Tanzania’s first albino MP has told the BBC of her surprise at being nominated by the president - and her determination to fight the discrimination that she and other people with albinism suffer.
Twenty people with albinism have been murdered in the past year in Tanzania, where there is a widespread belief that the condition is the result of a curse.
A group of villagers gather at the local bicycle repair shop at Njiapanda, a dusty roadside hamlet on the rift valley in Singida region in central Tanzania, to marvel at magazine pictures of massive electricity-generating wind turbines.
They have never seen anything like this before and are clearly impressed.
They will soon find out exactly what the turbines are like. In a matter of months, 24 of these 100m-plus-high power generators will be erected next to their homes, as part of the first commercial wind farm in sub-Saharan Africa.
The first in the book series Studies in the African Past was published in 2001, consisting of reports produced by the archaeology research project, ‘Human Responses and Contribution to Environmental Change’. The new research initiative developed out of this project is known as the ‘African Archaeology Network’. This is investigating how ancient African societies exploited resources, developed settlements and established long-distance trade networks. A pan-African project, it aims to develop new models to understand how ancient communities adjusted and responded to political and environmental upheavals; and to demonstrate the potential for more research in the different areas of African archaeology.
Consisting of ten chapters, this volume includes nine scientific reports and one review emanating from Mali, Nigeria, Uganda, Kenya, the Island of Mafia in Tanzania, Mozambique, Namibia, Madagascar and Zimbabwe. Topics covered include: dense ancient settlements along the Sahara desert; mappings of historical settlements in south-west Nigeria; excavations of the areas around Lake Victoria in Uganda; ancient iron industries; evidence of the domestication of animals and the importation of goods into Tanzania from India and the Nile Valley in the Neolithic age; contact with early European traders and travellers from 160, and how these paved the way for the extension of the western European system into African communities; and hunter- gather and pastoral adaptive strategies in the Namib desert.
Zanzibar is an archipelago made up of Zanzibar and Pemba Islands, and several islets. It is located in the Indian Ocean, about 25 miles from the Tanzanian coast, and 6° south of the equator. Zanzibar Island (known locally as Unguja, but as Zanzibar internationally) is 60 miles long and 20 miles wide, occupying a total area of approximately 650 square miles. It is characterised by beautiful sandy beaches with fringing coral reefs, and the magic of historic Stone Town - said to be the only functioning ancient town in East Africa.
Years of neglect have left many buildings in Stone Town, the historic capital of the Indian Ocean island of Zanzibar, close to collapse - but now a team of women builders are trying to put that right.
The Indian Ocean island of Zanzibar is an iconic travel destination, known for white sandy beaches and its capital Stone Town, with its eclectic mix of Arab and African influences.
Ben and I go to the Post Office to collect his new passport which has arrived from the British consulate in the capital; I know to collect it because the Expedited Mail Service called me to notify me: ‘You have a letter’, they said.
The story develops - and I guarantee you’ll smile.
Friend or foe? Private sector sales of anti-malarial drugs in rural Tanzania Malaria treatment policy in Africa has focused mainly on government-run health systems. But many episodes of fever are treated at home using shop-bought drugs. Does the private sector threaten effective malaria treatment? Research involving the London School of Hygiene and Tropical Medicine looked at retailers selling drugs in four districts in Tanzania.
Good quality treatment practices at retail outlets are essential because:
Malaria can progress very quickly to severe illness and death.
Uncontrolled drug use can increase the spread of anti-malarial drug resistance.
Policy-makers are considering the use of combination therapy (using two or more drugs) to improve malaria treatment and slow the development of drug resistance, but effective implementation may depend on retail sector treatment practices.
Researchers interviewed staff at 808 retail outlets, covering nearly all of the private drug retailers in the area. 718 had drugs in stock – 43 drug shops and 675 general stores. The study took place in 2000 when chloroquine was the first line anti-malarial treatment. The researchers found that:
Almost all drug shops stock anti-malarials. Nearly all have chloroquine, 42 percent stocked quinine, 37 percent sulphadoxine-pyrimethamine (SP) and 30 percent amodiaquine. Only a third of general retailers stocked anti-malarials.
Chloroquine products include nine brands of tablets, three of syrup and one injectable, plus unbranded versions of each. There were five brands each of SP and amodiaquine tablets. Many shops stocked several brands of each drug.
Drug shops tended to use dedicated drug suppliers, mostly in Dar es Salaam – several hundred kilometres away. Most general retailers used more local general wholesalers. A few wholesalers supply a high proportion of all shops.
This study shows that private retailers are an important source of anti-malarial drugs in these poor rural areas, despite relatively good coverage of health facilities. This poses several potential problems:
Chloroquine was widely available despite high levels of drug resistance; so many patients probably received an ineffective drug.
SP and amodiaquine are potential components of combination therapy, but were sold as single tablets. If this promotes resistance to these drugs, the benefit of combination therapy may be lost.
Many drug stores had illegal stocks of drugs, suggestion that regulation is weak. This may reduce the ability of the government to work openly with the private sector.
The many different brand names may confuse customers.
But the private sector also provides opportunities for improving malaria treatment and distributing drugs to remote rural areas. Shops often have faster service, better drug availability and more convenient opening times than the public sector. Interventions targeting all retailers are likely to be costly and difficult to deliver due to the large number, diversity and high turnover of shops. The researchers recommend some more cost-effective approaches including:
shaping demand through consumer education
improving the quality, packaging and price of products entering the distribution chain
focusing on drug stores as there are relatively few of them and their staff have primary education and some health-related training
targeting the most popular general wholesalers through training, information and regulation.
Source(s):
‘Retail supply of malaria-related drugs in rural Tanzania: risks and opportunities’, Tropical Medicine and International Health 9(6): 655-663, by C. Goodman, S.P. Kachur, S. Abdulla, E. Mwageni, J. Nyoni, J.A. Schellenberg, A. Mills and P. Bloland, 2004
HINARI subscribers can access the full-text article here. Full document. Funded by: US Agency for International Development; Wellcome Trust; US Centers for Disease Control and Prevention; UK Department for International Development
id21 Research Highlight: 18 March 2005
Further Information:
Catherine Goodman
Health Policy Unit
London School of Hygiene and Tropical Medicine
Keppel Street
London
WC1E 7HT
UK
Be quick – seeking care for life threatening malaria in southern Tanzania
Prompt treatment with relatively cheap and effective drugs can prevent deaths from malaria. So why does this disease still cause more deaths than any other throughout Tanzania? The growth in the use of modern medicines has reduced the delaying impact of traditional remedies. The introduction of the ‘integrated management of childhood illness’ approach, which focuses on the overall wellbeing of a child, is crucial in reducing malaria deaths
The persistently high mortality rates from malaria suggest that a barrier exists in the pathway to effective care in Tanzania. Around 90 percent of Tanzanians live within one hour of government health services, where care for children under five years old is free. Do parents, relatives and other carers use these services when children develop malaria and can they get access to them in time?
This research by the Tanzanian Ministry of Health’s Essential Health Intervention Project (TEHIP) looks at care-seeking for 320 children under five who died from malaria in the Rufiji District of Coast Region, southern Tanzania. The results from a demographic surveillance system with follow-up for all deaths revealed that:
Convulsions (fits – an indicator of cerebral malaria) are seen in 9.4 percent of fatal cases. Tanzanians see these convulsions as a different disease - ‘degedege’, with different causes.
While people see ‘malaria’ as an illness that they can manage at home, using modern medicine from shops and health facilities, ‘degedege’ is a life-threatening condition for which they must quickly seek treatment.
Modern medical care is the first resort in 79 percent of malaria-attributable deaths; 9 percent use traditional care, at home or from traditional practitioners; 12 percent do not seek care at all.
Government health workers are the most common providers of modern care (45 percent) followed by home care with anti-malarials from shops (20 percent).
These patterns are unrelated to the sex of the child or of the head of the household, socioeconomic status or presence of convulsions. But cases with convulsions are less likely to receive no care at all.
More than half of cases seek care two or more times for the same illness from different types of provider. This is more common with convulsions. In malaria deaths where care is accessed more than once, modern care is the first or second resort for at least 90 percent of cases.
This study shows that traditional remedies are no longer a significant delaying factor in accessing modern treatment for life-threatening malaria in Tanzania. At the time of this study, all government providers in Rufiji had adequate drug supplies and offered integrated management of childhood illness (IMCI). This could be a factor in the popularity of government providers. However, the first line anti-malarial in use was chloroquine for which drug resistance was common.
Most care-givers now include modern care early in their search for treatment for eventually severe and fatal malaria. And yet many children are still dying. The recent introduction of IMCI into the study area and replacement of chloroquine with sulfadoxine-pyrimethamine as the first-line drug treatment are important steps to reduce malaria mortality. The researchers also recommend:
focusing public messages on improving early recognition of malaria and severe malaria and improving promptness of treatment seeking
improving quality of modern care in public, private and NGO sectors
simplifying and reinforcing patient adherence to modern treatments.
Source(s):
‘Care-seeking patterns for fatal malaria in Tanzania’, Malaria Journal 3: 27 by D. de Savigny et al, 2004 Full document.
Tanzania Essential Health Interventions Project (TEHIP) Full document. Funded by: International Development Research Centre, Canada; UK Department for International Development; US Centers for Disease Control; National Academy of Sciences, Institute of Medicine
id21 Research Highlight: 31 March 2005
Further Information:
Don de Savigny
Swiss Tropical Institute
Basel 4002
Switzerland
Mosquito nets challenge tradition in Tanzania New bylaws in 2002 legislating against ‘misleading traditions’ were passed in Kyela, southwest Tanzania. Although the bylaws were said to address malaria control, their formulation was influenced by local traditions.
One tradition concerned women who sleep outside at funerals. A new bylaw states that women are forbidden to sleep outside without a mosquito net. However, no bylaw addresses the common practice of men sleeping under the only net in a household, even though children and pregnant women are most at risk from malaria.
A second bylaw required young men to construct brick houses to stop mosquitoes, rather than building with bamboo or mud plaster. However, even brick houses can’t prevent mosquitoes from entering through the roof or windows. It is much cheaper for households to buy mosquito nets for a whole family.
Failure to keep to the new bylaws risked a fine of 10,000 shillings (an average month’s income in rural areas) or a sentence of six months in prison.
Clearly these bylaws are about more than just malaria control. Research revealed that:
Mosquito bites are traditionally symbolic of a woman’s suffering when in mourning. Sleeping under a net at a funeral or a son building a brick house for himself before he builds a home for his father results in punishment by witchcraft.
The sexuality of women is thought to be dangerous to others when mourning: discussions about mosquito nets and funerals quickly led to men’s concerns that women meet their lovers at night.
Keeping a woman under a net at funerals is one of many ways in which men use symbols of ‘modernity’ to discipline women’s behaviour.
Political conflict between young and older men leads to an increase in accusations of witchcraft.
By encouraging young men to build brick houses, older men are seen to be progressive and not practicing witchcraft.
Findings suggest that the bylaws probably originated from a study on belief and malaria in which local people took part. Policymakers need to be aware that the effects of such studies can extend far beyond their original remit. Research and policy recommendations include:
broadening the concept of ‘belief’ from the extraordinary (funerals and witchcraft) to the everyday (men sleeping under nets instead of women and children, and brick houses protecting against mosquitoes)
being aware that medical agendas can be hijacked by local issues
recognising that for local people, concerns about the risk of malaria must be understood in the context of competing risks, such as witchcraft and AIDS.
Further Information:
Rebecca Marsland
Department of Anthropology
School of Oriental and African Studies
University of London
Thornhaugh Street
London WC1H 0XG
UK
Malaria: the acceptable disease in Tanzania What are the social consequences of labelling mild fevers as malaria in Africa? Research in northern Tanzania highlights the social and cultural factors that influence women’s experiences and attitudes to malaria and its diagnosis.
While the diagnosis of a disease is biomedical, the labelling of an illness involves social processes including the cultural norms regarding the accepted ‘sick role’ for a disease. If being tested for malaria is performing a social, as well as a clinical function, then changing the behaviour of both patient and provider requires an understanding of the symbolism of malaria diagnosis.
In sub-Saharan Africa, malaria is often perceived as a common illness, producing minimal disruption. Treating the tolerable signs and symptoms is considered the responsibility of the individual or family. Even among children, uncomplicated malaria is seen as a mild everyday illness.
Unlike AIDS or tuberculosis, people with malaria do not suffer social sanctions or emotional trauma from stigmatisation. In Tanzania, malaria is being used to hide stigmatising situations. Although associated with poverty, malaria seems to be an acceptable label because it is not directly infectious and is ‘invisible’.
A study in the Kilimanjaro and Mawenzi regions of Tanzania found that women:
recognise the biomedical model of malaria and describe a broad range of ‘malaria’ illnesses, based on previous experiences, which cause different symptoms and affect different parts of the body
who are sure they have malaria but had negative tests, visit a second health facility for a repeat test. This is either because they believe the malaria could be ‘hiding’ or because they are looking for confirmation that they have malaria rather than a more serious illness
use the term ‘malaria’, even when they do not feel sick, to conceal other problems such as menstruation, early signs of pregnancy, gynaecological problems, and to avoid sex with their spouses.
Women use malaria as an excuse to avoid duties, but at the same time a diagnosis of malaria is reassuring when women are feeling sick. As a consequence, women are prepared to spend money on unnecessary malaria tests and treatment.
Practitioners and policymakers need to consider how the term ‘malaria’ is perceived and used because:
inappropriate malaria diagnosis can generate significant costs
wrong diagnosis may lead to inappropriate treatment and/or result in the real illness being overlooked
the willingness to adopt malaria as a label may reflect unmet social, rather than medical, needs.
The social construction of malaria calls for further investigation - especially given the costs of over diagnosis and overuse of antimalarial drugs.
Resistance to remedy: four malaria treatments tested in Tanzania The growing resistance of malaria parasites to single drug treatments in endemic areas of Africa has forced governments to seek more effective treatments, including combinations of drugs. A trial in Tanzania compared four different treatment regimes and found that drug effectiveness is compromised by the high cost of the treatments.
The rapid spread of drug resistance to chloroquine and to sulfadoxine-pyrimethadine (SP) is making the treatment of malaria difficult in many areas of Africa. As a result, governments are following World Health Organisation (WHO) guidelines calling for the introduction of anti-malarial treatments based on the combination of drugs. It is important to study the effectiveness of these treatments taken under operational conditions before implementing new drug policies.
Researchers carried out a trial in north-eastern Tanzania, a region with high levels of drug resistance to conventional anti-malarial treatments. The trial compared four treatments: amodiaquine (AQ) alone; amodiaquine and sulfadoxine-pyrimethadine (AQ+SP); amodiaquine and artesunate (AQ+AS); and artemether-lumefantrine (Coartem), taken unsupervised. Almost 2,000 children aged five years and below with malaria were assigned one of the treatments at random and were examined during the trial at 14 and 28 days.
Researchers found that:
More than 40 percent of children who had been assigned the AQ treatment still had parasites in their blood samples 14 days after commencing treatment. An even higher 76 percent of parasites remained after 28 days. As a result, the study stopped assigning AQ to new recruits.
Those who were assigned the other three treatments fared better. The levels of parasites in the blood at 14 days were 20 percent for AQ+SP, 11 percent for AQ+AS and 1 percent for Coartem. At 28 days, the levels were 61, 40 and 21 percent respectively.
In sum, the study found that there are limited treatment options available in parts of Africa where drug resistance is high. Adding an artemisinin to a drug which is failing locally leads to an ineffective combination.
Some combinations of drugs are not packaged in the correct doses for children. This may have lowered adherence to the treatment. On the other hand, the study showed that artemether-lumefantrine (Coartem) in WHO packaging was effective when taken unsupervised. However, in practice its effectiveness is likely to be compromised by the high price of the drug. High prices also limit the wider introduction of effective drugs in national anti-malarial programmes. The study calls for:
further development of affordable effective drugs against malaria
increased availability of the correctly packaged doses for children of existing combined therapies
substantial reduction in the cost of effective treatments through market mechanisms and subsidies.
