Livelihood diversification and the expansion of artisanal mining in rural Tanzania: drivers and policy implications

This paper provides an extended analysis of livelihood diversification in rural Tanzania, with special emphasis on artisanal and small-scale mining (ASM). Over the past decade, this sector of industry, which is labour-intensive and comprises an array of rudimentary and semi-mechanized operations, has become an indispensable economic activity throughout Sub-Saharan Africa, providing employment to a host of redundant public sector workers, retrenched large-scale mine labourers and poor farmers. In many of the region’s rural areas, it is overtaking subsistence agriculture as the primary industry. Such a pattern appears to be unfolding within the Morogoro and Mbeya regions of southern Tanzania, where findings from recent research suggest that a growing number of smallholder farmers are turning to ASM for employment and financial support. It is imperative that national rural development programmes take this trend into account and provide support to these people

Barriers to the use of morphine for the management of severe postoperative pain - A before and after study

Aim To reduce the number of patients experiencing severe postoperative pain by prescribing 10 mg Morphine either as oral solution or by IM injection as an alternative to Tramadol Hydrochloride in an analgesic protocol. Materials and methods Patients who received in-patient oral and maxillofacial surgery under general anaesthesia were included. Complex intervention analgesic protocols were developed including staff education, patient educations and analgesic protocols. 80 patients were treated under the original protocol (tramadol hydrochloride for pain unmanaged by other drugs in protocol) over 4 months. 75 patients were treated under the second protocol (oral or intravenous morphine for pain unmanaged by other drugs in protocol). Patient perceptions to their pain management were then assessed. Results Proportion of patients reporting ‘no pain’ increased from 5% of 80 patients to 28% of 75 patients (p < 0.001). Report of severe pain reduced from 37% to 31% and not significant. Pain duration reduced from 18% to 12% for 75–100% time from surgery to discharge and not significant. Staff used protocols for 96% patients. Nurses provided patient information leaflets for 85%–80% patients. Nearly all patients (96% and 95%) reported overall satisfaction with their pain management. Conclusions The use of morphine given orally or my IM injection rather than tramadol was associated with a significant increase in the number of patients reporting ‘no pain’. However the number of patients experiencing severe pain was not significantly reduced. Despite this, most patients reported high levels of satisfaction which suggested that satisfaction questionnaires should not be used in isolation. Most patients received morphine orally rather than by IM injection but the oral dose may not have been high enough in this study