"http://www.filariasis.org/pdfs/Tanzania%20Story.pdf"
In Tanzania, Lymphatic Filariasis (LF) is endemic in all districts of the country with five regions along the coast being most endemic with prevalence rates of up to 69%; about 43 million people are at risk of LF infection and 6 million have already shown clinical manifestations of the disease. It is estimated that 80% of those at risk live in remote rural areas with very limited access to primary health care. With the limited health work force and resources; reaching the millions of community members in the thousands of villages in Tanzania is extremely difficult.
In order to address this challenge, the use of community members to serve as Community Drug Distributors (CDDs) has proven effective in reaching remote populations and ensuring community ownership of the program.
Community members are motivated to take treatment when their own people have the responsibility for, and control over, distribution of the drugs. This strategy has been adopted by the TZ Ministry of Health and Social Welfare (MOHSW) through the Neglected Tropical Diseases Control Program (NTDCP) in partnership with USAID/RTI/IMA World Health, African Program for Onchocerciasis Control (APOC) and other partners. Using the community directed treatment with Ivermectin (CDTI) strategy, CDDs play a key role in the mass drug administration (MDA). The CDTI philosophy encourages communities to take responsibility for organizing their own drug distribution to prevent and eliminate the NTDs affecting their community.
The community leaders are instrumental in organizing and mobilizing communities in their respective areas to participate in MDA. They move from house to house doing a census of all household members prior to the actual MDA. During the census, CDDs emphasize the importance of having all eligible members of the population participate in the MDA in order to eliminate LF in their community. They also address any myths or concerns the community may have about the drugs.
“Having received the ABCs of control and elimination of NTDs, I feel very comfortable to push the agenda to the people in my area” said one village leader in the Bagamoyo district. He went on to say “I have been using the annual village meetings to clear all the misconceptions the people have about drugs given free of charge in our communities”.
“Gone are the days of taking pride in large hydrocele! This is a disease and we need to take drugs annually to eliminate this disfiguring and incapacitating disease, together we will eradicate it” said one District Commissioner when addressing ward counselors in one of their quarterly meetings.
To enable communities to organize high quality MDAs, the NTDCP and partners support CDDs through training, supportive supervision and mentorship, and supply all MDA related materials, including treatment registers, height poles, and drugs. The selection of CDDs is done by the communities themselves to ensure a transparent process facilitated by hamlet leaders; in some instances the hamlet leader is selected to serve as a CDD.
“I feel honored to serve and help my community; this has kept me going despite the challenges” said a middle aged female CDD when asked what motivates her serving as a CDD.
“People in our community call me doctor, they have built confidence in the work I do, and this has helped me gain more confidence and enthusiasm, to serve them even better” said a young man who has served as a CDD for the past four years.
“These drugs are very good, we are comfortable that we will remove this disease. We had problems at the beginning because some people had told us that the bazungu are giving us drugs to stop us from having children, but we have realized that this was untrue. We now happily take the drugs as we trust our CDDs and leaders; moreover, they could not allow us take something harmful in any way as they themselves are involved!” said an elderly lady who was eager to take her pills.
As a result of empowering the community to take responsibility in the fight against NTDs, hard to reach communities in Tanzania which otherwise would not have been reached, have been able to conduct successful MDA annually. Communities have gained a great awareness about elimination/control of NTDs.
Keeping the communities at the centre of control/elimination of NTDs is critical to realize any successful intervention. Communities in Tanzania have shown that when empowered and supported, they can address their health problems themselves. The power to eliminate LF is endowed in the affected populations. Once trained and equipped with the right tools, communities play a significant role in the global vision of LF elimination.
Monday, December 19, 2011
Buiding a strong health system in Tanzania
The economic growth of our beutiful country majorly depends on the health status of her inhabitants;its high time that every one who wishes to see the prosperity of our land contribute towards building a strong health system in Tanzania.
The different interventions that our government and other partners are doing will yield no results if our system remains at its current state!
Lets arise and build a strong health system,
This is just to open the matter, will be posting a number of articles on the topic to allow different stakeholders know their part in this noble call of building a strong health system.
God bless
The different interventions that our government and other partners are doing will yield no results if our system remains at its current state!
Lets arise and build a strong health system,
This is just to open the matter, will be posting a number of articles on the topic to allow different stakeholders know their part in this noble call of building a strong health system.
God bless
Friday, June 18, 2010
Home comming
After a long period of time of being away from famiy and friends, i cant wait joining my family again to share new experiences i have learnt from here and to enjoy they love and company.
Looking forward to re-uniting with family.
Looking forward to re-uniting with family.
Friday, March 26, 2010
Tanzania-Background Information
The United Republic of Tannzania is situated in East Africa, bordering Kenya(North East) ,Uganda(North West) ,Rwanda and Burundi (West North),Democratic Republic of Congo to the West, the Indian Ocean (East) and Malawi , Zambia, and Mozambique (South)
Tanzania got her indepence in 1961.Her political capital city is dodoma while the commercial city is dar es saalam.
The health of children and women is threatened by poor nutrition, gender inequalities and female illiteracy levels. Some specific public health concerns are outlined below.
HIV prevalence
HIV prevalence is currently reported at 7% (2003 -2004 Indicator Survey, National AIDS Control Programme). The cross-cutting effects of the pandemic have produced a rapidly growing orphan population. Responses to mitigate the attendant economic and social effects are piecemeal and insufficient
The high prevalence of malnutrition (21.8% underweight, 37.7% stunting of children) and high level of food poverty (22% below food poverty line and 39% below basic needs poverty line) is a grave concern for individuals already weakened by HIV. Agriculture has persistently been affected by factors resulting in low productivity and incomes.
Access to health services
Inequity in access to social services is mainly due to skewed income distribution, high levels of income poverty and non-functional social protection for the poor. The low income of the majority of the populations hinders their accessibility to health services as medicines and other services are unaffordable. At the national level, low financial capacity limits adequate resource allocations to the sector leading to inadequate service provisions.
Statistics:
Total pop: 39,459,000
Gross national income per capita : 980
Life expectancy at birth m/f (years): 50/51
Healthy life expectancy at birth m/f (years, 2003): 40/41
under five mortality rate(per 1 000 live births): 118
Probability of dying between 15 and 60 years m/f (per 1 000 population): 518/493
Total expenditure on health per capita (Intl $, 2006): 45
Total expenditure on health as % of GDP (2006): 5.5
Figures are for 2006 unless indicated. Source: World Health Statistics 2008-http://www.who.int/countries/tza/tza/en/
Total pop: 39,459,000
Gross national income per capita : 980
Life expectancy at birth m/f (years): 50/51
Healthy life expectancy at birth m/f (years, 2003): 40/41
under five mortality rate(per 1 000 live births): 118
Probability of dying between 15 and 60 years m/f (per 1 000 population): 518/493
Total expenditure on health per capita (Intl $, 2006): 45
Total expenditure on health as % of GDP (2006): 5.5
Figures are for 2006 unless indicated. Source: World Health Statistics 2008-http://www.who.int/countries/tza/tza/en/
Malnutrition in Tanzania- an Overview
Lack of nutrition security is reflected in malnutrition affecting many Tanzanians in different
forms. Child malnutrition is indicated through the use of three anthropometric indices of
nutritional status – height-for-age, weight-for-age, and weight-for-height Micronutrient
deficiencies are also common, notably anemia, and vitamin A and iodine deficiencies.
Under nutrition among Tanzanians is manifested at an early age, therefore, great emphasis is
placed on monitoring child nutrition to avoid or minimize the adverse consequences of
malnutrition. Data from the three demographic and health surveys conducted in Tanzania in the 1990s show a consistent pattern in nutritional status among children: growth falters at a very early age, and then stabilizes when children are 18-24 months of age
Not only is there early onset of malnutrition in Tanzania but the rates of child malnutrition are
high. According to data from the Tanzania Demographic and Health Survey (TDHS) 2004/05,
about 40% of children under five years of age are stunted, i.e., they are short for their age,
which is an indicator of chronic undernutrition, and about 3% are wasted, i.e., low weight for
height, which is an indicator of acute undernutrition (National Bureau of Statistics (NBS)
[Tanzania] & ORC Macro, 2005). Approximately 22% of children are underweight (low weight
for age), which is a composite measure of long- and short-term undernutrition
This last indicator is one of the Millennium Development Goals (MDG) indicators.
Overall, urban children are more likely to enjoy better nutrition than rural children; according to the TDHS 2004/05, 26% of urban children under five years of age were stunted, comparedwith 41% of rural children.
Data from the TDHS indicate some improvements in nutrition. The prevalence of stunting fell
in the 2004/05 survey after a period in the 1990s when there was no change. The
percentage of children underweight for age and the percentage wasted has also declined
since 1996. The declining rate of stunting among rural children accounts for the recent
improvements observed at national level. Between 1999 and 2004, the prevalence of
stunting in urban areas increased slightly to 26%. Rural rates, on the other hand, declined
from 48% to 41% over the same period. Nonetheless, given the high rates of
malnutrition which are prevalent among rural children, it is unlikely that Tanzania will reduce
stunting among children under five years to 20% by 2010, which is the target set by the government under MKUKUT program.
Nutrition rates are worst amongst the poor. According to the 1999 Tanzania Reproductive and
Child Health Survey (TRCHS), 50% of children in the poorest 40% of households were stunted,
compared with 23% of children from the least poor 20% of households (NBS & Macro
International, 1999)
Micronutrient disorders are also prevalent in Tanzania, particularly iron deficiency
(anaemia), and vitamin A and iodine deficiencies. According to the TDHS 2004/05,
approximately two-thirds of children and 43% of women are anaemic. The same survey
reported that 73% of households were consuming iodated salt, and that the adequacy of the
iodation varied considerably, with higher levels reported among urban households than
among rural households. There has been a substantial increase in the availability of vitamin
A supplementation. An assessment by Helen Keller International and TFNC in July 2004,
shortly after the Vitamin A Supplementation Campaign, indicated that 85% of children aged
6-59 months received vitamin A supplements.
Low birth weight (below 2.5 kg) has changed little in the past few years. The TRCHS 1999
recorded that 9% of babies who had been weighed at birth had weights under 2.5 kg. In the
TDHS 2004/05, the corresponding figure was 7%. Of note, about half of all births take place
at home, hence, birth weights are recorded for only about half of all births. Low birth weight
is a reflection of poor maternal health and nutritional status. There is evidence from a survey
of low birth weight that adolescent mothers are more likely to be anaemic and
undernourished than their older peers (TFNC, UNICEF (Tanzania) and Centre for
International Child Health, 2002). Anaemia is associated with the high prevalence of malaria
and parasitic infestations.
http://www.repoa.or.tz/documents_storage/Publication/Special_Paper_09.31.pdf
forms. Child malnutrition is indicated through the use of three anthropometric indices of
nutritional status – height-for-age, weight-for-age, and weight-for-height Micronutrient
deficiencies are also common, notably anemia, and vitamin A and iodine deficiencies.
Under nutrition among Tanzanians is manifested at an early age, therefore, great emphasis is
placed on monitoring child nutrition to avoid or minimize the adverse consequences of
malnutrition. Data from the three demographic and health surveys conducted in Tanzania in the 1990s show a consistent pattern in nutritional status among children: growth falters at a very early age, and then stabilizes when children are 18-24 months of age
Not only is there early onset of malnutrition in Tanzania but the rates of child malnutrition are
high. According to data from the Tanzania Demographic and Health Survey (TDHS) 2004/05,
about 40% of children under five years of age are stunted, i.e., they are short for their age,
which is an indicator of chronic undernutrition, and about 3% are wasted, i.e., low weight for
height, which is an indicator of acute undernutrition (National Bureau of Statistics (NBS)
[Tanzania] & ORC Macro, 2005). Approximately 22% of children are underweight (low weight
for age), which is a composite measure of long- and short-term undernutrition
This last indicator is one of the Millennium Development Goals (MDG) indicators.
Overall, urban children are more likely to enjoy better nutrition than rural children; according to the TDHS 2004/05, 26% of urban children under five years of age were stunted, comparedwith 41% of rural children.
Data from the TDHS indicate some improvements in nutrition. The prevalence of stunting fell
in the 2004/05 survey after a period in the 1990s when there was no change. The
percentage of children underweight for age and the percentage wasted has also declined
since 1996. The declining rate of stunting among rural children accounts for the recent
improvements observed at national level. Between 1999 and 2004, the prevalence of
stunting in urban areas increased slightly to 26%. Rural rates, on the other hand, declined
from 48% to 41% over the same period. Nonetheless, given the high rates of
malnutrition which are prevalent among rural children, it is unlikely that Tanzania will reduce
stunting among children under five years to 20% by 2010, which is the target set by the government under MKUKUT program.
Nutrition rates are worst amongst the poor. According to the 1999 Tanzania Reproductive and
Child Health Survey (TRCHS), 50% of children in the poorest 40% of households were stunted,
compared with 23% of children from the least poor 20% of households (NBS & Macro
International, 1999)
Micronutrient disorders are also prevalent in Tanzania, particularly iron deficiency
(anaemia), and vitamin A and iodine deficiencies. According to the TDHS 2004/05,
approximately two-thirds of children and 43% of women are anaemic. The same survey
reported that 73% of households were consuming iodated salt, and that the adequacy of the
iodation varied considerably, with higher levels reported among urban households than
among rural households. There has been a substantial increase in the availability of vitamin
A supplementation. An assessment by Helen Keller International and TFNC in July 2004,
shortly after the Vitamin A Supplementation Campaign, indicated that 85% of children aged
6-59 months received vitamin A supplements.
Low birth weight (below 2.5 kg) has changed little in the past few years. The TRCHS 1999
recorded that 9% of babies who had been weighed at birth had weights under 2.5 kg. In the
TDHS 2004/05, the corresponding figure was 7%. Of note, about half of all births take place
at home, hence, birth weights are recorded for only about half of all births. Low birth weight
is a reflection of poor maternal health and nutritional status. There is evidence from a survey
of low birth weight that adolescent mothers are more likely to be anaemic and
undernourished than their older peers (TFNC, UNICEF (Tanzania) and Centre for
International Child Health, 2002). Anaemia is associated with the high prevalence of malaria
and parasitic infestations.
http://www.repoa.or.tz/documents_storage/Publication/Special_Paper_09.31.pdf
Thursday, March 25, 2010
Under five Malnutrtion & its complexity in Tanzania
"I wasn’t able to breastfeed my child Shomary, because we had a shortage of food in the house and I didn’t get enough food to produce milk," she says. "As a result he suffered from malnutrition and other health problems like fever and sores. He’s underweight, compared to other children his age."
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Malnutrition among the under five still poses a big challenge especially in rural Tanzania, disease burden ,economic, social, and cultural factors and natural calamities like drought make the fight against malnutrition in Tanzania difficult.As malnutrition is a result of a combination of these factors ;its fight equally needs a mult-sectoral approach.
Each day in the developing world, 16,000 children die from hunger or preventable diseases such as diarrhea, acute respiratory infections, or malaria. Malnutrition is associated with over half of those deaths. That is equal to 1 child every 5.4 seconds.
Hungry children suffer from 2 to 4 times more individual health problems--such as unwanted weight loss, fatigue, headaches, irritability, inability to concentrate, and frequent colds--as low-income children whose families do not experience food shortages.
3/4 of all deaths in children under age 5 in the developing world are caused by malnutrition or related diseases.
http://images.google.com/imgres?imgurl=http://www.ncbi.nlm.nih.gov/bookshelf
www.ncbi.nlm.nih.gov/
groups.myspace.com/
www.guardian.co.uk/
www.childfund.org.nz/.../
mal-ed.fnih.org/
Monday, March 22, 2010
Key Determinants of Nutrition Security in Tanzania
Generally, nutrition status is affected by:
•Food intake,
•Health,
•Caring practices.
Food intake is determined by the amount and quality of food available. From birth to six months, exclusive breastfeeding is recommended. Data from recent demographic and
health surveys indicate that the percentage of babies under 6 months who are exclusively breastfed has been increasing, from 29% in 1996 to 32% in 1999 to 41% in 2004. However,exclusive breastfeeding is not common after a baby has reached two months of age; the practice tapers off quickly, and by the age of 4 to 5 months only 13.5% of babies are still being exclusively breastfed. Breastfeeding typically continues while infants are being weaned. For infants between 6 and 9 months, 91% are fed complementary foods along with breast milk (NBS, et al., 2005).
During the most critical nutritional period for children, i.e., under two years of age, the absolute amount of food in the household is unlikely to be the critical determinant of food intake. Children at this age consume little compared to older children and adults in the household. For such young children, food intake is more dependent upon the number of times per day they are able to eat – their small stomachs cannot absorb large quantities of food at one time – and the energy and nutrient density of their diets. The predominant diet in Tanzania is cereal-based with low energy and nutrient density. Food security, per se, is not the most critical determinant of the high prevalence of undernutrition in children in Tanzania.
In times of critical food shortages, children suffer along with other family members in affected households, but food shortages typically do not determine undernutrition in young children. The geographic pattern of malnutrition in Tanzania suggests that areas of the country which are the source of cereal surpluses, mainly in the south and west, are also the areas with relatively high rates of malnutrition. Food security, therefore, in the limited sense of cereal crop production, does not seem to be strongly associated with nutrition security.
Clearly, a broader perspective on food security is necessary, which is accepted in the Food Security Policy (Ministry of Agriculture and Food Security (MAFS) [Tanzania], 2004). Access to food and availability of food are the key determinants of food security, which, in turn, are strongly influenced by household income levels and food prices. Poverty is pervasive in Tanzania, and rural households are disproportionately poor. Not surprisingly, therefore,undernutrition in children is most prevalent among rural households and in the poorest households.
Thus the relationship between income and nutrition is a complex one, within and among
households, and nationally. It is only in the least poor 20% of households where the
percentage of children who are stunted falls substantially. According to the TDHS 2004/05, 15.7% of children in these households – which are predominantly urban – are stunted. In contrast, in households in the bottom four wealth quintiles, i.e., from the poorest to the less poor quintile, the percentage of children who are stunted is 45, 43, 41 and 38% respectively. There is a pattern of declining malnutrition with higher income, but several analysts have pointed out that increasing income accounts for only part of the decrease in malnutrition rates. Similar results have been found in analyses of the relation between higher national income (GDP) and rates of child malnutrition (Mkenda, 2004; Alderman, etal., 2005). Factors other than income alone are clearly at play.
Parents’ education affects children’s nutrition. The children of mothers with secondary education are much less likely to be stunted, but the difference in nutrition between the children of mothers with no education and children of mothers with only primary education is not significant (Research on Poverty Alleviation (REPOA), 2004). Currently, very few mothers have secondary education. Much greater investment in the education system will be required before higher levels of schooling are common Health factors are critical for nutrition. Fevers, diarrhoeal diseases and acute respiratory infections (ARIs) are all common among children in Tanzania, and they affect appetite –hence, food intake – as well as the body’s use of energy and other nutrients. During the two weeks prior to the TDHS 2004/05, 24% of all children under five years had fever, 13% had diarrhoea, and 8% had symptoms of acute respiratory infection (coughing accompanied by short rapid breathing). Children aged 6-23 months old were most affected. In this age bracket, 35% had a fever, one-quarter had diarrhoea, and 11% had symptoms of acute respiratory infection.
Recent improvements in prevention and treatment of malaria may explain in part the
reduction in child malnutrition. More effective drug treatment has been introduced, and more children are sleeping under mosquito nets.
Systems to deliver health and other services, especially for poor and rural children, are critical, especially for young children and pregnant women. The capacity of health workers and administrators who are responsible for service delivery need to be strengthened. Increased financial allocations to local authorities through basket funding and budget support are supporting improvements in healthcare. However, people in poor and rural households do not have the same access to health services as their less poor and urban peers, both in distance to service providers and in the costs of obtaining healthcare (NBS,et al. 2005). Moreover, while districts have prepared comprehensive health and
development plans, there is little mention of nutrition in these plans, even though malnutrition is recognised as a problem and some of the strategies in the district plans will indeed help to reduce rates of malnutrition.
Access to health services is one key aspect of care for children.
Caring practices also affect patterns of breastfeeding and the number of times a child is given anything to drink or eat during the day. Caregivers who must spend most of their time provisioning households –
farming, fetching water and fuel for cooking, washing, etc. – have little time to devote solely
to caring for young children. Care for the youngest children is, therefore, commonly
provided by older siblings, especially girls. And cooking is usually done only once per day.
Snack foods could provide additional intake to reduce malnutrition, but such foods are not
commonly given to young children, especially in rural communities and poor households.
In addition to feeding practices, care also includes hygiene practices and psychosocial
stimulation. Sound hygiene practices are hampered by shortages of water and soap,
unsanitary latrines, and inadequate waste disposal systems. As a result young children
suffer frequent bouts of diarrhoeal diseases. Psychosocial stimulation is limited by the
amount of time carers are able to devote to their children.
A particular group of children who need special care and feeding are those children who are
so severely malnourished that they have been admitted to hospital. Provision of food for
hospital patients is frequently inadequate, and is often left to the responsibility of families. In
cases of severely malnourished children, the circumstances of families are likely to have
contributed to the condition of the children who are in hospital. Hospitals, therefore, need to
be able to provide the food and healthcare to ensure that children are well nourished and
recover.
The effective communication of information plays a critical role in influencing caring and
feeding practices. Normally this information comes from families and communities through
informal means. However, health staff also have opportunities to provide information to
almost all mothers of young children during antenatal visits. The TDHS 2004/05 found that
97% of pregnant women visit a health facility for at least one antenatal check-up, and almost
all of them for two or more. In addition, at the time of the first visit to the health facility after
the birth of the baby, 91% of infants are immunised with BCG which is given at that time.
Community health days offer other possibilities for communicating sound nutrition practices.
Throughout Tanzania, health days are organised at least twice a year when children are
provided with vitamin A supplementation. These events are usually organised to coincide
with the Day of the African Child on June 16, and World AIDS Day on 1 December. Schools
are other venues for communication, both for siblings of young children who can share the
information with their families, and for older pupils, especially adolescent girls, to gain
greater understanding of nutrition.
Fundamental to all of the processes which influence nutritional outcomes is the importance
that society places on good nutrition and on supporting those who are most likely to suffer
from poor nutrition – children and pregnant women. Much more needs to be done to raise
the level of importance attached to policies and strategies affecting nutrition and vulnerable
groups, which, in turn, will significantly impact social and economic development more
generally.
The “silent” emergency of chronic malnutrition which so negatively affects the development
of nearly half the child population of Tanzania should command much greater attention, and
be accorded at the very least the same priority and resources which are provided to
emergency response to alleviate temporary food shortages caused by drought or flood
http://www.repoa.or.tz/documents_storage/Publications/Special_Paper_09.31.pdf
•Food intake,
•Health,
•Caring practices.
Food intake is determined by the amount and quality of food available. From birth to six months, exclusive breastfeeding is recommended. Data from recent demographic and
health surveys indicate that the percentage of babies under 6 months who are exclusively breastfed has been increasing, from 29% in 1996 to 32% in 1999 to 41% in 2004. However,exclusive breastfeeding is not common after a baby has reached two months of age; the practice tapers off quickly, and by the age of 4 to 5 months only 13.5% of babies are still being exclusively breastfed. Breastfeeding typically continues while infants are being weaned. For infants between 6 and 9 months, 91% are fed complementary foods along with breast milk (NBS, et al., 2005).
During the most critical nutritional period for children, i.e., under two years of age, the absolute amount of food in the household is unlikely to be the critical determinant of food intake. Children at this age consume little compared to older children and adults in the household. For such young children, food intake is more dependent upon the number of times per day they are able to eat – their small stomachs cannot absorb large quantities of food at one time – and the energy and nutrient density of their diets. The predominant diet in Tanzania is cereal-based with low energy and nutrient density. Food security, per se, is not the most critical determinant of the high prevalence of undernutrition in children in Tanzania.
In times of critical food shortages, children suffer along with other family members in affected households, but food shortages typically do not determine undernutrition in young children. The geographic pattern of malnutrition in Tanzania suggests that areas of the country which are the source of cereal surpluses, mainly in the south and west, are also the areas with relatively high rates of malnutrition. Food security, therefore, in the limited sense of cereal crop production, does not seem to be strongly associated with nutrition security.
Clearly, a broader perspective on food security is necessary, which is accepted in the Food Security Policy (Ministry of Agriculture and Food Security (MAFS) [Tanzania], 2004). Access to food and availability of food are the key determinants of food security, which, in turn, are strongly influenced by household income levels and food prices. Poverty is pervasive in Tanzania, and rural households are disproportionately poor. Not surprisingly, therefore,undernutrition in children is most prevalent among rural households and in the poorest households.
Thus the relationship between income and nutrition is a complex one, within and among
households, and nationally. It is only in the least poor 20% of households where the
percentage of children who are stunted falls substantially. According to the TDHS 2004/05, 15.7% of children in these households – which are predominantly urban – are stunted. In contrast, in households in the bottom four wealth quintiles, i.e., from the poorest to the less poor quintile, the percentage of children who are stunted is 45, 43, 41 and 38% respectively. There is a pattern of declining malnutrition with higher income, but several analysts have pointed out that increasing income accounts for only part of the decrease in malnutrition rates. Similar results have been found in analyses of the relation between higher national income (GDP) and rates of child malnutrition (Mkenda, 2004; Alderman, etal., 2005). Factors other than income alone are clearly at play.
Parents’ education affects children’s nutrition. The children of mothers with secondary education are much less likely to be stunted, but the difference in nutrition between the children of mothers with no education and children of mothers with only primary education is not significant (Research on Poverty Alleviation (REPOA), 2004). Currently, very few mothers have secondary education. Much greater investment in the education system will be required before higher levels of schooling are common Health factors are critical for nutrition. Fevers, diarrhoeal diseases and acute respiratory infections (ARIs) are all common among children in Tanzania, and they affect appetite –hence, food intake – as well as the body’s use of energy and other nutrients. During the two weeks prior to the TDHS 2004/05, 24% of all children under five years had fever, 13% had diarrhoea, and 8% had symptoms of acute respiratory infection (coughing accompanied by short rapid breathing). Children aged 6-23 months old were most affected. In this age bracket, 35% had a fever, one-quarter had diarrhoea, and 11% had symptoms of acute respiratory infection.
Recent improvements in prevention and treatment of malaria may explain in part the
reduction in child malnutrition. More effective drug treatment has been introduced, and more children are sleeping under mosquito nets.
Systems to deliver health and other services, especially for poor and rural children, are critical, especially for young children and pregnant women. The capacity of health workers and administrators who are responsible for service delivery need to be strengthened. Increased financial allocations to local authorities through basket funding and budget support are supporting improvements in healthcare. However, people in poor and rural households do not have the same access to health services as their less poor and urban peers, both in distance to service providers and in the costs of obtaining healthcare (NBS,et al. 2005). Moreover, while districts have prepared comprehensive health and
development plans, there is little mention of nutrition in these plans, even though malnutrition is recognised as a problem and some of the strategies in the district plans will indeed help to reduce rates of malnutrition.
Access to health services is one key aspect of care for children.
Caring practices also affect patterns of breastfeeding and the number of times a child is given anything to drink or eat during the day. Caregivers who must spend most of their time provisioning households –
farming, fetching water and fuel for cooking, washing, etc. – have little time to devote solely
to caring for young children. Care for the youngest children is, therefore, commonly
provided by older siblings, especially girls. And cooking is usually done only once per day.
Snack foods could provide additional intake to reduce malnutrition, but such foods are not
commonly given to young children, especially in rural communities and poor households.
In addition to feeding practices, care also includes hygiene practices and psychosocial
stimulation. Sound hygiene practices are hampered by shortages of water and soap,
unsanitary latrines, and inadequate waste disposal systems. As a result young children
suffer frequent bouts of diarrhoeal diseases. Psychosocial stimulation is limited by the
amount of time carers are able to devote to their children.
A particular group of children who need special care and feeding are those children who are
so severely malnourished that they have been admitted to hospital. Provision of food for
hospital patients is frequently inadequate, and is often left to the responsibility of families. In
cases of severely malnourished children, the circumstances of families are likely to have
contributed to the condition of the children who are in hospital. Hospitals, therefore, need to
be able to provide the food and healthcare to ensure that children are well nourished and
recover.
The effective communication of information plays a critical role in influencing caring and
feeding practices. Normally this information comes from families and communities through
informal means. However, health staff also have opportunities to provide information to
almost all mothers of young children during antenatal visits. The TDHS 2004/05 found that
97% of pregnant women visit a health facility for at least one antenatal check-up, and almost
all of them for two or more. In addition, at the time of the first visit to the health facility after
the birth of the baby, 91% of infants are immunised with BCG which is given at that time.
Community health days offer other possibilities for communicating sound nutrition practices.
Throughout Tanzania, health days are organised at least twice a year when children are
provided with vitamin A supplementation. These events are usually organised to coincide
with the Day of the African Child on June 16, and World AIDS Day on 1 December. Schools
are other venues for communication, both for siblings of young children who can share the
information with their families, and for older pupils, especially adolescent girls, to gain
greater understanding of nutrition.
Fundamental to all of the processes which influence nutritional outcomes is the importance
that society places on good nutrition and on supporting those who are most likely to suffer
from poor nutrition – children and pregnant women. Much more needs to be done to raise
the level of importance attached to policies and strategies affecting nutrition and vulnerable
groups, which, in turn, will significantly impact social and economic development more
generally.
The “silent” emergency of chronic malnutrition which so negatively affects the development
of nearly half the child population of Tanzania should command much greater attention, and
be accorded at the very least the same priority and resources which are provided to
emergency response to alleviate temporary food shortages caused by drought or flood
http://www.repoa.or.tz/documents_storage/Publications/Special_Paper_09.31.pdf
Food Fortification Project to Combat Malnutrition in Tanzania
By:Zaynab Turuku
15 March 2010
________________________________________
Nairobi — The Japan Social Development Fund has disbursed $2.69 million through the World Bank, to fight malnutrition in Tanzania.The programme will support food fortification in rural areas that are not reached by the national food fortification programme.
Last week, stakeholders from across the globe gathered at the United Nations Children's Fund (UNICEF) offices in Dar es Salaam to discuss the importance of food fortification, ways to increase the same and encourage media participation in changing societal perception on fortified products.
Statistics released at the conference showed that 27,000 children in Tanzania die each year due to vitamins and mineral deficiencies, while 1,600 women die as a result of complications related to anaemia during child-birth.
In a past project to encourage the use of fortified foods, negative perceptions posed a huge challenge.
Vincent Assay from the Tanzania Food and Nutrition Centre (TFNC) said, iodine capsules were distributed to women and goitre sufferers in severely affected districts, in a bid to control the alarming death rates associated with the condition, but the programme was not well received
"The people questioned why the facilitators had travelled all the way from Dar es Salaam to give them free iodine, believing that the capsules would lead to infertility," said Mr Assay. Godwin Ndossi, the centre's managing director said the project eventually folded because the capsules were too costly."A single capsule was selling at Tsh800 ($0.59) making purchases difficult," Dr Ndossi said.
Janneke Jorgensen, a nutrition specialist at the World Bank's Health, Nutrition and Population sector said, in a bid to change perceptions, the programme, would not provide free products this time round.
"There is a negative perception on free goods. Fortified foods are of superior quality as they contain more nutrients; Even if we sold them to affected communities, they would still offer good value for money," said Ms Jorgensen.
Dr Ndossi said micronutrients deficiencies pose devastating health threats not only to the education of the affected, but also to human dignity and economic growth.
"Iron deficiency in adults decreases work productivity by up to 17 per cent per year, while 90 per cent pre-school children's learning capacity is impaired," said Dr Ndossi. He added: "Economically, micronutrients deficiencies cost the government approximately $480 million (Tsh650 billion) each year."
Accruing losses
Until fortified foods are available in Tanzania, it is estimated that the country will lose over $111million (Tsh150 billion) each year through decreased productivity, according to TFNC.
Raymond Wigenge from the Tanzania Food and Drug Administration said the country was also losing out on the export of fortified salt (ionised salt) which is preferred by many overseas markets due to the slow pace of food fortification.
Dr Wigenge said the Salt Iodations Regulation Act of 1994, controls the use and distribution of non-ionised salt which still circulates in the country.
"We inspect, and if we find any, we destroy it," said Dr Wigenge.
Celestin Mgoba from TFNC said: Standardisation of the fortification process is delaying the process. We want to harmonise WHO standards with local standards and come up with the best standardisation," he said.
http://allafrica.com/stories/201003151150.html
15 March 2010
________________________________________
Nairobi — The Japan Social Development Fund has disbursed $2.69 million through the World Bank, to fight malnutrition in Tanzania.The programme will support food fortification in rural areas that are not reached by the national food fortification programme.
Last week, stakeholders from across the globe gathered at the United Nations Children's Fund (UNICEF) offices in Dar es Salaam to discuss the importance of food fortification, ways to increase the same and encourage media participation in changing societal perception on fortified products.
Statistics released at the conference showed that 27,000 children in Tanzania die each year due to vitamins and mineral deficiencies, while 1,600 women die as a result of complications related to anaemia during child-birth.
In a past project to encourage the use of fortified foods, negative perceptions posed a huge challenge.
Vincent Assay from the Tanzania Food and Nutrition Centre (TFNC) said, iodine capsules were distributed to women and goitre sufferers in severely affected districts, in a bid to control the alarming death rates associated with the condition, but the programme was not well received
"The people questioned why the facilitators had travelled all the way from Dar es Salaam to give them free iodine, believing that the capsules would lead to infertility," said Mr Assay. Godwin Ndossi, the centre's managing director said the project eventually folded because the capsules were too costly."A single capsule was selling at Tsh800 ($0.59) making purchases difficult," Dr Ndossi said.
Janneke Jorgensen, a nutrition specialist at the World Bank's Health, Nutrition and Population sector said, in a bid to change perceptions, the programme, would not provide free products this time round.
"There is a negative perception on free goods. Fortified foods are of superior quality as they contain more nutrients; Even if we sold them to affected communities, they would still offer good value for money," said Ms Jorgensen.
Dr Ndossi said micronutrients deficiencies pose devastating health threats not only to the education of the affected, but also to human dignity and economic growth.
"Iron deficiency in adults decreases work productivity by up to 17 per cent per year, while 90 per cent pre-school children's learning capacity is impaired," said Dr Ndossi. He added: "Economically, micronutrients deficiencies cost the government approximately $480 million (Tsh650 billion) each year."
Accruing losses
Until fortified foods are available in Tanzania, it is estimated that the country will lose over $111million (Tsh150 billion) each year through decreased productivity, according to TFNC.
Raymond Wigenge from the Tanzania Food and Drug Administration said the country was also losing out on the export of fortified salt (ionised salt) which is preferred by many overseas markets due to the slow pace of food fortification.
Dr Wigenge said the Salt Iodations Regulation Act of 1994, controls the use and distribution of non-ionised salt which still circulates in the country.
"We inspect, and if we find any, we destroy it," said Dr Wigenge.
Celestin Mgoba from TFNC said: Standardisation of the fortification process is delaying the process. We want to harmonise WHO standards with local standards and come up with the best standardisation," he said.
http://allafrica.com/stories/201003151150.html
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