AMSA-IUA: Conference Proceedings_Jan 2013: 5. Tanzania

8/13/2019 AMSA-IUA: Conference Proceedings_Jan 2013: 5. Tanzania

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International University of AfricaFaculty of Medicine and Health Sciences

African Medical Students Association Health Problems in Africa: Is there any

hope left?10 11 January 2013 AD/ 28 -29 Safar 1434 AH

Khartoum - Sudan

Major Health Problems in East Africa

Tanzania

Prepared by:Mastura Abubakar Abdu, MBBS Year 3;

Rashid Masoud Saed, MBBS, Year 2


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COUNTRY BACKGROUND

Tanzania is in East Africa on the Indian Ocean. To the north areUganda and Kenya; to the west, Burundi, Rwanda, and Congo; and to thesouth, Mozambique, Zambia, and Malawi.Tanzania contains three ofAfrica's best-known lakes Victoria in the north, Tanganyika in the west,and Nyasa in the south. Mount Kilimanjaro in the north, 19,340 ft (5,895m), is the highest point on the continent. The island of Zanzibar isseparated from the mainland by a 22-mile channel. Land area: 342,100sqmetre (886,039 sq km); total area: 364,898 sq mi (945,087 sq km)

ClimateTanzania has a tropical climate. In the highlands, temperatures range

between 10C and 20C (50F and 68F) during cold and hot seasonsrespectively. The rest of the country has temperatures rarely falling lowerthan 20C (68F). The hottest period extends between November and

February (25C - 31C, or 77F - 88F) while the coldest period occurs between May and August (15C - 20C, or 59F - 68F).


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Tanzania has two major rainfall regions. One is unimodal

(December - April) and the other is bimodal (October -December andMarch - May). The former is experienced in southern, south-west, centraland western parts of the country, and the latter is found to the north andnorthern coast. In the bimodal regime the March - May rains are referredto as the long rains whereas the October - December rains are generallyknown as short rains.

Country Health IndicatorsBasic Indicators to the

topUnder-5 mortality rank 41

Under-5 mortality rate, 1990 155Under-5 mortality rate, 2010 76Infant mortality rate (under 1), 1990 95Infant mortality rate (under 1), 2010 50

Neonatal mortality rate, 2010 26Total population (thousands), 2010 45,039,

000Annual no. of births (thousands), 2010 1862Annual no. of under-5 deaths

(thousands), 2010133

GNI per capita (US$), 2010 530

Life expectancy at birth (years), 2010 57Total adult literacy rate (%), 2005-2010*

73

Primary school net enrolment ratio(%), 2007-2009*

97
http://www.unicef.org/infobycountry/tanzania_statistics.html#0http://www.unicef.org/infobycountry/tanzania_statistics.html#0http://www.unicef.org/infobycountry/tanzania_statistics.html#0http://www.unicef.org/infobycountry/tanzania_statistics.html#0


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Major causes of death in Tanzania

DISEASE NUMBEROF DEATH

PERCENTAGE(%)

1.HIV/AIDS 90551 20.52

2.INFLUENZA ANDPNEUMONIA

53689 12.17

3.MALARIA 36945 8.37

4.DIARRHEADISEASE

35549 8.06

5.STROKE 21973 4.98

6.CORONARYHEART DISEASE

19086 4.33

7.LOW BIRTHWEIGHT

17318 3.93

8.BIRTH TRAUMA 17303 3.92

9.MARTENALCONDITIONS

14036 3.18

10.VIOLENCE 10357 2.35

HEALTH SYSTEM IN TANZANIAThe Government, Parastatal Organization, voluntary organization,

Religions Organization, Private Practitioners and Traditional Medicine, provides health Services in Tanzania. The referral System (structure) startsfrom the community level (village) up to the treatment abroad. Thefollowing pyramid, shows Health Service System (Structure) in TanzaniaHealth Services System (Structure). The health system and especially the

Governments referral system assumes a pyramidal pattern of a referralsystem recommended by health planners, that is from dispensary to


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Consultant Hospital (Better Health In Africa, 1993). The structure of health

services at various levels in the country is as follows:1. Village Health Service. This is the lowest level of health care

delivery in the country. They essentially provide preventiveservices which can be offered in homes. Usually each villageHealth post have two village health workers chosen by the villagegovernment amongst the villagers and be given a short training

before they start providing services.2. Dispensary Services Is the second stage of health services. The

dispensaries cater for 6,000 to 10,000 people and supervise all thevillage health posts in its ward.

3. Health Centre Services: A health Centre is expected to cater for50,000 people which is approximately the population of oneadministrative division.

4. District Hospitals: The district is a very important level in the provision of health services in the country each district is supposed tohave a district hospital. Government always negotiate with religiousorganisations to designate voluntary hospitals.

5. Regional Hospitals Every region is supposed to have a hospital.Regional Hospital offer similar services like those agreed at districtlevel, however regional hospitals have specialists in various fields andoffer additional services which are not provided at district hospitals.

6. Referral/Consultant Hospitals

This is the highest level of hospital services in the country presentlythere are four referral hospitals namely, the Muhimbili National Hospitalwhich cater the eastern zone; Kilimanjaro Christian Medical Centre(KCMC) which cater for the northern zone, Bugando Hospital which caterfor the western zone; and Mbeya Hospital which serves the southernHighlands.


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Health Facilities 2002 -2003:Facility Agency

Govt. Parastatal Vol/Rel Private Others

Consultancy/SpecializedHospitals

4 2 2 0 -

Regional Hospitals 17 0 0 0 -

District Hospitals 55 0 13

0 -

Other Hospitals 2 6 56

20

2

Health Centers 409 6 48 16 -Dispensaries 2450 202 612 663 28

Specialized Clinics 75 0 4 22 -

Nursing Homes 0 0 0 6 -

Private Laboratories 18 3 9 184 -

Private X-Ray Units 5 3 2 16 1

Source: Ministry of Health Statistical Abstract

The distribution of Health Facilities has a heavy rural emphasis because more than 70% of the population lives in rural areas. In 2010 thenumber of hospitals has increased to 223 hospitals where by 89 aregovernment, 90 faith-based hospitals, 37 private and 8 parastatal.

Number of Medical SchoolsTanzania has major six medical schools and several colleges and

health institutions that provide health education in the country. They offerdegrees and post graduate degrees in medicine, pharmacy, dentistry, andenvironmental health sciences.

Also there several health colleges and institutions that provides othermedical specialties like nursing, laboratory technicians, medical officersand also diploma in pharmacy.


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FREQUENT DIAGNOSED DISEASESNon communicable diseases

1. Cardiovascular diseases2. Cancer3. Chronic respiratory disease4. Diabetes5. Hypertension6. Injuries7. others

All non communicable diseases account for 27% of all deaths inTanzania in which cardiovascular diseases account for 12%,injuries

8%,cancer 3% respiratory diseases for 3%,diabetes 2% and other noncommunicable diseases account for 7%. Non communicable diseases contribute 35% of mortality due to

diseases while 65% is from communicable disease

Communicable disease1. HIV/AIDS2. Malaria3. Pneumonia4. Diarrhea diseases5. Tuberculosis

HIV/AIDS in TanzaniaThe survey interviewed and took blood samples from more than

9,000 women aged 15-49 and close to 7,000 men aged 15-49 in all 26regions of Tanzania. The results indicated a 4.7% HIV prevalence rateamong men and a 6.8% rate among women. This is a slight improvementover the 2003-04 survey which found rates of 6.3% and 7.7% respectively.

Iringa recorded the highest rate of 14.7% (previously 13.4%)followed by Dar es Salaam at 8.9% (previously 10.9%), Mbeya at 7.9%(previously 13.5%) and Shinyanga at 7.6% (previously 6.5%). Zanzibarhad the lowest prevalence rate at 0.6%. Age-wise, the highest prevalencewas among the 35-39 age group (10%).


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The survey also collected information on knowledge of HIV,

attitudes and behavioral aspects. Over 98% of respondents had heardabout HIV/AIDS. 68.6% of women and 76.3% of men knew that condomscan reduce the risk of contracting HIV, while 82% and 86.6% knew thatlimiting sex to one uninfected partner who has no other partners wouldreduce the risk. 85% and 89% where aware that abstaining from sexualintercourse is another recognized prevention method.

HIV Prevalence Tanzania

2001 2007

Adults (15+)and children 1 400 000 1 400 000

Low estimate 1 300 000 1 300 000High estimate 1 500 000 1 500 000

Adults(15+) 1 200 000 1 300 000

Low estimate 1 100 000 1 200 000High estimate 1 300 000 1 400 000

Children(0-14) 120 000 140 000Low estimate 100 000 130 000High estimate 130 000 150 000Adult rate (15-49) (%) 7.0 6.2

Low estimate 6.5 5.8

High estimate 7.4 6.6Women rate(+15) 740 000 760 000Low estimate 680 000 710 000High estimate 790 000 810 000

HIV PREVELENCE AMONG YOUNG PEOPLE


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male female

Prevalence among 15-24years old 0.5 0.9Low estimate 0.4 0.5High estimate 0.7 1.2

ESTIMATED NUMBER OF DEATHS DUE TO AIDS2001 2007

Adults and children 110 000 96 000Low estimate 99 000 860000High estimate 130 000 110 000


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MalariaMalaria is still a major public health problem in the United Republic

of Tanzania, as the leading cause of inpatient and outpatient consultations. Ninety three percent of the populations live in areas where malaria istransmitted for at least one month per year.

Although Tanzania has been on the forefront in promoting theuse of insecticide treated nets (ITNs), there are still between 60000 and80000 malaria attributable deaths estimated per year, mainly childrenunder the age of five. The disease is one of the main obstacles to theeconomical development of the country. The malaria situation in Zanzibar,the group of islands off the north-eastern coast of the Tanzania mainland,is a bit different than the one on the mainland. Over the past decade

Zanzibar has reached very low levels of malaria endemicity due torapidly scaling up of current anti malarial interventionsand it is now oneof the regions that is planning to eliminate the disease.

Planning and evaluating cost -effective strategies for the controland even more, the elimination of malaria, requires contemporary,high spatial resolution maps of the disease distribution as well asreliable estimates of the number of infected people. These measureswill help tracking the progress and documenting reduction in

parasitemia rates as a result o f control.Some earlier attempts to describe the situation of malaria

transmission in Tanzania were based on analysis of historical parasite

prevalence data.

Epidemiology of MalariaIn Tanzania, malaria is the major cause of morbidity and mortality,

accounting for about 30% of all hospital admissions and around 15% of allhospital deaths. Severe anemia and cerebral malaria are the two maincauses of death due to malaria. Malaria transmission and level of exposureto malaria infected mosquito bites varies with season, altitude, economicstatus, breeding sites and agro ecological systems. Multifaceted malariacontrol strategies are yielding significant results


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Progress over the last decade:2000-2010

Significant declines in parasite prevalence18% of children aged 6-

59 months tested positivefor malaria in mainland Tanzania; expected to beeven lower. Significant urban/rural difference in prevalenceRelativedecline in anemia ~30% over 3 years only!

Significant declines in under five mortality: 45%With regard toMalaria, 56% of the households covered in the study owned some type ofmosquito net (increased from 46% observed in the 2004-05 survey). 37%of children under age five years and 36% of pregnant women slept under amosquito net. Children and pregnant women in urban areas were found to

be twice more likely to use mosquito nets than their rural counterparts.The overall prevalence of malaria in young children in Tanzania was

18%. In rural areas, 20% of children carried the malaria parasite compared

to 7% in urban areas. Kagera had the highest prevalence of malaria amongyoung children (42%) while Arusha had the lowest with less than 1%.


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Influenza and PneumoniaPneumonia is the second biggest killer of children in Tanzania, after

malaria. Over the next couple of years the government hopes that this statisticwill change following the introduction of vaccines against

Haemophilusinfluenzae type b in 2009, and pneumococcal disease in 2010.Although Tanzania has made good progress in reducing child

mortality, pneumonia remains a serious problem, causing 21% ofdeaths in children under5 years of age. New vaccines could reducecases, especially since Tanzania has achieved a high coverage 90% for routine immunizations


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DiarrheaDiarrheal diseases are a leading cause of morbidity and mortality

among young children in low-income countries. Although oral rehydrationhas been shown to reduce early child mortality, the diarrhea-specificmortality in children less than 5 years of age in Africa has been estimatedat about 10.6 per 1,000. Diarrhea is the fourth most common diagnosis ininpatients and outpatients and the fourth most common cause of death inadmitted children.

A number of different social, political, and economic factors are present in Tanzania which contribute to the constant morbidity from acuteand persistent diarrhea, as well as intermittent epidemics of cholera anddysentery are common to this region of the world. Morbidity and mortalityfrom childhood diarrhea, whether due to invasive enteropathogens such asShigella or the most common rotavirus, are further compounded byinappropriate household case management.

A hospital-based prospective study including all children admitted tothe Diarrhea Unit during the study period. Data was collected usingcontent analysis checklists. A total of 50 children were admitted duringthe study period. Acute watery diarrhea was the commonest type ofdiarrhea (90%). Most of the patients stayed in the ward for 4 to 10 days.Commonly associated diseases apart from diarrhea were found to bemalaria, pneumonia and malnutrition. The diarrhea mortality amongchildren at the MNH diarrhea unit as reflected in this study was very high.

It has generally been believed that many; if not most of the childhooddeaths associated with diarrhea in developing countries are the result ofacute dehydration. Undoubtedly, acute diarrhea represents a substantial

proportion of the diarrheal deaths, but it may be less a predominant causethan initially believed as the frequent misuse of antibiotics. Among the 50

patients admitted in the diarrheal unit, 45 (90.0%) had acute WateryDiarrhea, 29 (58.0%) died during the study. However, 3 (6.0%) of thestudied patients had dysentery and they all died. Of the 29 patients whodied in this study, 16(55.2%) were male patients, and of the 21 patientswho recovered and were discharged, 7(33.3%) were female patients.

Among the 50 patients studied, Malaria 35(70.0%) followed by

Pneumonia 16(32.0%) and malnutrition 12(24.0%), were the leadingconditions associated with diarrhea among the studied patients.


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Undoubtedly acute dehydrating diarrhea represents a substantial

proportion of the diarrheal deaths. In this study, of the 58% patients whodied, 89.7% patients had Acute Watery Diarrhea and 10.3% hasDysentery.These finding are supported by the findings from a study6 done in fourcountries (India, Bangladesh, Brazil, and Senegal) which indicated thatacute watery diarrhea accounted for about 35% (25-46%) of all diarrhea-associated deaths

.

Tuberculosis

Routine data obtained from the National Tuberculosis and LeprosyProgramme (NTLP) of Tanzania has shown a constant increase in thenotified number of tuberculosis (TB) cases since 1982. Possible causes


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include an improved reporting system, improvement in health services

after the introduction of short course chemotherapy (SCC), and humanimmunodeficiency virus (HIV) infection.The Incidence of tuberculosis (per 100;000 people) in Tanzania was

last reported in 2010, according to a World Bank report published in2012. Incidence of tuberculosis is the estimated number of new

pulmonary, smear positive, and extra-pulmonary tuberculosis cases.Limited information on the different M. tuberculosis families, M.bovis and

NTM Is restricted to small geographical areas of Tanzania. Different M.tuberculosis strains have distinctive epidemiological and clinicalcharacteristics; Virulence, clinical presentation, appear to be straindependent. Diverse spoligotypes families were found from all zones of the

country. Common families were CAS, LAM, EAI. The Beijing familywas 7% and all patients were from eastern and southern Tanzania with80% reported from DSM. Dar es Salaam contributed significantly to allmain families reported. The spoligitypes families identified were noteither significantly associated with drug resistance or poor treatmentoutcomes. No M.bovis was identified, therefore this study aimed atidentification strains M. tuberculosis , M. bovis and NTM in relation totreatment outcomes and drug resistance.

PREVALENCE OF TB IN TANZANIA 2002-2010


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HEALTH WORKFORCEThe health workforce in Tanzania has declined in the past decade

over 35% between 1994/1995 and 2005/2006 due to migration outside thecountries or from rural to urban areas, and other factors like age of mostmedical practitioners.

In 2006 the country had only 1336 doctors in a population of

38.9milnlion people, where by 445 of them worked in private hospitals.This gave a ratio of 1:25000 where by the recommended (WHO) ratio is1:10000.The ratio of nurses is 0.39 for 1000 population and 0.25 clinicalstaff for 1000 population while the world average for health workers per1000 is 9.3.

The 2005 proposed national level of staff in health sector should be1,25,924 health worker but only 35,202 were available representing adeficit of over 72% and the decline will continue to be more serious in thecurrent proposal of one hospital for every district and one health center foreach ward and a dispensary for each village.

The current health situation is less than 40,000 excluding non

professional staffs, this constitutes a very low number of health worker per population.


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Gender has also been noted to be one of the important issues in

health workforce distribution. A common picture is given by nurses wheremajority are females.

CONCLUSION1. Most of the African countries are in a poor socio-economic state

which makes them suffer the burden of the disease with noappropriate management towards them. Major health problems inTanzania are brought about by the poor socio economic standard ofthe country.

2. Heath problems in Tanzania have been one of the majorcauses ofmorbidity and mortality which affect the productivity of the countryand there by adversely affecting the development of this country.

3. Limited awareness and appropriate knowledge in the communitiestoward the diseases including their (risk factors,causes,mode oftheir transmission and preventive measures) have been one of thefactors that contribute to late reporting and consequently delayeddiagnosis and lack of appropriate treatment.


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RECOMMENDATIONS1. Improvement in data collection and the flow of information in health

information system so as to provide easy access to healthinformation and publications, this will simplify different activitieslike research and planning also will facilitate the accessibility ofthe country to foreign aids through mult-donors.

2. All health statistical data and records should be documented and published with periodic updating of information (yearly) inmediathat can make them easily accessible locally and eveninternationally. This will help in identifying the health status and

ranking the disease that affect it regionally3. As far as the deficit in workforce is concerned the gap should be bridged by increasing the number of standard medical schools thatwill also provide qualified students in medical fields

4. Increase provision of scholarships in medical field so as to increasethe number of graduates who will serve their communities from this

burden of diseases and explore more capable student in differentregions of the country.

5. Post graduates students should be given opportunities for furtherstudies to increase the number of specialists In various fields

6. Provision of incentives to health workers by building conducive

environment in their working fields

Documents

AMSA-IUA: Conference Proceedings_Jan 2013: 5. Tanzania