Antke Zuechner – Improving children’s health through the mother
As a pediatrician, Antke Zuechner knows that the health status of children is in a large part determined by the health and knowledge of their mothers. Dr. Zuechner is working at Bugando Medical Centre in Mwanza Tanzania for three years with a German nonprofit called AGEH (Association for Development Cooperation); one of the main reasons she has committed her time and expertise to this East African hospital is the great need in terms of the sheer volume of children in Tanzania and the lack of pediatricians and other health professionals.
Dr. Antke Zuechner
Dr. Zuechner divides her time between working in the wards, particularly in the Neonatal Intensive Care Unit (NICU), and teaching students in the adjacent university, Bugando University College of Health Sciences. For a start, women need to know their HIV status in order to ensure they do not pass the infection to their newborns, especially since new drugs and practices make infection of the child so preventable. Education about HIV/AIDS, breastfeeding and other topics related to child health are important aspects of prenatal and antenatal care that Dr. Zuechner engages in on a daily basis. It is not uncommon for the mother to face a problem with breastfeeding due to calorie or vitamin deficiencies that are driven by a poor diet and poverty. A well recognized fact is that the economic status of a person affects their health-seeking behavior. A woman would need the means to travel to a hospital or health facility in order to receive and pay for their necessary treatment; fortunately, the government of Tanzania mandates that treatment for women and children under five is free of charge.
In Sengerema Hospital outside of Mwanza, a novel initiative to reduce the risk of pregnancy or delivery complications is at work. A housing complex has been devoted to pregnant at-risk women so that in the event of an emergency they are close to a well-equipped and staffed facility. This addresses a slue of the problems in Tanzania and throughout Africa: the lack of transport to health facilities, the unavailability of equipment and chronic understaffing. Perhaps programs such as this are possible in other areas in an effort to reduce maternal mortality. Dr. Zuechner has witnessed too many women that go into labor in transit to a health facility and put their child in danger.
Dr. Zuechner chose the medical profession because its dynamic and interesting work, research and experiences amaze her. Only one year into her three year stretch at Bugando, she realizes that she has quite a bit to learn still about the culture and medical situation. Driven by visible improvements to the situation, motivated students and residents, and a commitment to care for the 20 million children in Tanzania, she will continue to battle one of the world’s highest maternal and child mortality rates through her work.
Amy Lehman — Sex education, family planning and reproductive medicine in remote areas
I am honored to follow Kristina Graff’s piece about fistula risk as one of the major – and all-too-common – risks of childbirth in sub-Saharan Africa, which in my work in the Lake Tanganyika basin is something I see with awful regularity.
Last year, I witnessed a 16 year-old girl die after experiencing exactly the type of scenario Kristina described:
A teen-aged girl from Wampembe (one of the most remote places in all of Tanzania), with an immature pelvis, in an area with no health care workers at all, suffering from obstructed labor, rides an unstable bus and walks over 120 kilometers. When she arrives at the district hospital in Namanyere, she is in septic shock, with a dead baby in her body, and a massive fistula has developed between her ruptured uterus and her bladder. She collapses, and is brought to surgery – performed by an overwhelmed generalist, as there are no Obstetric-Gynecologists in the region. She has lost a tremendous amount of blood during her awful journey, and there is no blood with which to transfuse h
er. There are no proper antibiotics. There are not enough nurses for the hospital to look after her post-surgery. There is no critical care. Just as I walk into the ward, shared with other very young mothers and their infants, the girl dies.
Because Kristina has done such a complete job of delineating the infrastructural barriers woman come up against when trying to deliver a healthy baby, while remaining free of personal and shameful injury, I would like to talk about an issue that is both highly controversial and incredibly integral to a discussion of improving maternal health: sex education, family planning, and reproductive medicine training in general.
As the Touch Foundation has identified, improving the health of societies requires an entire “molecular” framework that includes education. I see this in terms of both education of healthcare workers, as well as education of girls and women. In the ultra-rural areas of Tanzania, and in fact the entire Lake Tanganyika basin, women and girls suffer a disproportionate lack of both access to care and access to education. Here are the areas where girls are married very young, and begin having children when they themselves have not yet physically matured. In the basin, it is not uncommon to see girls having children beginning at age 14 – and then by the time they are 35 or 40 – they have had multiple pregnancies, have multiple children (and experienced the deaths of a number of those children), suffer from fistula, uterine and/or vagina prolapse, urinary incontinence, severe arthritis and spinal trouble, and many other disorders and diseases resulting from unremitting pregnancies and births.
We have partnered with organizations like The Primary Health Care Project Lake Tanganyika which provides counseling on family planning as well as access to contraception to the girls and women who live in remote Lakeside villages in Rukwa region. These sorts of interventions can prevent deaths like the one I described here, as well as the scenarios described in the previous blog posting, by empowering women to have more control over their reproductive lives in general.
This is an upstream, public health intervention, which is both effective and inexpensive. And this is control that is desperately desired by women in the region, who in the absence of this access, often take their own lives into their hands by ingesting herbs which cause miscarriage, or attempt abortions using dirty tools – even sharp sticks – or other even more desperate measures. Which, again, results in tragic and unnecessary death.
Acceptance of family planning and reproductive health in these rural areas is far more widely accepted than one might imagine. The religious and ethnic make-up of women along the lake is diverse. There are Christians, Muslims, Animists. There are ethnic Congolese, Burundians, Zambians, along side Tanzanians. And most women agree: they need more control over their bodies. For this reason, The Lake Tanganyika Floating Health Clinic is initiating new partnerships with U.S. and international organizations like the Midwest Access Project and Ipas to develop curricula for local health care providers on how to expand sex education, family planning, and reproductive health access to the region, as well as to respond to Obstetrical Emergency.
In the basin, family planning is not a political issue, but rather one of life and death which touches every girl and woman, and indeed their entire families.
Amy G. Lehman, M.D., M.B.A, is the founder of the Lake Tanganyika Floating Health Clinic. The Lake Tanganyika FHC is an international organization whose mission is to address the problem of health care access for isolated communities in the Lake Tanganyika basin/Great Lakes region in Central Africa.
Kristina Graff — Without proper care during childbirth, mothers can suffer lifetime of indignity
Imagine a mountain village in Tanzania. Tiny homes and farms pepper the steep hills, crisscrossed by narrow dirt footpaths that women, men and children use to travel to their fields, schools and markets in town. It is picturesque, remote and untainted by the trappings of industrialization and development.
Now consider a medical emergency. A pregnant woman goes into labor and plans to deliver her baby at home, aided by her mother-in-law and other female relatives. Things do go awry: two days later the woman is still in labor and needs an emergency cesarean section. The nearest road is miles away, and the nearest hospital even further. The only means of transportation is a bus that runs along the main road just twice a week. To get to a doctor the woman must descend the mountain, travel to the nearest road, and find a way to the hospital – all while in labor.
At each step of the way she and her family will encounter barriers: scraping together the money for transportation, borrowing a neighbor’s wheelbarrow or bicycle to carry her down the narrow mountain paths, hiring a car to drive her to the main road – often for a high fee – and traveling to the hospital by bus, flatbed truck or even on foot. When she arrives, hours or days later, her baby will have died. If she survives the journey, she will have suffered an obstetric fistula, a condition that will change her life.
Obstetric fistula occurs when women experience prolonged, obstructed labor and cannot get to a medical facility. Put more simply, when a baby gets stuck in the birth canal for too many days or too many hours, the pressure of its head against the mother’s pelvic bones causes tissue to disintegrate between the vagina and the bladder and/or rectum. A hole forms, and the resulting condition is somewhat akin to incontinence: the mother leaks urine, and sometimes feces, uncontrollably from her vagina. The condition causes an unpleasant odor and can lead to nerve damage in the feet. Women with fistula are thus commonly ostracized from their families and communities, working, living and sleeping alone.
Fistula is the product of several socio-cultural, economic and infrastructural dynamics. The cultural tendencies to deliver babies at home, without prenatal care or any plan for medical intervention in the event of an emergency, is a contributing factor. Social norms that remove women from economic decision-making – including the choice of where to give birth, and when to use a family’s limited money on emergency health care – are another common culprit. Poverty exacerbates the problem, such that even those who wish to go to the hospital cannot afford the cost of getting there. On the societal level, fistula is borne of a lack of roads, reliable transportation and a functional health care system.
Fistula can be treated by surgical repair, and many women spend years saving money just to pay the bus fare to the hospital. Few doctors are trained to provide this service, however, and most women cannot afford the cost of the operation. Even when the repair is provided free of charge, getting the word out to the affected women presents a challenge: they tend to live in more remote locations, and they may not be able to pamphlets and flyers giving information on how to access fistula treatment.
International and local organizations alike are working to raise awareness of how to prevent and treat fistula, and they are training doctors to do repairs…but the demand for care far outpaces the supply. For every woman who learns that repairs are offered and gets to the hospital for treatment, several more will sustain the same devastating injury in childbirth.
The end to fistula will require infrastructural development to provide reliable transportation to and from the furthest corners of the poorest countries, a stronger emergency medical care system that trains primary-level providers to recognize and refer the signs of a high-risk pregnancy and obstructed labor, and a new social order that prioritizes women in economic and cultural decision-making. Only then can the women who live high up along the mountain footpaths count on the safe delivery of their babies.
Kristina Graff is the Associate Director of the Center for Health and Well Being at Princeton University. Her past focus has been on maternal and reproductive health problems that stem from gender inequities and economic disparities. Kristina has worked in sub-Saharan Africa, Asia, Latin America, and New York City. She spent a year in Tanzania working for the Women’s Dignity Project on fistula issues.
Editor’s note: Bugando Medical Centre, which the Touch Foundation supports, is a center of excellence in East Africa on fistula repair.
Karen Bell — An often overlooked maternal health issue: micronutrients!
Women in Africa face yet another health risk that is largely invisible until pregnancy or infection place extraordinary demands on their bodies. 
Micronutrient deficiencies affecting much of the population—specifically lack of iron, iodine, folate, zinc, and vitamin A—can contribute to death and disability from anemia, diarrhea, miscarriages, and birth defects if left uncorrected. For example, folic acid, the synthetic form of folate, a soluble B vitamin found in spinach, legumes, citrus fruit, and whole grains, will prevent severe birth defects if a woman takes it regularly prior to becoming pregnant.
Much of the population consumes diets that don’t contribute enough of these key vitamins and minerals. In many countries, maternal and child health programs have been distributing iron and folic acid supplements to pregnant women for years, yet these often, especially in sub-Saharan Africa, do not reach the most vulnerable women in time to make a difference. Folic acid consumption will prevent most cases of spina bifida and anencephaly if taken daily prior to conception, will promote healthy fetal growth, and will help protect a woman from developing severe anemia during pregnancy and postpartum. Folic acid has many benefits for people of all ages, including cardiovascular disease and possibly cancer prevention. A UNICEF report estimates that up to 27,000 infant and 1,600 maternal deaths annually could be avoided in Tanzania if young women who might become pregnant consumed adequate amounts of micronutrients.
Tanzania is now considering whether and how to implement a strategy that will deliver folic acid to the entire population through fortification of staple foods, wheat and corn. A National Food Fortification Alliance is working with international donors to help millers make this program a reality. The annual cost of this intervention, including both iron and folic acid enrichment, would be less than $1 per person per year. It is important for health care leaders to speak out and encourage government leaders to adopt the regulations and incentives needed to fortify flour with folic acid and iron. Other countries that have required flour fortification, like the United States and Chile, have documented decreases in neural tube defects ranging from 20 to 40% annually.
Karen N. Bell, MPH, is a Senior Faculty Associate at the Rollins School of Public Health at Emory University.
Molly Ferguson: Preventing HIV Transmission from Mother-to-Child
Mother-to-child transmission of HIV is a significant and preventable public health problem in sub-Saharan Africa. HIV can be passed from a mother to her child during pregnancy, delivery, or breastfeeding. In 2008, about 90% of new HIV infections in children occurred in Africa, mainly through mother-to-child transmission. In some areas of southern Africa, 30% or more of pregnant women are HIV positive. Without treatment, 25-30% of babies born to HIV positive women will become infected through mother-to-child transmission.
430,000 African children under the age of 15 contracted HIV through mother-to-child transmission during 2008. This is particularly astounding because of the distinct disparity between the rates of mother-to-child transmission in African nations versus high-income countries throughout the world. In the United States, HIV is transmitted from a mother to her baby in 100-200 out of the 40 million US births per year. In Tanzania, it is estimated that mother-to-child transmission occurs in up to 7 out of every 100 children. HIV transmission from mothers to their children has been all by eliminated in the United States and other wealthy nations as a result of access to antiretroviral therapy, early detection and testing practices, and widely available access to safe breast-milk substitutes. These prevention strategies are fairly simple and low-cost, and are effective methods of preventing the spread of HIV from mothers to their babies.
There are several ways to prevent mother-to-child HIV transmission. First and foremost, there is a need for widespread availability of HIV testing for potential parents and other adults. In addition, it is important to address the stigma attached to testing positive for HIV infection, and substantial work is needed to understand the barriers that lead to discrimination associated with being HIV positive. Contraception also plays an important role in mother-to-child HIV transmission because of its ability to protect HIV-positive women from unintended pregnancies. Another effective method is the use of antiretroviral drug therapy. For HIV positive women who become pregnant, increased availability of and access to antiretroviral drugs and other preventive measures is a safe and effective way to prevent the spread of HIV from a mother to her baby. Last but not least, comprehensive counseling, education, and support are needed for HIV positive women and their families before, during, and after pregnancy.
Women in Tanzania often rely on their husbands financially, and are thereby at an increased vulnerability to financial difficulty if they are diagnosed as HIV-positive. Many women in Tanzania have found support through organizations including the Mother-to-Child Transmission of HIV/AIDS program, which has been piloted by the Tanzanian Government and UNICEF. Despite the existence of such programs, many HIV positive women do not utilize the services due to perceived stigma, rejection, and denial from husbands on whom they are financially dependent. As a result, the promotion and supply of contraceptive resources for use among women is a strong prevention strategy because it prevents almost 30% more HIV-positive births than antiretroviral therapy for the same cost.
Photo credit: USAID Africa Bureau Photo Library. A child health nurse consults with a mother at a maternal child health clinic in Iringa, Tanzania.
Molly Ferguson has a Masters in Public Health and conducts research on evidence-based practice at Northwestern University.
Touch Foundation launches maternal health campaign, unite4moms!
As part of our unite4moms! initiative, the Who Cares? Campaign blog is exploring maternal health from April 15 to June 15, 2010.
Globally, childbirth is the leading killer of young women. More than 500,000 women die each year from pregnancy- or birth-related complications and 99% of maternal deaths are in developing countries. In the vast majority of cases, deaths could be prevented if women receive improved access to skilled healthcare workers.
The maternal health statistics in sub-Saharan Africa – and in Tanzania in particular – are shocking. On average, 1 woman and 6 infants die each hour from preventable, birth-related complications in Tanzania.
The connection between the lack of healthcare workers and poor maternal health is clear. Risks of mortality for women and their babies are highest at the time of birth. Maternal deaths decrease dramatically if a woman receives access to prenatal care and if a trained health worker is present while a woman gives birth.
Sadly, in Tanzania, fewer than 50 percent of women have access to a doctor, nurse or other skilled medical worker during childbirth. The Touch Foundation is working to address this dire shortage of healthcare workers in Tanzania.
As part of our new unite4moms! campaign, we are promoting 4 ways that people like you can join the effort to advance maternal health. For example, you can purchase global crafts – from hand-woven baskets made by women artisans in Swaziland to chic 
New York charm necklaces featured in Vogue – to benefit the training of healthcare workers in Africa.
Check our unite4moms! campaign page for details! (click HERE)
Erick J. Mazyala: Challenges in Transforming Medical Schools in Tanzania
Medical professors throughout the globe have a similar role of ensuring that future doctors acquire adequate training to provide competent and safe care.
In Tanzania, as is the case for the majority of Least Developed Countries (LDCs), the need for doctors is exceedingly high. Life expectancy is 43.5 years compared to 78.9 in developed countries. Doctor: population ratio in Tanzania stands at 1:30,000, well below the World Health Organization’s (WHO) recommended doctor: population ratio of 1:1,000. Most of the deaths in Tanzania and LDCs in general are due to preventable or curable causes. This is most often due to limited access to basic healthcare. In poor resource settings and a tropical climate, conditions are ripe for parasites and infectious diseases, many of which remain neglected.
Tanzania endorsed the Millennium Development Goals (MDGs) in 2000, but we are far from meeting the 2015 targets. For example, according to data from 2008, infant mortality is 68/1000 live births, under-five mortality rate is 112/1,000 live births, and maternal mortality is 578/100,000 live births. The proportion of the population below the basic needs poverty line (earning less than $1 per day) is 33 %.
Availability of healthcare givers who are competent enough to deliver primary healthcare and correctly diagnose diseases are in high demand in Tanzania. This will improve in the long run to ensure accessibility of primary healthcare to the community. Medical institutions such as Bugando’s university in Mwanza are trying hard to expand student enrollment to reduce the deficit of physicians. With this in mind, being a medical academic at Bugando’s university, I feel overburdened, yet privileged, charged with the responsibility of nurturing future doctors.
With better infrastructure and information technology (IT), we will be able to transform the curriculum to a more student-centered approach in which students can become more active learners via problem-based learning (PBL). As is the case in most sub-Saharan African medical schools, Internet connectivity and IT, an indispensable entity in modernizing medical trainings, is underdeveloped. The relatively small faculty size is another serious challenge.
The Touch Foundation, through charity donations from the international community, has been working tirelessly with the people of Tanzania to support the training of doctors and other healthcare workers at Bugando’s university. However, there is still a long way to go in improving physical infrastructures such as lecture theaters, laboratories, IT facilities, and expanding the faculty to match the high student enrollment.
Dr. Erick J. Mazyala is an Assistant Lecturer in the Anatomy and Histology Department of Bugando University College of Health Sciences (BUCHS), which is the second largest medical school in Tanzania and is supported by the Touch Foundation.
Brad Tytel: Sustained Voices Will Lead to Sustained Commitment
One of my TB heroes—a man who has dedicated his life to stopping the disease—tells a story about how he first got involved with a killer everyone else seemed to have forgotten.
In 1990, he was a doctor at Muhimbili Hospital in Dar es Salaam, Tanzania. It was the first time he saw how TB and HIV conspired to kill more patients than over-stretched and under-funded health systems had any hope of treating. The hospital had only 3,000 beds for nearly 6,000 patients, so patients with HIV and patients with TB ended up doubled up in the same beds. Looking back, it is easy to see a recipe for disaster: patients with infectious TB in close quarters with highly immune-compromised neighbors. But the TB diagnostic was lousy, and by the time he and other doctors knew a patient had TB, that patient had almost certainly infected dozens of others.
With stories like these, why doesn’t TB have us all marching through the streets? Nearly two million people each year are dying of a disease that developed countries such as the U.S. “defeated” half a century ago. Twenty years after Muhimbili, the most commonly used diagnostic is still lousy and misses up to one-half of all TB cases. The drugs are old, have unpleasant side effects and take a minimum of six months to treat a patient. If patients don’t complete treatment—whatever the reason—they may develop and spread a more deadly form of drug resistant TB. There are doctors and nurses in the field doing their heroic best to stop the TB epidemic. But without more resources and new and better tools TB will continue to spread.
TB needs strong champions to push back against the neglect that led to a resurgent epidemic. If the history of the HIV/AIDS epidemic has taught us anything, it’s that effective advocacy and communications can shape the international response to a disease. At the grassroots level, TB patients, doctors and community activists need to demand better access to, and tools for, treatment and prevention. At the national and international level, advocates have to make the case for increased funding for healthcare and investments in research that will lead to improved tools and methods.
Fortunately, much progress is being made. Passionate, engaging and effective TB patient advocates and grassroots organizations have emerged, either independently or with support from international TB or HIV organizations. Many of these activists are joining forces with colleagues focused on other disease. At the November 2009 Multilateral Initiative Against Malaria Conference in Nairobi, Kenya, I witnessed a sizable and impressive demonstration convened with the help of several TB groups that called on President Obama and other leaders to meet their commitments to the Global Fund to Fight AIDS, Tuberculosis, and Malaria.
At the international level, funding for TB prevention and control has increased significantly, particularly through the Global Fund, UNITAID, and the US government. This is largely due to the efforts of TB advocacy organizations and increased attention to the dangers of TB/HIV and drug resistance. At the same time, many high TB burden countries, particularly those with emerging economies like South Africa, China and India, are now taking increased steps to stop TB—and there is hope that these gains could translate into assistance for countries like Tanzania.
There is still an enormous amount of work to do, and resources available for TB are still a fraction of what is needed. But sustained voices will lead to sustained commitment. By telling stories like that of Muhimbili and using those experiences to push for change, we can draw renewed attention to an ancient killer.
Brad Tytel is a Director at Global Health Strategies, an international consulting company that uses advocacy and communications to help ensure development and worldwide delivery of health technologies and information – including for TB.
Photo captions: Activists in Nairobi, Kenya, call on donor governments to stop TB, AIDS and Malaria – November 2009. Credit: Global Helath Strategies
Heather Ignatius — Community Outreach is an Essential Component of TB Research
Mbeya CAB members march to spread awareness about the TB trials taking place in their community.
TB kills nearly 5,000 people a day—that’s 1 person every 20 seconds. Of the 1.8 million TB deaths each year, over 90% occur in developing countries, further exacerbating poverty among the world’s poorest and most vulnerable populations. Fueled partially by a high burden of HIV, Tanzania is among the nations hardest hit by the TB epidemic.
For those affected with TB, successfully completing treatment is extremely challenging. TB treatment relies on 4 drugs administered over a period of 6 – 9 months, and often includes daily observation. In low-resource settings, the requirements of treatment place a tremendous burden on patients and health systems alike. The hardships of administering and completing TB treatment, including the accompanying side effects, cause many to stop taking their medicine prematurely. This leads to the development of drug-resistant TB, which is much more deadly and much more difficult and costly to treat.
The challenge of completing TB treatment is further complicated by dangerous drug interactions between TB drugs and certain anti-retrovirals commonly used to treat HIV. For the millions infected with both TB and HIV, treatment of one disease is often interrupted to administer treatment of the other.
However, recent developments in TB drug development offer hope for the future. After decades of stagnation in research and development, the first new TB drug candidates in more than 40 years have reached the clinical testing phase. One drug, which has the potential to reduce treatment to 4 months, is currently being tested at two sites in Tanzania: the Kibong’oto National TB Hospital near Moshi, and the Mbeya Medical Research Programme (MMRP) at Mbeya Referral Hospital.
As a component of this clinical trial, the Tanzanian sites have implemented community engagement programs to ensure that the communities in which they work are aware of and educated about the research.
Drawing clients from a catchment area that spans several communities across Mount Kilimanjaro’s foothills, Kibong’oto Hospital offers primarily in-patient TB care, as patients are unable to make the daily trek to receive observed treatment. The hospital staff has set up a permanent outreach department for the patients’ families and communities, as well as a Community Advisory Board (CAB)—a group of 15 local community leaders and health outreach workers who educate others about TB and the trials being conducted at the hospital and related issues.
The Kibong’oto community engagement program finds that holding public educational events on the Hospital’s grounds helps bridge the gap between the medical staff and the community. One notable event last year included an art competition open to local students. The winners’ artwork was featured in educational materials on TB disease that were disseminated in the CAB’s outreach in an effort to raise awareness and combat stigma. This year on March 24, World TB Day, the hospital will host an Open House and quiz show to educate the community about TB.
A theatre troop performs for World TB Day to educate the community about TB.
In the more urban Mbeya, community outreach by the MMRP has used call-in radio shows and theatre performances to educate the surrounding community about the issues associated with TB.
The local CAB, originally developed around participation in a previous HIV trial, consists of about a dozen community leaders such as lawyers, educators and religious leaders. This group took it upon themselves to learn about TB diagnosis, treatment, and research and expand the scope of their educational efforts. On World TB Day, the Mbeya CAB will hold its second annual march to raise awareness about the TB trials taking place in their community.
Heather Ignatius is Policy Manager at the Global Alliance for TB Drug Development, which is a not-for-profit, product development partnership accelerating the discovery and development of new tuberculosis drugs that will shorten treatment, be effective against susceptible and resistant strains, be compatible with antiretroviral therapies for those HIV-TB patients currently on such therapies, and improve treatment of latent infection.
Photo credits: Mbeya Medical Research Programme
Emily Bell: An Ancient Disease Has Made a Deadly Resurgence
An X-ray of a patient diagnosed with advanced bilateral pulmonary tuberculosis. Credit: US Centers for Disease Control (CDC)
The Who Cares? Campaign blog is exploring tuberculosis (TB) for the month of March.
Tuberculosis (TB) is an airborne, bacterial disease that has been around for centuries. In fact, scientists now estimate the disease may have existed 3 million years ago! We now have the tools to diagnose and treat this deadly disease, but almost 2 million people continue to die each year. This is unacceptable.
Those who are infected with and die of TB predominantly live in the poorest communities of the world. A disease of poverty, TB generally affects the most marginalized communities who are also affected by malnutrition, HIV/AIDS, and malaria. They lack adequate access to clean water and basic healthcare.
Sub-Saharan Africa, therefore, faces a particularly high burden of TB with the largest number of TB-related deaths. Tanzania is hard hit, with TB responsible for taking more than 32,000 lives per year. In fact, TB has made a deadly resurgence in Tanzania and elsewhere in sub-Saharan Africa over the past two decades in large part to the spread of HIV/AIDS. The HIV/AIDS pandemic presents a multitude of challenges in tackling TB:
- People who are HIV-positive are more susceptible to TB infection due to their weakened immune systems. This fuels the spread of TB.
- TB is more difficult to diagnose among people who are co-infected with HIV. People who are co-infected often suffer longer before accessing treatment and may also spread TB to their loved ones unknowingly.
- TB is harder to treat among people with HIV. The antibiotic drug regimen to combat TB must be carefully coordinated with other medications, such as antiretrovirals.
Dr. Fred Lwilla, senior program officer for Tanzania’s National TB and Leprosy Program, noted that the number of reported tuberculosis cases is increasing in Tanzania in part because of high HIV prevalence, weak health infrastructure and poverty, according to a recent Tanzanian publication. He cited lack of public awareness and insufficient integration between TB and HIV/AIDS programs as additional obstacles.
The extreme shortage of doctors, nurses, laboratory technicians and other critical healthcare workers in Tanzania makes diagnosis and treatment of TB even more challenging. Treatment, for example, requires a minimum six-month course of antibiotics. Community health workers have proven instrumental in providing daily observed treatment (DOT), but patients often require periodic follow-up with a doctor, especially if they face complications due to HIV/AIDS.
Emily Bell is Head of Advocacy and Communications at the Touch Foundation. She was formerly a Program Officer at the Open Society Institute, where she oversaw a TB monitoring project that focused on several countries, including Tanzania.