Remaining Challenges in Tanzania's Efforts to Eliminate Iodine Deficiency.

To determine iodine levels in salt and iodine deficiency prevalence in school-aged children in 16 districts in Tanzania with previous severe iodine deficiency. A cross-sectional study in schoolchildren. Systematic probability sampling was used to select schools and subjects for goitre assessment and urinary iodine determination. Sixteen districts randomly selected from the 27 categorised as severely iodine-deficient in Tanzania. The study population was primary-school children aged 6-18 years who were examined for goitre prevalence and urinary iodine concentration (UIC). Salt samples from schoolchildren's homes and from shops were tested for iodine content. The study revealed that 83.3% of households (n=21,160) in the surveyed districts used iodised salt. Also, 94% of sampled shops (n=397) sold iodised salt, with a median iodine level of 37.0 ppm (range 4.2-240 ppm). Median UIC in 2089 schoolchildren was 235.0 microg l(-1) and 9.3% had UIC values below 50 microg l(-1). The overall unweighted mean visible and total goitre prevalence was 6.7% and 24.3%, respectively (n=16,222). The age group 6-12 years had the lowest goitre prevalence (3.6% visible and 18.0% total goitre, n=7147). The total goitre prevalence had decreased significantly in all districts from an unweighted mean of 65.4% in the 1980s to 24.3% in 1999 (P<0.05). We believe this difference was also biologically significant. ConclusionThese findings indicate that iodine deficiency is largely eliminated in the 16 districts categorised as severely iodine-deficient in Tanzania, and that the iodine content of salt purchased from shops is highly variable

Voices from Urban Africa: The Impact of Urban Growth on Children

Urban poverty -- and its impact on children -- is often overlooked and misunderstood. More than half of the world's population now lives in cities. Each year the number of urban residents increases by nearly 60 million.1 By 2050, it is projected that two thirds of the global population will be living in urban areas.2 It is estimated that 94 percent of urban growth will take place in less developed countries.3Africa, though it is the least urbanized continent today, is predicted to have one billion urban dwellers by 2040, with a substantial youth majority. Over the next 40 years, 75 percent of urban population growth in Africa will take place in Africa's secondary cities.4 Currently, over half of the African urban population lives in slum conditions. These figures alone demonstrate the growing importance of prioritizing the urban context in development work.Coupled with this growing urban population, the development community's reliance on aggregate data, which generally compares development indicators for urban and rural areas within a country, means that children and adults living in urban areas appear to be better off than those living in rural areas.Citywide statistics and the 'urban advantage' allow the wealth of some urban individuals to obscure the hardships faced by those living in urban poverty and the vast inequalities present within urban communities. The absence of detailed data means that the depths of urban poverty are often missed and children living in urban poverty are at risk of not being reached by development efforts

Focus on Mainland Tanzania:(Progress & Impact Series)

Tanzania's National Malaria Control Programme (NMCP) has provided strong, stable leadership in coordinating malaria control activities since 1995. Because of continuity and focus on programme implementation, both the number of partners and resources have been growing, most notably over the last seven years. Between 2003 and 2010, about US$ 450 million in external funding was allocated to scale up the malaria control programme. These increasing contributions have been used to deliver preventive and curative services. 18 562 571 insecticide-treated mosquito nets (ITNs) were distributed between 2007 and 2010 through mass campaigns and the national voucher scheme. Indoor residual spraying (IRS) began in 2007 and had expanded to cover 94% of the targeted structures in 18 districts by March 2011.Rapid diagnostic tests (RDTs) and artemisininbased combination therapies (ACTs) have been deployed to reach half of the population so far, and health workers have been trained in using them. Efforts have also been made to make these new treatments available in the private sector, where up to 40% of the rural population seek care for fever. This deployment of interventions has resulted in improved coverage. 63% of households owned at least one ITN in 2010, compared with 23% in 2004–2005. 64% of all children under five and 56% of all pregnant women nationwide used an ITN the night before the 2010 survey—a more than twofold increase since 2007. In addition, between 2001 and 2006, Tanzania changed its recommended antimalarial drug from chloroquine to sulfadoxine-pyrimethamine (SP) to ACTs, thereby providing access to more effective antimalarials. Because of good coverage results, the Tanzanian government has been able to reduce disease burden and save lives. In the Ifakara surveillance area, the prevalence of parasitaemia in children under five was reduced by more than 5-fold, from 25% in 2004–2005 to less than 5% in 2010. Nationally, severe childhood anaemia was halved, dropping from 11% in 2004–2005 to 5.5% in 2010. All-cause under-five child mortality fell by 45% between 1999 and 2010—from 148 deaths per 1000 live births in 1999 to 81 per 1000 live births in 2010. According to the Lives Saved Tool (LiST estimation model), the lives of 63 000 children under five have been saved by malaria control interventions since 1999. Tanzania's improved malaria and health indicators are all signs that malaria control efforts are working and delivering results. Consideration of other factors that might explain the declines in all-cause under-five mortality leads to the conclusion that the improvement in child health is due in large part to malaria control efforts. The country is also achieving equitable impact on major mortality and malaria coverage indicators. With demonstrated ability to deliver and achieve impact on child survival, Tanzania has articulated even more ambitious malaria control goals: universal ITN coverage, IRS in half of the country, and enhanced diagnosis and ACT treatment of all malaria cases. This will require increased funding and a strengthened health infrastructure. If challenges of resource mobilization, boosting the work force, and strengthening the health system can be met, Tanzania will have paved the way towards unprecedented public health achievements and protection of its population against a major scourge.\u

Preventing childhood malaria in Africa by protecting adults from mosquitoes with insecticide-treated nets

Malaria prevention in Africa merits particular attention as the world strives toward a better life for the poorest. Insecticide-treated nets (ITNs) represent a practical means to prevent malaria in Africa, so scaling up coverage to at least 80% of young children and pregnant women by 2010 is integral to the Millennium Development Goals (MDG). Targeting individual protection to vulnerable groups is an accepted priority, but community-level impacts of broader population coverage are largely ignored even though they may be just as important. We therefore estimated coverage thresholds for entire populations at which individual- and community-level protection are equivalent, representing rational targets for ITN coverage beyond vulnerable groups

Analysis of Research on the Effects of Improved Water, Sanitation, and Hygiene on the Health of People Living with HIV and AIDS and Programmatic Implications

This paper reviews the existing scientific and programmatic evidence, raises WASH issues in the HIV and AIDS context that need further study to build the evidence base, assesses current WASH guidance through a review of national HIV/AIDS guidelines from five African countries, and identifies programmatic implications that home-based care programs and the WASH sectors must consider

Start With a Girl: A New Agenda for Global Health

Examines how social factors shape the health issues adolescent girls face in developing countries. Calls for a health agenda for girls, including focused HIV prevention and maternal health advocacy; elimination of child marriage; and secondary education

The silent burden of anaemia in Tanzania children:a community-based study

Objective was to document the prevalence, age-distribution, and risk factors for anaemia in Tanzanian children less than 5 years old,thereby assisting in the development of effective strategies for controlling anaemia.\ud \ud Cluster sampling was used to identify 2417 households at random from four contiguous districts in south-eastern\ud United Republic of Tanzania in mid-1999. Data on various social and medical parameters were collected and analysed.\ud \ud Blood haemoglobin concentrations (Hb) were available for 1979 of the 2131 (93%) children identified and ranged from 1.7 to 18.6 g/dl. Overall, 87% (1722) of children had an Hb <11 g/dl, 39% (775) had an Hb <8 g/dl and 3% (65) had an Hb <5 g/dl. The highest prevalence of anaemia of all three levels was in children aged 6–11 months, of whom 10% (22/226) had an Hb <5 g/dl. However, the prevalence of anaemia was already high in children aged 1–5 months (85% had an Hb <11 g/dl, 42% had an Hb <8 g/dl, and 6% had an Hb <5 g/dl). Anaemia was usually asymptomatic and when symptoms arose they were nonspecific and rarely identified as a serious illness by the care provider. A recent history of treatment with antimalarials and iron\ud was rare. Compliance with vaccinations delivered through the Expanded Programme of Immunization (EPI) was 82% and was notassociated with risk of anaemia.\ud \ud Anaemia is extremely common in south-eastern United Republic of Tanzania, even in very young infants. Further implementation of the Integrated Management of Childhood Illness algorithm should improve the case management of anaemia. However, the asymptomatic nature of most episodes of anaemia highlights the need for preventive strategies. The EPI has good coverage of the target population and it may be an appropriate channel for delivering tools for controlling anaemia and malaria

Hygiene and Sanitation Software: An Overview of Approaches

A review of the state of the art in methods and techniques for sanitation and hygiene behaviour change, and other non-hardware aspects of sanitation programming. Includes introductory text and detailed entries on more than 20 approaches and techniques, with key references, summary information on effectiveness and implementation and an assessment of when different approaches should be used