Juma Mrashani, a 48-year-old businessman based in Dar es Salaam works almost 16 to 17 hours a day, hustling between his two liquor stores. With his busy, tiring schedule, Mrashani had ticked off his snoring problem of seven years as stress and fatigue.
He never knew snoring was a problem until he fell so sick that he was admitted to Amana Hospital a year ago.
“My wife and other family members have been complaining on the annoying noise I make when I’m asleep. I never took it seriously because it never affected my sleep. The doctors told me to consult an Ear, Nose and Throat (ENT) specialist for a further check-up,” says Mrashani.
Mrashani isn’t the only one in the pool of snorers who think that snoring isn’t an issue. A brief survey done by Your Health reveals that majority of snorers think that snoring is normal and cannot lead to serious health complications. 8 out of 10 people responded saying that snoring is due to fatigue and 2 out of 10 people said they didn’t know.
Why do we snore?
Here’s a wake-up call for Mrashani and his fellow snorers. Snoring is very dangerous and may put you at a greater risk than those who are overweight, smoke or have high cholesterol, reveals Dr Khuzema Rangwala, an ENT Specialist based at Comprehensive Community Based Rehabilitation in Tanzania (CCBRT).
“Don’t ignore snoring, it is a disorder that needs immediate attention,” Dr Rangwala tells Your Health. He explains that snoring is a sound either from the nose or mouth and occurs when breathing system is blocked when one is asleep.
The sound is harsh and can disturb a person sleeping in the same room. Basically, anything that narrows your breathing passages can cause snoring.
“Generally, snoring and obstructive sleep apnea (OSA), are part of other sleeping disorders that are among the silent killers as they can damage every system of body over time,” says Dr Rangwala.
Not everyone who snores has apnea, but it is a key symptom. The difference is that, with obstructive sleep apnea, the snoring is accompanied by pauses where you literally stop breathing because your airway collapses or is blocked.
These pauses, which can last from a few seconds to minutes, are followed by choking, snorting or gasping, Dr Rangwala further explains.
“Most people who snore are not aware of the condition. The condition is often detected by the bed partner who witnesses the symptoms. 60 per cent of people who snore have OSA,” says Dr Rangwala.
According to a research conducted in 2015 titled ‘Prevalence and risk factors for obstructive sleep apnoea in Dar es Salaam, Tanzania’, a total of 1,249 people were involved in the study. Of these, 65.2 per cent were females. Night snoring was reported by 9.3 per cent of the respondents.
The prevalence of OSA was 11.5 per cent (144/1249). OSA was significantly more common among females, the study further revealed.
Poor sleep because of snoring condition that is not being treated in return will end up with several effects including excessive daytime sleeping, morning headaches, irritability, depression, workplace performance impairment etc.
Snoring, according to Dr Rangwala, is caused by different lifestyle factors but obesity seems to me the major reason. Alcohol consumption, allergies and cold also contribute to snoring.
Health consequences of snoring
Untreated snoring can result to threatening conditions like hypertension, diabetes, obesity, stroke, heart diseases and attacks, metabolic syndrome, liver problems etc.
Dr Rangwala says that early screening can prevent serious complications. As soon as one is diagnosed with health problems, a treatment process has to immediately start.
A study done at Henry Ford Hospital in Detroit, researchers have pointed out that ‘Snoring may be early sign of future health risks.’ The study reveals changes in the carotid artery with snorers -- even for those without sleep apnea -- likely due to the trauma and subsequent inflammation caused by the vibrations of snoring.
Obstructive sleep apnea has long been linked to cardiovascular disease, along with a host of other serious health issues.
But the study reveals that the risk for cardiovascular disease may actually begin with snoring, long before it becomes OSA. Until now, there was little evidence in humans to show a similar connection between snoring and cardiovascular risk.
Why Mrashani is still not treated?
Treating snoring depends on the kind of diagnosis. Monitoring your snoring for patterns can often help you pinpoint the reasons why you snore, what makes it worse, and how to go about stopping it.
Mrashani till to date has not been able to treat his condition because of the treatment cost he has to endure.
Upon attending an ENT clinic, Mrashani was asked to go for a specific kind of sleep test/study that cost anything between Sh400,000 to Sh600,000, of which he never went back as he is still struggling to raise enough money to support his treatment as he currently isn’t under any insurance schemes.
Dr Rangwala agrees that treating snoring comes with a cost here in Tanzania. As a way of raising awareness, CCBRT held a free screening camp for snorers. But out of 38 people who attended, only four people came back for further treatment. “One of the drawbacks to treating snoring is the costly tag it comes with it. Majority of the citizens cannot afford and it just paints a challenge in seeking further treatment,” Dr Rangwala explains.
Snoring is generally regarded as a cosmetic issue by health insurance, requiring significant out-of-pocket expenses by patients.
Adding that currently the ‘sleep study’ is only covered by AAR and Jubilee insurance schemes.
What does the treatment entail?
Albert Simeone, 40, started his ENT clinic soon after the screening. As part of his treatment he had to go through sleep test as one of the diagnostic tools for snoring and OSA.
A sleep test is a non-invasive, overnight exam that allows doctors to monitor you while you sleep to see what is happening in your body.
Commenting about the sleep test Dr Rangwala says, it is a test that costs Sh400,000 and requires the patient to spend an entire night at the hospital wearing a sleep test as it is easy to identify the possible disruptions in the pattern of ones sleep.
He says, a sleep study measures things like oxygen levels in your blood through a sensor, and breathing rates, snoring and body movements. The day from your sleep study will usually be taken by a technologist and later evaluated by your doctor.
Simeon went through that test and he is currently waiting for his results to be out for him to start his treatment. Results always determine the levels of damage has been done by snoring. Dr Rwangala says, with treatment there are people who are advised to do some exercise in addition to medication, some will be taken for a surgery while other will require continuous positive airway pressure (cpap) whenever they sleep to support them with breathing.
“The cpap machine is still a new technology in the country. It is not possible to get the machine here. For patients who are advised to use machine, they have to purchase it from Germany,” says Dr Rangwala.
The cpap machine ranges from Sh900,000 to Sh2,200,000 depending on the features of the machine. Dr Rangwala calls health stakeholders to supporting citizens who cannot afford the medical bills find a way that will help people access treatment easily.
“We’re hoping to change that thinking [from insurance to making treatment affordable] by calling upon health stakeholders, including the Ministry of Health, so that patients can get the early treatment they need, before more serious health issues arise,” says Dr Rangwala.
One of the most challenging questions I always face during consultations, is when my patients bombard me on the question ‘what level of alcohol intake is recommended’. My answer usually is, ‘none at all.’
I often feel my patients see me as a miserable spoilsport, always nagging them to give up things they enjoy, especially when it comes to alcohol. But I am a human being too, I know it’s natural to crave for those things. So I tend to take a pragmatic approach along the lines of suggesting that, any amount of alcohol counts.
I have come across various alcohol products written on their labels, “Excessive consumption of alcohol is dangerous to your health, drink responsibly” but my concern is, how much of excessive intake is excessive? Is there such a thing like responsible or irresponsible alcohol consumption? Because what I know is, from the medical point of it, alcohol is alcohol, no matter how little you consume.
Last week, I decided to take this matter on twitter and there, people came with a lot of mixed reactions to it. “Beer and wine manufacturers be like “excessive drinking is harmful to your health” but how much is too much? Don’t come with justifications to make it sound like little levels of alcohol intake is okay. We always make it clear: No alcohol level is safe, I wrote.
People always have different thoughts when it comes to alcohol, as in which type of alcohol product is safe and what is not, what level of it is safe and what level is not? The answers to this debate have been controversial for quite sometime until various researches recently concluded that no alcohol level is medically safe.
We have those who take alcohol occasionally, probably during weekends, we call them moderate drinkers; and those who consume alcohol on regular basis.
Unlike what it was presumed, these two groups share the same risks. One of them replied to my tweet saying, “I only take beer once or twice a week, how can you compare me with someone who takes it everyday, isn’t this crazy doc?”
A study published by the UK-based Lancet Medical Journal early this year titled: ‘Global burden of alcohol’, suggests that even an occasional drink is harmful to health.
The study was carried out by the researchers who investigated the levels of alcohol consumption and health effects in 195 countries including some of the East African countries to work out the common drinking and health risks. It came to a conclusion that even a little amount of alcohol contributes to a number of negative side effects to your health.
Although most guidelines suggest that there are healthy benefits to one or two glasses of an alcohol drink, but the results of this study, showed that the safest level of drinking is none.
What about wine? People also have different views on side effects of wine. The concept that wine do not pose any risk to health, probably comes from misinformation.
Wine, especially red wine has so many health advantages. Red wines are linked in lowering extra body fat, reducing the risks of heart attack and have some nutrients too but the tricky part of it is, people are fooled by the taste and colour of wine and they forget to consider the alcoholic part of.
Almost all types of wine, despite of their taste and colour, have a certain concertation level of alcohol, and that’s where the problem begins.
With the studies concluding that, no alcohol level is safe, we should now put in our minds that even wine is no longer safe than we used to presume. It’s not the wine itself , but that little concentration of alcohol in it.
Alcohol has negative impacts in our well being. It affects how we look, it affects our mental health, mood and memory, it hosts a number of non-communicable diseases which can be fatal. It’s not about how much of it you take, it’s about it.
When I was little, I recall the day my uncle took me to a walk-in clinic for treatment following a 2-day long persistent fever. After all was done, from consultation to lab tests, that guided my doctor to reach into conclusion on what I was diagnosed with, he prescribed medications and directed me and my uncle to the pharmacy window where we could access them.
There by the window, I met this gentleman, with empathic face, waiting to serve us. “Pole sana bwana mdogo, tupo kwa ajili yako kuhakikisha utapona haraka iwezekanavyo” he consoled me, loosely translated as ‘we are here for you to get better’. I said, “Asante sana”.
My uncle then handed over the piece of paper given to us by the doctor, for him to proceed.
After taking a look at my prescription, he realised that something was wrong with my dosage and that it needed to be readjusted according to the strength of that particular medicine.
“The prescription needs to be corrected,” the pharmacist asserted and asked us to take it back to the doctor for confirmation. My uncle reacted negatively to the pharmacist’s response on the basis that how on earth could a doctor do something wrong for the pharmacist to correct it? “No it might be you that is wrong here, may be you don’t understand what the doctor has written. Please don’t waste our time,” said my uncle.
Today, being in the medical field and when I recall this incident, I understand where this professional inequality comes from. Patients and physicians don’t acknowledge the role and importance of pharmacists in our well-being. All they perceive is that pharmacists are just the “common drug sellers” and they tend to make classes between medical professionals especially when it comes to a doctor and pharmacist and that’s why even when the doctor is wrong and the pharmacist is right, they will always believe the former.
One thing everyone needs to know is that pharmacist knows more about drugs than doctors. Your doctor might be your first port of call if you’re ill, but when it comes to what’s actually in the drugs your doctor prescribed, your pharmacist is your go-to person. After all, they spent years in pharmacy school, learning about medicinal chemistry, pathophysiology and pharmacotherapy. Pharmacists have more training and knowledge than doctors on how medications are made into pills, patches, and how medications are absorbed and distributed in the body, metabolised.
And let’s not forget that pharmacists serve as the last double-check before you get home with your medication. They check dosing, strength, directions, and to make sure you’re receiving the right drug. Your pharmacist’s checks to make sure none of your medications interact with each other, which ones to avoid with certain types of foods, and which ones you should take on an empty stomach.
I’ve also come across patients who will ask me how much a drug costs. I honestly have no idea since it depends on so many factors. But your local pharmacist knows the answer. One of the most useful, but a little known secret of pharmacists is they may be able to negotiate with your insurance to minimise cost for patients. This is an important service especially for patients with limited income.
Learn to value your pharmacist. Your doctor can only diagnose you, but for your successful treatment, your pharmacist plays a vital role.
Debates and discussions by health stakeholders on how to reduce maternal mortality and morbidity in Tanzania have been continuing, reflecting at the toll of unsafe abortion and related maternal mortality.
Despite some promising progress recorded so far, reduction of maternal mortality and morbidity in Tanzania is still a challenge. Key findings of the 2015-16 Demographic and Health Survey and Malaria Indicator Survey (TDHS-MIS) shows that the estimated mortality and morbidity rate (MMR) of 556 deaths is “lower” than that recorded in the 2004-05 TDHS (578), but is higher than the ratios reported in the 2010 TDHS (454) and in the 2012 Population and Housing Census (432).
The 2013 research by Tanzania National Institute for Medical Research and Guttmacher Institute shows unsafe abortion accounts for one-quarter of maternal death in Tanzania. According to the research, some 405,000 Tanzanian women performed unsafe abortion in 2013.
About 40 per cent result in complications that require medical treatment and 60 per cent of them do not receive needed medical.
Speaking during her presentation at a recent stakeholders meeting in Dar es Salaam, a representative from the Association of Gynaecologists and Obstetricians of Tanzania (Agota), Dr Belinda Balandya, says maternal mortality and post abortion care is still a challenge as it is the second leading cause of maternal death.
According to Agota, gathered statistics show that the Lake Zone is leading in unsafe abortion cases as 51 out 1,000 women perform unsafe abortion.
Dar es Salaam Regional Medical Officer Yudas Ndugire says it is very important to have stakeholders’ meeting often so as to discuss on how to reduce maternal mortality and morbidity.
He urges health stakeholders and service providers to help in reducing the problem by establishing good communication with their customers and ensure that the society has full information on abortion, understand its effects and ways to reduce abortion cases.
“Discussion like this helps to reduce the effects of maternal mortality in Tanzania,” he adds.
Unsafe abortion is still a critical problem in Tanzania. Despite being criminalized, unsafe abortion is still practiced widely and secretly.
The Penal Code, Chapter 16 of the Laws Principal Legislation [Revised Edition of 2002], Sections 150-152, and 219 criminalises abortion while section 230 gives a slight room only for preservation of the mother’s life if the performance of the operation is reasonable.
The Maputo protocol
Advocate Kelvin Bateyunga from Levee Attorneys, is of the opinion that the law on abortion should give a room for termination of pregnancy in certain circumstances.
“Just imagine if the pregnancy is a result of rape by a close family member. How could the impregnated woman live in peace” says Kelvin.
Kelvin says the current law also does not allow abortion unless is performed to save the life of the mother.
“In that situation, most women and girls would opt for unsafe means to terminate the pregnancy because they know medical doctors will refuse to do abortion,” he says.
He urges relevant authorities to fully comply and implement the Maputo Protocol, especially Article 14, which clearly articulates the reproductive rights of women.
“The Maputo Protocol was the first human rights instrument that explicitly provide for the right to abortion in specific instances, such as rape, incest or in circumstances where the pregnancy endangers the life of the mother,” he says.
On the other hand, the advocate says it is high time health stakeholders to fill the gaps by helping to reduce stigma in post care abortion and save women lives.
Speaking after the discussion, the Regional Coordinator of Women‘s Global Network for Reproductive Right Africa (WGNRR Africa), Nondo Raymond says people have to change and come together to reduce maternal mortality and Morbidity in Tanzania.
A gynaecologist from Sinza - Palestina Hospital in Dar es Salaam, Dr Andreas Mgaya, says policy review as well as amendment of the law to allow abortion in certain circumstances than only to safe mother’s life will provide a smooth way forward in curbing unsafe abortion hence reducing maternal mortality.
“As long as safe abortion will not be fully recognised as a standard health service, then unsafe abortions will continue to cost the lives of hundreds and thousands of our women and girls,” he says.
Losing her seven unborn babies in a row was the most painful experience that Zainabu Issa, currently 43, could endure as a woman who always desired to become a mother.
“It was not easy for me to endure such pain to lose all those babies,” Zainabu narrates to Your Health in an exclusive interview.
Zainabu who is currently a mother of two--living with her husband and children at Mbezi in Dar es Salaam further evokes that the misfortune was attributable to health complications before she was blessed with two children.
“It all started when we lost our first baby, I was six months pregnant, but my husband (Amiri Mohamed) and I thought it was just God’s plan so we didn’t bother seeking for medical assistance,” Zainabu narrates.
After one year, she got pregnant for the second time and a similar disaster happened to her, the baby died before birth.
This time they went to consult a specialist at Magomeni Hospital, and Zainabu was diagnosed with chronic hypertension or high blood pressure— the leading contributor to the global burden of diseases, according to the medical sources.
Doctor’s advice on family planning
The specialist at the hospital had advised her to use contraceptive for a while to prevent another pregnancy until she completed her medication for hypertension.
Due to her health status, she was prescribed to use oral contraceptives-medications that prevent pregnancy.
“I used the pills, but it didn’t work. I still got pregnant for the third time and the child also died in the womb before birth,” Zainabu narrates the sad ordeal.
Zainabu recalls that all her seven previous pregnancies had failed, saying she was giving birth to dead babies—The condition is medically called ‘stillbirth’—defined as the delivery of a baby who has died, the sources indicate.
“My husband was supporting me throughout the difficult time. He kept telling me that we will have babies when the right time comes,” says Zainabu.
Following the persistence of health complications, Zainabu further re-counts that she once consulted a witchdoctor-- suspecting that she could have been bewitched.
“The situation became even worse when I started using traditional medicine. So I had to stop using them,” says Zainabu.
According to an expert in maternal health, Prof Siriel Massawe who doubles as an obstetrician and gynecologist from Muhimbili University of Health and Allied Sciences (Muhas), high blood pressure during pregnancy can be life-threatening to a woman in some cases, noting that if left untreated, the condition can cause harm to both the mother and her infant.
The gynaecologist further demonstrates that high blood pressure may cause reduction of blood flow to the placenta hence the baby receives less oxygen and fewer nutrients from the mother. She adds that the condition can also cause a baby to be born too small or too soon.
“It is true some babies die in the uterus (womb) before they are born (called an intra-uterine fetal death) attributable to high blood pressure. It can happen during the last half of pregnancy or, more rarely, during the labour and birth,” Prof Siriel explains in an interview with Your Health.
Adding: “Seeing a doctor early and often is so important in keeping both a mother and a baby healthy. The condition can only be controlled by medication especially before the woman diagnosed with high blood pressure gets pregnant.”
Other reasons why a baby may die in the womb
The medical sources indicate that the reasons include; how the placenta works, genetic factors, a mum’s health, age and lifestyle, and infection.
Cases of high blood pressure during pregnancy have increased dramatically in Africa, study finds.
A new study titled “The burden of hypertensive disorders of pregnancy in Africa” published in the Journal of Clinical Hypertension (JCH) in March this year, finds an alarming rise in high blood pressure among African women during pregnancy.
The study further demonstrates that Hypertensive disorders in pregnancy (HDP) is a major threat to global health.
According to the study, HDP complicate 5.2 per cent-8.2 per cent of pregnancies globally and are associated with an increased risk of adverse fetal, neonatal, and maternal outcomes including premature delivery, fetal growth restriction, intrauterine death, renal or hepatic failure, haemorrhage, and stroke.
According to the World Health Organisation (WHO), Africa has the highest age-standardised prevalence of hypertension with 46 per cent of adults older than 25 years being affected.
More importantly, previous reports have shown that in Africa where access to antenatal care (ANC) and emergency obstetric care services are limited, HDP are among the top leading causes of maternal and perinatal mortality.
Joy of becoming a mother
Still not losing hope, Zainabu recalls that in 2013, she got pregnant for the eight time, and managed to give birth to a boy--currently six years old.
“For all these years I have been using the medicine to control high blood pressure as prescribed by the doctor,” says Zainabu.
“I gave birth through the operation. It was joyful for all of us,” Zainabu tells.
God kept showering her with blessings as she got the second son who is currently three years old.
“I can’t thank God enough for all that he has done for me. Now I have two sons,” says Zainabu. While her face says it all how she feels blessed and honoured to be called a mother.
“Though, I still continue with medication for high blood pressure. And I thank God, I have been doing well,” says Zainabu.
She opted for contraception
Zainabu and her husband opted contraception to stop further reproducing on the grounds that they feared that she [Zainabu] could face death due to the health complications.
“We discussed and agreed together that she stops pregnancy permanently due to her health status. I was afraid I could lose her if she could keep reproducing, so I had to advise her to undergo the procedure,” says Amiri, Zainabu’s husband.
Therefore, Zainabu narrates that in 2018 she consulted Sarah Simama, a registered nurse at Malamba Mawili Health Centre in Dar es Salaam and received knowledge on family planning.
Later Zainabu had opted to undergo sterilization-- a permanent form of birth control that is extremely effective at preventing pregnancy, the sources say.
“She took me to Mwananyamala Hospital for the procedure. In early days after the procedure, I was experiencing pains, but later the pains disappeared,” narrates Zainabu.
Ms Sarah is among health care providers in Dar es Salaam who have benefited through comprehensive training on family planning under The Challenge Initiative (TCI) Tupange Pamoja project led by Jhpiego.
The project is supported by Bill and Melinda Gates Foundation, which among other main objectives, it serves to scale up effective programs leading to increased use of modern contraceptive methods among all women 15-49 years of age in urban poor areas by working closely with the local governments in Tanga, Arusha, Dar es Salaam and Mwanza.
“The project also focuses on enhancing the capacity of providers and facilities in specific intervention areas of FP or Adolescent and Youth Sexual and Reproductive Health,” says TCI program coordinator Rose Mnzava.
“The expectation is that local governments will show progress in the provision of quality family planning services,” adds Rose.
According to Demographic and Health Survey and Malaria Indicator Survey (2015-2016), total demand for family planning is high in Tanzania. Six in 10 currently married women age 15-49 have a demand for family planning; 39 per cent want to space births, and (22 per cent) want to limit births.
The report further indicates that the contraceptive prevalence rate (CPR) among currently married women in Tanzania is 38 per cent. Most women who are using contraception are using a modern method (32 per cent of currently married women).
In 2012, Tanzania pledged to increase the availability of modern contraception methods at all levels of its health system. With a promise to increase its allocation for family planning commodities from 14 billion to 17 billion by 2020.
Speaking to Your Health, Director of National Reproductive and Child Health Services Programme, Dr Ahmad Makuwani says Tanzania is committed to increasing the availability of modern contraceptive methods at all levels of the health system across the country.
Tanzania joined the world in the commemorating the World Sight Day (WSD) last week themed ‘vision first’. The day is set to focus on global attention on preventing blindness and vision impairment.
In Tanzania, the day brought together different health stakeholders at the Comprehensive Community Based Rehabilitation in Tanzania (CCBRT) hospital in Dar es Salaam.
Dr Cyprian Ntomoka, eye specialist and head of CCBRT eye services says the World Sight Day gives a platform for stakeholders to remind the government, non-government organisations and individuals to participate fully on the efforts to stop vision impairment by making eye services affordable and closer to the people.
Tanzania is one among the countries that joined the Vision 2020 - The Right to Sight, a global initiative for the elimination of avoidable blindness, a joint programme of the World Health Organization (WHO) and the International Agency for the Prevention of Blindness (IAPB).
In Tanzania a lot has to be done to support the availability of eye services as country’s man power is highly affected if serious measures will not be taken, says Dr Ntomoka.
Adding to that he says more than 75 per cent of vision impairment can be stopped only if people were able to get treated before the problem becomes irreversible.
Data from the Tanzania Ophthalmology Society shows that about 1.3 billion people globally are estimated to have vision impairment.
The report further shows that, vision impairment was at 4.58 per cent in 1990. The problem decreased up to 3.37 per cent in 2015.
On the current status of the country, Dr Ntomoka says in Tanzania people with vision impairment reach 1.8 million; that is 3.37 per cent of Tanzanians.
He adds, every age group needs to go for regular eye check-ups but most importantly the vulnerable groups like children, elderly and those with diabetes need to have a regular eye check-up to avoid irreversible problems at a later stage.
According to World Health Organisation (WHO), 2.2 billion people globally have a vision impairment. The WHO resolutions on universal eye health are a global action plan, prevention of avoidable and visual impairment, elimination of avoidable blindness as well as global elimination of blinding trachoma.
Some of the eye problems includes bulging eyes, cataracts, colour blindness, crossed eyes, diabetic macular and cataracts in babies.
Eye care tips
Medlineplus.gov suggests these are things you can do to help keep your eyes healthy and make sure you are seeing your best:
• Eat a healthy, balanced diet. Your diet should include plenty or fruits and vegetables, especially deep yellow and green leafy vegetables. Eating fish high in omega-3 fatty acids, such as salmon, tuna, and halibut can also help your eyes.
• Maintain a healthy weight. Being overweight or having obesity increases your risk of developing diabetes. Having diabetes puts you at higher risk of getting diabetic retinopathy or glaucoma.
• Know your other risk factors. As you get older, you are at higher risk of developing age-related eye diseases and conditions. It is important to know you risk factors because you may be able to lower your risk by changing some behaviors.
• Give your eyes a rest. If you spend a lot of time using a computer, you can forget to blink your eyes and your eyes can get tired. To reduce eyestrain, try the 20-20-20 rule: Every 20 minutes, look away about 20 feet in front of you for 20 seconds.
More than a billion people cannot see well, because they don’t have access to glass
More than a billion people cannot see well, because they don’t have access to glasses. Over 3 out of 4 of the world’s vision impaired are avoidably so what can be done to arrest this unconscionable fact? Arm yourself with your country’s prevalence data and eye health system information and your country’s plans to tackle blindness.
Nowadays, it’s really hard to understand what exactly is inside a student’s or pupil’s school bag. It is as if a student is going for a mountain climb or tour. Back in the days, students carried their books in ‘Sports’ (a simple small bag) or ‘Pundamilia’ a plastic bag as an alternative. Only few of the students were seen with school bags contrary to today where a school bag is a common item.
Well, I’m not against school bags, in fact, they are very useful. They help to keep the books, laptops and other stationaries in a good condition. But my concern is on the size of the school bag and the weight carried by our students/pupils.
The general rule suggests that the weight of the backpack should not exceed ten per cent of the weight of the one who is carrying it. That is if a student weighs 55kgs then 5.5kgs should be the maximum weight of the school bag on his/her back.
Unstable school timetables, lack of proper guidance from teachers as well as parents to students/pupils on how to select books for a particular day and theft cases among students themselves might be the reasons for why our students/pupils exceed the suggested weight as we have been seeing them around.
Size of the school bag might as well influence the weight to be carried since some of the students want to see their school bags fully packed, so the larger the school bag the more the weight that will be carried.
Though easily overlooked, the fact is, carrying an overweight school bag has negative impacts on the health status of a student/pupil. On the long run, which involves lots of years of studying, carrying a heavy school bag is like an unseen punishment.
Students/pupils who carry heavy school bags may distort the natural curves of the middle and lower backs as they are forced to bend forward so as to counteract the effects of the heavy backpacks which are pulling them behind. The process of competing against their heavy backpack reduces their body balance and makes it easier for them to fall.
There is a chance of causing muscle strain and irritation to the spine, joints and the ribcage since all these body parts are striving to carry the heavy load placed on them.
The outcome here is the development of shoulder, neck and back pain.
Sometimes, a pupil may carry the backpack by using one strap as part of giving break to one shoulder, this may end up leaning to one side so as to offset the extra weight and as the result one might develop pain on the back as well. If the straps are a bit narrower, they may lead to muscle fatigue and perhaps nerve damage due to high pressure induced by the narrow straps.
Tips to combat this
Before purchasing a backpack, parent, guardian or student must consider the size of the school bag and the size of the straps (the wider the straps the better).
A well-organised school timetable, which must be adhered by both teachers and students so that only the books and other materials which are needed for that particular day are carried.
Students must be reminded to carry their backpacks by using both straps so as to provide the evenly distribution of backpack’s weight all around the back.
Also involve the use of lockers in school if available so as to avoid unnecessary movement of materials around, in case of other materials like sports’ gears then an extra small bag can be used to keep them and a student/pupil may carry it on the hand whenever they are needed.
Studying is an endless opportunity for everyone and backpack being an inevitable material to enhance smooth learning, then knowing the proper ways to use it can help prevent the possibility of having chronic back pain in the future.
Tanzania, being one among the developing countries in the world, has an astonishing shortage in men-tal healthcare. Access to mental health services is restricted. And this restriction, comes from a variety of factors, from lim-ited healthcare facilities, lack of mental health caretakers, as well as lack of funding and budget.
Compared to 10 years ago there is improvement and a direction to go; you could say ‘from nothing to something’. But still mental health seems to have no priority in all levels of policies. Stigma and marginalising people with a mental health disorder is still rampant. Mental disorders include: depression, bipolar affective disorder, schizophrenia and other psychoses, dementia, intel-lectual disabilities and developmental disorders including autism.
Globally, an estimated 300 million people are affected by depression. More women are affected than men.
According to a mental health report from World Health Organisation (WHO), titled, Mental Health Gap Action Pro-gramme (mhGAP): Scaling up Care for Mental, Neurological and Substance Use Disorders, estimates that 14 per cent of the global burden of disease, measured in disability-adjusted life years (DALYs), can be attributed to mental, neurological and substance use (MNS) disorders.
According to WHO’s Mental health Atlas, Tanzania’s neuropsychiatric disor-ders are estimated to contribute to 5.3 per cent of the global burden of disease. The Atlas also shows that Tanzania has 124 mental health outpatient facilities, with 662 psychiatric beds in general hospitals.
Looking at the high number of people suffering from these disorders, it should be expected that there was a strong system in place to treat these illnesses. But in fact, this is far from the reality. Getting a help for a patient with a mental illness is often an exercise in futility.
As a general practi-tioner, I often see patients with all kinds of diseases. When a patient has a disease where more specialised medical care is needed, I refer the patient to an appropri-ate specialist. But with mental diseases, this is often an impossible feat.It’s understood that people with mental health illness are always stigmatised.
This can be true especially when we tend to neglect or not pay attention to what they are going through. Patients already have a hard time admitting there is a mental problem. People even crack jokes about mental diseases, saying someone is acting schizo-phrenic or something similar.
And people laugh and think it is funny.Apart from it, the lack of mental health-care expertise at all levels still remains a challenge. There is still a general idea that ‘crazy people’ can’t be treated, so why choose psychiatry; better send the ‘crazy ones’ to traditional healers. There are also not many well paid jobs in the sector of psychiatry. There isn’t much involvement from the international sector [non-governmental organisations, for instance] or job opportunities either, like in the HIV/Aids and Malaria sector. There are even examples where even few mental health specialists we have, are now working in other health sectors or even in totally other professions.
A way forwardWe should strengthen the mental health capacity building by training more and more mental health specialists as well as increasing funding on mental health programmes. Tanzania, one of the devel-oping countries, has lowest physician to population ratios: 1.4 healthcare providers (HCPs) per 1000 individuals. And when it comes to mental health, this is even worse, with 0.04 psychiatrists and 0.005 psychologists per 100,000 pop-ulation, and an overall total of 0.3 mental health workers (including psychologists, psychiatrists, nurses, and other mental health providers) per 100,000 population.
Primary healthcare is generally provid-ed through district hospitals, community health centres or dispensaries. Failure to recognise mental disorders as a priority in health policy and funding, stigmatisation of patients, and specialty mental healthcare providers, poor mental health literacy, and a lack of mental health competencies among community based healthcare providers are all additional fac-tors associated with challenges in delivery of mental healthcare to young people.
It’s understood that, majority of the population consists of those aged between 0 and 25years. Due to gradually increas-ing life-expectancy, this group will mature into adulthood, bringing with them a high prevalence of depression resulting in increased pressures for mental healthcare systems that are unable to address current needs.
For this reason, there is a need to address the issue of adolescent depression in Tan-zania as soon as possible and, given the magnitude of the challenge, it should be addressed at the primary healthcare level.
The author is the Medical Doctor based in Dar es Salaam.
Geita. It was around midnight when Atanas Mbuli, 36, a Community Health Worker (CHW) at Buchundwakende village in Geita received a call informing him that there was a pregnant woman at the village who needed urgent medical assistance. “Without further delays, I got off the bed and grabbed my phone and called a doctor at the regional hospital to inform him about the emergency,” narrates Mr Atanas to Your Health.
He adds; “The hospital promised to send an ambulance to the village so as to carry the patient.”
Mr Atanas recalls how he left his home at midnight and headed to the patient’s house to closely follow up the reported case.
After reaching the house, he met Ms Grace Jeremia, 24, laying on the floor, surrounded by her relatives.
He learned that Ms Grace was eight months pregnant and she had experienced upper-right abdominal pain, severe headache and mental status changes—common symptoms of Eclampsia, the medical sources indicate.
A condition occurs in a pregnant woman during a woman’s pregnancy or shortly after giving birth in which one or more seizures occur in a person often followed by coma and posing a threat to the health of mother and baby, says Ms Stella Filbert, a registered nurse at Geita regional hospital.
Mr Atanas recalls that for the second time he called the doctor’s number to confirm whether the ambulance was coming.
“They said the ambulance driver had left the hospital in fifteen minutes ago. So we kept waiting,” says Mr Atanas.
According to him, after a few minutes, the ambulance arrived at the village and Grace was referred to the regional hospital for specialized diagnosis and treatment.
Mr Atanas admits that the referral system in the village had improved following the donation of the mobile phones to the CHWs, dispensaries, health centres and the regional hospital by the Jhpiego.
“Since I have been given the mobile phone, it has been easier for me to communicate with the healthcare providers at the health facilities especially during the emergency situations,” says Mr Atanas.
He says previously, scores of pregnant women at the village lost their lives due to pregnancy-related complications.
“The deaths were caused by the poor referral system attributable to lack of communication,” says the CHW.
The mobile phones were donated by Jhpiego under the USAID Boresha Afya project.
The five-year project is supported by USAID, led by Jhpiego partnering with, PATH, Engender Health and the government of Tanzania.
Among other objectives, the project aimed to increase access to high-quality, comprehensive and integrated health services through a package encompassing reproductive, malaria, maternal, newborn and adolescent health services.
Grace received at the hospital
The doctor and nurses at the hospital received Grace and took her to the emergency department. She underwent diagnosis and the results showed that she had eclampsia.
“The doctors feared that the baby was dead. So they took me to the operating room to remove the baby so as to save my life,” narrates Grace in an interview with Your Health.
Grace further narrates that after a successful operation, they found the baby was still alive.
“I was very happy to become a mother. It is something that I had dreamt of for several years,” says Ms Grace.
Tanzania in the past few years has experienced a substantial reduction in child mortality rates. This decrease can be in part attributed to improved breastfeeding practices and high immunization coverage.
Maternal mortality, on the other hand, has not benefited from trends similar to those of child mortality.
This follows, the maternal deaths in Tanzania, with a ratio of 578 per 100 000, represent 18 percent of all deaths of women age 15-49, according to WHO data.
The main direct causes of maternal death are hemorrhages, infections, unsafe abortions, hypertensive disorders and obstructed labours, the medical sources indicate.
Grace’s married life before becoming a mother
After Grace got married in 2011, she was unable to conceive. She opted to use traditional medicine, but it didn’t work out.
“I later consulted a medical doctor (gynecologist) at the private hospital, but I couldn’t afford the treatment cost that stood at Sh400, 000,” recalls Ms Grace.
She adds: “My colleague at the village advised me to go to the regional hospital for further specialized diagnosis and treatment.”
At the hospital, the results showed that she suffered from fallopian tube damage or blockage that leads to infertility.
“I paid Sh70, 000 as treatment fee. After being prescribed to the prolonged medication, I managed to conceive. I want to have four children,” says Ms Grace.
Maternal deaths in Geita
Dr Michael Mashala, Acting Regional Medical Officer for Geita reveals that the number of maternal deaths has decreased from 80 in 2018 to 36 recorded this year between January and June.
The use of mobile phones in improving referral system
Ms Agnes Ndonde, a registered nurse at the Geita regional hospital who doubles as Assistant Labour Ward in-charge admits through the donated mobile phones, the referral system has improved in the region. Ms Agnes highlights that under the USAID’s project the hospital has also received delivery kits.
“Under the project, we also received comprehensive training on reproductive and child health,” she says.
She adds: “Through the training, we have been able to reduce the number of maternal deaths associated with Eclampsia and PPH.”
According to Ms Agnes, the hospital in 2018, recorded 8 deaths associated with Postpartum bleeding or postpartum hemorrhage (PPH), while this year, only one death has been so far reported.
PPH is often defined as the loss of more than 500 ml or 1,000 ml of blood within the first 24 hours following childbirth, says Ms Agnes.
Symptoms include vaginal bleeding that doesn’t slow or stop, she adds.
According to a study titled ‘Maternal mortality in urban and rural Tanzania’ funded by International Growth Centre (IGC) Tanzania, conducted in August 2018, indicates that the maternal mortality rates (MMRs) in Tanzania have remained stubbornly high over the last decade.
These results have raised concerns from the Government of Tanzania and stakeholders about the reasons for such inconsistencies.
The project further indicates that funding challenges remain, therefore resulting in a heavy reliance on external financing.
The study, among other recommendations, suggests that reducing the delays in mothers receiving treatment is key to reducing MMRs in Tanzania
The untold story of a silent killer, Hepatitis, shows that the disease is known for killing more people than HIV/AIDS. Hepatitis is caused by a viral infection; and because of that it has more striking force than that of HIV. It attacks the liver and can cause both acute and chronic disease.
A study by the Global Burden of Disease shows deaths caused by viral hepatitis have surpassed all chronic infectious diseases including HIV/AIDS, malaria and tuberculosis.
Speaking to Your Health, Dr Zacharia Kabona, says one-third of the world’s population has been affected with 2 people dying each minute from hepatitis - a viral infection that attacks the liver. Dr Kabona says unlike ebola which is mostly concentrated in Central and some parts of West Africa, hepatitis has spread almost in every region of the world.
“Any person can be infected with the virus that causes hepatitis as the disease is transmitted through viral micro organisms, which are found in three concentrations in body fluids,” Dr Kabona explaining to Mwananchi Communications Limited workers during a morning health-talk session on hepatitis B, which was conducted and organised by a team of specialists from AAR Health Care.
“One can be affected through blood, serum, and wound exudates. The second, more moderate means of infection is where by one can be affected through semen, vaginal fluid and saliva and lastly one can be affected hrough urine, feaces, sweat and tears though these pose a lower risk,” he says.
Who is at risk?
Dr Kabona says different people are at the risk of getting the infection. One of the risk factors is through needlestick injury used by infected drug abusers or during infected blood transfusion and hemodialysis.
“For example in the process of cleaning blood a person with hepatitis B (dialysis patient) his/her blood passes from his/her body to the dialysis machine and when another person without hepatitis B virus use the same machine to clean his/her blood he will be transmitted (hemodialysis),” he says.
Another group who at great risk in getting the disease are health workers due to fact that most of the time they touch blood so it’s easy to be infected.
Therefore it is important for health workers to be very careful in performing their daily duties.
Sexual intercourse with an infected partner is another mode of transmission. “Sexual transmission of hepatitis B may occur, particularly in unvaccinated men who have sex with men and heterosexual persons with multiple sex partners,” he says.
The virus can also unfortunately be transmitted from mother to child during birth. Dr Kabona is therefore urging women to visit the antenatal clinic as soon as they discover they are pregnant.
World Health Organisation (WHO) recommends that women start antenatal care at a gestational age of less than 12 weeks – this is referred to as ‘early antenatal care’.
Early antenatal care is a critical opportunity for health providers to deliver care and support, and to give information, to pregnant women in the first trimester of pregnancy, including hepatitis status.
“If they start clinic early they will be vaccinated,” he says.
According to Dr Kabona, hepatitis B virus can survive outside the body for at least 7 days and the virus can still cause infection if it enters the body of a person who is not protected by the vaccine.
Speaking on the symptoms, Dr Kabona says most people with hepatitis B virus (HBV) don’t have any symptoms until is too late. He says patients don’t experience any symptoms when newly infected although the symptoms begin from 60-159 days after exposure to HBV.
“The symptoms and signs include flu, fatigue, abdominal pain, loss of appetite, nausea, vomiting, joint pain and jaundice (yellowing of the skin and eyes). Patients can have either an acute symptomatic disease or an asymptomatic disease. One in four adults with chronic HBV will die from liver cancer or liver cirrhosis,” he says.
According to the WHO, an estimated 257 million people, globally, are living with the hepatitis B virus. There is no specific treatment for acute hepatitis B although chronic hepatitis B infection can be treated with medicines, including oral antiviral agents to help slow the progression of cirrhosis and reduce occurrence of liver cancer.
“All people should go for vaccination while the WHO recommends all infants receive the first dose of the hepatitis B vaccine within 24 hours of birth (often called the “birth dose”) and to then complete the vaccine series at 2 and 6 months.
Cancer is tricky! The moment it shows its symptoms, is probably when it is too late to treat.
This is why we always urge people to visit doctors often, since it helps them with early diagnosis and knowing their risk factors they stand and how they should get rid of them.
Last week, I was involved in free screening camp here in Dar es Salaam, organised by young doctors and health activists.
The camp aimed at providing health education to youth, raising awareness about different ailments to individuals as well as encouraging them to understand their medical status.
Youth were mainly targeted but people with different age groups showed up and we made sure they were all attended to.
Since it’s September, a prostate cancer awareness month, before screening started, I took a chance to educate the mass what exactly they need to know about the disease, which positively influenced them to get prostate cancer screening through a PSA test; a simple blood test that is used to identify initial symptoms, or the possibility of prostate cancer at some point in life, which was one of the screenings we offered during the camp.
Honestly, I was baffled by the fact that almost 24 out of 200 young men at their early 30s to 40s screened, their PSA results were positive.
These numbers are significant. This was only in 200 men, can you imagine what if the campaign was country wise?
In most cases, young men barely expect to be diagnosed with enlarged prostate, but although prostate cancer risks increases with age, this is the case.
Age remains the number one risk factor for prostate cancer, it should be understood that apart from age, there are other risk factors that even people at their youth days may stand.
Knowing these risk factors will help young men to get rid of them before they develop the disease.
Learn about personal risk factors. Like I said earlier, the risk of prostate cancer increases the older you get mostly starting around early 60s.
Another personal risk factor is family history. People who come from families with strong history of prostate issues, stand the high chance of developing the disease. Men who have a father, son, or brother who had prostate cancer are at increased risk for getting prostate cancer.
Men with three or more first-degree relatives (father, son, or brother), or two close relatives on the same side of the family who have had prostate cancer may have a type of prostate cancer caused by genetic changes that are inherited.
If you know you belong to families of this kind, it’s recommended you talk to your doctors for genetic testing to determine your chance of developing prostate cancer due to family factors, especially genetic factors.
By doing this at an early age, it will help you get rid of any chance of the disease.
Recognise the symptoms. There are some symptoms that you can look for that might be caused by prostate cancer.
See your doctor if you experience symptoms such as frequent urination especially at night, weak or interrupted flow of urine, difficulty urinating or straining to start the urine stream, inability to urinate, pain or burning while urinating, blood in the urine or semen, difficulty having an erection, or nagging pain in the back, hips, or pelvis.
These symptoms don’t necessarily mean that you have prostate cancer, but you should see your doctor to get tested for it or other issues.
Remember, the phrase that prostate cancer is ‘old man’s disease’, is nothing but a myth and it should be debunked.
Old men are more likely to develop it, but it is real in young age too. This September you are reminded to visit your doctor to determine your risk factors and get rid of them while you are still young. Don’t wait until it’s too late.
It was a sunny morning at Chipuputa in Mtwara region – a quiet street tucked in South-eastern Tanzania. Almost all the house fronts were filled with trees. Soon as I arrived at the street I saw children in a jolly mood playing outside their houses.
As I stood outside one of the many small houses, Asha Wemba, 37, a mother of five children appeared. She embraced a broad smile while holding her one month old baby boy. She was covered in a blue khanga and her baby in blue clothes and a red baby blanket to protect him from the cold.
Her smile hides the ordeal she went through during her last pregnancy. Asha only visited a health facility in third trimester. Feeling headache and fatigue prompted her to visit Ufukoni dispensary, where she was diagnosed with Malaria but alas she was already eight months pregnant.
She says, upon her arrival at the hospital she was educated on the importance of pregnant women making prompt visits to the hospital soon after finding out they are pregnant. She realised how late it was for her and the health dangers she was most likely to face if the malaria was not treated.
“I will educate other women around me on the importance of going to the hospital soon as they know they are pregnant. I am happy the information I received from the hospital helped me understand why it’s important to go to the clinic soon after a woman knows she is pregnant,” says Wemba.
Thanks to community health worker Esther Mpinyi, who benefited through training by USAID ‘Boresha Afya’ project, Wemba was educated on the importance of attending antenatal clinic.
According to statistics from Regional Medical Offices of Lindi and Mtwara, three years ago the two regions recorded not less than 60 per cent of pregnant women who used to get up to one to two doses of Intermittent preventive treatment in pregnancy (IPTp) . Cases which are similar to Wemba’s were many. Thanks to the USAID Boresha Afya program which has boosted the use of IPTp by over 80 per cent in the two regions respectively.
The program, which aims at addressing health service gaps among 43 Councils in Njombe, Iringa, Morogoro, Lindi, Mtwara and Ruvuma has reduced cases which are similar to Wemba’s as the community is well involved through community awareness programs.
Mtwara Regional Medical Officer, Dr Silvia Mamkwe, says malaria in pregnancy has been found to contribute to maternal deaths. She says early visits to an antenatal clinic enables women to get four doses of Intermittent Preventive Treatment in pregnancy, anti-malarial tablets.
Dr Mamkwe further says that early antenatal clinic visits allow women to get four doses of IPTp’s and prevent maternal and fatal anaemia, low birth weight and placental parasitaemia. Information available from Mtwara RMO shows that, funds from USAID Boresha Afya program has helped the region to conduct quarterly reports which shows out of 9,000 women who delivered in the last quarter, more than 700 women delivered either from home or on their way to the hospital.
As a way of educating the community on the importance of attending antenatal clinics at an early stage, Dr Faustine Rwebogora – the Mtwara Regional Malaria Adviser for USAID Boresha Afya project, says several efforts are being taken, including training health workers on how to handle pregnant women in connection to malaria.
Such efforts to cut down Malaria in pregnant women are wide-spread. The aim is to ensure that women are in the right health status throughout the pregnancy period. In Lindi, such efforts have resulted in a positive outcome as more than 80 per cent of pregnant women are using Sulfadoxine-Pyrimethamine (SP) tablets.
According to the Lindi Regional Medical Officer Dr John Sijaona, from training health workers on the right approach of giving the tablets, to raising awareness among the community on the importance of using the tablets for pregnant women, women are now getting at least to two to three doses of Sulfadoxine-Pyrimethamine (SP) after each trimester.
He says, the tablets are given to prevent pregnant women and their unborn babies against Malaria with the aim of reducing maternal deaths in the country.
“In the past five years, Boresha Afya program has helped Lindi to reduce Malaria prevalence from 17 per cent in 2016 to 12per cent this year,” says Sijaona
Adding to that, he said the program has empowered them [women] to start a programme that shows medication availability in all 247 health centres in Lindi. As a result the health centres never run out of medical stock and women can easily access both medication and treated bed nets.
Dr Living Colman, a gynaecologist based in Dar es Salaam, says pregnant women should be given malaria medication after each trimester to prevent them contracting malaria. He further says women are given the medication at the hospital as a way of monitoring usage.
Lindi Coordinator for Mother and Child Health Care, Zainab Mathradas, says despite facing social barriers when giving pregnant women services, they have managed to involve the entire community on the importance of using SP through outreach programs that happen once a month and pregnant women who cannot reach health facilities are also covered.
“Lack of skilled health personnel in the regions was also a challenge, but the program has helped train health workers on the right ways to deal with a pregnant woman as well as documenting everything after administering the medication,” says Mathradas.
The doctor acknowledged the role played by men in the fight against malaria, advising more involvement from them.
The program is implemented by Deloitte Consulting Limited in various regions: Iringa, Njombe, Morogoro, Lindi, Mtwara and Ruvuma.
On visiting the Lindi Town Health Center, I met Mwanaisha Ally, 39, a mother of four children. She is holding her two-month baby as she waits for a routine check-up. She is among other women who have benefited from the awareness programs on the importance of using IPTp.
“I managed to get four doses of SP when I was pregnant. I am happy that I never got malarial or any other disease during my pregnancy. I advise other women to visit antenatal clinics soon as they know they are pregnant,” says Mwanaisha.
Adding to that she says, through information from health and community workers women are now accessing information through village and street meetings on the importance of using the IPTp. The information reaches the community through community gatherings and door to door visits.
Software to track medication availability at the health centres, training CWH
Bosco Chilongola, a Malaria Coordinator in Lindi Municipal, says three years prior to the commencement of the project, they had no access to far-flung villages, making it impossible for some women to make it to the health centres, as a result they missed the IPTp.
Currently the program has helped them to deliver IPTp in areas which are more than 20 kilometres from the centre through outreach programs. In addition, there is a software that tracks the amount of medication in stock. This helps them know when exactly to take another batch of medication, for how many women and vaccination for children.
“Some areas like Mnali, Ng’apa etc, are not easily accessible. Outreach programs have helped us to meet women and children from these areas. If there is new registration of pregnant women we always get informed before we go there to disperse medication,” says Cholongola.
Commenting on the software, Taiwan Seleman the Regional Health Secretary says apart from training health workers they have introduced a software which allows all medical centres to see how much medication is in stock and it helps them know when it’s the right time for them to supply other medication.
He says, each health centre has been provided with an iPad for them to upload data on medication availability. The information fed on the iPad is very useful in providing insight on where there is shortage and where there is adequate stock.
Dr Godlove Mkumbo, the Project adviser for malaria in Lindi, commenting on the CHWs, says the project has benefited about 260 CHWs in the region by building capacity to health workers to enable them to spread positive information to the citizens on the accessibility of health services.
The survey by the National Bureau of Statistics (NBS) indicates that malaria prevalence rate dropped from 14.4 per cent in 2015 to 7.3 per cent in 2017. According to information from World Health Organization (WHO), Malaria infection during pregnancy is a significant public health problem with substantial risks for the pregnant woman, her fetus, and the newborn child. Malaria-associated maternal illness and low birth weight is mostly the result of Plasmodium falciparum infection and occurs predominantly in Africa.
The symptoms and complications of malaria in pregnancy vary according to malaria transmission intensity in the given geographical area, and the individual’s level of acquired immunity.
Four young new mothers lay on the hospital bed at Shinyanga regional hospital’s maternal ward, sharing a light moment with their new-borns. The nurses are spotted moving from one corner to the other, making sure everything is under control.
The room has large windows to allow natural sunlight and fresh air in. Seated on a bench by the beds in the maternal ward is 57-year-old farmer Njile Chaba with her granddaughter Patricia. Patricia who is 19-months-old suffers from stunting; a form of malnutrition that impairs growth and development that children experience from poor nutrition or sometimes repeated infection.
The maternal ward that Patricia is undergoing treatment at also treats children suffering from tuberculosis (TB), diarrhoea and malnutrition – few among the most common ailments affecting children below 5 years in Tanzania.
But most of the beds at the ward are vacant. “Other patients have been discharged a few days ago. Their condition had improved. Only a few patients have been admitted for further treatment,” says Zainab Juma, an enrolled nurse at the hospital.
The grandmother and granddaughter duo were at the hospital that day to attend their monthly nutrition clinic session.
Speaking to Your Health during a recent visit at the hospital, Ms Chaba says that she doesn’t miss out on these sessions because they have been significant in improving Patricia’s health.
Two months ago, Patricia was abandoned by her mother after her parents decided to separate. “Zawadi [Ms Chaba’s daughter-in-law] brought her daughter to me, but she never came back and I don’t know where she is. Patricia was not in a good condition at all,” Ms Chaba tells.
The grandmother who barely speaks Kiswahili, but fluent in Sukuma—spoken in an area southeast of Lake Victoria between Mwanza, Shinyanga and Lake Eyasi—recalls that back in June this year, when Patricia was brought, she was very weak and malnourished. Ms Chaba sought to seek medical help and that’s when she was referred to Shinyanga Regional Hospital for treatment.
Severe acute malnutrition, or very low weight for one’s height is the most extreme and visible form of undernutrition, and severely impacts child survival and long-term well-being.
In Tanzania, 34 per cent or 3.3 million children under-5 years suffer from chronic malnutrition (stunting or low height-for-age) and 58 per cent or 5.6 million suffer from anaemia as per data from the Tanzania Demographic and Health Survey and Malaria Indicator Survey (TDHS-MIS) 2015-2016.
Ms Chaba further recalls her granddaughter as being “inert” when they had arrived at the regional hospital for the first time. “I didn’t think she would make it,” she adds.
The results at the hospital showed that Patricia suffered from severe malnutrition accompanied by diarrhoea.
“The doctor said my granddaughter was underweight and weak due to undernutrition,” says Ms Chaba.
Ms Nyachiro Mujaya, a registered nurse at Shinyanga regional hospital who attended Patricia when they arrived at the hospital on the first day says Patricia was weighing 5 kilograms--considered very low weight and therefore she prescribed her to eat foods high in energy and nutrients.
“Parents are feeding their babies with dried foods that don’t have enough nutrients, as a result, the babies are completely malnourished,” says Ms Mujaya.
“We normally provide the malnourished babies with milk and nuts, but we first diagnose the stage of their condition. The medication also depends on the baby’s age and weight,” she adds.
It took a few weeks before Patricia began to recover. She is now growing well, currently weighing 7.4 kilograms; however, she is still undergoing treatment for malnutrition at the regional hospital.
Causes of childhood malnutrition
Health experts indicate that inadequate food intake, infections, psychosocial deprivation, the environment (lack of sanitation and hygiene), social inequality and genetics contribute to malnutrition in children.
Ms Mujaya is one among the 55 health providers in the region who have received comprehensive training on malnutrition under the USAID Boresha Afya project aimed at enhancing the providers’ capacities in addressing malnutrition in children.
The project is supported by USAID, led by Jhpiego partnering with, PATH, EngenderHealth and the government of Tanzania to increase access to high-quality, comprehensive and integrated health services through a package encompassing reproductive, malaria, maternal, new-born child and adolescent health services.
“The project is implemented in line with the health ministry’s Integrated Management of Childhood Illness (IMCI) guidelines,” says Dr Suka Charles, regional project coordinator.
Referring to the positive impacts of the project, regional nutrition officer for Shinyanga, Dennis Madeleke, highlights that 450 malnourished children received treatment in the region between January and June this year.
However, he acknowledges that the shortage of therapeutic foods— prepared foods that contain calories, vitamins and minerals for specific nutritional needs -- at the public health facilities is the key challenge, citing that the situation is attributable to the fact that the aforementioned foods are manufactures abroad.
“Prevalence of malnutrition in Shinyanga is still high, hence redoubling of efforts is necessary to curb the burden,” says Mr Madeleke.
The burden of malnutrition is unacceptably high
The 2018 Global Nutrition Report states that the burden of malnutrition across the world remains unacceptably high, and progress unacceptably slow. Malnutrition is responsible for more ill-health than any other cause. Children under five years of age face multiple burdens: 150.8 million are stunted, 50.5 million are wasted and 38.3 million are overweight. Meanwhile, 20 million babies are born of low birth weight each year.
Beyond health, slow progress on malnutrition is also impacting the social and economic development of countries.
It is estimated that malnutrition in all its forms could cost society up to $3.5 trillion per year, with overweight and obesity alone costing $500 billion per year.
The report further states that women have a higher burden than men when it comes to certain forms of malnutrition. “One-third of all women of reproductive age have anaemia and women have a higher prevalence of obesity than men. Millions of women are still underweight,” the report further says.
Progress to date is simply not good enough
Significant steps are being made to address malnutrition. Globally, stunting among children under five years of age has fallen from 32.6 per cent in 2000 to 22.2 per cent in 2017. There has been a slight decrease in underweight women since 2000, from 11.6 per cent to 9.7 per cent in 2016. Yet, while there has been progressing, it has been slow and patchy.
The 2018 assessment of progress against nine targets reveals only 94 of 194 countries are on track for at least one of the nine nutrition targets assessed. This means that most countries are significantly off-track on meeting all nine targets.
Situation in Tanzania
Tanzania is listed among the examples of countries building multisectoral plans to deliver on their targets in improving nutrition among children under 5 years of age. A wide range of targets has been adopted – seven in all, including for stunting, anaemia and low birth weight. These targets form part of an ambitious five-year action plan to reduce multiple burdens of malnutrition.
The plan was set up under the direct leadership of the Prime Minister’s office to reduce all forms of malnutrition associated with both deficiency and imbalances.
Its broad goal is to scale up high-impact interventions among the most vulnerable people, including children under five years of age, adolescent girls and pregnant and lactating women. It does this by calling for action across sectors, from social protection to education and food.
“All regional commissioners have been instructed to effectively supervise the outreach campaigns designed to curb malnutrition in their respective areas,” says Dr Faustine Ndugulile, Deputy Minister of Health, Community Development, Gender, Elderly and Children.
He adds that the government has embarked on conducting research works to come up with comprehensive strategies to reduce malnutrition burden in the country. “Tanzania is on the right track when it comes to the availability of nutritious foods, but majority of the people lack education on nutrition, hence the burden persists,” he adds.
Breastfeeding within the first hour after birth is critical for saving newborn lives.
Despite the importance of early initiation of breastfeeding, too many newborns are left waiting too long for different reasons, as an estimated 78 million babies globally– or three in five – are not breastfed within the first hour of life, putting them at higher risk of death and disease and making them less likely to continue breastfeeding, say United Nations Children Fund and World Health Organisation in their joint report titled, “Capture the Moment: Early initiation of breastfeeding – the best start for every newborn”.
Capture the Moment, which analyses data from 76 countries, finds that newborns who breastfeed in the first hour of life are significantly more likely to survive. Even a delay of a few hours after birth could pose life-threatening consequences. Skin-to-skin contact along with suckling at the breast stimulate the mother’s production of breastmilk, including colostrum, also called the baby’s ‘first vaccine’, which is extremely rich in nutrients and antibodies.
One of my patients, in his 50’s, let’s name him Ben, came for a check-up last week complaining of blurred vision. According to Ben, he has been experiencing this for the past four months now. He was using over-the-counter eye drops but with zero relief. Ben has no family history of eye problems. I carried out some basic eye tests, which weren’t of a help to draw out a conclusion or a cause, and that’s when I referred Ben to an eye specialist for a comprehensive eye test and management. The results showed that the blood vessels at the back of his eyes were damaged.
This rose curiosity and we decided to run further tests which revealed that he has diabetic retinopathy; a medical condition whereby blood vessels at the back of Ben’s eye are damaged due to existing high blood glucose, which later turns into diabetes.
He was terrified by the news since he has no family history of diabetes.
As a doctor I can confess that about 25 per cent of my diabetic patients are never aware that they have been living with the disease until it reaches a complicated stage. Why? Because they never paid attention to early signs and regular screening. Diabetes symptoms are easy to miss, but it’s becoming more vital than ever to recognise the signs.
Diabetes symptoms can be difficulty to identify since they often come on slowly and can be mistaken with a lot of other issues; anybody could think that their symptoms are due to something else. People also may not visit their doctors as often as they should, which at times, they won’t know that something is off.
Early detection is vital
Pay attention to the following signs, especially when they last for few months. Pay attention when you are constantly craving foods. It happens at times when you eat your meal but in a span of very short time, an increased hunger attacks you again. It is medically called polyphagia. Polyphagia is caused by the reduced ability to metabolise sugar, and since sugar is a key nutrient for every cell in the body, they become malnourished and signal the brain that more food is needed to keep the body functioning, which results in feelings of hunger. One should not confuse polyphagia with increased appetite; that’s why it is advised to get medical advice if this persists.
But this also goes together with increased thirst. Normally the kidneys absorb glucose in the bloodstream and recycle it, making it available to supply the body’s cells. When there is too much glucose in the bloodstream, the kidneys are not able to keep up with absorbing it and will simply discard it by excreting it in the urine. The increased urination that results can often cause dehydration and cause a person to feel thirsty.
And what about that explainable weight loss? Now you realise that diabetescan be very tricky! You get increased feelings of hunger, you eat a lot, yet you drastically lose weight and you can’t even explain about it. Since the body is not able to process the sugar in the bloodstream, the body’s cells that require it do not get the nourishment they need. In response the body will begin to tap into fat reserves that are stored in various areas, and as it is depleted to use for energy, weight loss can occur.
Diabetes is obviously a serious condition, so it’s crucial to be aware of the sometimes subtle signs — and to see your doctor if you have any concerns. We are however, advised to practice healthy lifestyle, let’s be selective in what we take in, sugary and processed food are okay once in a while but when it becomes too much they put us at the risk of developing diabetes.
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.