Condoms to be distributed to police, army and students, Tanzania

The government-run Daily News says the Tanzanian government will distribute condoms to students, soldiers, and policemen as part of its 5-year program to control AIDS. The program also includes improved screening of donated blood and promotion of the use of sterile instruments in hospitals. The newspaper quotes Dr. Justin Nguma of the national AIDS control committee as saying the condoms are being donated by the World Health Organization. Students, soldiers, and police officers were chosen to receive the condoms because they are seen as sexually active sectors of the population, and because they are generally young. However, he said these groups did not represent sources of AIDS infection. He says Tanzania has recorded over 3,000 AIDS cases. The country's AIDS program also includes a publicity campaign about AIDS and counseling for those with the disease.

Female stress and birth seasonality in Tanzania

Delivery records from Tanzanian hospitals reveal a marked seasonality of births in areas with holoendemic malaria. Accepted explanations of variations in conception rate are inadequate to account for these seasonal variations. The magnitude of the variation increases with higher parity but it has decreased over the past decade. The differences are related to different activity patterns of younger and older women, and to recent changes in the rural economy. Conception rate has a negative association with rainfall 4 months earlier; birth seasonality is therefore considered in relation to the agricultural cycle. While seasonal variations in sexual activity and pregnancy loss may be contributory factors, female stress due to the combination of malarial infection and physical exhaustion emerges as the major cause of seasonally depressed fecundity in areas with holoendemic malaria.

Theology versus AIDS

Theologians in Tanzania are joining hands in the fight against the disease Acquired Immune Deficiency Syndrome (AIDS). Spiritual teachings aside, the Evangelical Lutheran Church of Tanzania (ELCT) has launched a 5-year control program. The program, estimated to cost US$3.5m (Tsh254m) involves public education and blood screening at all ELCT dispensaries throughout the country. Part of the cost is the screening of equipment worth Tsh75m (US$1m). Aware that 97% of AIDS cases in the country were heterosexually infected, the ELCT said the situation warranted "spiritual care emphasizing the prohibition of adultery among christians", hence the need for theologians to join in hands to combat it. The program, and especially the screening equipment is perhaps the best news for Tanzanian health authorities who have been longing for such facilities since AIDS was 1st reported in Kagera Region in 1983. An ELCT report issued in December, 1987, showed that 308 men and 217 females had contracted the disease, of whom 145 and 119 died respectively. The new availability of the blood screening facilities would help to identify the extent of the spread of the disease. At present there are fewer than 6 screening machines in the country, which had made it difficult to diagnose AIDS in remote areas. Tanzania is among 4 African countries which the World Health Organization reports to have many cases of AIDS cases of AIDS. others are Uganda, Zaire and Zambia.

Pathogenetic role of HIV infection in Kaposi's sarcoma of equatorial East Africa

Thirty residents of north-central Tanzania with various forms of Kaposi's sarcoma (KS) were evaluated. The absolute number of peripheral blood OKT4 lymphocytes in patients and Tanzanian control subjects tended to be low (in comparison with healthy young American adults), and many had inverted T4/T8 ratios. Plasma polyclonal beta- and gamma-globulin concentrations were increased in many patients with KS and in control patients in Tanzania with chronic dermatopathies, but not in African hospital employees and patients undergoing elective surgery. Three of nine patients with locally aggressive KS possessed antibodies to human T-cell lymphotropic virus type III/lyphadenopathy-associated virus (HIV), but none had evidence of the acquired immunodeficiency syndrome (AIDS) or the AIDS-related complex. Three patients with disseminated, rapidly progressive KS and high HIV-antibody titers had an immunologic and clinical picture consistent with AIDS. Two of 13 patients with the classic plaque/nodular form of KS had low plasma titers of HIV antibody, but the significance of these serologic findings is not known. The evidence suggests that HIV plays a role in the pathogenesis of some cases of KS in East Africa, but most patients with KS in East Africa have no evidence of overt immunologic deficiency or HIV infection.

Modern family planning, sexual behavior and marriage status among women in Tanzania

"This article looks into sexual behavior and marriage status among women attending Mother and Child Health Care clinics in Tanzania. It looks into the effects of such behavior on the marriage and suggests some policy implications, especially in relation to modern family planning methods. The data which form the basis of this article were collected [in 1987] among 244 women in two urban centers in Tanzania."

Prevalence of HIV infection in healthy subjects and groups of patients in Tanzania

During 1986 sera from 2508 individuals representing various groups of healthy subjects and patients in Dar es Salaam (the capital city of Tanzania), Bukoba (the capital of Kagera region in the northwest corner of Tanzania), Arusha (in the northeast of Tanzania) and Mbeya (in the southwest of Tanzania) were screened for antibodies to HIV by enzyme-linked immunosorbent assay (ELISA). All ELISA-positive sera were also tested by Western blot analysis. In Dar es Salaam HIV antibodies were demonstrated in 3.6% of 192 pregnant women, 5.2% of 784 blood donors, 29.0% of 224 barmaids, 8.0% of 50 male bar workers, 9.25% of 400 male and 12.2% of 90 female patients attending a clinic for sexually transmitted diseases (STDs), 85.7% of 35 patients with herpes zoster and in 97.6% of 84 patients clinically suspected of AIDS. Among the barmaids the seropositivity rate was higher in younger women (45%) than in middle-aged women (11%). Only three (4.6%) out of 65 HIV-seropositive barmaids had HIV-related symptoms. The prevalence of HIV seropositivity among healthy low-risk subjects was highest in Bukoba, namely 16% of 100 pregnant women and 13.9% of 36 blood donors, while in Arusha only one (0.7%) of the 144 pregnant women and none of 41 bar workers, none of 42 blood donors and none of 61 patients with STD were positive. In Mbeya, 3.4% of 118 pregnant women and 11.8% of 34 men with STD were seropositive. Thus the prevalence of HIV infection differs considerably in various population groups and in various parts of Tanzania.

Control project in Bagamoyo District, Tanzania

Control of acute respiratory infections (ARI) in children under five years of age has been implemented as an integrated part of Primary Health Care in rural Bagamoyo District in Tanzania. Community supported Village Health Workers visited each family at their homes every six to eight weeks, giving health education on recognition and prevention of ARI, treating children with pneumonia on the spot with oral Cotrimoxazole or referring them to the next higher level of care. Within a two-year period the total under five mortality has been reduced by 27.2% from 40.1 to 29.2/1000 children aged under five per year. The disease-specific mortality rate for pneumonia has been reduced by 30.1% from 14.3 to 10.0/1000 under-five per year, contributing 40% to the overall mortality reduction. It is concluded that an active health service outreach programme, within Primary Health Care, can efficiently reduce high child mortality rates from ARI and other diseases. A similar approach will be used to tackle other problems such as diarrhoeal diseases, malnutrition, malaria and child spacing.

Slim disease: a new disease in Uganda and its association with HTLV-III infection

A new disease has recently been recognised in rural Uganda. Because the major symptoms are weight loss and diarrhoea, it is known locally as slim disease. It is strongly associated with HTLV-III infection (63 out of 71 patients) and affects females nearly as frequently as males. The clinical features are similar to those of enteropathic acquired immunodeficiency syndrome as seen in neighbouring Zaire. However, the syndrome is rarely associated with Kaposi's sarcoma (KS), although KS is endemic in this area of Uganda. Slim disease occurs predominantly in the heterosexually promiscuous population and there is no clear evidence to implicate other possible means of transmission, such as by insect vectors or re-used injection needles. The site and timing of the first reported cases suggest that the disease arose in Tanzania.

Hospital outbreaks of cholera transmitted through close person-to-person contact

Three hospital outbreaks of cholera which started in a children's infectious diseases ward in Dar es Salaam in 1977/78, 1981, and 1983 were controlled by bacteriological screening and isolation of infected patients, administration of antibacterial chemoprophylaxis to all at-risk patients and their accompanying relatives, and by reducing overcrowding. The outbreaks in 1981 and 1983 were caused by two distinct multiply antibiotic resistant E1 Tor Vibrio cholerae O1 strains. In these three outbreaks overcrowded conditions facilitated person-to-person transmission of cholera within the hospital. Cholera patients should be nursed separately and high standards of hospital hygiene should be maintained. This is one of the first reports of hospital outbreaks of cholera caused by multiply antibiotic resistant strains.

Rainfall and birthweight distribution in rural Tanzania

Seasonal variations in birthweights over a 10-year period are compared with the local rainfall pattern in a rural area of Tanzania. Mean birthweight falls by about 60 g in the course of the rainy season. Lagged regression analysis reveals a negative impact of rainfall on birthweight after 3 months. Deviations from average rainfall show a positive correlation with birthweight after 4 months, but only in the months when rainfall is critical for food crop production. The interactions of these contrary effects are held responsible for the sudden fluctuations in mean birthweight that were observed.

The impact of rapid population growth, expanding urbanisation, and other factors on development in sub-Saharan Africa: the contrasting responses of Tanzania and Kenya

When the nations of Sub‐Saharan Africa won independence some twenty years ago, they faced formidable constraints on development which continue to impede their economic and social progress, despite considerable interim achievements. This article discusses five of these constraints‐internal factors based largely on historical circumstances and the physical environment: (1) underdeveloped human resources; (2) military and political conflict; (3) the colonial institutional heritage; (4) climate and geography; and (5) the twin factors of rapid population growth and expanding urbanisation. However, as an urban sociologist, the author will focus on the fifth development constraint and on the contrasting policies Tanzania and Kenya have devised in response to it. These two countries were chosen because while Tanzania is a low‐income Sub‐Saharan African nation, defined by the World Bank as one with a per capita income of $370 or less, and Kenya is a middle‐income Sub‐Saharan African nation with a per capita income exceeding $370, Tanzania and Kenya are similar in total population, being the fourth and fifth most populous nations in Sub‐Saharan Africa (Nigeria ranks first with a population of 82.6 million; Ethiopia, second, with a population of 30.9 million; Zaire, third, with a population of 27.5 million; Tanzania and Sudan essentially tying for fourth place with populations of 18 million and 17.9 million, respectively; and Kenya, fifth, with a population of 15.3 million, its closest competitors being Uganda with a population of 12.8 million and Ghana with a population of 11.3 million). Moreover, Kenya and Tanzania had the same average annual rate of population growth‐3.4 percent‐between 1970 and 1980, and their projected populations for the year 2000 are only 1 million apart – 34 million and 35 million, respectively. Even more relevant to the theme of this article, however, is the fact that by 1980 Tanzania had reached nearly the same level of urbanisation – 12 percent and 15 percent, respectively, as well as nearly the same concentration of urban population in their capital or primate cities—50 percent and 57 percent, respectively (World Bank, 1983).

Population needs identified for assistance in some ECA member states

The U.N. Fund for Population Activities (UNPFA) has conducted Needs Assessment Missions in many developing countries as a means of identifying population and related areas in which individual countries would need assistance to achieve self-reliance in formulating and implementing population policies and programs. This exercise is still going on in some of the countries. In ECA member States these needs missions have been conducted in the following countries: Burundi, Cameroon, Comoros, Ethiopia, the Gambia, Guinea, Ivory Coast, Liberia, Madagascar, Malawi, Mauritania, Morocco, Niger, Rwanda, Sierra Leone, Senegal, Somalia, Sudan, Swaziland, Tanzania, Zambia, and Zimbabwe. The areas identified for assistance vary from country to country, however, in some cases the needs are similar. Data collection and analysis is still 1 of population needs for which many countries require assistance. This includes conducting of national population censuses and demographic surveys and establishing or improving the civil registration systems on vital events. Training of nationals in data collection and analysis is another area in which ECA member States need assistance. It was identified that there is lack of integration of population variables in socioeconomic development planning. The various missions recommended assistance to help ECA member States to integrate population variables in development planning. Creation of Population units in ministries of planning and/or other departments was recommended as a means to help this integration. The various missions also identified the need to create or to enhance the awareness of the interrelationship between population and sociodevelopment and their implications. To this end the missions on needs assessment recommended assistance in population information and communication activities, including the introduction of population education in formal and nonformal education, conducting of seminars and workshops on population and development etc. To help formulation of population policies, the establishment of National Population Commissions at the highest level was recommended. Such commissions would examine population issues in detail and formulate suggestions for policy decisions and measures. Other common population related areas which require greater assistance include health programs of maternal and child health care, health education activities, and family planning activities. Last but not least is the need to improve the role and status of women in Africa so that they can be integrated to take a more active part in the various economic and social activities in national development.

Results of a pilot study

In an attempt to determine the prevalence of asymptomatic gonorrhoea in women in Tanzania urban areas, 405 women attending family planning clinics in Dar es Salaam had cervical swabs cultured on a selective gonorrhoea medium for Neisseria gonorrhoea. Twenty-nine of them (7.1%) were found with the organism despite absence of symptoms of the disease at the time of screening. Twenty (69%) of those with N. gonorrhoea came back after two weeks for results and all were treated with a single dose of penicillin. Only four (13.8%) of their male contacts came forward for treatment. In view of this high prevalence rate, it is recommended that gonorrhoea and other sexually transmitted diseases be regarded as among the most prevalent communicable diseases in the country necessitating control measures. Consideration should be given to screening for gonorrhoea in antenatal and family planning clinics as is now the case for syphilis. The material cost of gonococcal screening per individual was estimated at 10 T shillings (US$ 1.25) which is well above the health ministry's capability.