat what you enjoy” is her new advice. “That said, breast meat is typically leaner than thigh, and you should always look at how it’s prepared.” Chicken wings loaded in sauce are not the best option. Gans recommends baking and grilling, and a skinless, boneless cut of poultry to keep each serving the healthiest.
You might need fish and poultry even less than you think. (Research from the American Journal of Clinical Nutrition shows that even white meat consumption can increase cholesterol.)
Though the American Heart Association recommends two to three servings of fish a week and eight to nine servings of super-lean protein, Laster says consuming just two to four servings per month of fish and two to four servings per month of poultry can provide benefits, according to research.
“There is data to suggest a very low quantity of meat in general for healthier disease-free living, around two to four servings per month,” Laster said.
“But if poultry is consumed, it should be of the best farming practices, with free range, no antibiotics or hormones, and livestock being provided with proper food, along with uncontaminated slaughtering practices.”
Less is more: Red meat
Most meat-eaters love a juicy hamburger or steak - but that should fall more in the category of indulgence than in dietary staple. The pros to red meat - which includes beef, pork, lamb, veal, venison and duck - are found in its minerals.
Red meats can be great sources of iron and also pack “vitamin B12, zinc and protein, all of which are important nutrients,” said Amy Patton, a registered dietitian at Ohio State University’s Wexner Medical Center.
The cons, however, are notable. “According to the American Institute of Cancer Research, red meat intake can possibly promote certain cancers such as colorectal cancer,” Patton said.
“Cooking red meat at high temperatures may also increase cancer risk, and red meats tend to be higher in saturated fats than other protein sources.” The saturated fat may, in turn, increase your risk for cardiovascular disease.
What should you probably avoid altogether, or at least only eat on a very rare occasion? Processed meats.
“Essentially, this is any meat that has been preserved or had a chemical added, like bacon, bologna, pepperoni, beef jerky, hot dogs, sausage and deli meats,” Laster said. There are other ways to get your protein fix - without all the downsides. (The World Health Organisation classifies processed meat as “carcinogenic to humans.”)
When it comes to overall health, saturated fat should be limited as much as possible. Lamb typically has more saturated fat - which can raise your levels of bad cholesterol, putting you at higher risk of cardiovascular disease - than beef or pork.
T-bones, rib-eye and New York strip steak tend to be fattier forms of beef when compared to ground rounds, sirloin or flank steak.
Pork is typically lowest in calories and saturated fat when compared with other red meats - as long as it isn’t processed into bacon or cured ham.
According to the World Cancer Research Fund, you should not eat more than 12 to 18 ounces of red meat each week, or roughly three servings - but some experts suggest less is more.
“Many trials have shown decreased progression or reversal of chronic diseases, cancer, obesity and metabolic syndrome, including diabetes, hypertension and high cholesterol, when you avoid processed red meats and greatly limit red meat consumption,” Laster said.
A recent study published in the BMJ showed that increased red meat consumption leads to a higher risk of mortality.
If you choose to consume red meat, keep it smart. “Select leaner cuts, and use more healthful cooking methods, such as baking or broiling rather than frying or grilling,” Patton said. Gans tells her clients that “round” or “loin” cuts are often leaner - think “pork tenderloin,” “loin chop” - when ordering off a menu or selecting at the store.
Substituting even one serving per day of red or processed red meat with poultry, fish or legumes “significantly decreases” the risk of metabolic syndrome, Laster said.
And don’t forget those non-meat sources of protein. In addition to legumes, nuts, seeds, tofu, almond milk, quinoa and chia can be part of a healthy dietary regimen.
If you’re thinking of a step-by-step way to improve your diet, Laster recommends “cutting back on red meat, and then limiting animal products to a few times per month,” rather than in the typical American diet of a few times per day.
“There’s been a few studies that have come out to show it’s what Americans are not eating daily - such as beans, grains, legumes, vegetables, fruits - that may account for some of the [unhealthy] effects we see in studies,” Laster said.
When it comes to meat in your diet, small adjustments can reap big rewards, Laster said. “These incremental changes will help with weight loss, improve diabetes, high blood pressure and cholesterol, and possibly help you get off medications.”
Additional reporting by Janet Otieno Prosper.
It started with abnormal pain in his back that prompted Zabron Mababula, 43, resident of Songea to consult a doctor at Peramiho hospital back in November 2017.
“I used to sit for many hours on a chair while working at the office. I am an accountant so I was confined to working on a computer non-stop throughout the day and sometimes, I even skipped breakfast and lunch breaks,” Zabron narrates to Your Health in an exclusive interview.
The doctor at the hospital instructed him to avoid sitting on a chair for too long, especially with a desk job and advised him to join a physiotherapy programme at the hospital to treat the lower back pain.
“I found the programme very useful because the back pain disappeared eventually,” says Zabron.
A father of two and a public servant recalls that after recovering from severe lower back pain, he resumed office duties.
But later in October 2018, he started experiencing difficulty in walking accompanied by severe headache with no known cause—common warning signs of a stroke.
“The symptoms started after I collided with an opposing player during a football match. Then I experienced loss of balance,” he tells Your Health.
In February 2019, he went back to the hospital, but this time the condition didn’t go away, prompting him to seek further medical assistance at another hospital—Ikonda hospital in Njombe district.
The hospital results showed that he suffered spinal disc damage—the situation leads to lower back pain, leg pain and other symptoms such as numbness and weakness, according to medical sources.
“I was prescribed to use Vitamin B and D tablets to recover the damage. Eventually, I recovered and resumed office works,” Mr Zabron tells.
Mr Zabron is currently seeking further specialised medical treatment at Muhimbili National Hospital-Mloganzila in Dar es Salaam, after succumbing a stroke disease.
“I came to Dar es Salaam for a work meeting which was scheduled to be held on Sunday and Monday,” says Zabron.
He narrates that on Sunday morning while he was preparing to attend the meeting, he accidentally hit his right foot on stairs and lost his balance.
“I experienced severe leg pain that persisted for 10 minutes and later felt tingling in the right feet. I could not move so I stood up after 20 minutes,” Zabron tells.
He later managed to walk inside the house, but after a few minutes the condition worsened and he could not attend the meeting.
On the same day, Mr Zabron, accompanied by his young brother Mresi, went to MNH in Mloganzila but he didn’t receive treatment because the specialist was not on duty.
Therefore, they returned to the hospital on Monday whereby Zabron managed to undergo CT scan and magnetic resonance imaging (MRI) and when the results came out, he was diagnosed with minor stroke that necessitated prolonged medication.
The patient waiting area at the Neurology Department located on the first floor of the hospital building was overwhelmed with over 30 patients suffering from different neurological diseases including stroke.
One could easily notice that the patients were attending a clinic session at the hospital as they were spotted being summoned one by one to see the doctor at the consultation room.
Some of the patients were on the wheelchair and others seated on hospital benches awaiting their turns to see the doctor.
Zabron was one among the young adult patients in the queue, and others were older adults accompanied by their relatives.
At his age, he represents millions of Tanzania’s young adults aged below 45 years who are at high risk of developing Non-Communicable Disease (NCDs) such as stroke disease, according to local specialists.
Stroke affects young adults too
This follows a local study that was presented during the 7th Muhimbili University of Health and Allied Sciences (Muhas) Scientific Conference indicating the alarming prevalence of stroke in young adults.
The study titled, “Stroke in Young Adults admitted at MUHAS Academic Medical Centre in Tanzania: A Comparison with Older Adults,” involved 1403 patients admitted at Muhas Academic Medical Centre in Dar es Salaam. It indicated that out of 369 patients recently diagnosed with a stroke, 123 were younger adults, whereas the remaining were older adults.
A stroke is the rapid loss of brain function(s) due to a disturbance in the blood supply to the brain. This can happen because of lack of blood flow caused by a blockage or a leakage of blood, according to medical sources.
The study served to determine the magnitude of stroke and describe stroke sub-types, risk factors and outcomes in young adults aged below 45 years compared to older adults aged above 45 years in Tanzania.
The lead author of the study which was carried out from June 2018 to January 2019, Dr Sarah Matuja, from Department of Internal Medicine at Muhas said stroke was popularly believed to be a condition affecting the elderly.
The study indicates further that 68 stroke patients were female younger adults (55.3 per cent) and 138 (56. 1 per cent) were female older adults.
Furthermore, the study shows that younger adults were more likely to be current alcohol consumers and unmarried, also 10.2 per cent of the older adults diagnosed with stroke were alcohol consumers.
Ms Naomi Edson, Nurse Officer at the neurology department at MNH, tells Your Health that clinic session takes place twice a week--on Tuesday and Thursday involving patients diagnosed with neurological diseases including strokes.
“The number of patients attending the clinic keeps changing. Last Tuesday, 30 patients and today (Thursday) 30 have attended, but more are still coming,” says Naomi.
According to Naomi, during the previous clinic session on Tuesday, 17 out of 30 neurological patients were young adults aged below 45 years including stroke patients.
“Today until this hour, 13 out of 30 neurological patients who have attended the clinic are young adults,” says Ms Naomi.
Normally the clinic session at the hospital starts at 9 am and ends at 3 pm, but sometimes the hospital’s specialists are forced to continue attending the patients even after the clinic session time is over, according to Naomi.
“This happens when there is still a number of patients in the queue waiting to see the doctor,” says Naomi.
Dr Leonard Msango, a Neurophysician at MNH tells Your Health that high blood pressure (hypertension) is one the most common causes of stroke.
“Other risk factors include tobacco smoking, obesity, diabetes, use of illicit drugs, hormonal contraception, HIV infection and sickle cell disease,” says Dr Msango.
Current epidemiological data suggests that strokes are occurring at a younger age. As many as 1 out of every 6 strokes occurs in a young adult (18 to 50 years old). Heterogeneity in incidence rates, stroke subtypes, and aetiology among younger stroke victims in both developed and developing countries is often noted.
The ischemic stroke [when the arteries to your brain become narrowed or blocked] in the young poses many challenges such as premature death and years of healthy life lost attributed to a disability, according to medical sources.
“A stroke often requires emergency care. Chronic stroke can lead to either death or disability. Minor stroke can be cured. Succumbing a stroke at a young age has social and economic repercussions,” says Dr Msango.
According to Dr Msango, prevention for stroke includes decreasing the risk factors such as abandoning tobacco smoking, eating healthy food and engaging in physical exercise, to mention a few.
World Health Organisation (WHO) estimates that more than 17.5 million people died of cardiovascular diseases such as heart attack or stroke in 2012.
Contrary to popular belief, more than 3 out of 4 of these deaths occurred in low- and middle-income countries, and men and women were equally affected.
The good news, however, is that 80 per cent of premature heart attacks and strokes are preventable. Healthy diet, regular physical activity, and not using tobacco products are the keys to prevention. Checking and controlling risk factors for heart disease and stroke such as high blood pressure, high cholesterol and high blood sugar or diabetes is also very important.
Eat a healthy diet: A balanced diet is crucial to a healthy heart and circulation system. This should include plenty of fruit and vegetables, whole grains, lean meat, fish and pulses with restricted salt, sugar and fat intake. Alcohol should also be used in moderation.
Take regular physical activity: At least 30 minutes of regular physical activity every day helps to maintain cardiovascular fitness; at least 60 minutes on most days of the week helps to maintain healthy weight.
Avoid tobacco use: Tobacco in every form is very harmful to health - cigarettes, cigars, pipes, or chewable tobacco. Exposure to second-hand tobacco smoke is also dangerous. The risk of heart attack and stroke starts to drop immediately after a person stops using tobacco products, and can drop by as much as half after 1 year.
Check and control your overall cardiovascular risk: An important aspect of preventing heart attacks and strokes is by providing treatment and counselling to individuals at high risk (those with a 10 year cardiovascular risk equal to or above 30%) and reducing their cardiovascular risk.
A health worker can estimate your cardiovascular risk using simple risk charts and provide the appropriate advice for managing your risk factors. Know your blood pressure: High blood pressure usually has no symptoms, but is one of the biggest causes of sudden stroke or heart attack.
Have your blood pressure checked and know your numbers. If it is high, you will need to change your lifestyle to incorporate a healthy diet with less salt intake and increase physical activity, and may need medications to control your blood pressure.
Additional information from WHO.
It’s always exciting and nerve-wracking at the same time when an expectant mother enters her third trimester. I have four children, but with every child the preparations felt like a first-time mother.
There are essentials that an expectant mother will need to carry that will help them during labour, birth and after the baby is born. A lot of first-time mothers-to-be wonder what should be inside a maternity hospital bag? If your due date is just around the corner, make sure your hospital bag is packed and ready with this handy checklist we have prepared.
There are must-haves (and some nice-to-haves but not a necessity) for the hospital. This list is a good starting point, but every hospital does things differently, so ask ahead of time what they will supply and what you need to bring from home.
Here are mothers sharing their experience in preparing their clinic maternity bag and a health experts’ checklist for you.
Mariam - mother of four kids
Mariam Masele*, 36, a school teacher at Kimanga Primary School is a mother of four children. Three years ago she delivered her last born at Muhimbili National Hospital (MNH).
Mariam didn’t anticipate an early labour, which was two weeks before her due date. But that didn’t mean she wasn’t prepared.
Mariam had prepared her maternity bag one month prior to her due date. This is what she packed.
• 3 pairs of khanga
• 2 sets of baby clothes that are unisex in colour and each set includes a romper, socks, hat and mittens.
• Unscented, mild soap
• 2 sets of maternity dresses
• 5 pairs of medical gloves
• 3 injection syringes
• Cotton wrapped in a cloth (that she uses as maternity pads)
• Diapers for the newborn
• Thermos (to put warm water or hot black tea)
• Baby blanket
Dr Julius Twoli, a general physician based at Bagamoyo District Hospital says it is important for expectant mothers to prepare their hospital maternity bag before they reach week 36. It is also advised for an expectant mother to be with her maternity bag wherever she goes when she hits week 36, Dr Twoli says.
“I know it is challenging to walk around with the maternity bag everywhere but it is advised as labour can’t be anticipated. Some hospitals, especially government hospitals, prefer women to have their own maternity essentials,” says Dr Twoli.
Adding to that he says, before a woman packs her maternity bag, she needs to check with the hospital ahead of time as to what will be provided and what needs to be brought from home.
“Majority of private hospitals will only require new mothers to bring newborn baby clothes and few pairs of khanga. However it is advised for a woman to carry her things just in case,” Dr Twoli says.
Adding to Mariam’s list, here is what Dr Twoli suggests:
• Maternity pads
• Breast pads
• Breastfeeding bra
• Mobile phone, charger
• Insurance card and hospital documents if any
• Muslin cloths
32-year-old Josephine Lawrence, a civil servant and a mother of two believes in a birth plan.
She learned about a birth plan when she was expecting her first child, where she came across a book named ‘Mahali Pasipo Na Daktari’ (places where there are no doctors).
She says the book helped her to come up with a birth-plan that included preparing a maternity bag, arranging for a person beforehand to take you to the hospital when need be and also prepare for a person to stay back at home if you have other children.
She says, the book recommends women to share their experiences with regards to maternity bag essentials and the changes over the years. Like back in the days, the umbilical cord used to be tied with a thread but these days there is a special clamp for that purpose.
“There is no limit when it comes to learning. It is important for women to share knowledge so that no one should be left behind as we all know giving birth is not easy. I only carry few things in my maternity bag as I always find most of it at the hospital. I only carry three pairs of khanga, three pairs of vitenge and a maternity dress,” says Josephine.
Majority of women go through a lot of challenges and complications during pregnancy. As if that is not enough, labour and child-birth is the most painful experience a woman goes through in her life, of which most mothers testify true.
As a result, it has come to Your Health’s attention that many women in Tanzania decide to use traditional medicine or herbs without consulting a health expert so as to ease pregnancy complications or fasten the labour process without considering the health dangers associated with it.
About three months ago, Velena Thomas* lost her sister Sara, a first-time mother. Sara died due to complications during birth. Velena till date is not sure what caused her death but her sister had a big baby that was to be delivered by caesarean section.
“She was advised by her doctor to go for C-section and was given a specific date for the surgery. Sara was always against surgery and had always wanted a normal delivery. So what Sara did was go look for traditional herbs to help her induce labour naturally before the given date for C-section,” Velena tells Your Health.
Velena furthers narrates the sad ordeal that when Sara began experiencing labour pains, none of them were aware of the herbs she had taken. She kept it as a secret. They only came to realise when the nurses began perusing Sara’s clinic bag for clothes and other necessities.
“We found a well wrapped piece of paper with directions written in Kiswahili on how to use the powdery substance and it was stated that it is specifically for fastening labour process. It is when we realised why she went into labour early before the given dates. Both my sister, and the unborn child died,” says Velena.
Dr Marie Voeten, Chief Medical Officer at the Sengerema District Hospital in Dar es Salaam reveals to Your Health that the use of traditional medicines during pregnancy and labour are very common in Sengerema. She says, it is a practice that needs to be stopped urgently as they pose health risks for mothers-to-be and their unborn child.
Commenting on what would have been the cause of Sara’s death, Dr Voeten says, it is not possible to suggest what might have caused Sara and the baby’s death. However if her bag was found with traditional medicines, health experts can link the death to its use.
She says, “At Sengerema hospital, we always find expectant mothers with traditional roots from home claiming that after eating them, it helps to fasten their labour pain process. Instead of waiting for 8 hours for the first birth, it takes up to 3-4 hours.”
Dr Voeten adds, “This seems to be good news to the pregnant women, but it is not medically right, in fact it is a risky affair. It is advised for women to wait for natural process to take its course as it comes with right process of the baby to slowly come to its right position, waiting for the water bag to rupture and when the baby is ready, it will just come out healthy without jeopardising the mother and its life.”
Adding to that, Dr Voeten says, researches that are aimed at revealing direct cause of death and other side effects resulting from the traditional use of herbs are very limited that doesn’t allow health workers to give data on deaths and side effects due to traditional medicine.
“As health experts, all we can do is to take away the traditional medicines if it happens they [expectant mothers] are found with them in the labour ward.”
A common practice
Georgina George, 34, a business woman in Kariakoo still remembers the tough experience she went through during her first pregnancy six years ago. Georgina always worried about having baby number two. Hormone changes due to pregnancy hit her badly.
During her first trimester, she survived on drips as she could not manage to eat anything. Morning sickness being accompanied by spitting and unable to eat are the memories that her mind refused to let go.
On this, she is not walking alone. A brief survery by Your Health reveals that majority of women go through a very challenging journey of pregnancy.
As a way of calming the discomforts, majority of women opt for unprescribed traditional medicines during pregnancy to ease the discomforts during pregnancy as well as during labour.
But is the practice of having traditional medicine/herbs safe to take during pregnancy/labour and approved by the medical doctors? Are the women putting their lives at risk and increase chances of them losing their lives? Interviewed health experts warn against the use of traditional medicine during pregnancy and labour as they can result to the increase of maternal deaths.
A 2017 report titled ‘Prevalent use of herbs for reduction of labour duration in Mwanza, Tanzania: Are obstetricians aware?’ aimed to determine the prevalence and factors associated with the use of herbs during labour among women in Mwanza, Tanzania.
The report shows the use of herbs during pregnancy and labour is rapidly increasing because the herbs are considered to be natural and therefore free of risks. The report shows despite of this perception, a number of herbs have been reported to have negative effects to the new-borns and the mothers.
Traditional herbs which were only identified by local names were ekakwingili, matola, makarekambona, akabindizi, ekinunulizi, enyabashumi, binzari nyembamba, mgagani, mshana and msuana. Among those reported to use herbs, 12 (29.3 per cent) reported to use herbs, which could not be identified by their generic or local names as the users did not know what they were given and ingested.
Georgina is one among the women who used traditional medicine as soon as she was introduced to a WhatsApp group by a friend. The group advises and encourages pregnant women to use traditional medicine from Lake Zone to stop early discomforts as well as prolonged labour.
“I was talking at a ladies outing on the challenges that come with pregnancy. Two of the women who attended the outing told me about a WhatsApp group that directs women on the usage of traditional medicines during pregnancy and even when they are in labour,” says Georgina.
To her that was good news. In an instant, she joined the group by just paying Sh1,000 as a monthly fee and she was added. The group, according to Georgina, consists of more than 200 members. The traditional medicines being given starts from those who are unable to conceive for years, hormonal imbalance, problems around menstruation as well as those of using during pregnancy and labour.
Adding to that she says, she then decided to purchase traditional medicine as advised by the admin, which she had to boil and drink two glasses a day. She was also given another medicine and was told to mix in her food whenever she felt like vomiting after eating. Both medicines were dried leaves and they worked best for her.
“I had a pleasant experience with my second child. I got none of the challenges and discomforts during pregnancy,” adds Georgina.
Georgina might have been one of the few fortunate ones to deliver safely, but it’s not the case for many.
Why it’s dangerous?
Health experts say that labour is supposed to be progressive, with the cervix becoming thinner and wider (dilating) gradually. But most women don’t adhere to the natural process.
Dr Colman Matunda, a consultant gynaecologist based in Dar es Salaam, says traditionally, women use the herbs to ease discomfort during pregnancy, widen the birth canal and speed up labour.
Dr Matunda doesn’t advise expectant mothers to use any type of traditional medicine or herbs to induce labour because it may result to complications during birth.
In an article published in New Vision, Dr Evelyn Nabunya, a gynaecologist/obstetrician was quoted explaining the risk of eating or drinking labour-inducing herbs.
The herbs cause hyper-uterine stimulation, where by contractions occur frequently and do not allow the baby to rest, Nabunya explains.
The frequent contractions put the baby at risk of distress because there is no time for the uterus to recover. The mother may also end up distressed. Under normal circumstances, a mother should not exceed five contractions in 10 minutes, she affirms.
The mother is also prone to miscarriage, suffering a uterine rupture because of hyper stimulation, which may lead to severe bleeding and premature birth, Dr Matunda warns.
In addition, Nabunya says some mothers may present with cervical dystocia, a condition where the cervix fails to dilate even with normal contractions.
If a mother is unlucky, she may end up with a tear of the cervix extending down to the vagina. Usually when such a condition presents, operation is done to deliver the baby, Nabunya says.
A way forward
Vestina Rugasha, a midwife at Maddona hospital says that in her 36 years experience of working in the labour ward, she has seen a lot of women who attend monthly clinics as well as in the labour ward walk in with traditional medicine.
She says, it is very difficult to stop women from using traditional herbs as they claim even their mothers used the same and are the ones advising them.
“We try to educate these women during their clinic sessions, yet there is always a new bad case indirectly linked to the use of herbs at the hospital,” Rugasha says.
More needs to be done in terms of spreading awareness on the risks of ingesting herbs during pregnancy and labour, Rugasha says. She suggests, hospitals should play videos or edutoons on this kind of information when mothers-to-be queue during clinics so that they can make informed decisions.
How to ease labour without the use of herbs
Health experts advise the following:
• Moving around: Walking, swaying, changing positions, and rolling on a birthing ball can not only ease the pain but can help your labor progress.
• Team: Having partners or loved ones around can play essential roles on your birth team. Choose people who will treat you with respect and patience. The proper support can help decrease stress and inhibitions, so you can find your best coping mechanisms more easily.
• Breathing: Whether you’re hee-ing or haa-ing, panting or deep inhaling, as long as you’re focusing on your breath and releasing it, you’ll find some relief.
*Not her real name
I recently came across a 70-year-old patient complaining of difficult swallowing when he eats. The old man as he narrates his symptoms, tells me that he starts coughing after the first bite of food and occasionally, has nasal regurgitation [the action of bringing swallowed food up again to the mouth].
According to his presentation, for the past two weeks he has been going through throat irritation and painful swallowing associated with mild fever on and off.
He brought with him his past medical records (which I always recommend patients to go with previous medical history when they visit a doctor), which tells that he went to a walk-in pharmacy about 5 days ago where he bought certain antibiotics with the aim to treat what we medically call, acute tonsillitis, a condition that involves an inflammation, infection of the tonsils, and was given oral medications.
And this mostly happens due to comprised immune system. This infection can sometimes be due to certain bacteria or even certain viruses.
Acute tonsillitis, most of the time goes away with time, but in some cases, medication for instance, first line antibiotics can help.
Now back to my patient’s story: His situation continued to drastically worsen despite the medication he was prescribed. There was no sign of improvement.
And worse enough, this time he even started to experience that sensation of food getting stuck in his throat, which later made him being unable to swallow anything that he drank or ate.
Physically he looked pale, with swollen and white patches tonsils. Judging from his medication history, since antibiotics didn’t help him, I went for essential investigations; endoscopic examination (a test whereby a thin, flexible lighted instrument is passed down your throat so that your doctor can see your oesophagus).
And that’s when I came to find out that he was suffering from dysphagia, a condition that hardens the passage of foods or liquids from the mouth to the stomach.
Pay attention to signs
In most cases, people have limited awareness of this kind of medical condition, that’s why they always confuse it with tonsillitis and sometimes these two conditions share similar symptoms.
It’s therefore recommended to keenly pay attention to the symptoms especially when the symptoms lasts for quite some days even after taking commonly used medication.
If you get trouble swallowing, it’s time to take it seriously especially when you go through some of these symptoms which at times, can be, having pain while swallowing, hoarseness, having frequent heartburn and coughing or nagging when swallowing food.
The causes of this medical condition, dysphagia or commonly known as ‘difficulty swallowing’, varies by age, environmental causes or even presence of certain systemic diseases.
Generally, people with chronic stomach ulcers, or with neurological or nervous disorders are more likely to experience difficulty swallowing.
Although swallowing difficulties can’t be prevented, you can reduce your risk of occasional difficulty swallowing by eating slowly and chewing your food well. Early detection and effective treatment of digestive disorders can lower the risk of developing dysphagia.
See your doctor if you regularly have difficulty in swallowing, regurgitation or vomiting after eating.
The average child in America drinks more than 30 gallons (around 114 litres) of sugary beverages each year, including sports drinks, sodas and fruit-flavoured refreshments. Global nutrition report also shows, more than four in 10 children drink sugary drinks daily and one in three do not eat fruit each day, a trend that is also reflected in Tanzania.
Because this excessive sugar consumption is tied to a greater risk of heart disease, high cholesterol and Type 2 diabetes - Tanzanian Parliament in 2017 endorsed a set of ambitious governmental policies to help curb this. During the 2017/18 Tanzania budget, taxation on sugary beverages was highlighted where by the excise duty on carbonated drinks was increased to Sh61 per litre.
In the last two years, Tanzania has not made any changes with regards to taxation on the sugary beverages despite the rise in awareness on non-communicable diseases in Tanzania.
But, of course, parents don’t need to wait around for the government to act.
In a position paper released in March, the American Academy of Pediatrics (AAP) and American Heart Association (AHA) came up with five recommendations to help children drink fewer sweetened beverages, such as taxing sugary drinks; limiting the advertising of sugary beverages directed at children and teens; making water the default beverage on children’s menus; and improving the quality of nutrition labels - perhaps by adding front-of-pack labels about the health consequences of consuming sugary drinks.
“This is a comprehensive approach to tackling the problem,” says Federico Asch, a cardiologist with MedStar Heart & Vascular Institute at MedStar Washington Hospital in Washington, D.C.
“Problems start because people are not educated about the detriments of sugary drinks. We want to give information so people can make educated decisions.”
Asch says people may think twice before offering soda to their children if they knew that a 20-ounce cola has the same amount of sugar as 14 cookies or five doughnuts.
He also wants everyone to know how to read and understand sugar content on the Nutrition Facts label, so they can see how much sugar is in products they buy.
So where’s the problem?
The worldwide prevalence of obesity has nearly tripled since 1975. Report by World Health Organisation (WHO) titled: Taxes on sugary drinks: Why do it?, an estimated 39 per cent of adults were overweight in 2014 and 13 per cent were obese. Some 41 million children under the age of 5 were overweight or obese in 2016 and this number of obese children and adolescents rose from 11 million in 1975 to 124 million in 2016 – a tenfold increase.
Not only this but the prevalence of overweight in pre-school aged children is increasing fastest in low- and lower middle-income countries. People who consume sugary drinks regularly – 1 to 2 cans a day or more – have a 26 per cent greater risk of developing type 2 diabetes than people who rarely consume such drinks.
Speaking of non-communicable diseases, the number of people with diabetes has risen from 108 million in 1980 to 422 million in 2014 (6). Apart from diabetes, obesity is a major risk factor for heart diseases, cancers and other diseases.
Evidence as reported by World Health Organisation (WHO) shows that implementing taxes on sugary drinks leads to reduced consumption of these products.
Several countries are well on their way to implementing taxes on sugary drinks. In January 2014, the government of Mexico added a 1 peso per litre excise tax on any non-alcoholic beverage with added sugar (powder, concentrates or ready-todrink) to the country’s Special Tax on Production and Services, which is paid by the producer and represents about a 10 per cent increase in price for the consumer.
A study conducted by the Mexican National Institute of Public Health and the University of North Carolina evaluating the first two years of implementation showed an average reduction of 7.6 per cent in the purchase of taxed sugary drinks during 2014 and 2015.
Households with the fewest resources had an average reduction in purchases of 11.7 per cent. The study showed a 2.1 per cent increase in purchases of untaxed beverages, particularly purchased bottled water.
Over US$ 2.6 billion was raised during the first two years of implementation; some of this revenue is beginning to be invested towards installing water fountains in schools across Mexico.
A healthier choice
The idea of monitoring, taxing or policing sugary drink consumption remains controversial. There will always be people who complain that the government has no right to tell parents how to raise - or feed - their children. But, as Asch points out: “It’s not about stopping people from getting sugary drinks, and it’s not about health organisations or governments making decisions for the parent. It’s about giving a healthy choice first.”
If you take your children out to dinner, the default choice on children’s menus is often sugary soda, so that’s what children get. But if the menu offered water up front, children and parents would have a healthier option.
“If parents want to walk away from the healthy choice and let their children have a sugary drink, they can do that,” Asch says. But in this scenario, the parent has to actively make that choice.
Of course, there are eateries out there that are already making changes as parents push for healthier options. According to the AHA report, “Some restaurants have voluntarily changed the default beverage choice on the children’s menu from soda and other sugary drinks to water or milk, although more than 75 per cent of the 50 largest chain restaurants have not.”
How parents can encourage water consumption
Parents can support the AHA’s efforts by patronising restaurants that offer healthy choices. They can also push for such choices to be available in drink and snack machines or on the menus at the schools and other places their children frequent. But most importantly, they can encourage their children to turn to water first.
(What about juice, you might ask? Sip for sip, kid-friendly choices such as apple or grape juice have as much sugar as soda, which negates the small amount of vitamins they contain. Water is still a better choice.)
Start with a fun, reusable water bottle of your child’s choosing. Add some stickers or a funky reusable straw.
If the bottle is cool, your child is more likely to use it. Bonus: carrying a water bottle helps decrease your use of plastic beverage bottles, which end up in landfills or worse - in the ocean.
Single-use plastic bottles makes up more than 40 percent of all plastic trash, so if you can’t sell your kids on water, amp up the environmental message.
Tote that fun and fancy water bottle to restaurants, malls and outings. Make a game of spotting water refill stations or by seeing how many sips they can take each day.
You can also make games out of drinking water - sip some at a mock tea party, or fill small espresso cups with water and play “coffee shop baristas.”
If your children find that water tastes bland compared to sweet soda, try adding mint leaves, cinnamon sticks or a squeeze of citrus.
Have fun by freezing crushed berries in ice cube trays, and floating them in cold water. And make sure your kids are part of the process.
If you love apps, download Plant Nanny or Drink Water Aquarium. You’ll get reminders for you and your children to drink more water, and your children will totally dig the cute cartoon graphics.
And, finally, be a role model. If you make water your drink of choice, your children will most likely follow suit.
Additional reporting by The Washington Post.
Abortion in Tanzania is illegal. Being the case, it makes it harder for girls and women to get access to safe abortion. But even then, women still find their own ways to terminate unwanted pregnancies.
Have you ever asked yourself, what women and girls go through when trying to end unwanted pregnancy? A simple survey by Your Health confirms that girls and women go through a lot of pain and suffering that sometimes leads to deaths or permanent reproductive health issues.
Unsafe abortion is defined as unsafe when it is performed by either an unskilled person or in unapproved premises or both. According to Dr Anna Temba from Population Service International (PSI) says, worldwide there are over 20 million unsafe abortions occurring every year.
She says, various methods have been used to perform abortions, including the administration of herbs, the use of sharpened implements, the application of abdominal pressure, and other techniques. Amina Ismail* is one of the girls who underwent unsafe abortion, that was 25 years ago.
She still recalls the scaring incident during her first year at the college. She found herself pregnant and had no idea on how to go about the pregnancy.
It was unwanted pregnancy and she could not go for safe abortion as abortion is restricted in the country.
She recalls how she and her boyfriend came to an agreement to go for an abortion. Since Amina was new in town the boyfriend had to look for a doctor in one of the dispensaries. They had an abortion which came with heavy pain as it was done with no anaesthesia.
“I had never gone through such pain since then. I was screaming and the doctor would stop me from screaming. I couldn’t take it. I jumped out of the bed and walked out. The abortion was not complete. We had to go to another hospital the following day,” says Amina.
She says, again next day pain was just the same as it was at the dispensary but she had to bare it just to serve the purpose.
The Penal code provisions on termination of pregnancy are frequently misunderstood as a total prohibition on abortion. Under section 230, it is stated that termination of pregnancy is lawful where it is done to preserve the life or health of the pregnant woman.
But Sections 150 -152, criminalises only unlawful acts related to termination of pregnancy. And this act can be done by any person attempt to procure an illegal abortion, the pregnant woman who induces and the supplier who provides drugs or equipment used to induce an illegal abortion.
Dr Temba quotes the information from guttmacher.org, that 13 per cent of maternal mortality rates in Tanzania are caused by unsafe abortions. Each year 405,000 Tanzanian women have abortions almost all clandestine. 40 percent result in complications that require medical treatment and 60 percent of them do not receive needed medical care.
Raheli Richard, 37,* says she is also a victim of unsafe abortion. She is calling upon the government, parents and other health stakeholders to invest more in educating women and young girls the importance of family planning from an early stage and make sure they clear the doubts that come along with family planning methods.
She says, since abortion is restricted in Tanzania it doesn’t mean people are having enough education on how to avoid unwanted pregnancies. Women are ready to use family planning methods but they always come with so many complications that leave women with dilemma on which are the right methods for them.
Rahel has tried two of family planning methods and all of them never worked for her. She started with an injectable, she missed her monthly periods for two years. On visiting the hospital she was told everything is okay. When it was the right time for her to get a baby she had to try for three years with no success.
“Previously I had unwanted pregnancy. With the fear of disappointing my parents I had to go for an abortion. I used some pills from the pharmacy but they did not help. I had to also use what was recommended by friends and it never helped. Three days later I experienced stomach pain and was rushed to the hospital where I had access to post abortion care,” says Raheli.
If I had to get the right family planning method for me I am sure I wouldn’t have gone through a horrible experience. And by now I am still struggling to get a child but in vain. The doctors are telling me I have no problem but I don’t know why until now I cannot be pregnant.
Josephine Mugishagwe is the Advocacy, Communication and Public Relations Officer at Family Planning Association of Tanzania (UMATI). She says, at UMATI they have copied a method called the harm and risk reduction model against unsafe abortion with two main objectives.
She says the objectives are reducing morbidity and mortality among pregnant women caused by unsafe abortions. Reducing future unintended pregnancies, by offering access to contraceptive options.
The model wants to bring women to the health services make sure that they feel entitled to access health services when faced with an unintended pregnancy. At the health services they will be able to get more information that might help them to decide keep their babies instead of going for unsafe abortion that will endanger their lives.
She says, the harm reduction model is not a mechanism to cover the implementation of abortions that are not permitted under the law. The model recognizes that a more progressive regulation is required to ensure that women have access to the services they need. However, through implementing the model, an organisation makes the conscious decision of operating within the legal framework of the country. Adding to that she says, in 2014 Buguruni became the first fact operational research on the implementation of the harm reduction model against unsafe abortion in Tanzania. A total of 110 women received harm reduction services at Buguruni health centre between February and October 2014 while 50 women underwent quantitative surveys.
Majority of women 82.7per cent were between the ages of 19 and 35 years, had primary education 56.4per cent were married or living with a partner 61.8 per cent, were petty traders 56.4 per cent and had a gestation age of 8 weeks or below 66.4per cent.
The mean clients age was 26.5 years with the youngest client aged 13 years and oldest 42 years, she says.
The mean gestation age was 7.9 weeks. Despite the fact that the 50 women who underwent quantitative surveys were interviewed depending on whether they accepted the invitation to be interviewed; their background characteristics were similar to the bigger group.
Information available from the Causes and Magnitude of Maternal mortality in Tanzania presentation by Dr Temba shows that, maternal mortality is amongst the leading public health concern nationally and globally.
Unsafe abortion is 2nd leading direct cause of maternal mortality in Tanzania and women have used various methods to perform abortion inclidung herbs and sharp instruments.
On the midnight of February 21st, Ms Mwanahamisi Juma (37) heard a loud knock at the door of her house in Moto village, Chemba District, Dodoma. Men and women had come to her house in haste.
Being a Village Executive Officer (VEO), she wasn’t surprised that people from her community could throng her home in the night.
Her job entails listening to people’s concerns. However, she says, that day’s incident was more worrying. Today, as Mwanahamisi narrates the story to Your Health, memories of what happened still linger in her mind, months on.
On the fateful night, she says, “People who came to my house told me that a pregnant woman had been in labour pains, that started since morning. She delivered at home but she was in a bad condition. They wanted assistance on how to get a vehicle to transport the woman to a hospital for emergency care.” “The woman later died, but this shouldn’t have happened,” says Mwanahamisi.
She recalled the sad incident on the day when 35 village leaders, 15 ward councilors, Community Health Workers (CHWs) as well as clinical officers of Chemba District convened a task force meeting to discuss how a CHWs Project, run by Benjamin Mkapa Foundation (BMF), could help hem tackle health challenges.
Over a year ago, BMF in collaboration with the government deployed CHWs, under the 2018 to 2022 project dubbed: Mkapa Fellows III. The CHWs are touted as the health cadre that could revolutionise primary healthcare in Chemba.
A lesson for all
Mwanahamisi, together with other local leaders, held the meeting—top on the agenda was: how to bring down cases of maternal and child deaths in the district, improving nutrition among children and increasing the uptake of HIV/Aids services as well as encouraging people to enroll in health insurance schemes.
During the meeting, ward councilors were keen on raising key challenges that villagers face, such as inadequate access to improved Community Health Fund (CHF) services in terms of its quality, funding and registration for membership.
“This is a moment to plan on how to ensure such health services we are receiving through Community Health Workers, will still be available even after the Mkapa Foundation project has ended,’’ remarked Kidunda Hussein, councilor for Mundu ward.
“In my area, CHWs would wish to get reliable transport means to reach to as many households as possible. They need better and user-friendly bicycles. We hope the government and stakeholders will work on this one,’’ remarks Hussein.
In attendance were government officials from the Ministry of Health, Community Development, Gender, Elderly and Children and those from the President’s Office (Regional Administration and Local Governments).
When Mwanahamisi was allowed to stand up and address the gathering through sharing experiences, she recalled the story from her village, saying the death of the pregnant woman has left lessons to the community.
CHWs are using the scenario to intensify awareness promotion among residents, emphasising on why men must accompany their spouses to antenatal clinics and get more involved.
Although the CHWs and Clinical Health Assistants (CHAs) are still grappling with inadequate health promotional materials at facilities, such as fliers and stationeries and papers, they are key in reducing the country’s maternal mortality ratio which now stands at 556 per 100,000 live births.
And, for Mwanahamisi, male involvement in antenatal services could further play a bigger role in boosting maternal health.
“When a man accompanies his pregnant wife to the clinic, he can learn how to detect danger signs related to pregnancy and help his wife in making better decisions,’’ says Mwanahamisi.
She further raises the curtain on the story of a pregnant woman who died in her village, saying, “That day, when labour pains begun, she was in the farm with her husband. It was her 8th pregnancy when she complained of pains, the husband simply told her to go home and rest,’’ she narrates.
“Little did the husband know that the date of delivery had come and that his wife needed close attention. It was only hours later when the husband was informed by neighbours that her wife’s condition had become worse. After several hours of trying and failing to help her deliver, that’s when the pregnant woman was rushed to Moto Dispensary.”
Moto Dispensary Clinical Officer Ms Neema Joel says the woman succumbed to severe bleeding after delivery, known as Post-Partum Hemorrhage (PPH). Severe PPH can cause death within hours.
“I am informed that she attempted to deliver at home, assisted by neighbours and her husband. By the time she was brought to us, she had lost a lot of blood. After resuscitation, we referred her to the hospital. But she died on the way and her newborn baby didn’t survive,’’ says Ms Joel.
The incident captured the attention of the Ministry of Health’s CHWs Coordinator Dr Shaba Kilasi who was in attendance.
“We should not wish for another scenario like this. What we are seeing here is the need to intensify awareness campaigns for male involvement and the community at large,’’ he noted.
“Health problems facing people at household and community level require a united front of local leaders, healthcare workers and the government at large, this meeting is a clear testimony of how united they are,’’ he said during the meeting.
Village Executive Officers resolved to facilitate village meetings for men and Traditional Birth Attendants (TBAs) so that community health assistants (CHAs) can promote male involvement and facility delivery.
The priceless role of CHWs
Mr Baniet Ashery, a Community Health Worker from Mesimba village, Babayu ward believes that people in villages can be more informed about healthcare services if village health committees in Chemba are strengthened and given more incentives to support Community Health Workers to reach out to more and more households.
Chemba’s District’s Executive Director Dr Semistatus Mashimba, says Community Health Workers who were picked from among villages in the district have been at the forefront in educating people in their communities on why it’s important for pregnant women to give birth at a health facility, among other things.
“These [CHWs) are a great asset in primary healthcare. Through the Mkapa Fellows project, we are beginning to realise their positive impact, especially in Reproductive and Child Health and the uptake of HIV/Aids services,” says Dr Mashimba.
BMF’s Senior Program Officer-Community Health and Social Welfare Ms Emma Kinyamagoha, says that for the past one year, the number of people joining Community Health Fund (CHF) has increased, thanks to awareness campaigns initiated by the CHWs.
“We are seeing more patients with chronic illnesses being identified in communities, a rise in the number of people seeking health services and the efforts to get onboard children who missed out on immunization,’’ says Kinyamagoha.
Data collected from the field and presented in BMF’s implementation report show that the number of patients attending at Out Patient Department (OPD) increased from 3418 in 2018 to 4937 in 2019 and the number of women applying at least one modern family planning method increased from 5710 to 6605 under the same year period.
It’s around 7:30pm, I arrive at my work place, ready to take over for the night, as I was on-call that day.
Before anything, I decided to make a ward round first, to see how my in-patients (patients who are admitted) are faring and what management do they need.
The inpatient department here is at the top-most floor and as I was taking my steps, I heard someone shout for help for a doctor.
I decided to quickly turn back to emergency department, only to realise that it was my nurse that was calling after receiving a patient who was suffering from high grade fever and was brought to the hospital by his wife and two children. The patient wasn’t able to speak by then due to fever, so I took his history from the family.
They presented to me that he was fine during the whole day until 2 hours before they came to hospital, he suddenly started feeling unwell with severe fore headache, intense painful joints, high body temperature, extreme weakness and the fever.
To start his management, I counselled the family to be calm since they were with deep tension and ordered them to go to waiting area. I put my patient under observation, and ordered all the relevant labs, and while waiting for the results, I gave my patient paracetamol injection to relieve his severe headache and fever.
In few minutes, the results were back with everything normal expect his full blood picture that confirmed dengue diagnosis.
I then continued his management for dengue with maintenance of fluids and with time the patient slowly started to stabilise.
When the patient’s stabilisation was improving, that’s when I was able to share the prognosis to his family.
I was surprised at their reaction, when I told them that he is diagnosed with dengue fever.
For them, it looked like, the whole family is now doomed, since they put their minds that by being close to him and making body contact with him the whole day while helping him, they are also infected by dengue fever and they will fall sick and probably die soon if they will not get treated.
With this concept in their minds, they were extremely shocked, and that gave me an extra job to educate them and make them understand that what they think is nothing but a myth.
Since for the first time, the government confirmed the outbreak of dengue fever, almost more than a month ago, the number of dengue fever patients I have been receiving at my work station has been quite significant compared to how it was perceived.
Medical professionals particularly, have been using different platforms to raise awareness about dengue fever, until the word dengue is no longer new to a non-medic.
To every medical personnel that has been in front line to keep this awareness up, I strongly applaud them.
However I have come to realise that, there is still that random understanding about the disease among the people. People still have a lot of misconceptions about the dengue fever.
The concept that dengue fever is contagious like the family of my patient had, particularly rises from fear and lack of information.
The belief that an infected person is able to transmit the virus through physical contact is false. You can only be infected with dengue through a bite of female Aedes aegypti mosquito, which carry the virus.
I therefore urge everyone to take this from today that dengue fever is not contagious and can never be transmitted via cough, close contact, and body fluids with the infected person.
The author is the medical doctor based at sanitas hospital in Dar es salaam.
Microwaves have become a must-have in most modern kitchens. From warming a meal to heating up a cup of tea, microwaves seem indispensable. I guess we could peg that to our fast-paced lifestyles and technology that seems to push us to look for ways to better our lives.
It is a given that when any appliance is in good condition, it is safe for use. The same goes for a microwave. That said, we need to take care of the containers we use in the microwave regardless of its safe condition. While they may be convenient to use owing to their availability, some plastics may pose health risks.
How microwaves work
According to homeguides.sfgate.com, microwave ovens use high frequency waves of electromagnetic radiation to heat and cook foods and beverages. These microwaves of energy cause the molecules within foods and liquids to vibrate rapidly, producing heat. Many glass or plastic containers do not absorb enough microwaves to become hot during cooking. In fact, “microwave safe” glass, plastic or ceramic cookware allows most of the microwave energy to pass safely through to the food within.
In contrast, metal objects reflect the microwave energy back within the oven cavity and may spark a potentially damaging electrical discharge.
Angella Nalukonge, a nutritionist, says: “First of all, I would advise people to limit their use of microwave ovens as much as they can. When it comes to using plastics whether in form of containers, wraps or films, most of them are not safe because they contain chemicals called plasticisers which may be transferred to the food.” She adds that these chemicals are thought to cause cancer or disrupt the hormonal system in the body.
“Some plastic containers are however safe for use and these are labelled, ‘microwave safe’,” she says.
David Walugembe, a nutritionist, says plastics are not safe to be used in microwaves because when they are exposed to heat, bisphenol A, (BPA), a hormone is released. “This endocrine disrupting chemical leaches into the food and higher doses can result into heart disease and impotence,” he explains.
Health.harvard.edu, an online portal also cites another endocrine disrupting chemical found in plastics called phthalates. It states that these substances mimic human hormones, and not for the good. “When food is wrapped in plastic or placed in a plastic container and microwaved, BPA and phthalates may leak into the food. Any migration is likely to be greater with fatty foods such as meats and cheeses than with other foods,” the site adds.
The nutritionists unanimously say, “Before any heating is done, it is safe to look out for materials such as glass and ceramics because they are safe and recommended.”
• Do not use cling film while microwaving because it may melt. In place of cling film, a container that fits well over the plate or bowl are a better alternative.
• Most, if not all takeout containers (foil containers) or jars that hold yoghurt, and foods such as mayonnaise, and mustard are not safe to use in microwaves.
• Microwavable takeout trays are meant for one-time use only.
• Never microwave foods in plastic bags got from grocery stores.
Medical school has a long tradition of teaching students that the body is in a constant war with foreign bodies, notably the micro organisms.This type of teaching for a while limits your tactics to the human versus microrganisms. However with time, it dawns on the future doctors that the enemy in most cases is not just these micropic creatures.
The body can too be harmed by the individual himself. I am reminded of an old man who came to the clinic and was told his foot had to be amputed because of tobacco smoking.
He lamented and immediately called his wife home to throw all boxes of cigarettes out. However this could not save his foot. Tobacco is one such example of behaviours that harm the body leading to self destruction.
A list of habits that can harm the body is long and poses a major threat now than ever before. According to the report by the HelpAge Internation, about 30 per cent of deaths is due to non-communicable diseases.Times have really changed and so must we.
Why quit smoking
Tobacco smoking has a lot of documented harmful effects to the health of a human body. According to World Health Organisation (WHO), still about 1.1 billion people smoked tobacco in the year 2015.Since 1964 following the US General’s report on smoking and tobacco use, there have been many successful campaigns to reduce smoking with admirable declines mainly in the west.
Eastern Mediterranean region, Asia and Africa regions have not mimicked the trend and hence a lot of work needs to be done.
In Tanzania today, according to the WHO steps survey, tobacco users account for 15.9 per cent of the population. This number though lower than the average world tobacco use of 20 per cent, still poses a threat to a country like ours whose health system is already constrained.
We are aware of so many ailmensts associated with tobacco use, it affects nearly every organ of the body. The harm of the ciggarettes is related to its more than 600 chemicals in it which when burned rise to around 7000. It’s a vice by all measures.
The diseases associated with cigarette smoking are many and include multiple cancers (lung cancer as number one), cardiovascular conditions, chronic obstructive pulmonary diseases, rhemaotid arthritis, Type 2 diabetes and so on. It can also lower one’s immunity, reduce sperm count, affect bone health, increase the risk of cataract and damage maternal health including reducing the birth weight.
From the public health point of view, cigarette smoking should be discouraged by all means possible and safeguard especially those that don’t smoke but suffer from smokers.
There are multiple ways to quit, from nicotine replacement methods (patches, gums, lorengez and inhalers) to exrecise.
Smoking cessation can be a challenge due to its social dimension. In some societies, those who smoke are the cool ones and in some like in China, carries respect. It’s therefore important to consider this when providing treatment for those who wish to quit. Currently in Tanzania, there are treatment centres for quitters.
The treatment is mainly psycho therapy aimed at helping the individual change certain behaviours that put him or her at risk of smoking.
The good news about quitting smoking is that one begins to enjoy the benefits immediately. For example for cardiovascular risk, after a year of quitting smoking, the risk for heart attack drops sharply.Between 2 to 5 years a quitter’s risk for stroke will be the same as that of a non-smoker.
For the cancer of the mouth, throat, oesophagus and bladder, the risk drop by a half within 5 years. After 10 years without cigarette smoking, one’s risk of dying from lung cancer is cut by a half. As the date to commomerate ‘world no tobbaco day’ nears, we should remind each other of this vice which can be detrimental to one’s wellbeing.
Campaigns should not give up and non-smokers should be given incentives like lowering their health premiums.
Our manufactures should be reminded to reduce the nicotine content and put those visible warnings signs in every pack of cigarette.Health is wealth and it is never too late for one to quit smoking.
Seven years ago, my first born refused to breastfeed. I opted to pump because I could not imagine giving her anything other than breastmilk. So for the next seven months, I pumped milk for her. What made it even more difficult was that she took only a little milk and her weight was alarmingly low.
Luckily, my second born was able to breastfeed and had healthy weight. Not only did he blossom but his eating habits have remained good.
Breast milk also changes according to the baby’s needs such as age, the time of day and even during a given feeding. According to psmag.com, the fat concentration of expressed milk increases with the baby’s age in the same way that breast-fed milk does. But if mothers do not pump for long enough at each session, their infants may receive predominantly fore milk (which is high in carbohydrates) and not enough hind milk (which is high in fat).
Feeding on demand
During antenatal classes, mothers-to-be are advised to feed on demand, but that is difficult when feeding a baby on pumped milk.
Sr Victoria Elizabeth, a senior midwife at Paragon Hospital, says: “Milk production is produced on the basis of demand. Feeding a baby on demand at the breast rather than pumping to a schedule can encourage a continuing milk supply, and ensure a long and healthy feeding relationship.”
However, Eve Nabaggala who did not breastfeed her child could not control how much milk her child consumed. “She barely took 25ml in one feeding in the first three months and only increased to 50ml in the fourth month. It was disheartening because while I had plenty of milk, she had refused to breastfeed and her weight was described as unhealthy during the hospital visits,” she says.
A lot goes on while a mother breastfeeds their child. From the soothing touches, a few pecks as well as noticing anything that might be amiss. But that was never Christine Namale’s experience.
“Failure to breastfeed my child was a present pain, so I never enjoyed bottle feeding her in as much as it was breastmilk. I guess it also affected the bonding process because all I cared for was to ensure she fed. Looking back, I wish I would have done better.”
Medics also say that the skin-to-skin contact during breastfeeding promotes relaxation and helps mother and child learn a lot about each other.
Nancy Namara is thankful for the skin-to-skin contact owing to breastfeeding because without it, she would never have realised that her child was developing jaundice.
“In the first few days from hospital while breastfeeding my child, I noticed a yellowish shade on her skin. I would never have noticed it if it was not for the close contact during breastfeeding,” she says.
Benefits of pumping
That said, pumping milk also has its benefits. Caregivers control pumping time to a schedule that works for them. That way, milk does not flow uninhibited. Besides that, they are also able to return to work, more so in places where a nursing room is not provided.
That helps put a mother at rest that her baby will still have food while she is at work.
Shared feeding responsibility is possible, only when the baby is feeding on pumped milk. That is unlike when the baby is breastfeeding where only the mother is responsible for the many times the baby needs to feed, even in the wee hours of the morning.
Sharing the responsibility helps the mother not to feel overwhelmed and creates convenience as the mother can be allowed time to rest.
Old habits die hard, so the saying goes – but for 40-year-old Allan Mwamba*, it was different. Allan has smoked since he was a teenager but after a number of failed attempts, he’s now been able to avoid having a cigarette for over four years now.
Allan says that it is possible to kick off the habit for good if one puts their mind to it.
Allan as he talks to Your Health says the first time he ever tried a cigarette was back in 1995 when he was in his Advanced-levels.
He used to be a renowned footballer in Dar es Salaam back in the days but one fine day he met with a leg injury that restricted him from playing football or do any sort of exercises.
Football was his life, as he says. “I got almost depressed and stressed of being unable to go on the ground and that’s when the bad habits kicked in, you know, drinking and smoking because you are so idle,” Allan says that it was the stress of not able to play football that led him to take his first puff.
When Allan began work in the media industry after five years, his purchasing power grew bigger.
Smoking grew from a mere habit to a style statement for Allan. That means the number of cigarettes that he smoked grew from 2-3 to almost 11-14 cigarettes a day. “You know smoking was stylish for me back then and there were triggers where I craved a cigarette such as coffee in the morning, break time, after a meal, beer in the evening and smoking also helped me to fit in unfamiliar new work places,” Allan confesses.
First trigger to quit: Warning label
Allan could smoke more than 10 cigarettes per day. With his nature of work, Allan used to travel a lot across Africa.
It was in Egypt during a work tour where the thought of quitting smoking popped for the first time in his mind. “When I was in Cairo, I went out to buy a packet of cigarettes. But what really disturbed me was the graphics on the pack of cigarettes,” Allan says.
On the packet of cigarette, there was a loud display of warning sign that was illustrated graphically on how smoking may be harming your body, as Allan says. “I was repulsed and disgusted to see those images of rotten parts of the body displayed on the packet and I took back that image in my mind home,” Allan adds.
Experts say that the goals of such labels is to inform consumers about the risks of smoking, encouraging quitting among smokers, and preventing others from ever starting.
World Health Organisation reports that health warning labels on tobacco products constitute the most cost-effective tool for educating smokers and non-smokers alike about the health risks of tobacco use. In many countries, more smokers report getting information about the health risks of smoking from warning labels than any other source except television. Just like the case with Allan.
Cigarette packages in most countries carry a health warning; however, the position, size and general strength of these warnings vary considerably across jurisdictions.
In Tanzania, the type of warnings on cigarette packs are text warnings/messages that cover only 30 per cent of the packet, both front and back.
Section 6 of the Tobacco Products Act (TPA) states: “No person shall sell tobacco products unless the packet containing it displays in the prescribed form and manner such information as stipulated in the Second Schedule to this Act.” The Second Schedule requires that any one of ten text-only health messages “shall be displayed in Kiswahili and English on every packet of cigarettes or tobacco product.”
Tobacco Control Laws’ online portal reports that although the Tanzanian law meets the minimum requirements of Framework Convention on Tobacco Control (FCTC) Art. 11 with respect to size (at least 30%), to fully align with FCTC Art. 11 and the FCTC Art. 11 Guidelines, the law should require that warnings cover at least 50 per cent of both principal display areas.
In addition, the law or regulations implementing the law should specify rotation of the health messages and require combined picture and text health warnings and messages.
Second attempt to quit: Support
One of Allan’s good friend whom he wishes to keep anonymous was always on his neck to stop smoking. Whenever they both sit down for a coversation or drink, the topic of ‘quitting smoking’ always used to emerge, Allan tells.
“A good friend of mine has always been advising me on quitting smoking. He used to lecture me on the ill effects of smoking by giving real life cases that he has witnessed. But I never used to take him seriously,” Allan says.
He adds, “The day I told him that I want to quit this habit [smoking], I knew I could count on him for not only support but also the push.”
In 2012, Allan tried quitting. But he didn’t go beyond three months. And after several failed attempts, Allan finally quit in 2014.
It has been more than four years that Allan hasn’t touched a cigarette.
“My wife played a big role in helping me quit. She used to have a fun, creative way of challenging me to go without smoking a cigarette for weeks or months, so that is one other thing that really pushed me to quit,” Allan says.
After 24 years, Allan stopped smoking completely. But he is one in a thousands who have decided and strong willingly quit smoking.
Still about 14.1 per cent of all Tanzanians smoke tobacco daily while the product remains to be a major health risk, government statistics show.
There are more than 4000 chemicals in tobacco smoke, of which at least 250 are known to be harmful and more than 50 are known to cause cancer, according to World Health Organisation (WHO).
Ahead of ‘World No Tobacco Day’ that falls on 31 May every year to raise awareness on the harmful and deadly effects of tobacco use and second-hand smoke exposure, anti-tobacco activists and campaigners are urging government to enforce bans on tobacco advertising, promotion and sponsorship at sporting events.
Renowned anti-tobacco activist in Tanzania, Ms Lutgard Kagaruki, was quoted in an interview with The Citizen, “I am very sad! Because I cannot concur with other countries that we are fighting against the use of tobacco products while the country has 10 companies producing different tobacco products and at least 20 cigarette brands.”
She lamented on the existing laws and regulations that are not in line with the WHO Framework Convention on Tobacco Control (WHO FCTC).
The WHO FCTC is the world’s most powerful tool to tackle tobacco’s negative impact on development, insisting on increasing tobacco taxes and prices as effective ways to reduce demand for tobacco by reducing its affordability.
Tobacco kills up to half of its users, WHO reports. More than 8 million of deaths are the result of direct tobacco use while around 1 million are the result of non-smokers being exposed to second-hand smoke and around 80 percent of the world’s 1.1 billion smokers live in low- and middle-income countries. Tobacco is deadly in any form and threatens the lung health of everyone exposed to it, where by, it kills one person every 4 seconds
One of the golden rules to cut the risk of cancer, Dr Chris Peterson, a medical practitioner based in Dar es Salaam says to avoid use of tobacco products, including smoking.
He says, “If you have tried to quit, don’t give up. Eventually something will work.”
Adding, “Lung cancer is one of the deadliest cancers. Since cigarette smoking is the cause of over 90 per cent of lung cancer cases, avoiding smoking or quitting smoking can significantly lower a person’s risk of developing this disease.”
A smoker’s risk of lung cancer is 15 to 25 times more than that of a non-smoker and the risk increases with the number of cigarettes smoked each day and the number of years of smoking. Quitting at any age will significantly lower the risk, Dr Peterson explains.
Life after quitting 24 years of smoking
Almost four years into his nicotine-free life and Allan says he has never felt this good. “Initially, I used to have about three cigarettes per drink. You know these are triggers that bring on the cravings. But I always told myself, if I can sustain going without a cigarette for a week, why not keep going,” he says.
And then, weeks turned into months and months into years.
Allan never experienced extreme withdrawal symptoms because, according to him, he religiously worked out. “I think exercising to a big extent has helped my body accept and that’s why I haven’t really felt ill or weak because of not smoking,” Allan says.
Allan leads a normal busy work routine, exercises at least 30 minutes a day, still enjoys a drink at the bar once in a while, tries to maintain a healthy diet and keeps stress at bay.
Allan advises all those who are trying to quit smoking to put their boxing gloves on and be determined. It is possible, he says.
“Develop mindfulness to deal with cravings and outsmart nicotine. If you become aware of the mind games the ghost of nicotine plays, you have the advantage in overcoming them. Also, think of it as if you are fighting back against the injustice of ‘smoking’, robbing you of good health – and money,” Allan advises.
Going out and enjoying the showers of the season, gorging on great street food, and playing in puddles of water is how many of us wish to be associated with the rains. But all of these come with the risk of exposing ourselves to various germs and viruses, which lead to spending the rest of the season in bed due to sickness.
Rainy season illness in babies also begins to ramp up since their bodies are suddenly exposed to a huge fluctuation in the atmosphere and a considerably larger amount of microorganisms that the body has to fight against.
Ms Bernadetha Lugwisha, 32, from Mabibo, Dar es Salaam narrates to Your Health that her 4-year-old daughter Chanice fell sick at midnight on Wednesday and her body temperature increased to 39.1 degrees celsius, a sign of fever.
Most doctors agree that a normal body temperature for a healthy child is between 97 and 100.4 degrees fahrenheit (36 to 38 degrees celsius).
A child is considered to have fever if his or her body temperature is higher than 38 degrees celsius. High fever usually means more than 39 degrees celsius.
“I gave her paracetamol and the body temperature dropped to 38.9 degrees celsius. But after a few hours later at around 4 am, her body temperature increased up to 39.3 degrees celsius. I had to wait until 7 am in the morning and I took her to the Regency Medical Centre for treatment,” says Bernadetha.
Upon arrival at the hospital, they were received at the Emergency Unit and later instructed to see a paediatrician for further medical examination.
“Her body temperature was still higher, I was very worried. My husband had travelled. I was accompanied to the hospital by a house girl,” she says.
The hospital’s results showed that Chanice had dengue fever and therefore the doctor recommended that she had to be admitted at the hospital for a prolonged medication to treat the fever.
“The hospital charged me Sh60,000 for the medical examination. Then after she was diagnosed with dengue fever, the doctor instructed that she has to take paracetamol to control fever and drink a lot of water at the same time. I thank God, her condition keeps improving, she will be discharged any time soon,” says Bernadetha.
Speaking to Your Health over the telephone last week, Dr Rahim Damji , a Paediatrician at Regency Medical Centre explained that the paracetamol relieves pain, further noting that the medicine also reduces raised body temperature (fever).
He further elaborated that patients can take a dose of paracetamol every 4-6 hours if needed, but cautioned that patients should not take more than four doses in any 24-hour period.
“Drugs like Diclofenac, Ibuprofen and Aspirin are all under the group of NSAIDs (Non-steroidal anti-inflammatory drugs). They all carry antiplatelet benefit hence thinning the blood. During Dengue illness, most of the time the platelet count is low hence the chances of bleeding from the skin and mucous membranes are increased. Hence, taking NSAIDs during that time is prohibited,” Dr Damji further explained.
He added, “Again, dengue fever causes fever and dehydration, hence water is recommended to lower the body temperature and reduce chances of dehydration.”
Causes of dengue
Dengue fever is caused by any one of four types of dengue viruses spread by mosquitoes that thrive in and near human lodgings. When a mosquito bites a person infected with a dengue virus, the virus enters the mosquito. When the infected mosquito then bites another person, the virus enters that person’s bloodstream.
Dr Damji pointed out some key symptoms of the disease including extreme pain in the joints and muscles, swelling of the lymph nodes, weakness, headaches, fever, that can even lead to haemorrhagic bleeding which can be fatal.
In order to curb the spreading of dengue fever, Dr Damji advised people to clean all water containers once a week and scrub the sides well to remove eggs of mosquitoes sticking to the sides.
He further advised people to clean gutters of leaves and debris so that rainwater will not collect as breeding places of mosquitoes.
“I urge people to puncture or cut old tires used as roof support to avoid the accumulation of water. Again, they should collect and dispose of all unusable tin cans, jars, bottles, and other items that can collect and hold water,” advised Dr Damji.
Global burden of dengue
The incidence of dengue has grown dramatically around the world in recent decades. A vast majority of cases are asymptomatic and hence the actual numbers of dengue cases are underreported and many cases are misclassified.
One estimate indicates 390 million dengue infections per year (95 per cent credible interval 284–528 million), of which 96 million (67–136 million) manifest clinically (with any severity of disease).
Another study, of the prevalence of dengue, estimates that 3.9 billion people, in 128 countries, are at risk of infection with dengue viruses.
Member States in three World Health Organisation (WHO) regions regularly report the annual number of cases. The number of cases reported increased from 2.2 million in 2010 to over 3.34 million in 2016. Although the full global burden of the disease is uncertain, the initiation of activities to record all dengue cases partly explains the sharp increase in the number of cases reported in recent years.
In Tanzania, cases of patients being diagnosed with dengue fever in Dar es Salaam have increased by 50.8 per cent in a week, the Chief Medical Officer, Prof Muhammad Kambi revealed during a press conference last week.
He further revealed that the number increased from 1,200 to 1,809 patients recorded in Dar es Salaam alone, citing that so far at least 1,901 patients have been diagnosed with the fever countrywide.
How to prevent other common rainy season diseases
Apart from diseases spread by mosquitoes such as dengue and malaria, the rainy season may bring with it other diseases that endanger the health of children, said Dr Mariam Noorani, Paediatrician and Head of Paediatric Department at Aga Khan Hospital in Dar es Salaam when she spoke to Your Health last week.
She added: “Some of these include water-borne diseases such as diarrheal diseases and hepatitis A, which can be spread by drinking contaminated water. Other diseases include skin conditions especially fungal skin infections which occur if children play in dirty water and infection of open wounds which get contaminated with water.”
Referring to the tips to prevent children from developing the diseases, Dr Noorani advised parents to discourage their children from playing in areas flooded by rainwater and make sure their children always wash hands after contact with rain and flood water.
Again she further advised people to remove collected rain water around the house and make sure children sleep in insecticide-treated bed nets.
“Use of mosquito repellants and long sleeves and trousers to cover children’s arms and legs is also useful. Children should wear closed shoes if they have to walk through puddles of water. If a child has a wound, wash it with clean water and keep it dry,” advised Dr Noorani.
Following the increase of dengue cases in the country, the government last week assured Tanzanians that it embarked on conducting deliberate preventive and treatment measures including distributing medical supplies for testing dengue free of charge with a particular focus on curbing the burden.
“We have ordered 3,000 test kits, of which 200 have already landed in the country, ready for distribution to various hospitals in Dar es Salaam,” revealed Prof Kambi.
As a child, Heri Tungaraza cycled as part of play just like his age-mates at that time. His dad bought him his first bicycle. “It was a foldable one and unlike other bicycles at that time, the brakes of this one were initiated but with a reverse pedal. It was a bicycle from Holland,” 39-year-old Oncologist, Dr Tungaraza recalls.
In his teenage years, he rode occasionally to medical school when he bought himself a mountain bike but he didn’t ride for long.
He resumed cycling when he was in China doing his Masters. “When I was in China, that time the motivation was as part of a workout. And I have not stopped since then,” Dr Tungaraza tells Your Health.
Dr Tungaraza rarely uses cycling as a means of commute because of the many challenges.
“One of them is the lack of changing and shower rooms at work. The other is the bad traffic during peak hours. Since we don’t have cycling lanes in most parts of the city, it becomes dangerous and our motorists don’t respect us as yet,” he says.
However this past week, Dr Tungaraza took his bicycle with him to Morogoro and while there he did use it to go to work and run a few errands and go for dinner 4kms away. “So I mainly cycle for workouts in the morning hours when the traffic is at the minimum,” he says.
His childhood pastime of cycling has now become a habit
Dr Tungaraza mostly cycles with a bunch of cycling enthusiasts. “I have several cycling groups to sweat with over the weekend. I cycle at least once per week and a maximum of three times per week. During the weekend I get the maximum time,” he tells.
Being in the health field himself, Dr Tungaraza explains that the advantages of cycling are many.
The list is long but it does help one stay in shape, keep fit, improve cardiovascular system, lose weight when combined with a proper diet, improve flexibility and muscle strength, increase bone strength, reduce stress and also cycling has been associated with prevention of chronic diseases like heart diseases and cancer.
He adds, “Of course cycling to work or errands means less pollution and cheaper too.”
Which bicycle to opt for?
On suggesting which bicycle to go for, Dr Tungaraza says just like buying a car or anything for that matter one needs to look at his or her needs. There are different types of bicycles but there are two major groups i.e. Mountain bikes and road bikes.
The mountain bikes are those with big tyres and are meant for off-road and any other road. For someone buying a bike for the first time in Tanzania should opt for this.
So they are able to ride almost anywhere at a speed that is safe enough.
The road bikes are for those with need for speed or adrenaline junks. “The things to look for are size (size 26 is preferred), brands (there are many) and of course affordability. Currently in the market we get both new and second hand bikes mostly from Europe and Japan. I have both types to satisfy my thirst for variety,” he explains.
Cycling has improved Dr Tungaraza’s mental wellbeing, as he tells. “Possibly unknowingly, cycling allows me to feel free and wonder around mentally and physically. With the blood gushing to my brain, I am usually at peace and I feel good while on the saddle. Cycling has also enabled me go places that I had never been before here within Dar and that has helped me load my brain with beautiful moments and respect nature. Good nutrition for the brain indeed,” Dr Tungaraza explains.
The roads are not very safe and friendly for cyclists in Dar es Salaam. Most main roads don’t have cycling lanes. “The Morogoro road was well constructed, it does have bike lanes and that’s the real meaning of inclusiveness. In fact, if we want people to fight off diseases such as the non-communicable diseases, we should have more cycling lanes on our roads to encourage people to cycle more and hence be healthy,” Dr Tungaraza advises.
Currently morning hours remain the best times to ride and a few areas like University of Dar es Salaam and Masaki are ideal and safer to ride, Dr Tungaraza says. For those who own a mountain bike, there are a lot of trails or off-road routes.
Cycle away from the big C
Cycling does cut cancer risks Evidence has linked more specifically colon and breast cancer to cycling. If one cycles, the risks of getting these cancer goes down.
“With cycling your anticipated weight loss will also add value to reducing risk of getting other obesity related cancers,” he explains.
It was way back in the late 1990’s when this little girl of two years suffered with recurrent, productive and wheezy coughs accompanied with fevers every single month. Along with all the cough and cold medications, she was also on antibiotics. She would constantly miss school (play school) for being so sick.
It was only until her mother had the opportunity a year later to have her child properly diagnosed, did she realise that she was actually suffering from asthma. The girl suffered so severely, gasping for breath, that she was constantly rushed to the hospital for nebulisation [a drug delivery device used to administer medication in the form of a mist inhaled into the lungs].
The mother having become sick with worry with the notion that this disease is life threatening, drove her to learn how to beat the asthma symptoms by not only constantly watching her child and realising what is aggravating her attacks but also by gaining knowledge about its control and management.
The child would wake up in the middle of the night coughing up sputum and vomiting. This, was due to the allergic reaction to dust mites (invisible to the naked eye), and although the bed room had no dust the allergen was present. To combat this, the whole room with furniture was cleaned with detol diluted in water. That did the trick said the mother; no more night duties!
Environmental triggers were avoided, and a watch out for what the child ate was kept in check, peanuts, especially were detrimental to the child’s health, causing raspy wheezing and coughing, gasping, and breathlessness.
At the same time the child benefited from vitamin C rich soups and foods, and teas made with honey and sometimes with turmeric and a spot of ginger.
The mother having stumbled across a good paediatrician learnt about the different inhalers, and when to take them.
With all the care, it only took the child another couple of years before she did not ever require to use the nebulizer, and only very seldom uses her inhaler. The child was trained on how to cope with her asthma, to know of her allergens, weather changes that can trigger an attack, and to know her warning signs so she can take her appropriate medication in a timely manner.
So, moms, dads, guardians, teachers, children with asthma having proper medical diagnosis and management can greatly reduce the number of attacks and enjoy life to the fullest! Asthma is not contagious, and it is not a disease to be afraid of, or to run away from. Although asthma cannot be cured, it can be managed and controlled.
Asthma is chronic disease of the lungs caused by swelling and irritation in the lining of the airways. Tightness of the airway muscles along with excess mucus makes breathing difficult.
Asthma is a leading cause of school absenteeism, but by encouraging guardians and school personnel to recognise asthma as a chronic disease requiring ongoing care and management, school attendance can be improved and ultimately asthma will be controlled.
When children’s asthma is managed effectively, they will have minimal or no asthma symptoms and so they can safely participate in all their hobbies and school activities.
Effective management of asthma also prevents symptoms of acute episodes and minimises the amount of medications, and reduces long term lung damage.
A person with asthma may need two types of medications, one a preventer and the other as a bronchodilator.
Asthma treatment does not just end in the hospital, but it is an ongoing process of managing the asthma at home too, to minimise your attacks, know of your ‘warning signs’, avoid environmental triggers and allergens, and know of your action / prevention plan.
As the saying goes – ‘that which cannot be measured, cannot be changed’, you will only have difficulty getting control of your asthma, if you do not monitor your asthma symptoms well.
The author writes from an NGO Sanitas Medical Foundation currently raising asthma awareness.
During the holy month of Ramadan, a healthy adult Muslim fast from dawn until dusk. The fast includes abstaining from drinking, eating, immoral acts and anger. Doing other acts of worship such as prayers, reading the Quran and charity are encouraged. Muslims also believe that Quran was revealed in the holy month of Ramadan.
Fasting is one of the pillars of Islma; there is also a verse in the Quran that prescribe fasting for all Muslims who are mature and healthy enough to fast all day. This month is believed to bring people together and become compassionate to one another; fasting is also seen as a way to be patient and break bad habits.
During this month, those who fast have two main meals; they wake up at dawn to eat a meal called suhoor and break the fast in the evening with the meal referred as Iftar.
Every year during Ramadan, healthcare professionals across the country see hundreds of residents suffering from a condition that only surfaces that month, stomach cramps and bloated bellies.
After more than 14 hours of fasting, it can be tempting to break your fast with enthusiasm, but you could be spoiling your enjoyment and harming your health.
“It is usually because they over eat,” says Pazi Mwinyimvua, a Nutritionist at College of Agricultural Sciences and Fisheries Technology (CoAF), University of Dar es salaam.
Every year, doctors repeat the same advice to those fasting: Break you fast by eating in moderation and gradually.
And every year, the numbers are steady across the hospital network.
Mr Mwinyimvua says when breaking your fast, you are advised to eat healthy by including all groups such as vitamins, carbohydrates, proteins, fats and minerals.“And all that has to be eaten in the right amount,” he says.
What to eat
Mr Mwinyimvua says, “Think of your stomach as a car engine that has been switched off for a long time. When you restart it, you need to give it time to warm up before speeding off. The same applies to the digestive system. It has been dormant for a long period of time and you can’t suddenly overload it with food.”
Nutritionists advice to start breaking fast with a few dates and some soup or porridge followed by a short break, perhaps to pray, before returning to eat more.
It is always advisable to have small, light, frequent and nutritious meals during Iftar, food with natural sugar such as sweet potatoes, pumpkins, cassava are more advisable for Iftar because they are light food and easy to be digested” says Mr Mwinyimvua. “And avoid fatty foods, beverages, juices and syrups with high concentrated sugar that are always served during Ramadan,” he added.
Many vegetables and fruits are high in water content. It is advisable to have them during Iftar to compensate for the water loss during the day.
Suhoor is in many ways the most important meal during Ramadan and prevents nausea and headaches while fasting during the day.
The nutritionist advices to eat heavy food such as foods made from grain, wheat flour, milk and lots of vegetables which means when fasters rise for work, they will have plenty of energy, at least for the start of the day, and not feel queasy from hunger.
“It is best to avoid any salty, processed and canned foods, avoid eating food with too much sugar, oil and salt,” Mr Mwinyimvua says.
For those who suffer from caffeine withdrawals he says, “Decrease the number of caffeine intake a week or two before Ramadan, also it is not advisable to drink tea or coffee because it causes to pee many times, which may result to dehydration”.
Skip the gym
Health experts advise people not to use fasting as a means to diet and reduce their weight by additional workouts. The body is already fatigued and this is not the purpose of fasting.
Sleep is also of particular importance if an individual wants to keep their energy levels up while fasting.
This can be challenging when Ramadan tents and entertainment run into the early hours of the morning.
“Managing our sleeping hours is the most difficult area but is also very important. If you don’t get enough sleep and in addition to fasting, then you will be unable to focus at work,” Mr Mwinyimvua says.
Mr Mwinyimvua recommends sleeping after Iftar until about 11pm or midnight, and then after suhoor.
After suhoor they can sleep again for a few hours before heading to work so that in total you would have slept around six to seven hours.”
Many people worry about their weight at some point during their life. Maybe you have struggled with your weight going up and down for years, or perhaps it increased following a difficult time in your life.
If you are overweight or obese, you are not alone – according to the World Health Organisation, around 1.9 billion adults worldwide are overweight or obese. But being overweight or obese can increase your risk of developing type 2 diabetes, heart disease and high blood pressure.
Not only that, it is also linked to developing cancer and can cause joint problems and back pain. It can even be responsible for causing trouble sleeping and low self-esteem.
The World Health Organisation (WHO) advises that in order to become healthy, one is supposed to do light exercises for at least 150 minutes per week, meaning spending 30 minutes in five days of the week.
However, we need to ask ourselves, how many people who do exercises know about health advantages?
For 27-year-old Mpoki Thomson, being active is an important part of losing weight and keeping it off. He says the more active he is, the more calories he burns up, which makes it easier to lose weight.
Due to poor eating habits, Mr Thomson started gaining a lot of weight. So in 2012, he decided to start exercising in order to maintain a balance between his choices of food and eating preferences.
“In the long run I had to watch my diet as well. I came to learn that you can’t have your cake and eat it too. You can’t exercise and continue on a bad diet, it is counterproductive,” Mr Thomson tells Your Health.
He started with light weights just to adjust his body to the new changes, but soon after, Mr Thomson advanced to heavy weights to build strength and because he had a lot of fats that needed to be dealt with. “Endurance was key in order for my body to adapt,” he says.
Mr Thomson lost about 15 kilogrammes and since then he has built a discipline in terms of his schedule to maintain his required weight. He says, “I exercise 5 days a week. I mostly rest on weekends. Or sometimes I workout from Monday to Wednesday, rest on Thursday, then workout Friday/Saturday, rest on Sunday again.”
Mr Thomson reveals that ever since he embarked on the discipline of working out, most aspect of his lifestyle have changed for the better, both physically and mentally.
“Physically, my body started changing fast. For a guy who was on the road to being fat, when I started exercising and lifting heavy weights, within a short period of time my body started transforming. Mentally, my mindset became more conscious on my choice of lifestyle, I became more cautious on my eating habits and other indulgences that might be considered unhealthy,” he says.
But with exercising, Mr Thomson had to deal with stretch marks. “Your skin stretches a lot trying to accommodate the gained muscle, there is a risk of developing stretch marks, that’s one of the issues I’ve had to deal with over the years. So you can find a lot of bulky guys with stretch marks on their upper chests and arms,” Mr Thomson reveals.
You can make it easier to achieve your daily exercise target by building activity into your everyday life and not always seeing it as something extra to fit in, which we term it as light exercises. Walking slowly, cooking, vacuuming, gardening, dusting and golfing using a cart to travel between tees are all types of light exercise.
Walking more is a good way of doing this and also does not cost anything. Try walking to the shops instead of driving or taking the stairs instead of the lift.
It is important that you reduce the amount of time you spend sitting still. Watching TV, driving, playing on the computer or sitting at a desk burn up very few calories. Combine aerobic training that burns fat, such as running, with resistance exercise such as weight training that builds muscle.
According to the World Health Organization, men with a waist measurement of 102 cm (40 inches) or more, and women with a waist measurement of 88 cm (34.5 inches) or more, have the greatest risk to their health.
These guidelines may vary from country to country.
Dr Shita Samwel, a general physician based in Dar es Salaam tells Your Health on the 25 health advantages of doing light exercises when you make it part of your daily life.
1. Protects you against non-communicable diseases
Doing regular exercises helps you reduce the risk of being attacked by non-communicable diseases including heart-related illnesses like stroke, cancer and diabetes. Doing exercises also helps you to have healthy heart and well workable blood systems.
2. Controls obese and excessive body weight
Obesity is a risky sign of making you get different types of non-communicable diseases, but by doing exercises your body parts will get activated, accumulated fat in your body will also get burned and finally controlling your excess body weight.
3. Lowers high blood pressure
Doing exercise helps make your heart and blood vessels become healthy as it also contributes to bringing down your high blood pressure, which is a silent killer.
4. Strengthens respiratory system
Exercises such as walking, jogging and swimming helps make your body muscles work efficiently by increasing oxygen flow in your lungs that directly removes carbondioxide from the body.
5. Improves food system
Physical exercises helps you build an appetite. It helps food to be digested, absorbed and easily removed from the body hence avoid the problems of stomach gas and constipation.
6. Reduces the risk of succumbing to cancer
Studies show that those who do physical exercises have the little danger of suffering from breast, rectum and lung cancers compared to those who do not.
7. Controls bad cholesterol
Cholesterol is that fat stored within the blood vessels. So, physical exercises reduce a quantity of bad cholesterol and instead increase a volume of good cholesterol that has an advantage for the body.
Bad cholesterol normally destroys the blood vessels including the heart. So, controlling it reduces the risk of getting a heart attack and stroke.
8. Firm protection against illnesses
The more you do an exercise the more you avoid the danger of suffering from different diseases. This is because exercising makes you have a strong protection against contracting viruses.
9. Strong muscles
Physical exercises strengthens your muscles and makes you become much stronger and enables you to withstand difficult circumstances.
10. Lightens body joints
They help lighten body joints to enable you to quickly and efficiently do different physical jobs without easily picking injuries.
11. Strong bones
Exercises help you have strong and well-built bones that enable you to have a reduced risk of having a bone disease, which is medically known as osteoporosis. It is a disease that makes bones crumble.
13. Calmness and sound sleep
Exercises contribute to making you have bodily calmness and sound sleep, which has an advantage for the body including correcting different bodily malfunctions and building a strong immunity.
14. Improves mental health
A chemical known as endorphin, which is produced during a physical exercises, causes the body to have a good feeling of happiness.
Likewise, exercising helps you dispel a negative feeling including fear and depression. It also makes you feel a new person, who becomes much keener and more confident.
15. Makes you avoid bad habits
Exercising regularly helps you get used to it hence making you avoid temptations and bad habits such as using tobacco, binge eating, excessive drinking and adultery.
16. Gives-off poisonous body waste and protecting body temperature
When you exercise, you will give off sweat profusely including poisonous waste and water, which is accompanied by excess temperature. So, exercising will help protect your temperature inside your body.
17. Improves skin health
It makes your skin clean and healthy. Likewise, bulging muscles make your skin stretchy and clear.
This is why those who do exercises usually seem to be healthy and who do not get old.
18. Makes you thirsty for water
When you exercise, your heart rate speeds up and your muscles work faster. These actions create a lot of heat in your body.
To cool yourself off, you begin to sweat, which causes water and salts from your body to seep out of your pores. Hence, you need to drink water in order to replace the lost fluids.
Drinking water helps replace water and salt wasted through sweating during an exercise hence making you continue to have a good blood circulation in your body.
19. Removes fatigue and pain
Fatigue causes the body’s pain feelings. So, exercising helps to discharge accumulation of Lactic Acid, which causes fatigue, pain, strain and inflammatory muscles.
Not only that, but also exercising reduces pain during the menstruation period in women.
20. Strengthens relationships
Exercises also increase muscle firmness including those muscles of the waist back that increases efficiency during sex by both partners hence strengthening relationships.
21. Treats virility in men
Exercising helps increase virility, controls excess obesity, helps smooth blood flow in the manhood muscles and dispels fear of making sex.
22. More firmness and strength to pregnant woman
Exercises help the pregnant women to prepare their waist muscles and hips to expand well so to enable her deliver safely.
Not only that, but also exercises enable the pregnant woman to have endurance and strength to push the baby during delivery.
23. Improves mental ability
It helps improve study ability, memory capacity and keenness. This is because exercises strengthen the consciousness system and that of the brain.
24. Reduces the risk of sudden death
Those who do exercises reduce the risk of succumbing to sudden deaths as the exercises also make you avoid having heart-related and blood vessel diseases.
25. Live a long life
Generally, all the above advantages and others contribute to making those who practise to have good health and ultimately living a long life because they are free from diseases.
Additional information from Daily Nation.
Last Sunday, my daughter who turned 1 year and four months developed a mild fever around noon. She had just recovered from an ear infection and I began to think ‘maybe it was never over’.
By 3pm the fever rose and I had to administer paracetamol syrup for the fever to subside. By evening she began scratching the area around her ankles and elbows. Since she has eczema and scratching is quite normal for her, I ignored the sign.
Mild fever was the first sign. After the fever, she developed painful red blisters in her mouth, red or fluid filled blisters on arms and legs, loss of appetite, a sore throat and mouth, she was generally feeling tired and was very irritated. We all assumed it was chicken pox.
We took her to the hospital the same evening and upon examination, her paediatrician diagnosed her condition with what is called hand, foot and mouth disease (HFMD).
Her paediatrician told us that HFMD is a common viral illness that he has seen a lot of cases in Dar es Salaam lately and unfortunately there is no specific treatment. She was prescribed paracetamol syrup for fever and calamine lotion to soothe her blister-like bumps.
My daughter’s paediatrician warned me that HFMD is very contagious and the symptoms can get worse in the first three days before it begins to settle, which can take 7 to 10 days. HFMD is common in children under four years. It spreads easily – your baby can catch it if someone coughs or sneezes near her or from places such as playgroups or from sharing toys.
The bumps and spots gradually spread to the legs, bottom and groin. She was reluctant to eat or drink because the blisters in her mouth got very painful on the second day.
How I took care of her
Usually, baby with HFMD can become very grizzly and hard to settle, but there are things you can do to comfort her and this is what I did as advised by her paediatrician.
Since it hurt for her to swallow anything, I tried offering smaller but more frequent feeds of her usual milk.
I gave her soft, easy-to-eat meals, such as mashed potato or soup - nothing spicy or tart, as this could sting her mouth.
I gave her water or cold juice to sip every now and then for her to stay hydrated.
Infant paracetamol helped to relieve her pain and reduce her fever. Consult your physician on the dosage according to her age.
After a bath, I would pat her dry, as the affected areas of her skin were tender. I was also advised to trim her nails because scratching would pop the blister and could further infect other parts.
I also patted the affected areas with calamine lotion to soothe the blistered areas.
Health experts say that HFMD can’t be treated with antibiotics, because it’s a virus. It just needs to run its course, however miserable it is for your baby and you.
Sometimes, though, HFMD causes problems that do need a doctor’s advice. Take her to the doctor if you spot these signs:
• Tearless crying
• Drier nappies than usual
• Dark yellow wee
• Cold hands and feet
Keep an eye on your baby’s temperature too. Take her to the doctor if:
• Her fever doesn’t improve.
• She is under three months old and has a temperature of 38 degrees C or above.
• She is between three months and six months old and has a temperature of 39 degrees C or above.
According to kidshealth.com’s health experts, frequent hand washing helps decrease the chance of spreading the infection. This is because the virus is found in poo, blisters and saliva, and from a runny nose.
Take special care to wash hands:
• After using the toilet
• When changing nappies (the virus can be found in poo for several weeks)
• When handling objects and toys which children hold or put in their mouths.
Keep your child at home if they are unwell or have blisters. It is important that your child does not go back to childcare or school until all the blisters have dried. Staying away from others who have the disease, cleaning/not sharing toys during the infection also helps prevent spread of the disease.
The debate on the ideal length of time for children to spend in front of a TV screen continues to rage generating more heat than light.
At the end of the day the ultimate responsibility as to what is best for the child must rest with parents — no other authority can take over the role.
That said, there is evidence that time spent in front of a TV screen without much physical activity is not good for children.
Former US First Lady Michelle Obama led a campaign against obesity in children and in her autobiography, Becoming, she tells the story of her efforts to change children’s lifestyles.
These strategies included eating more vegetables and less junk.
To this end she dug up part of the White House lawn to grow vegetables! She also held strong views on physical activity for children, including limiting time they spent with electronic gadgets.
A few sobering facts might help shed more light.
Studies show that every two hours of watching TV leads to 23 per cent increased risk of obesity in women.
The same number of hours of watching TV increases the risk of diabetes by 14 per cent.
This means that excessive TV watching is harmful to your health. In a 2001 study published in the North American Paediatric Journal, the authors demonstrated the harm of watching TV in children.
In their conclusion, watching TV leads to obesity through a number of ways. The first and most obvious is the fact that children do not burn any calories as they sit fiddling with the remote control all day long.
By nature, children are meant to play. Whether one looks at humans, monkeys, lions or hyenas, the young of all these animals are in constant play.
Television is the unnatural intruder since it slows down physical activity in children.
It is impossible to see obese antelopes or lions at the Maasai Mara because they play a lot.
In captivity, however, many animals become obese, just like children who do not play and instead rely too much on electronic gadgets.
Beyond reduced activity, children eat more (junk) food while inactive. This happens for two reasons.
The first is the reality that the fridge is near and any left overs are easy to get to.
A child playing outside the home has less access to snacks than one who is inside the house. Any visual cues of food near them is a sign to eat, be it a biscuit or cake, left lying around. Sadly, the more the child eats the more he has to eat. Manufacturers of junk food and drinks are aware of this and insert food and drink adverts on the screen to “remind” children to eat and drink.
The third and less obvious reason is that as a child watches TV or something on the phone he is less conscious of what is going on in the body.
Some children regularly wet themselves as they watch cartoons. Engrossed on the screen, the child is unaware of the fullness of the bladder and only becomes aware of it when it is too late to rush to the toilet.
In a similar way, a child eating while watching TV is unaware of the sensation of being full. He eats in a mechanical way and keeps on eating even as the body tells him to stop.
What I have said about childhood obesity above will apply to speech development in your five-year-old.
Speech develops in a social context and the more a child interacts with adults and other children the more vocabulary they learn. In this regard, I suggest that you take your neighbour seriously.
The article was first published in The Business Daily.
The author is a mental health consultant who has authored several scientific papers and books.
Victor Mwibese, 22, a third-year student at St Magdalene School of Nursing and Midwifery in Kagera narrates to Your Health his passion and commitment to work in rural health facilities and assist in reducing maternal deaths in women and children.
He believes that modern health methodologies that he will acquire after completing his nursing course will enable him to handle complex complications related to delivery more precisely.
Mwibese’s major concern is about a critical shortage of skilled maternal health services providers which he himself perceives it as a driving factor attributing to maternal deaths burden in the Lake Zone and other parts of the country.
“Ignorance and lack of education on reproductive health among some nurses and midwives particularly in rural areas, are key factors that attribute to maternal deaths,” Mwibese tells Your Health during an interview.
As a young and inexperienced health professional, Mwibese uses his holidays to work at a health facility in his village in assisting the maternal health services providers to handle deliveries and complex complications that endanger the life of both mother and unborn child.
“The problem is that we (young nurses) sometimes face difficulties to work with senior nurses in the facilities because they don’t trust our capacities to handle maternal matters just because we are still learning,” says Mwibese.
Backing up Mwibese’s arguments, Grace Mliambate, who is also a third-year student at the school, says the existing shortage of skilled health professionals in rural areas is attributable to a shortage of modern learning equipment in the country, as a consequence, the schools produce incompetent graduates.
“Availability of modern learning equipment is essential in facilitating the acquisition of modern health methodologies among students,” says Mliambate.
Health workforce issues particularly the substantial shortage of maternal health service providers with nursing and midwifery skills jeopardize the government’s efforts to scale up coverage for maternal, new-born and child health. Based on a recent visit to Missenyi District, in Kagera, Your Health interviewed the District Medical Officer (DMO) Dr Hamis Abdallah about the shortage of health professionals.
The DMO confirmed that the district is hit by a critical shortage of health professionals including maternal health services providers.
“Health professionals’ unwillingness to work in unreached areas like islands is another factor attributing to under-staffing in the lake zone particularly in rural areas,” says Dr Abdallah.
According to him, there are 32 islands with a population of over 300,000 people in Missenyi District.
“During the 2017/18, only 12 healthcare providers were distributed to the district. The demand for health services is still high in the district, therefore I call upon the government to distribute more professionals,” says Dr Abdallah.
The existing shortage of health professionals in the district, particularly in the rural, is also contributed by lack of graduates with good competencies to cover the gap, according to the DMO.
Due to the shortage, the Lake Zone that comprises Mwanza, Mara, Kagera, Simiyu, Geita and Shinyanga regions continue to be the country’s part with the greatest burden of maternal ill-health.
According to recent statistics availed by Ministry of Health, Community Development, Gender, Elderly and Children, a total of 1,744 maternal deaths occurred in Tanzania Mainland in 2018.
At least 262 out of the deaths occurred in the Lake Zone, whereby Mwanza region alone recorded 151, becoming the region with the highest number of maternal deaths.
World Health Organisation (WHO) data indicates that the main direct causes of maternal death in Tanzania are haemorrhages, infections, unsafe abortions, hypertensive disorders and obstructed labours.
Henceforth, the availability of skilled health providers particularly midwives, nurses and doctors is critical in assuring high-quality antenatal, delivery, emergency obstetric and post-natal services in the region.
Indeed, the Sustainable Development Goals (SDGs) for maternal health is unlikely to be achieved without attention to the recruitment and retention of health professionals.
In this context, St. Magdalene School of Nursing and Midwifery in Muleba District, Kagera region has embarked on modern methodologies to recruit more young and competent nurses and midwives to deal effectively with the maternal burden in the Zone.
“The causes of maternal mortality and morbidity are well known, and mainly result from the inability of a health system to deal effectively with complications, especially during or shortly after childbirth,” says Renata Scarion, the St. Magdalene School’s Principal.
According to her, the school offers nursing and midwifery education in Diploma and Certificate levels. Currently, the school has registered 142 students pursuing nursing and midwifery education.
The school is among 10 private medical institutions in the region that benefited from the $32 million (equal to Sh70 billion) project dubbed ‘Maternal and Child Survival Programme (MCSP)’ led by Jhpiego in partnership with the health ministry and the Regional Administration and Local Government, funded by the USAID.
The organisation under the project donated lab skills equipment such as Mankins to facilitate learning in medical schools.
The schools also benefited through various training programmes aimed at building capacities of teachers to ensure they effectively equip the students with modern health methodologies related to reproductive health.
Referring to the positive impacts of the project, Ms Scarion reveals that the school performance in providing quality education pertaining to nurse and midwifery has increased from 48-94 per cent.
However, she further reveals that the school is hit by a critical shortage of funding.
“Majority of boys and girls in the region are keen on joining the school, but they are unable to afford the fees. I, therefore, call upon the donors and private institutions to offer scholarships to them,” says Ms Scarion.
Speaking to Your Health, Mr John George, the MCSP project director advised the school management to market itself through social media platforms, radio and television in order to increase enrollment of students.
Meanwhile, Mr George further noted that Jhpiego in collaboration with the government of Canada under ‘More and Better Midwives project’ was determined to continue offering scholarships to young Tanzanians pursing health courses.
Indirect effects of shortages in maternal health care
According to, Ms Placidia Muganguzi, a Reproductive and Child Health (RCH) in charge at the St. Joseph Hospital-Kagondo, in Kagera, an increasing workload within the health facilities due to a shortage of maternal health services providers can affect both the quality and safety of maternal care.
“This is especially relevant for rapidly evolving programmes in reproductive health, HIV/AIDS and tuberculosis, where strategies must be reinvented and re-taught, due to the loss of key personnel and the resulting loss of continuity,” says Ms Muganguzi.
Adding, “Staff may also need to work unpaid overtime to complete work to the level they are satisfied with.”
She further called for health sector reforms and macro-economic development policies to focus on curbing maternal deaths in the country.
When she was two, Maxine Kateregga, now 15 fell ill and started vomiting, feeling constantly thirsty and sleepy. “I also frequently asked my sister for sugary foods and drinks. Being sick and the last born, I guess she gave them to me out of sympathy,” she recollects. Little did her sister know that Kateregga had diabetes.
On her first day in Primary Seven, while waiting for the bus at home, she fainted. She was taken to hospital and after several tests, the doctor said she had ketones and her sugar levels were extremely high.
“I was in that state for a week and was disoriented when I finally woke up. I could not understand why I was in hospital,” Kateregga says adding that this is when the doctors told the family that she had diabetes.
Her life has changed drastically since then, “I never had to worry about my blood sugar but now I take medicine twice daily to control it. I previously ate whatever I wanted but was advised to stop taking sweet things such as candy, chocolate as well as soda,” she says. Katerega was also advised to lose weight lest her condition worsens.
“Although I was not a workout enthusiast, I now make time to either walk or exercise. I have also started playing lawn tennis and I have lost weight. I also eat smaller food portions thrice a day with lots of fruits and vegetables,” she says.
Kateregga adds that with time, she was told that she has Type 2 diabetes and all the changes, though difficult to adopt have helped her manage the disease.
She is thankful for her family’s support because she says she could have cheated or given up but they have been there to the point of adopting healthier lifestyles too.
Although, for the most part, diseases in childhood are similar to those in adults, Dr Sabrina Bakeera-Kitaka, a paediatric and adolescent health specialist, says there are several differences. For example, certain health issues such as precocious puberty, acute nephritis (inflammation of the kidney) are unique and common among children yet infrequent in adults.
Dr Kitaka also points out that some ailments such as gout, and hypertension (high blood pressure of unknown cause) are common in adults and not in children. That said, infectious disorders remain the leading cause of death. Some of these include measles, chicken pox and mumps.
Dr Boniface Ssegujja, a paediatrician at Naalya Children’s Clinic, adds that the prevalence of most of these has been lowered by immunisation. However, society is now grappling with diseases that were predominantly found in adults but now affect children.
Type 2 diabetes
This is when one’s body cannot control blood sugar because either the body is not producing enough insulin or its sensitivity to insulin is low hence being insulin resistant.
Typically, children suffer from Type 1 diabetes because their bodies are not producing insulin.
On the other hand, Type 2 diabetes is where one’s body cannot control blood sugar because either the body is not producing enough insulin or is insulin resistant and was common among adults.
However, lately, several children are suffering from this type of diabetes. Dr Ssegujja says one of the leading causes of Type 2 diabetes is obesity, “Many are severely overweight and one in four obese children will have Type 2 diabetes. This is because obesity increases the chances of a child getting Type 2 diabetes four fold,” he says.
He adds that some of the factors that lead to obesity in children is poor diet where children are fed on high sugar foods such as ice-cream and pastries which are loaded with calories.
“While these calories are meant to give them energy, in excess, they are stored by the body leading to insulin resistance,” Dr Ssegujja explains.
Most children also live sedentary lifestyles where they are drawn to video games and watching TV. However, according the World health Organisation (WHO), children and young people (5-17 years) must engage in physical activity such as sports, chores, recreation, physical education, or planned exercise, in the context of family, school, and community activities.
In order to improve cardiorespiratory and muscular fitness, bone health, and cardiovascular and metabolic health biomarkers, WHO recommends that children accumulate at least 60 minutes of moderate- to vigorous-intensity physical activity daily.
The organisation suggests that most of the daily physical activity should be aerobic while vigorous-intensity activities should be incorporated to strengthen muscle and bone, at least three times per week.
Suppose you wake up one morning feeling tired, with a headache and mild fever. Probably because of your busy schedules at work, you fail to report to the doctor for consultation and you decide to go for a self-prescription at a nearby pharmacy in an attempt to find relief. The medicines show some improvements on that particular day.
Unfortunately, the scenario seems to be the same when you wake up the next morning and you decide to go again to the same pharmacy to get your pain relievers.
It is true that this has been a habit of many of us but have we ever asked ourselves just how inappropriate it may be to use multiple over-the-counter drugs without being medically consulted? What if by doing that we worsen the disease instead of treating it? Or are we really aware, of such a thing called drug dependency?
One of the most common questions that people bombard me with in an effort to solve their medical concerns is; What medication should they take instead of explaining their problem, signs and symptoms.
I want to remind everyone that taking certain tablets cannot always be a wise decision for your health, especially if your medical condition is not an emergency.
Instead, take some time to understand what exactly your medical condition is, understand your body well, listen to symptoms, try at your knowledge to figure out what caused it, and before you take that tablet, seek medical advice from the hospital.
Suppose you thought of taking some tablets for your headache relief, while the doctor finds out, it only requires you to drink enough of water and have some time to rest?
Few days ago, I came across John (not his real name), my patient. When he entered the consultation room, he complained about long history of general body fatigue, loss of appetite, lower back pain and fore headache on and off for almost two weeks that led to fevers.
According to John, he was convinced that it was malaria that was behind his nightmare especially when he found out even several rounds of painkillers were not of any help. “Please doctor, of all the medications you are going to prescribe for me, please don’t forget antimalarial and those for typhoid; I’m sure it might be malaria or typhoid that is bothering me” he insisted.
During our conversation, I came to learn that John had some emotional issues, after he revealed to me about some social challenges that he encountered about a month ago, leaving him depressed, and extremely stressed, and I was sure that was enough to cause his complaints.
But John didn’t pay attention to his psychological issues, he only paid attention to what appeared the side effects of his psychological issues.
Just to remind you my dear reader, if someone is stressed or emotionally unstable, he/she is much more likely to experience a number of complications like, loss of appetite, extreme fatigue, headache, especially fore headache, or even fever just like what John went through.
In this particular case, I was sure that, John, had neither malaria nor typhoid as he claimed. In fact he had no indication for those conditions, even though he kept insisting on treating them. I ordered stress test instead; a medical test that measures the heart’s ability to respond to external stress, to make sure that John’s stress hasn’t affected his heart, causing him any cardiac issue.
Finally, I offered him a psychotherapy and few tablets to control the symptoms of depression, and counselled him on how he can find emotional stability again and reassured him that he is going to be okay with the counselling.
Few days later, John turned up again and this time he was grateful that the counselling he was given was helpful to him since he was able to deal/ treat the psychological issues. John confessed that he was wrong to dwell in his self-diagnosis.
The author is a medical doctor based at Sanitas Hospital in Dar es Salaam.
During the third trimester, an expectant mother is anxious but also happy that they are almost giving birth. The discomfort as you waddle around on your swollen feet, worries about how the labour will go and how healthy your baby is, may make you wish the baby would just pop out.
At this time, many of the worst risks and symptoms you and your baby experience are already over and the long awaited due date is closing in.
It was the same for Allen Nanyanzi, a mother of three. Her first pregnancy was not as bad in the first trimester, she had spotting but it cleared in two days.
Many people had told her about morning sickness but she did not experience it. “Everything apart from the two-day spotting in the second month was normal. I went for my first, second and third antenatal visit and everything was normal,” she says.
In the seventh month, however, Nanyanzi’s feet started swelling. She immediately went to hospital and the doctor told her that her blood pressure had risen. She was given medication to lower the pressure and was put on bed rest. After a week, she was discharged because the pressure was normal.
“After three weeks, the swelling was on again. I heeded the doctor’s advice and went to hospital immediately. I was diagnosed with preeclampsia and was told that the baby had to be removed as soon as my blood pressure was back to normal,” she recalls.
She was given medication but her blood pressure failed to normalise. “I saw doctors run up and down as they tried all means but things failed. I started getting nervous, started sweating because I feared I was going to lose my first born. I asked the doctors to do whatever they could to save it,” she says. By the time the pressure normalised, the baby had stopped moving. “The doctors said it had died. I had induced labour and was told to push normally. This was the worst moment in my life. The thought that I was going through pain for a dead baby made me cry throughout the delivery process. Other women had their babies cry after delivery but mine was dead,” she recalls.
For the subsequent births, Nanyanzi has always gone to hospital for review as soon as she clocks seven months and takes medication to keep her pressure normal.
Like Nanyanzi, many women notice some symptoms during their third trimester and ignore them yet some are fatal for both mother and baby.
Blurred vision, dizziness, headaches
Headaches that often make you feel dizzy and your vision blurry could be symptoms of preeclampsia. They may be accompanied by swollen hands, stomach pain (especially on the right side), and high blood pressure.
Dr Charles Kiggundu, an obstetrician/gynaecologist at Kawempe general hospital, says if it is not treated, a mother with preeclampsia will develop eclampsia, which causes seizures, kidney failure, and the death of mother and baby.
“You will need a variety of medications to bring down your blood pressure, prevent seizures, and improve your liver and kidney function,” Dr Kiggundu says.
After the blood pressure returns to normal, the baby must be delivered as soon as possible. You may need to undergo induced labour or a C-section, depending on how far you are into your third trimester.
Even if you do not have an existing health problem, many doctors recommend a preconception appointment with your health-care provider to ensure you are as healthy as you can be before you become pregnant. At this appointment your doctor may recommend steps you can take to reduce the risk of certain problems.
• Getting at least 400 micrograms of folic acid daily beginning before and continuing through pregnancy.
• Getting proper immunisations.
• Eating a healthy diet and maintaining proper weight.
• Getting regular physical activity, unless advised otherwise by your doctor.
• Avoiding cigarettes, alcohol, and drugs (except for medications approved by your doctor).
See your doctor immediately if you experience the following symptoms:
• Unusual discharge
• Baby stops moving
Swollen ankles and swollen feet are common and usually not cause for concern, particularly if you have been standing or walking a lot.
Sometimes you end up with swollen feet due to host of external factors such as injuries or nature of your work.
Our feet are probably one of the hardest working parts of our bodies, supporting our body weight and letting us, walk, run, working cooperatively as a team, which adds up a lot of wear and tear.
That is why no wonder a number of patients come to me complaining of swollen feet.
Like I said, injuries, body inactivity, tiredness, or sometimes the type of shoes which are worn can cause feet to swell, and we always offer counselling to patients with swollen feet when they seem to have some of these causes.
Is swollen feet something to worry?
A lot of patients ask me this question. In many cases, swollen feet can be worrisome, but majority of people always do not take it as serious as it may be, which eventually put them in major health concerns.
In this article therefore, I want to highlight just how swollen feet can be a warning from major hidden health concerns, especially when there is so much swelling that it leaves an indentation if you press your finger into it.
1. Heart failure
Swollen feet can be a sign of the heart failure. You may not believe it, but swollen feet and heart failure are highly connected. Heart failure doesn’t mean your heart stops working suddenly, just that, your heart can’t pump enough blood.
This means, blood backs up in the vein, leading to form fluid. This happens especially when the right side of the heart fails to function, which causes the body to retain salt and water resulting in swollen feet.
I therefore, urge you my readers to pay close attention to symptoms that may dim heart failure.
Apart from swollen feet, associated signs are: shortness of breath particularly when exercising or lying down, rapid heartbeat, weakness, fatigue, rapid weight gain from fluid and loss of appetite.
2. Kidney failure
Swollen feet can also be a sign of kidney failure. Your kidneys are responsible for balancing fluid that is no longer needed out of the system.
When one or both don’t function properly, you might end up with swollen feet, because the unwanted fluids which were to be secreted out by the kidney have looked for somewhere else to settle.
With kidney problems, your body has trouble getting rid of fluids then, that swelling is more marked, and not just in the feet, some people with kidneys issues have swelling on other parts of the body too like their hand and face.
Apart from these, swollen feet can be a sign of other many medical issues as well, liver diseases, unbalanced cholesterol, infections of the bones, lymphedema, and foot injuries just to mention few. Finally, my take-home message is, don’t always make your own diagnosis.
3. Pregnancy complications
Some swelling of the ankles and feet is normal during pregnancy. Sudden or excessive swelling, however, may be a sign of preeclampsia, a serious condition in which high blood pressure and protein in the urine develop after the 20th week of pregnancy.
If you experience severe swelling or swelling accompanied by other symptoms such as abdominal pain, headaches, infrequent urination, nausea and vomiting, or vision changes, call your doctor immediately. With so many potential reasons for swelling, it is important to let your doctor to drill down to the cause, prescribe the treatment you need, and help you get back on your feet, as soon as possible.
The author is the medical doctor at Sanitas hospital.
When 39-year-old Salum Awadhi spotted an artwork on colon cancer signs, he got really worried. He says, “Seven out of the ten signs that were on the artwork was happening to me. I was going through all that.”
Salum decided to go for a check-up the very next day so as to rule out anything worrisome that was already clouding his thoughts.
“Apart from this I have been suffering with other stomach diseases of which I have undergone several surgeries in India. I have to make sure I am okay. It is better to get to know the problem as early as possible before it is too late,” says Salum who was one among the many people who turned up at Ocean Road Cancer Institute (ORCI) in Dar es Salaam during a free colon cancer (saratani ya utumbo mpana) screening last month.
“The other reason why I have come for a check-up is because cancer is part of my family’s history. My grandfather, uncle and aunt died of cancer. That is why I thought it is wise for me to get it checked,” he adds.
It is Salum’s first time checking for colon cancer but has always believed to get his health status checked in case of any warning signs.
What signs to watch out for
A change in your bowel movement/habits is something to take note of, says Dr Maguha Stephano, ORCI Manager for Cancer Screening and Public Education.
The important signs and symptoms of colon cancer include:
• A change in your bowel habits, including diarrhoea or constipation or a change in the consistency of your stool, that lasts longer than four weeks
• Rectal bleeding or blood in your stool
• Persistent abdominal discomfort, such as cramps, gas or pain
• A feeling that your bowel doesn’t empty completely
• Weakness or fatigue
• Unexplained weight loss
Many people with colon cancer experience no symptoms in the early stages of the disease. When symptoms appear, they’ll likely vary, depending on the cancer’s size and location in your large intestine.
World Health Organisation’s 2018 cancer fact sheet reveals that cancer is a leading cause of death worldwide, accounting for an estimated 9.6 million deaths in 2018. Colon cancer is the third most common cancer in the world affecting more than 1.8 million people and causing 862,000 deaths a year.
Is nyama choma culture to blame?
Dr Stephano pointed that the biggest problem with Tanzanians is unhealthy eating and lifestyle. “Excessive eating of red meat, with a lot of oil has proven to be dangerous for our stomach,” he says.
Meat digests very slowly, this causes constipation and when you have constipation, it means the wastes are not removed from the stomach which is bad for the body. Also meat which is cooked by smoke (barbeque and nyama choma) is more dangerous because the smoke contains hydrocarbon, which in a long run can lead to cancer. Also preserved meat like sausages and bacon is bad because of the chemicals that are used.
Other factors that may increase your risk of colon cancer include:
• Older age. The great majority of people diagnosed with colon cancer are older than 50. Colon cancer can occur in younger people, but it occurs much less frequently.
• Inflammatory intestinal conditions. Chronic inflammatory diseases of the colon, such as ulcerative colitis and Crohn’s disease, can increase your risk of colon cancer.
• Family history of colon cancer. You’re more likely to develop colon cancer if you have a parent, sibling or child with the disease. If more than one family member has colon cancer or rectal cancer, your risk is even greater.
• A sedentary lifestyle. If you’re inactive, you’re more likely to develop colon cancer. Getting regular physical activity may reduce your risk of colon cancer.
• Obesity. People who are obese have an increased risk of colon cancer and an increased risk of dying of colon cancer when compared with people considered normal weight.
• Smoking. People who smoke may have an increased risk of colon cancer.
• Alcohol. Heavy use of alcohol increases your risk of colon cancer.
Prevention is better than cure
Dr Stephano advises people to start making lifestyle and dietary changes to reduce the risk of colon cancer.
He says, “Eat a balanced diet that incldues lots of vegetables and fruits. This helps the body produce more immunity to fight and prevent against diseases. Limit oily and smoked foods too.”
Eating high fibre foods such as carrots, banana, broccoli, apples, beetroots and sweet potatoes helps in digestion.
Exercise at least 30 minutes a day. People with an average risk of colon cancer can consider screening beginning at age 50.
But people with an increased risk, such as those with a family history of colon cancer, should consider screening sooner.