Health and wellbeing

Trachoma is the leading infectious cause of blindness worldwide. It is caused by an obligate intracellular bacterium called Chlamydia trachomatis. The infection is transmitted by direct or indirect transfer of eye and nose discharges of infected people, particularly young children who harbor the principal reservoir of infection.

Health and Wellbeing

a) HIV&AIDS Care and treatment, Malaria

Adolescents and young people represent a growing share of people living with HIV worldwide. In 2019 alone, 460,000 [260,000-680,000] young people between the ages of 10 to 24 were newly infected with HIV, of whom 170,000 [53,000-340,000] were adolescents between the ages of 10 and 19. To compound this, most recent data indicate that only 27 per cent of adolescent girls and 16 per cent of adolescent boys aged 15-19 in Eastern and Southern Africa – the region most affected by HIV – have been tested for HIV in the past 12 months and received the result of the last test (UNICEF) https://data.unicef.org/resources/children-hiv-and-aids-2030/

In Tanzania’s HIV epidemic is generalized, meaning it affects all sections of society, but there are also concentrated epidemics among certain population groups, such as people who inject drugs, men who have sex with men, mobile populations and sex workers. Heterosexual sex accounts for the vast majority (80%) of HIV infections in the country and women are particularly affected. The severity of the epidemic varies geographically. Some regions of Tanzania report no HIV prevalence (Kusini Unguja and Kaskazini Pemba) while other regions have prevalence as high as 11.4% (Njombe). Overall, the epidemic has remained steady due to ongoing new infections, population growth and increased access to treatment (AVERT)

HIV/AIDS, malaria and other diseases (Source: WHO)

38 million people globally were living with HIV in 2019.
25.4 million People were accessing antiretroviral therapy in 2019.
1.7 million People became newly infected with HIV in 2019.
690 000 people died from AIDS-related illnesses in 2019.
75.7 million people have become infected with HIV since the start of the epidemic.
32.7 million people have died from AIDS-related illnesses since the start of the epidemic.
Tuberculosis remains the leading cause of death among people living with HIV, accounting for around one in three AIDS-related deaths.
Globally, adolescent girls and young women face gender-based inequalities, exclusion, discrimination and violence, which put them at increased risk of acquiring HIV.
HIV is the leading cause of death for women of reproductive age worldwide.
AIDS is now the leading cause of death among adolescents (aged 10–19) in Africa and the second most common cause of death among adolescents globally.
Over 6.2 million malaria deaths have been averted between 2000 and 2015, primarily of children under five years of age in sub-Saharan Africa. The global malaria incidence rate has fallen by an estimated 37 per cent and the mortality rates by 58 per cent.

Strategic Development Goal number three (3) put more emphasis on ensuring healthy lives and promotion of well-being for all at all ages. Responding to all these health challenges above Maasai Girls initiatives for Development- MGI4D through our community champions and community action teams have developed various strategies and interventions for the out school and in-school youth on HIV/AIDS awareness on prevention, prevention with positive, VCT, as well as well as the care and treatment by ensuring that we educate women and youth but also we are strengthening referral mechanisms for those who are positive, promoting adherence to treatment and encourage health living behaviours. We also have the inclusive microfinance activities to economically empower young girls and women living with HIV&AIDs to enable them adhere on treatment by having access to facilities, afford meals and ultimately it enhances the level of disclosure and break the silence and stigma to PLHIV. We are also involved on conducting various researches and base line surveys on public health issues. We are also working day to day ensuring that community is very much aware on the use of treated mosquito nets, fumigate their areas accordingly and as advised by the health providers and also make proper use of anti-Malaria drugs and creating health seeking behaviours among people in the communities

WOMEN

Women are disproportionately affected by HIV in Tanzania. In 2018, 880,000 women aged 15 and over were living with HIV, compared to 580,000 adult men. In the same year, more than 36,000 women acquired HIV, compared to around 27,000 men. The nationally representative 2016-2017 Tanzania Impact Survey (THIS) found that women aged 15-39 are more than twice as likely to be living with HIV as their male counterparts. HIV prevalence is higher among women aged 45-49, at 12% (compared with 8.4% among men of this age) .Gender inequality is widespread among women of all ages in Tanzania. In 2016, around 30% of women aged 15-49 who had ever been married or in a long-term relationship were estimated to have experienced physical or sexual violence from a male intimate partner in the past 12 months. This increases many women’s vulnerability to HIV, either directly, through sexual violence, or indirectly, through an inability to negotiate condoms or prevent their partner from having other sexual relationships. In addition, women tend to become infected earlier because they have older partners and get married earlier.

YOUTH

It is estimated that more than half the population in Tanzania are aged 19 and under. THIS reported HIV prevalence among young people (ages 15-24) at 1%, with young women around four times more likely than young men to be living with HIV (2% prevalence among young women, compared to 0.6% prevalence among young men). Prevalence among children (ages 0-14) is 0.3%. In 2018, just under 24,000 young people in Tanzania became HIV-positive; roughly two-thirds of whom were young women (16,000 new infections among young women, compared to 7,600 among young men).13 In 2016/17, 3.4% of women aged 20-24 were living with HIV, compared to 0.9% of their male counterparts. The disparity between the sexes is linked to age-related vulnerabilities experienced by young women that intersect with widespread gender inequality. For instance Tanzania’s ‘sugar daddy’ culture, in which young women embark on sexual relationships with older men in exchange for material goods or social advancement, is a key driver of HIV among young women. Despite the fact that their partners come from age groups with higher HIV prevalence than younger men, and may also engage in other sexual relationships, young women are often unable to negotiate condom use due to the unequal power balance in these relationships. This is demonstrated by a study involving 18 to 24 year-old women in Dar es Salaam, which found that in couples of the same age decisions about condom use were made together (48%) or by the young women alone (34%). Decision-making during sex with older men was predominantly made by the male partner (79%) (Avert)

MALARIA

Malaria is another disease that remains a major public health problem in sub-Saharan Africa, with approximately 1 million deaths and more than 400 million cases a year. In Tanzania, over 95% of the 37.4 million people are at risk for malaria infection. The disease is responsible for more than one-third of deaths among children under the age of 5 years and for up to one-fifth of deaths among pregnant women. Malaria contributes to 39.4% and 48% of all outpatients less than 5 years of age and aged 5 years and above, respectively.1 In terms of hospital admissions, malaria accounts for 33.4% of children under the age of 5 years and 42.1% in children aged 5 years and above. Malaria is implicated in decreased learning capacity in children, students, and trainees in the 5–25 age range and in loss of economic productivity in the workforce age range 15–55 years.2 In general, $2.14 is spent on malaria control per person per year, representing 39% of the country’s health expenditure and 1.1% of its GDP.3 Malaria accounts for over 30% of the national disease burden, making it a top health priority for allocation of resources for its prevention and control

Sexual and reproductive Health

Reproductive health rights of adolescent girls are enshrined in international human rights law. According to the 1994 International Conference on Population and Development (ICPD) everyone has “the right to attain the highest standard of reproductive and sexual health,” “the right to make decisions concerning reproduction free of discrimination, coercion and violence,”8and the right to decide when and whether to bear children and to have the information and means to make such decisions.

This is another gray area due to the fact that today, 88 per cent of adolescents live in developing countries. Adolescent populations are growing fastest in Sub-Saharan Africa and the least developed countries overall. These are the very places where the risk associated with pregnancy and childbirth is highest. There is an urgent need to increase investment in comprehensive programmes, including sexual and reproductive health care for adolescent girls in these countries. Doing so would yield multiple benefits, enabling girls to stay healthy, avoid unintended pregnancies, finish an education, engage in productive work, and choose to have fewer and healthier babies, when they are ready. The choices that girls have and the actions they take during these seminal years have far-reaching consequences within their societies, economies and environments, which ultimately affect all of us around the world (UNFPA)

The current Situation

complications in pregnancy and childbirth are the leading causes of death among adolescent girls ages 15-19 in low- and middle-income countries, resulting in thousands of deaths each year.6 The risk of maternal mortality is higher for adolescent girls, especially those under age 15, compared to older women. Adolescent pregnancy brings detrimental social and economic consequences for a girl, her family, her community and her nation. Many girls who become pregnant drop out of school, drastically limiting their future opportunities. A woman’s education is strongly correlated to her earning potential, her health and the health of her children. Thus, adolescent pregnancy fuels the intergenerational cycle of poverty and poor health. The younger a girl is when she becomes pregnant, whether she is married or not, the greater the risk to her health. It is estimated that girls under the age of 15 are at greater risk of dying in childbirth than women in their 20s.

Whether married or unmarried, young women are less likely than their older counterparts to use modern contraceptives. Married adolescents may feel social pressure to bear a child and thus not seek family planning services. Unmarried adolescent girls face a different type of social pressure, fearing judgment or dealing with a socially-unsanctioned pregnancy. Increasing their vulnerability, some adolescent girls are subject to sexual exploitation and abuse, and many have limited knowledge about how to protect their health (UNFPA). This is an area where from our experience and from the ongoing literature we thought Maasai Girls initiatives for Development-MGI4D would necessarily intervene on providing SRH education in order to enable adolescent girls to make their informed choices so as to enable majority of them finish and or remain in schools and health. At school level we have various Health clubs where we coordinate health talks and debates; we have essay competition, Youth Camping as well as the ‘’Talk to grandma’’ intervention where we deploy retired nurses or old mama to go to schools every Thursday evening and talk with girls on issues around sexual reproductive health. We would like to see the girls making informed choices when it comes to issues that affects their lives especially the SRH issues

Trachoma

While global efforts to control and ultimately eliminate trachoma have been successful in many contexts, it has proven to be more challenging in many societies. Due to social, political or economic vulnerabilities, the approach to delivering global health programmes to some marginalized communities requires a more social science perspective. The Maasai, semi-nomadic pastoralists predominantly spanning the central border of Tanzania and Kenya, are one such community in which trachoma is endemic despite efforts to deliver interventions. Trachoma continues to be a signiﬁcant cause of blindness in pockets of Tanzania as well as other sub-Saharan African countries. The current World Health Organization strategy for reducing trachoma is the SAFE strategy. This includes Surgery for trachomatous trichiasis, Antibiotic distribution for villages where active trachoma is endemic, and changes in basic hygiene practices including face washing and Environmental hygiene

Key facts about Trachoma

Trachoma is a disease of the eye caused by infection with the bacterium Chlamydia trachomatis.
It is a public health problem in 44 countries, and is responsible for the blindness or visual impairment of about 1.9 million people.
Blindness from trachoma is irreversible.
Based on March 2020 data, 137 million people live in trachoma endemic areas and are at risk of trachoma blindness.
Infection spreads through personal contact (via hands, clothes or bedding) and by flies that have been in contact with discharge from the eyes or nose of an infected person. With repeated episodes of infection over many years, the eyelashes may be drawn in so that they rub on the surface of the eye, with pain and discomfort and permanent damage to the cornea.
The elimination strategy is summarized by the acronym "SAFE", which means Surgery for advanced disease, Antibiotics to clear C. trachomatis infection, Facial cleanliness and Environmental improvement to reduce transmission.
The World Health Assembly adopted resolution WHA51.11 in 1998, targeting the global elimination of trachoma as a public health problem.
In 2019, 92 622 people received surgical treatment for advanced stage of the disease, and 95.2 million people were treated with antibiotics. Global-level antibiotic coverage in 2019 was 57%.

FISTULA

Obstetric fistula is a devastating condition, affecting between two and three million girls and women across sub-Saharan Africa and Asia. The exact number is difficult to estimate, however, due to a lack of commitment to address and resolve this problem, as well as a lack of awareness within the healthcare system. It is estimated that each year, between 50000 and 100,000 women worldwide develop obstetric fistula (WHO).

Obstetric fistula is an abnormal opening between the vagina and the bladder or rectum, leading to continuous urinary or fecal incontinence. It is predominantly caused by a very long, or obstructed, labor when women do not have access to quality emergency obstetric care services. Women who experience this preventable condition suffer constant urinary incontinence which often leads to social isolation, skin infections, kidney disorders and even death if left untreated. Affected women are often abandoned by their husbands and families, and ostracized by their communities. Obstetric fistulae can largely be avoided by delaying the age of first pregnancy, by the cessation of harmful traditional practices and by timely access to quality obstetric care, especially caesarean section (UNFPA)

Most genital fistula can be repaired surgically. There are, however, numerous challenges associated with providing fistula repair services in developing countries like Tanzania, including a dearth of available and motivated surgeons with specialized skills, operating rooms, equipment and funding from local or international donors to support both surgeries and post-operative care. Finding ways of providing services in a more efficient and cost-effective manner is paramount. WHO Department of Reproductive Health and Research recently published new research on post-operative catheterization aimed at reducing discomfort among women who have undergone surgery, allowing earlier discharge thus lowing costs and increasing capacity for treating additional fistula patients. For more information, read the result from the link below

Obstetric fistula was eliminated in Europe and the USA following a public health effort that ran from 1935 to 1950,that allowed universal access to safe delivery care. That it is still a public health problem in some countries shows the enormous gap in maternal health care between high-income and low-income nations. Women with obstetric fistula are indicators of the failure of health systems to deliver accessible, timely and appropriate intrapartum care. Obstetric fistula disproportionately affects the poorest women, whose voices are scarcely heard.

According to the latest United Nations statistics, Tanzania is one of 11 countries that together account for 65 per cent of all maternal deaths worldwide. Every fourth woman who dies during pregnancy in Tanzania is a teenager—more than half the girls in the country get pregnant before they turn 19.

Women who experience obstetric fistula suffer constant incontinence, shame, social segregation and health problems. It is estimated that more than 2 million young women live with untreated obstetric fistula in Asia and sub-Saharan Africa. Preventing and managing obstetric fistula contribute to the Sustainable Development Goal 3 of improving maternal health, that’s why MGI4D have decided to bridge this gap by ensuring that we are improving access to high quality care for obstetric fistula by creating health seeking behavior among women and girls, raise awareness of the endemic, change the norms that promotes early and forced marriages and ensure that we cease stigmatization of people with Fistula

Obstetric fistula is preventable; it can largely be avoided by:

Water Hygiene and sanitation

Studies show that only 62 percent of schools in Tanzania provide an improved water source. Eighty-four percent of the 2,697 primary schools in Tanzania goes without hand washing facilities. These conditions create an unsanitary environment for children and make them more susceptible to diseases like dysentery, diarrhea or an acute respiratory infection. When schools have safe water, toilets and soap for hand washing, children have a healthy learning environment, and girls are more likely to attend when they are on their period. Beyond the schoolyard, children who learn safe water, sanitation and hygiene habits at school can reinforce positive life-long behaviors in their homes and their communities. However, millions of children go to school every day in unsafe learning environments, with no drinking water, no proper toilets, and no soap for washing their hands.

Every child has the right to a quality education, which includes access to drinking water, sanitation and hygiene (WASH) services while at school. Children spend a significant portion of their day at school where WASH services can impact student learning, health, and dignity, particularly for girls. The inclusion of WASH in schools in the Sustainable Development Goals (targets 4.a, 6.1, 6.2) represents increasing recognition of their importance as key components of a ‘safe, non-violent, inclusive and effective learning environment’ and as part of ‘universal’ WASH access, which emphasizes the need for WASH outside of the home (UNICEF)

Key facts about wash IN schools

Drinking water:

1. Globally 69% of schools have a basic drinking water* service.
2. In 1 in 4 primary schools there is no drinking water service. Worse, that number drops to 1 in 6 at the secondary school level.
3. Overall, nearly 600 million children lacked a basic drinking water service at their school in 2016, and less than half the schools in Oceania and only two thirds of schools in Central and South Asia have a basic drinking water service.

Toilets

4. Globally only 66 per cent of schools had a basic sanitation service** in 2016.
5. 1 in 5 primary schools have no sanitation service as well as 1 in 8 secondary schools.
6. One third of schools in sub-Saharan Africa and Oceania have no sanitation service. In most countries where data is available, less than 50 per cent of schools have toilets accessible to students with limited mobility.
7. Globally, 600 million children do not have a basic sanitation service at school.

Hand washing:

8. Nearly 900 million children worldwide lacked a basic hygiene service*** at their school.
9. 1 in 3 primary schools have no hygiene service and over a quarter of secondary schools have no hygiene service.
10. Over one third of schools worldwide and half of schools in the least developed countries have no hygiene service.
11. UNICEF has WASH in Schools programmes in more than 90 countries and reaches an average 3 million children a year.

Responding to these, Maasai Girls Initiatives for Development has developed a pool of trained community champion and Action teams in order to raise awareness on various public health intervention, our concern is to ensure that people are have access to these services but we also advocating for quality service provision, renovating hospitals and maternal wards, hospital toilets and distributing hospital equipment’s like beds, ultra-sound machines, surgical equipment and training for the Health care workers etc

Health and wellbeing