MOROGORO

NEWSLETTER

Vol. No. 2 December 2003

CHOLERA OUTBREAKS IN MOROGORO

Cholera is an acute diarrhoea disease occasionally accompanied by vomiting. The disease is caused by Vibrio cholerabacteria. The Community is infected through taking water or drink or eating food which has been contaminated with the bacteria. More than 80% of cholera cases result from drinking water contaminated with Vibrio cholera. Recently the disease has resurfaced in areas in (along major rivers, which are contaminated by Cholera bacteria), for example: • Morogoro Municipality: Tungi, Kingolwira, Nanenane. • Morogoro Rural: Mvuha, Turiani, Ngerengere. • Kilosa: Msowero, Magubike, Kidodi.

• Kilombero: Mangwale and Viwanja Sitini. Cholera Patient at Emergency Treatment Camp

• Ulanga: Kivukoni, Malinyi, Lupiro. 3. Poor management of solid and liquid wastes in Other reasons which cause cholera outbreaks the Municipality and Townships in Morogoro. include:- 4. Unsafe disposal system of human excreta. 1. Scarcity of safe water caused by: • Low coverage of sanitary facilities in • Vandalism of water pumps and spare parts of communities and public places such as pumping machines. auctions mine areas, fishing camps, bus • Worn out and dilapidated water distribution stands and some of the schools. system. • Preparation and selling of food and drinks • Prolonged draught. which do not conform to health regulations.

2. Failure in observing personal hygiene such as washing hands with soap and safe water after - In This Issue – using toilets and before preparing and serving food. z Cholera Outbreaks in Morogoro ---- p.1

z The Editorial Morogoro Health Newsletter --- p.3

z Community Participation in Malaria Control

-Kilosa ------p.3

z Rabies Control - Ulanga ------p.4

z Focused Antenatal Care Approach ------p.5

z Control of Onchocercasis ------p.6

z HMIS ------p.7

z Important Events ------p.7

z Reader’s Forum ------p.8

z Announcements ------p.8

Children are fetching contaminated water

MHP Morogoro Health Project 1 Morogoro Health Newsletter

Unfavourable effects of cholera outbreaks:

1. High morbidity and mortality. The region has had

13,109 cases and 590 deaths in the past ten

years (1993 – 2002).

2. The Governments spends a lot of resources for

treatment of cholera patients.

3. Reduced economic production leading to low

general economic growth.

4. Other costs to the community include patient care

and funeral costs

Recommended steps to contain outbreaks:

1. Availability of adequate safe water to be given

high priority when developing community based

participatory planning.

Unsafe disposal of solid waste

2. Primary Health Care Committees at all levels to Cholera Prevalence in MOROGORO Cases (1993-2002) meet regularly to review strategies for controlling

5,000 No. of CASES and containing out breaks, using National No. of DEATHS 4,500 4,566 guidelines. 4,000 3,632 3,069 3. To conduct and monitor participatory Health 3,500 3,000 education involving other sectors. 2,500 4. To make By Laws to be applied against those 2,000 who contravene cholera control measures. 1,500 5. Health service providers be given continued 1,000 983 829 190 181 education regularly on proper treatment and 500 117 21 0 0 0 3 78 0 0 30 preventive measures against Cholera. 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 Mr. N. Masaoe Years Regional Health Officer Morogoro

EDITORIAL BOARD

Chairman Chief Advisor Mr. N. MASAOE Regional Health Officer Dr. M. MASSI Regional Medical officer Secretary Associate Members

Ms. C. MARO District Reproductive and Child Dr. A. TANAKA Advisor, MHP*

Health Coordinator, Morogoro Ms. M. CHITOSE Coordinator, MHP* Deputy Secretary Dr. F. FUPI Advisor, MHP* Ms. N. AHMED Nursing Officer, Morogoro Municipality Members Mr. J. MANKAMBILA Regional Health Secretary Dr. G. MTEY Municipal Medical Officer of Health, Advisory Committee Morogoro Dr. O. MBENA District Dental Officer,Morogoro Mr. H.Mohamed Mr. J. BUNDU District Health Officer, Kilosa Lecturer, Mr. K. KAKWAYA District Health Secretary, Kilombero Sokoine University of Agriculture Mr. B. MBUMBUMBU District Health Officer, Ulanga Ms. Y. KITAYAMA Advisor, MHP* * MHP: Morogoro Health Project, JICA

WASH YOUR HANDS WITH SOAP BEFORE MEALS AND WHENEVER YOU LEAVE THE TOILET

2 Morogoro Health Newsletter

MOROGORO HEALTH NEWSLETTER

the step we have made towards achieving our Mr. N. MASAOE expectation of establishing the Newsletter. Chairman The Central Government and all the Councils of Editorial Board Morogoro Region have indicated their commitment of sustaining the Newsletter by including in their Dear esteemed readers; Welcome to The 2004 and subsequent years plans, budget line cost Second Issue of Morogoro Health Newsletter. The component for the Newsletter publication of the Newsletter, is published by the Morogoro Health coming issues. Project, twice annually in English and Swahili To ensure sustainability, and future development languages. the Editorial Board requests all stakeholders and The main object of establishing the Newsletter is the readers to contribute to the cost of publications to facilitate exchange of information and experience of the Newsletter for the benefit of the Morogoro sharing among Health Sector personnel in community and the Nation as a whole. Morogoro Region and other Stakeholders. We request our esteemed readers to submit In the first issue 1,181 copies were distributed articles for publication for the forthcoming issue. within and outside the region. We had the pleasure We thank all those who have supported us in to receive from readers of our First Issue invaluable one way or the other in the publication of these two comments, on various matters of interest about the issues. Special thanks should go to the Japan Newsletter and on the commendation of the job International Cooperation Agency through done, to which we are very grateful. The Morogoro Health Project for facilitating publication enthusiasm and seriousness by which our readers of the initial issues. have shown in their comments is an assurance of COMMUNITY PARTICIPATION IN MALARIA CONTROL-KILOSA

started by training 2 facilitators in Iringa. Later 6 district facilitators were trained under this programme to facilitate Ward Development Committees and Village Health Committees in participating in implementing Malaria control activities by developing

Community Based Malaria control plans to be implemented at the community level.

During 2000 – 2002 the district sold about 8,466 ITNs and 10,000 Zuiambu tablets. The programme also through Basket Fund support managed to purchase 487 ITNs and distribute them to 5 Health Centres and to the District Hospital. Further more the district, through UNICEF support, introduced a special programme, known as

Discount Voucher System, to pregnant mothers.

Under this system, Discount Voucher worth Tsh.2,500.00 paid by UNICEF is provided to a

A Pregnant mother being issued with discount voucher pregnant mother during the first visit to MCH clinic at Health facility. The voucher is then used to purchase an ITN from authorized businessmen in Community Based Malaria Control in Kilosa the community. The remaining amount of the total District started in 2000. The main objective was to price of the ITN is paid/settled by the pregnant involve community in combating Malaria in the district mother. using ITNs(Insecticide Treated Nets). The programme which is under UNICEF support Ms. R. Nguruwe

3 Morogoro Health Newsletter CBMC Coordinator-Kilosa mothers RABIES CONTROL–ULANGA Rabies (caused by Rhabdovirus) is a disease, which is transmitted by rabid animals like dogs and cats; Animals not related to dog family, for example bat, can also transmit the disease. In Ulanga district in 2001 a total number of 25 cases due to suspected animal bites were reported. In 2002 there were 18 and in 2003 were 29 bites. Often rabies occurs because people fail to observe technical advice. This leads our 2. Human being: Government to incur great expenses to buy the • Suddenly becomes very aggressive. costly rabies vaccine instead of using the meager • Difficult to swallow due to pain and thick saliva funds for development above all there is human in the mouth. always humanloss. • Feels pricking pain at the animal bite wound. • Convulsions, later the body paralyses and ANIMAL BITE CASES IN ULANGA invariably death. (2001-2003) 40 First Aid to a person bitten by a rabid animal: 1. Clean the wound with soap or Hydrogen peroxide. Never cover the wound leave it open. 30 29 2. Refer at once the patient to a health facility, 25 where she/he will be vaccinated immediately. 3. Tie rabid animal for one week observing for signs of rabies. 20 18 Cases 4. If the animal dies or is killed before one week elapses send the animal head to a veterinary laboratory for examination. 10 5. A person bitten by a rabid animal must have complete vaccination.

Factors to be considered in prevention of the 0 disease: 2001 2002 2003 Years 1. Vaccinate your dog against rabies yearly. Signs and symptoms of rabies: 2. Ensure that your dog is tied from 6:00 am up to 1.Animals: 10:00 pm. • Becomes silent, restless or very aggressive. 3. Keep children away from any animal suspected • Discharges saliva in the mouth and cannot eat to be rabid. or drink. 4. Tie for 1 week the suspected animal observes for • Often the animal becomes mad and can bite symptoms of rabies. any object. 5. Kill and bury all stray dogs. • The rabid animal dies after 5 to 7 days from the day it shows first symptom. BE CAREFUL WITH AN ANIMAL WITH RABIES SYMPTOMS. ITS SALIVA ON AN OPEN

WOUND IS ENOUGH TO GET YOU INFECTED.

Mr. B. Mbumbumbu District Health Officer-Ulanga

PLEASE SEND YOUR ARTICLE TO THE EDITOR FOR PUBLICATION 4 Morogoro Health Newsletter

FOCUSED ANTENATAL CARE APPROACH In in spite of high antenatal THE USE OF DRUGS IN PREGNANCY attendance by pregnant women at health facilities in Drugs are generally discouraged unless advised various regions, 529 per 100,000 live births die by service providers but routine drugs prescribed every year due to avoidable complications. Also during pregnancy to protect the mother and the only 40% of pregnant mothers deliver in Health baby include: Facilities. • Folic Acid, Ferrous Sulphate – every visit. In view of this, the Ministry of Health resolved to • Tetanus Toxoid vaccine – 1st visit and 2nd visit for strengthen the quality of Reproductive and Child a mother never vaccinated even once. Health Services(RCH) by developing the National • Sulphadoxine Pyrimethamine (SP) Package of Essential RCH interventions in the - 1st dose in 20 to 24 weeks of pregnancy. following areas: - 2nd dose in 28 to 32 weeks of pregnancy • Malaria in pregnancy • Anaemia in pregnancy, and • Syphilis in pregnancy OTHER MATTERS FOR CONSIDERATION 1. Each woman must be assisted to develop an WHAT IS ANTENATAL CARE? individual birth plan, which includes: Focused antenatal care is providing the purpose • Choice of a health facility for delivery. oriented care that is timely, friendly, simple, • Identifying a skilled attendant to assist at birth. beneficial and safe to pregnant women. The • Collection of essential items for clean delivery if components of focused antenatal care are: not provided at the health facility. • Early detection and management of diseases • Identifying transport and funds in case of and abnormalities, emergency. • Health promotion and counselling to pregnant mothers, 2. Provision of essential supplies at the RCH Clinic: • Birth preparedness and readiness to combat • Weighing scale, sygnomanometers complications such as blood loss and • Supplies for investigation of: Malaria, HIV, • To have individual delivery plan. Syphilis, urine and haemoglobin. • JIK/Sodium hypoclorite for disinfection. ANTENATAL VISIT Studies shows that, ideally, in normal 3. Availability of Family Planning services at RCH pregnancy women should have at least 4 Clinic comprehensive antenatal visits, spread out during the entire period of pregnancy. Ms. C. Maro The recommended visits are as follows: st District RCH Coordinator • 1 Visit --16 weeks of pregnancy Morogoro nd • 2 Visit --Between 20 – 24 weeks of pregnancy • 3rd Visit --Between 28 – 32 weeks of pregnancy • 4th Visit --At 36 weeks of pregnancy WHICH MAKE YOU MORE TIRED ??? Authors: Mr. J. BUNDU and Dr. A. TANAKA Drawing by: Ms. Y. KITAYAMA

PREGNANT WOMEN ENSURE YOU DELIVER IN A HEALTH FACILITY

5 Morogoro Health Newsletter CONTROL OF ONCHOCERCACIASIS

Onchocercusis or River Blindness is a skin and from the affected person it also sucks microfilariae also a blinding disease caused by a worm called which continue to grow to be larvae inside the fly’s “Onchocerca volvulus”. The disease is transmitted body and infects another person when biting again. by a female small black fly (Simulium damnosum) on biting a patient and later biting a healthy person. The disease is endemic in areas along fast The common signs and symptoms include: moving rivers. Such places provide conducive • Periodic fever environment for the fly to live and breed. • Enlargement of lymph nodes. In Tanzania among the worst hit regions include: • Itching of skin Tanga, Ruvuma, Mbeya and Morogoro. The Ulanga, • Appearance of skin patches. Kilombero, Kilosa, Morogoro and Mvomero are the • Itching skin nodules. They appear mainly in districts affected by the disease in Morogoro axilla, groins, thighs elbows, shoulders, Region. around the neck, and ultimately spread in the whole body. • Eyes swell, become red, leading to a gradual loss of sight. Delayed treatment may result into total blindness.

The laboratory investigation consist of taking skin snip to examine for worms/ microfilaria.

Disease control measures: 1. TAKE “MECTIZAN (INVERMECTIN)” TABLETS ONCE PER YEAR FOR NOT LESS THAN 20 YEARS. 2. Killing of blackfly where possible by using approved insecticides. 3. Wearing clothes that cover the whole body to prevent insect bites. 4. To create community awareness on the disease transmission, effects and correct ways of prevention and treatment. The worm live in the body of the affected person 5. To apply approved body repellants. and inside the body of the female black fly. 6. The community should be fully involved in the planning implementation and evaluation of Adult worms live on nodules inside the skin Onchocercaciasis control strategies. (subcuteneously) and in the lymphatic vessels. The male and female worms embrace together. The Mr. R Fue male fertilizes the female eggs which develop into Health Officer Vector Control microfilariae. Later the microfilariae migrate to live in the skin. When the female black fly sucks blood

BLACKFLY HUMAN HOST

Develop into infective Larvae penetrate skin through bite of blackfly larvae and migrate to mouth-parts

Adult worms in subcutaneous

tissue in module LIFE CYCLE

Onchocerca voluvulus

Microfilaria produced and Microfilariae taken up by present in skin, eye blackfly when it takes a blood meal

Microfilaria taken up by blackfly

COMBAT ONCHOCERCIASIS PROTECT YOUR HEALTH

6 Morogoro Health Newsletter MMIISS!!!!!! HH Top 10 Diseases Out Patient Department Morogoro Region Under 5 years 5 years and above

Typhoid Skin Skin UTI 2% Anaemia Worm 3% Disease 2% Disease 2% UTI 2% Infestation 2% Anaemia 3% Eye Disease Typhoid 1% 3% 2% Eye Disease 3% Surgical Disease Surgical Malaria 5% Malaria Disease 41% 41% 4% Worm Diarrhoea Infestation 13% 14%

Diarrhoea Pneumoni 10% Pneumoni a/ARI a/ARI 28% 19% Source: Annual Report Health Sector Morogoro Region 2002 The data presented in the pie chart is for Out Patients Department for the year two thousand and two. In children under five years, malaria, pneumonia, ARI and diarrhoea ranked the top three; a similar trend is observed in those above five years with slight difference of magnitude. In each of the five districts, malaria was the leading disease in OPD attendance. The majority of top ten diseases listed are associated with the poor environmental sanitation, low utilisation of Insecticide Treated Nets (ITNs) and poor personal hygiene triggering diseases such as skin diseases, worms infestations, diarrhoea and malaria. Participatory approach should be initiated to stimulate the community to identify, plan, implement and evaluate strategies of improving the environment and personal hygiene. There is still weakness in HMIS data management. Data is not processed and utilised at point of collection. This constraint should be resolved in order to strengthen data management. Mr. N. MASAOE / Dr. A. TANAKA

IMPORTANT EVENTS: July – December 2003 INTERNATIONAL • October 7: World Elders Day: Nationally the celebrations were held in Dar-es-salaam Theme: “Wazee washirikishwe kwenye maamuzi ya serikali” (“Involve Elders in Government decisions making”) • November 7-9: MHP Mid-Term Evaluation: Held at Tanesco Training Centre Morogoro, to evaluate the performance of the Project for the period April 2001–October 2003. • December 1: World AIDS Day: Nationally Celebrations held in Mwanza City. Theme: “Live and Let Live” NATIONAL • August 8: Peasants Day (NANENANE): Celebrations for Eastern Zone (Morogoro, Tanga, Dar-es-salaam and Coast regions) held at Morogoro and Nationally were held in Mbeya Municipality. • November 12: JCC (Joint Coordinating Committee) Meeting of MHP: Held at Oasis Hotel. It was an honour the meeting to be attended by a representative from Japan Embassy in Tanzania and the Mid-Term Evaluation Team for MHP from Tokyo Japan. • November 17 – 21: TPHA (Tanzania Public Health Association) Annual Scientific Conference held at TANESCO Training Centre Morogoro.

7 Morogoro Health Newsletter

• December 1st Week: Provision of Vitamin A micronutrient to children aged 6months-5years was conducted in all Morogoro Districts.

REGIONAL/ DISTRICT

• July-September: Morogoro Rural – Conducted training on “Strengthening Health Management in Districts”: Municipality, Kilosa, Kilombero and Ulanga CHMTs. • September 5: Morogoro Mvomero – Onchocercusis activities officially initiated. • September 30: Kilombero -“MUAJAKI” project handed over to Council.

RREEAADDEERRSS FFOORRUUMM STRENGTHENING OF PRIVATE HEALTH SERVICES IN KILOMBERO DISTRICT

The private health services providers association known as KIPHA (Kilombero Private Health Services Association) has been formed in Kilombero District. Legal procedures for The registration of the association are in the final stage. The Association includes the privately owned health facilities: dispensaries, medical laboratories and Part II drug stores. The objective of KIPHA is to improve the provision of quality health services in cooperation with the Council Health Management Team (CHMT) so that the provision of private health services for profit become competitive without compromising the ethics of the professional ethics . It is expected that the formation and functioning of KIPHA will inculcate a challenge among many health actors in Kilombero District in the course of implementing the current Health Sector Reform. KIPHA believes that the solidarity among her members and the co-operation with various health institutions, realistic strategies to implement National health policies and directives through the Regional and District authorities, on health service provision will be accomplished in order to reduce the health problems faced by the entire Kilombero District community in general. Mr. Paschal C. Mihambo Secretary KIPHA-Kilombero

• Our esteemed readers, we invite views and suggestions on a name you deem suitable

for this Newsletter.

• Also we invite your contributions of articles to be included in the Newsletter for the next issue due for July 2004: the articles should be related to health or opinions and suggestions on how health services are rendered in Morogoro Region and are not to

exceed 400 words.

Articles or letters to the Editor should be sent to the following addresses: The Editor Morogoro Health Newsletter P.O.BOX 110, MOROGORO or, P.O.BOX 1193, MOROGORO, FAX 023 – 4148 or, Could be sent to the respective District Medical Officer or Municipal Medical Officer as follows: • P.O.BOX 166, Morogoro for Municipality. PUBLISHED BY THE EDITORIAL BOARD • P.O.BOX 1862, Morogoro. MOROGORO HEALTH NEWSLETTER • P.O.BOX 14, Kilosa. P.O.BOX 110, MOROGORO • P.O.BOX 47, Ifakara, Kilombero. • P.O.BOX 4, Mahenge, Ulanga

MHP 8 Morogoro Health Project