Burns in Tanzania: Morbidity and Mortality, Causes and Risk Factors: A Review.

Burn injuries in low and middle income countries still remain a significant health problem, even though numbers of burn injuries in high income countries have decreased showing that such events are not "accidents" but are usually preventable. WHO states that the vast majority (over 95%) of fire-related burns occur in low and middle income countries. Burn injuries are a major cause of prolonged hospital stays, disfigurement, disability, and death in Africa Region. Evidence shows that prevention strategies can work. However prevention strategies need to be tailored to the specific environment taking into account local risk factors and available resources. An examination of the patterns and causes of burns should allow site specific recommendations for interventions. This literature review, specific to the United Republic of Tanzania, was conducted by researching PubMed, SafetyLit, and African Journals on Line data bases for primary sources using key words <Tanzania> plus <burns, suicide, homicide, injury mortality, injury morbidity>. Two sets of student data collected as part of Bachelor's degree final dissertations at Muhimbili University of Health and Allied Sciences were used. In all, twenty two primary sources were found. Risk factors for burn morbidity in Tanzania are: 1/ a young age, especially years 1-3, 2/ home environment, especially around cooking fires, 3/ epilepsy, during seizures, and 4/ perceived inevitability of the incident. It was expected that ground level cooking fires would be found to be a risk factor, but several studies have shown non-significant results about raised cooking fires, types of fuel used, and cooking appliances. Risk factors for burn mortality are: being male, between 20-30 years of age, and being punished for alleged thieving by community mobs. An important factor in reducing burn morbidity, especially in children, is to educate people that burns are preventable in most cases and that most burns occur in the home around cooking fires. Children need to be kept away from fires. Epileptics should be monitored for medication and kept away from cooking fires as well. Community members need to be encouraged to bring wrong doers to the police

Youth unemployment, community violence, creating opportunities in Dar es Salaam, Tanzania: a qualitative study

Background: Tanzania has consistently shown in recent decades to have a high overall crime rate.  Although its homicide rate is moderate, Dar es Salaam has an unusually high amount of community violence; more than half of all homicides were due to lynching and vigilantism. Most of these homicides were a reaction to petty theft of purses, cell phones, and domestic meat animals. Employment is hypothesized to decrease petty theft and the resulting homicidal community violence. The objective of this research is to characterize appropriate interventions.Methods: In-depth interviews took place with proxy respondents of youth who had been killed through community violence. Most respondents were relatives of youth killed by community violence or youth who had directly experienced community violence. A focus group was held with at risk youth.Results:  “Lack of employment” was the largest node in terms of number of references and sources. It is reported with “Business Ability” and “Normal Life”. Occupational categories for uneducated youth in Dar es Salaam are:  formal employment, agriculture, petty business, and day labour. Stealing, begging and emigration occur when other options have failed. Suggestions for decreasing death by community violence fell into three categories, all to do with employment: employment creation, working with youth in groups, and creating a supportive environment for small enterprises.Conclusions: Productive occupations are needed, including the revivification of traditional natural resource based industries such as fisheries and forestry. The physical and legal environment must be made conducive for “self-employed non-agricultural workers”.  To optimize potential effectiveness, rigorous experimental research should be conducted, to facilitate humane, equitable, and environmentally sound scale up of youth employment opportunities

Using Constructed Wetlands to Remove Pathogenic Parasites and Fecal Coliforms from Wastewater in Dar es Salaam and Iringa, Tanzania

Wastewater treatment is a widely used health protection measure that can be applied to control the transmission of wastewater-related infectious diseases to communities exposed to wastewater. This study determined the efficiency of three full-scale constructed wetlands (CWs) in removing pathogenic parasites and fecal coliform (FC) bacteria from wastewater. Wastewater samples were collected from three CW systems located in the Dar es Salaam and Iringa regions of Tanzania. The modified Bailenger and modified Ziehl-Neelsen stain techniques were used to detect and quantify parasites. The membrane filtration method was used to detect and quantify FC bacteria. Data were analysed using IBM SPSS version 20. Helminth (Ascaris lumbricoides, hookworm, and Taenia spp.) eggs were completely removed by two CW systems. In all the systems, the removal of protozoa ranged from 99.8% to 100%. The mean concentrations of FCs in effluents ranged from 5 to 6 log units/100 mL. Effluents of all CW systems met the recommended parasitological quality requirements of the World Health Organization for the safe reuse of wastewater. FC effluents concentrations did not meet the local discharge standards of the Tanzania Bureau of Standards. Therefore, improvement to the CWs’ design, operation, and maintenance are required for the efficient removal of bacteria. Keywords: helminth, protozoa, fecal coliform, wastewater treatment, constructed wetlan

Natural Wastewater Treatment Systems for Prevention and Control of Soil-Transmitted Helminths

Wastewater reuse has been considered as an alternative way of overcoming water scarcity in many parts of the world. However, exposures to wastewater are associated with higher prevalence of soil-transmitted helminths (STHs). Globally, about two billion people are infected with at least one species of STHs with those having heavy infections presenting considerable morbidities. The most serious STH species infecting humans include roundworm (Ascaris lumbricoides), whipworm (Trichuris trichiura), and hookworms (Necator americanus and Ancylostoma duodenale). Despite ongoing control campaigns using preventive chemotherapy, wastewater in endemic countries still contains concentrations of STH eggs that put exposed populations at risk of infection. According to the World Health Organization, we can achieve sustainable control of STH by using improved sanitation systems. Since natural wastewater treatment systems (waste stabilization ponds and constructed wetlands) require low maintenance and operational costs, have low mechanical technology and energy consumption, they are ideal for sustainable sanitation services. In addition, natural wastewater treatment systems are reported to efficiently remove various pathogenic organisms from wastewater. This chapter explains the role of natural wastewater treatment systems as sustainable sanitation facilities in removing STH from wastewater and therefore preventing disease transmission

Snakebite Treatment in Tanzania: Identifying Gaps in Community Practices and Hospital Resources

Snakebite envenoming causes more than 140,000 deaths annually and at least triple this number of disabilities. The World Health Organization classified snakebite as a Neglected Tropical Disease in 2017 and developed a strategy to halve death and disability from snakebite by 2030. To achieve this goal, snakebite victims need to receive safe and effective treatment. This descriptive, cross-sectional study surveyed student health professionals (N = 312) in Dar es Salaam, Tanzania, and was designed to identify major gaps in community practices and hospital resources for snakebite treatment. Participants reported using traditional community practices (44%, 95% confidence interval (CI) = 39-50%), allopathic practices (7%, 95% CI = 5-11%), or a combination of both (49%, 95% CI = 43-54%) to treat snakebite. Harmful practices included tight arterial tourniquets (46%, 95% CI = 41-52%) and wound incisions (15%, 95% CI = 11-19%). Many participants (35%, 95% CI = 29-40%) also turned to traditional healers. Students who treated snakebite injuries within the last 5 years (N = 69) also reported their general experiences with snakebite in hospitals. Hospitals often lacked essential resources to treat snakebite victims, and 44% (95% CI = 30-59%) of snakebite victims arrived at a hospital only three or more hours after the bite. A significant percentage of snakebite victims experienced lasting damage (32%, 95% CI = 20-47%) or death (14%, 95% CI = 7-25%). Snakebite outcomes could likely be improved if hospitals were universally and consistently equipped with the essential resources to treat snakebite victims, such as antivenoms. Educational interventions aimed at communities should focus on discouraging tourniquet use and tampering with the wound. Collaboration between the allopathic and traditional health system could further boost snakebite outcomes because traditional healers are often the first health workers to see snakebite victims

Review Article Burns in Tanzania: morbidity and mortality, causes and risk factors: a review

Abstract: Burn injuries in low and middle income countries still remain a significant health problem, even though numbers of burn injuries in high income countries have decreased showing that such events are not &quot;accidents&quot; but are usually preventable. WHO states that the vast majority (over 95%) of fire-related burns occur in low and middle income countries. Burn injuries are a major cause of prolonged hospital stays, disfigurement, disability, and death in Africa Region. Evidence shows that prevention strategies can work. However prevention strategies need to be tailored to the specific environment taking into account local risk factors and available resources. An examination of the patterns and causes of burns should allow site specific recommendations for interventions. This literature review, specific to the United Republic of Tanzania, was conducted by researching PubMed, SafetyLit, and African Journals on Line data bases for primary sources using key words &lt;Tanzania&gt; plus &lt;burns, suicide, homicide, injury mortality, injury morbidity&gt;. Two sets of student data collected as part of Bachelor&apos;s degree final dissertations at Muhimbili University of Health and Allied Sciences were used. In all, twenty two primary sources were found. Risk factors for burn morbidity in Tanzania are: 1/ a young age, especially years 1-3, 2/ home environment, especially around cooking fires, 3/ epilepsy, during seizures, and 4/ perceived inevitability of the incident. It was expected that ground level cooking fires would be found to be a risk factor, but several studies have shown non-significant results about raised cooking fires, types of fuel used, and cooking appliances. Risk factors for burn mortality are: being male, between 20-30 years of age, and being punished for alleged thieving by community mobs. An important factor in reducing burn morbidity, especially in children, is to educate people that burns are preventable in most cases and that most burns occur in the home around cooking fires. Children need to be kept away from fires. Epileptics should be monitored for medication and kept away from cooking fires as well. Community members need to be encouraged to bring wrong doers to the police

Risk and protective factors for homicide death in Dar es Salaam, Tanzania 2005

Background. Little is known scientifically about patterns of violence and peace in low income countries, especially in Africa. Mainland Tanzania gained independence without violence and has maintained political peace, which is rare for an economically poor nation with natural resources. It is not known if this peace is reflected in the realms of the community, family, and individual. What is the context of violent death in a politically peaceful country? Objectives. To describe the homicide rate in Dar es Salaam (DSM) 2005, the individuals who were murdered, and the contextual circumstances. To test the feasibility of the Injury Surveillance Guidelines developed by WHO/CDC (Holder et al. 2001). Design and methods. A mortality survey following the Guidelines, was instituted at Muhimbili National Hospital Mortuary. Quantitative variables were: sex, year of birth, date of death, residence, place and site of death, occupation, cause of death, weapon(s), events leading to death, and relationship of perpetrator. Qualitative data were gathered from participant observation, newspapers, and one open-ended question. Results. The Guidelines were practical and easy to use. They were flexible enough that a new code for the variable of intent was adopted: Mob violence. Active surveillance was unsustainable. The crude homicide rate of 12.95 per 100,000 is higher than the world average, but the lowest reported in Africa so far. The male and female homicide rates per 100,000 were respectively 23.7 and 1.7. The female rate was low compared with rates worldwide. The male:female gender gap of 14.03 was unusually wide. Unemployment and urbanization were risk factors for homicide death. Fifty percent of all homicides were victim-precipitated—males caught thieving and killed by citizen mobs responding to a cry for help. Discussion. Partial passive surveillance is continuing through data in the Mortuary Ledger books. Mob violence is based on community self-policing against petty theft. The significance of the wide gender gap in homicide rates is not clear and has previously been seen in cities with rates of violence five times higher. Conclusion. The Guidelines are suitable for low-income countries. More research is needed on community differences within DSM. Employment for young men with fair reimbursement and training is urgently needed

<em>Schistosoma</em> Hybridizations and Risk of Emerging Zoonosis in Africa: Time to Think of a One Health Approach for Sustainable Schistosomiasis Control and Elimination

Current control of human schistosomiasis in Africa is based on preventive chemotherapy, whereby populations are mass-treated with an anthelminthic medication, praziquantel. The World Health Organization has set a goal of eliminating schistosomiasis as a public health problem and, ultimately, eliminating transmission in all countries where schistosomiasis is endemic by 2030. However, recurrent hybridization between Schistosoma species is an emerging public health concern that has a major impact on the distribution of the disease and ultimately may derail elimination efforts. The One Health approach recognizes interconnections between the health of humans, animals and the environment, and encourages collaborative efforts toward the best outcomes. This chapter explains how the One Health approach can accelerate the control and elimination of schistosomiasis in Africa

Can training interventions in entrepreneurship, beekeeping, and health change the mind-set of vulnerable young adults toward self-employment? A qualitative study from urban Tanzania.

Young adults face unemployment-related challenges, particularly in low- and middle-income countries. Self-employment is encouraged by the Tanzanian government and international institutions such as the World Bank. It has been found that young adults who are employed or self-employed show more functional independence and less inequality and social polarization, as well as a decrease in deviant behaviour. However, limited knowledge and skills related to entrepreneurial activities contribute to lack of motivation towards self-employment among young adults. In order to examine these behaviours, an intervention study implementing an entrepreneurship and beekeeping training in Dar es Salaam, Tanzania was conducted. After completion of the intervention, a qualitative study was conducted that used focus group discussions (FGDs) to explore the experiences and changes in behaviour of young adults following the intervention. A total of 36 of the original 57 young adults from four camps who fully participated in the four arms of interventions were recruited. Qualitative content analysis was used to analyze the FGD data. Three themes emerged from the findings: establishment and maintenance of an entrepreneurial business, changes in behaviour, and perceived challenges. Improved entrepreneurial skills, customer care, and financial management were expressed as positive changes the participants attained relating to business management. Similarly, changes in the participants' behaviours, attitudes, and lifestyle practices led to improved health and increased recognition and respect in their communities. Insufficient start-up capital and long intervals between sessions were the main challenges. The study showed an improvement in the ability of the participants to generate the human, social, and financial capital prerequisite to business development. Increase in customer care, social capital and financial management are key factors for successful microbusiness activities for stable self-employment