Primary Health Care in Tanzania
I am working with Frank Sebahene a teacher from Ngala in the Kagera area of North Western Tanzania to bring primary health care awareness to teachers and other youth workers in the region. I hope to visit Mwanza and St Augustine's University in 2010 and hold a series of seminars.
Tanzania - Teachers as part of the PHC delivery team
An excellent article on combating River Blindness in Burkina Fasso
http://news.bbc.co.uk/1/hi/world/africa/8105840.stm
The main child killers
Whipworm
Trachoma
Elephantiasis
Dengue Fever
An example of simple resource that can be used in the classroom, youth club, village or anywhere else where young people are present
Cholera
Cholera - 2
World Distribution of Cholera
Africa Distribution of Cholera
Malaria - 1
http://www.malariasite.com - An excellent site on Malaria
TB - 1
TB - 2
Worms
Information Documents - some examples
Death during Childbirth
Feeding young people
Helping the young to grow.doc
Health Care - major cause for concern
Having a baby
Encouraging healthy eating
PHC Workshops
We can also develop visual stimulus to assist in teaching
Aids
Malaria Risks
Malaria Distribution
How cholera develops
Some of the other major African illnesses
Sleeping Sickness
Human African Trypanosomiasis, also known as sleeping sickness, is a vector-borne parasitic disease. The parasites concerned are protozoa belonging to the Trypanosoma Genus. They are transmitted to humans by tsetse fly (Glossina Genus) bites which have acquired their infection from human beings or from animals harbouring the human pathogenic parasites.
Tsetse flies are found in Sub-Saharan Africa. Only certain species transmit the disease. Different species have different habitats. They are mainly found in vegetation by rivers and lakes, in gallery-forests and in vast stretches of wooded savannah.
- Sleeping sickness occurs only in sub-Saharan Africa in regions where there are tsetse flies that can transmit the disease. For reasons that are so far unexplained, there are many regions where tsetse flies are found, but sleeping sickness is not.
- The rural populations living in regions where transmission occurs and which depend on agriculture, fishing, animal husbandry or hunting are the most exposed to the bite of the tsetse fly and therefore to the disease.
- Sleeping sickness generally occurs in remote rural areas where health systems are weak or non-existent. The disease spreads in poor settings. Displacement of populations, war and poverty are important factors leading to increased transmission.
- The disease develops in areas whose size can range from a village to an entire region. Within a given area, the intensity of the disease can vary from one village to the next.
Guinea Worm
Guinea worm disease is a debilitating and painful infection caused by a large nematode (roundworm), Dracunculus medinensis. It begins with a blister, usually on the leg. Around the time of its eruption, the person may experience itching, fever, swelling and burning sensations. Infected persons try to relieve the pain by immersing the infected part in water, usually open water sources such as ponds and shallow wells. This stimulates the worm to emerge and release thousands of larvae into the water. The larva is ingested by a water flea (cyclops), where it develops and becomes infective in two weeks. When a person drinks the water, the cyclops is dissolved by the acidity of the stomach, and the larva is activated and penetrates the gut wall. It develops and migrates through the subcutaneous tissue. After about one year, a blister forms and the mature worm, 1m long, tries to emerge, thus repeating the life cycle.
For persons living in remote areas with no access to medical care, healing of the ulcers can take several weeks. This can be further complicated by bacterial infection, stiff joints, arthritis and even permanent debilitating contractures of the limbs. People in endemic villages are incapacitated during peak agricultural activities. This can seriously affect their agricultural production and the availability of food in the household, and consequently the nutritional status of their family members, particularly young children.
At the beginning of the 20th century, guinea-worm disease, was widespread in many countries in Africa and Asia. It is estimated that there were about 50 million cases in the 1950s. Due to concentrated efforts by the international community and the endemic countries, the number of cases of guinea-worm disease was reduced to about 96 000 by 1999. Guinea-worm disease is prevalent in only 13 countries in Africa including Sudan, Nigeria, Ghana, Burkina Faso, Niger, Togo and Côte d'Ivoire. A small number of cases have also been reported in Uganda, Benin, Mali, Mauritania, Ethiopia and Chad.
To start the work necessary for such a visit I am beginning to build this page as the first part of a digital teaching resource.
Bilharzia
Bilharzia an example of the style of materials we will be publishing.
What is Bilharzia?
Bilharzia is a human disease caused by parasitic worms called Schistosomes. Over one billion humans are at risk worldwide and approximately 300 millions are infected. Bilharzia is common in the tropics where ponds, streams and irrigation canals harbor bilharzia-transmitting snails. Parasite larvae develop in snails from which they infect humans, their definitive host, in which they mature and reproduce
Worms wriggling in your veins
Adult Schistosomes worms are about 1 cm long and hang out in mesenteric veins (the small veins that carry blood from the intestine to the liver). The worms feed on red blood cells and dissolved nutrients such as sugars and amino acids. This can cause anemia and decreased resistance to other diseases.
Schistosomes live in pairs, the male holding and protecting the female inside his ventral groove. Once paired, the two remain in constant copulation. The female lays hundreds of eggs each day, which find their way out of the human body through the urine or the faeces, depending on the species. The pathology is mostly caused by the large number of eggs becoming stuck in various body parts, in particular the liver (causing liver enlargement and malfunction) and the kidneys (causing kidney damage, detectable by blood in the urine).
Schistosomes eggs are evacuated from the human body via faeces or urine. When sanitation is poor, they can reach rivers or lakes. They hatch into tiny swimming larvae called miracidia. These swim about until they locate a snail and bore into its body. Over a period of 3 to 4 weeks, miracidia develop into hundreds of sporocysts, which each produce thousands of cercariae, the next infective stage. A single snail can shed thousands of cercariae each day
Can I catch Bilharzia from someone infected?
No - unless you are a snail !
Schistosomes must alternate between humans and snails to complete their life cycle. This means that Bilharzia can only caught from snails.
Under the tropics, any body of water containing vegetation could contain bilharzia-transmitting snails. Washing, swimming or paddling in that water therefore exposes you to infection by the parasite.
Is there a vaccine?
Not yet, although many medical scientists are working on it. The problems involved in vaccine development are threefold:
- Adult worms are about one thousand times larger than the white blood cells responsible for the immune response.
- Worms protect themselves with a tough tegument, protecting them from chemical attack.
- Worms mimick their host by coating themselves with host molecules.
The good news is that there is a readily available treatment. A drug called praziquantel is injected into the bloodstream and disrupts the parasite's tegument. The parasite is then destroyed.
Some WHO Publications that should be available in Tanzania
http://www.who.int/wormcontrol/education_materials/tanzania/en/swahili_sth_poster.pdf
http://www.who.int/wormcontrol/education_materials/tanzania/en/swahili_poster.pdf
http://www.who.int/wormcontrol/education_materials/tanzania/en/swahili_posters.pdf
http://www.who.int/wormcontrol/education_materials/tanzania/en/english_healthpromoschools.pdf
http://www.who.int/wormcontrol/documents/urbani_booklet.pdf
Improving Child Health
No child in the world will go to bed hungry by the year 2000.’ This was one of the closing statements of the Food Security Conference in Rome in 1974. (1) According to the United Nations Development Programme, hunger now prevails among at least a quarter of the world’s inhabitants. Every day there are 30,000 – 40,000 child deaths in the world and most of these are from diseases related to poverty. (2) This means that there are 12 to 14 million-child deaths associated with hunger each year.
The well-known phrase ‘Health for all by the year 2000’ was first heard at the United Nations Alma Ata conference in 1978. Alas, its aims were never realised and so in the year 2000 it is now time to examine both why the target was not reached and what can be done to try and make some serious reductions in this tragic waste of human life. Such statements fall easily from the lips of politicians and planners but what is the reality against which they must be put in context?
According to the World Bank almost 65% of the inhabitants of Africa live in ‘absolute poverty’, a term used by the former World Bank President Robert MacNamara to describe a condition of total deprivation of the minimum living conditions essential for human dignity. (3)
We are familiar with such terms as the ‘Debt Trap’and other causes of morbidity and mortality amongst children and women – the most vulnerable groups. This ‘pathology of poverty’ in the Third World is associated with increased scarcity of resources, more hunger, and increasing death rates. The poverty gap has increased by 30% over the past decade. We are also aware of the problems caused by aids, the enforced reductions in public expenditure on health and welfare and the shrinking education budgets that many countries now battle with.
So, how can ordinary people attempt to do something positive to improve their quality of life and that of their families and communities? Well, let’s look at two simple statements.
· there are more teachers than doctors
· there are more pupils than patients
Simple statements yes but they offer a base from which to build programmes that allow those most at risk from serious and life threatening disease to begin to do something positive to help themselves. In modern political terms people need to be ‘empowered’ or offered the knowledge to ‘enable’ them to begin an active campaign to improve living condition for the most vulnerable members of society.
Let’s look again in more detail at the two statements.
Teachers meet with the young and build a trusting relationship through which knowledge and its application are passed. Why not incorporate in normal timetables/curriculum’s simple advice on the major diseases that cause so much of the poverty that is evident in Africa? This can be done in interesting ways that encourage participation and a desire to spread the information. Lessons can centre on outward signs of possible illness, ways of reducing the risk of catching such diseases and effective proposals for helping those who already have an illness. Greater awareness may also reduce prejudice and misunderstanding. (4) Access to life saving information need not be the privilege of those fortunate to live near to better-stocked medical centres.
The second statement noted that more pupils exist than patients. So, once again here is a perfect opportunity to allow the young to be pioneers within their own communities in the spreading of health messages that offer a positive input to communal life. None of this need be sophisticated. Indeed, the more basic the message the greater the chance of acceptance. Young people can be ‘peer educators’ to their own age group and ‘ information providers’ to their wider community. Such programmes do not require vast sums of money and individuals feel involved and valued.
Evidence of the impact on both individual and community health standards can be gathered from many different locations. An example is that of Nicaragua, where successive Structural Adjustment Programmes seriously reduced the fabric of the health and education facilities. A more ‘upside down approach’, in which simple primary health information was given to young people has now been introduced in some regions and the levels of malnutrition and infant mortality are beginning to drop – though only by a little. (5) In India the ‘bottom upwards’ approach adopted in Vellore, South India has also paid visible dividends in increased child welfare and better treatment for women. (6)
In the coming weeks we will be concentrating on many of the diseases most prevalent in West Africa and producing simple, effective and free teaching materials. We will be including materials on each disease, community and individual reactions and possible life style changes that could help in the fight against the killer diseases. Each disease will be given adequate coverage to allow teachers and others who work with the young to offer positive, enabling instruction that will empower the next generation to make a significant contribution to the health of both themselves and their communities. We will also be offering other sources of information. If anyone would like to converse with John you can contact him on: john_birchall@bsc.biblio.net
References
1.United Nations Development Programme: Human Development Report, 1991. Oxford: Oxford University Press, 1991.
2. Grant JP The state of the world’s children. Oxford University Press.1992
3.McNamara RS. The McNamara years at the World Bank: major policy addresses of Robert McNamara, 1968-1981.Baltimore: John Hopkins University press, 1981.
4. Birchall JN, The reactions of the young to leprosy when the disease is explained to them, Journal of Health Education in Development, Volume 2, Summer 1998. London 1998 and empowering the young to be peer educators, Indian Journal of Primary Education, New Delhi, Spring 1997.
5 Zuniga MH, Nicaragua: Health in a Global Era, Contact, Number 159 February to march 1998, Geneva, Switzerland.
6 Bhattacharji S, Challenges to the Healing Ministry, Contact, Number 159 February to March 1998, Geneva, Switzerland.
Why not visit: http://www.johnbirchall-economist.com/primary%20health%20care/healthcare.html and note the materials that are there.
The diseases affecting Africa are changing
Until recently combating illness in Africa was mainly focused on the battles against HIV/Aids, Tuberculosis and malaria. But the continent is home to nine of the most prevalent ‘neglected tropical diseases’. To these we must also add the noticeable increase in diseases of affluence amongst the emerging middle classes.
It is now time to accept that treating HIV/Aids is not enough and attention and money must be channelled towards persistent childhood respiratory illnesses and diarrhoea and the too often neglected diseases such as hookworm and bilharzia.
The diseases of affluence need to be now immediately, for as the developed world has already witnessed obesity and the illnesses that derive from this quickly take hold of a generation and then become very difficult to reduce.
The rapidly growing urban conurbations of Africa pose new health threats to their inhabitants. Programmes against the chronic diseases have begun but little is being spent on diabetes, hypertension, cardiovascular diseases and strokes – and all are on the increase amongst those whose ‘life style’ will move closer to those of their western equivalents and with that will arise an increased prevalence of the illnesses now mainly experiences in the developed world. The paradox of Africa’s economic growth is that the middle class who have emerged as a result of this newly created economic wealth have adopted the very life style that will encourage damaging life style choices. Smoking, the consumption of alcohol and a more sedentary life style will only increase the prevalence of the diseases associated with ‘western-styles’ of life. The increase in car ownership, the use of computers and television watching and the consumption of heavy saturated fats in fast foods will also increase such diseases amongst those who can afford such consumption. African food by tradition well balanced and nutritious – the fast food revolution seldom, if ever, is!! Though accurate data does not exist it is an agreed fact amongst medical practitioners that the incidence of respiratory diseases, diabetes, high blood pressure, heart disease and other chronic illnesses is increasing. The statistics which do exist suggest that nearly half of all premature adult deaths in urban areas are the result of the disease associated with affluence. This figure is set to rise to 7 out of 10 deaths by 2020.
Public information campaigns are thought to be the effective means of confronting the problem of chronic disease of affluence. In developed economies these campaigns have at least slowed the incidence of cardio vascular disease, though the incidence of diabetes is increasing. However, whether the main causal factor of a significant rise in heart disease or diabetes is diet or a lack of exercise is still to be researched. It maybe that some people are genetically more at risk than others. One study, recently published in the US suggested that a certain plastic found in food packing (bisphenol A - BPA) maybe a contributory factor. The study found that individuals with a large amount of BPA in their urine had nearly three times the risk of a heart disease and more than twice the risk of diabetes.
Sub-Saharan Africa’s Nine Neglected Tropical Diseases
Condition Cases in Africa Proportion of global burden in Africa
Hookworm 198m 27%-34%
Roundworm 173m 14%-22%
Bilharzia 166m 89%
Whipworm 162m 20%-26%
Trachoma 33m 40%
Elephantiasis 46m 38%
River Blindness 18m 99%
Sleeping Sickness 0.5m 100%
Guinea Worm 0.1m 100%
The Above still account for almost a quarter of Africa’s disability-adjusted life years (DALY’s) – the internationally recognised standard measure of a disease’s impact. Yet the cost of combating the more common of these diseases is about $0.5 a person a year. Such a low cost for allowing large numbers of people to live a healthier and more productive life must surely make African governments allocate funds to addressing the above. The fight against Bilharzia clearly shows the benefits of co-ordinated public awareness campaigns and wide spread drug availability. For just $0.30 a person a year and most sufferers are children this debilitating disease can be controlled. The same applies to River Blindness.
Grants, subsidised drugs and other forms of donations have led to almost 100 million now being treated for the prevention of NTD’s – the figure was 0 twenty years ago.
Bilharzia is thought to infect up to 200 million people a year and this then adversely impacts on those responsible for caring for the sufferers. Yet, if the world community put aside sufficient funds to address diseases such as this and other water borne illnesses it is agreed that in a relatively short space of time they would become ‘confined to the history books’.
Alas, most of the sufferers do not even know that they have the disease and so do not seek treatment. It is here that a systematic campaign of public awareness, within which educational establishments could play a major role, would help reduce the suffering of those with the diseases and those most at risk of catching them.
John
June 2009
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