By Goodness Njakoi – Art in Tanzania internship

In the globally connected world of today, disease threats can spread unpredictably quicker than ever before. Emerging diseases are a global threat to human existence. Every country is exposed to potentially emergence of infectious disease. Several factors such as changes in ecology, climate and human demographics play distinct roles in a complex mechanism contributing to the occurrence of infectious diseases. Important aspects towards control in case of outbreaks are surveillance, preparedness and prompt response.

Tanzania has not experienced a major public health threat except for HIV/AIDS. she should take opportunity of the currently present calm situation to prepare. Talking about threatening bacterial epidemic in the country, two diseases are looked at: Cholera and Tuberculosis.

Cholera

Cholera is an acute diarrheal infection caused by ingestion of food or water contaminated with the bacterium Vibrio cholerae. the disease occurs in epidemics when conditions of poor sanitation, crowding and famine are present. It attacks both children and adults all over the world, but most common in typical areas such as per-urban and slums, where basic infrastructure is not available as well as camps for internally displaced people or refugees where minimum requirements of clean water and sanitation are not met.

Clinical signs for V. cholerae infection often begins with stomach cramps and vomiting followed by diarrhea, which may progress to fluid losses of up to one litter per hour. These losses result in severe fluid volume depletion and metabolic acidosis, which may lead to circulatory collapse and death. Symptoms of cholera can vary from mild to severe, the most common being sudden onset of watery diarrhea, dehydration, rapid heart rate, dry mouth, excessive thirst, low urine output, nausea and vomiting.

Since the seventh cholera pandemic reached Tanzania in 1974, the country reports outbreaks almost every year and had notified over 250,000 cases and 13,078 deaths by 2018. according to existing literature, Dar es Salaam is one of the endemic cities experiencing cholera outbreaks. From 15 August 2015 through 7 January 2018, 33,421 cases including 542 deaths were reported across all 26 regions of the Tanzania (Tanzania mainland and Zanzibar). Tanzania mainland reported 86% of total cases in the outbreak. active cholera transmission has persisted in Tanzania mainland, with Mbeya and Songwe Regions being the most active.

Irrespective of the fact that Cholera has been a recognized disease for about 200 years, control of the deadly disease still is a challenge. several strategies are being employed to control and mitigate cholera outbreaks, most of these are focus on basic sanitary and hygiene measures such,

as treating water supplies, improving water delivery systems, sewage control, hand washing facilities, latrines and adequate hygiene in food handling. However, control activities based on the provision of safe drinking water and improved sanitation have often failed to contain the spread of cholera, and outbreaks are now common in sub-Saharan Africa. The risk factors for cholera outbreaks in Africa are also incompletely understood, and thus it’s challenging to predict outbreaks reliably.

TB

Tuberculosis (TB) is an airborne bacterial infection caused by Mycobacterium tuberculosis. TB can be acquired by breathing contaminated air droplets coughed or sneezed by a person nearby who has active Tuberculosis. Humans can also get ill with TB by ingesting unpasteurized milk products contaminated with Mycobacterium bovis also known as Bovine Tuberculosis.

Mycobacterium tuberculosis is present worldwide and typically spreads in cramped, overcrowded conditions. There is no evidence that pulmonary TB is more easily transmitted in airplanes or other forms of public transportation. Long-term travelers, those with a weakened immune system or visiting friends and relatives (VFR travelers) in areas where Tuberculosis is endemic are at risk. Humanitarian and healthcare personnel working in communities with active TB are also at increased risk. Persons with active TB should not travel.

Mycobacterium tuberculosis

Most persons with the illness (90% to 95%) have latent TB infection (LTBI) and do not show any symptoms. The bacteria can remain inactive for many years and the chance of developing active TB diminishes over time. Persons with active TB have symptoms which include excessive coughing (sometimes with blood), chest pain, general weakness, lack of appetite, weight loss, swollen lymph glands, fever, chills, and night sweats. It can be misdiagnosed for bronchitis or pneumonia. If untreated, active TB can fatal.

Tanzania is ranked 14^th among the thirty high burden countries (HBC) that contribute 80 percent of the world’s TB burden. TB is highly endemic in Tanzania and is one of the main public health emergencies in Tanzania causing the death of 38,000 people in 2018. The WHO estimates that in the same year, 142,000 people fell ill with the disease but only 75,828 were notified meaning that 47% of all people with TB were not reached by the national health services. the burden of TB is highest in the regions where the two largest urban centers are found, Dar es Salaam and Mwanza.

REFERENCES

ManguC. D., ManyamaC. K., MsilaH., SudiL., ChaulaG., NtinginyaN. E., SabiI., & MabokoL. (2016). Emerging viral infectious disease threat: Why Tanzania is not in a safe zone. Tanzania Journal of Health Research, 18(3).https://doi.org/10.4314/thrb.v18i3.

Hounmanou, Y.M.G., Mølbak, K., Kähler, J. et al. Cholera hotspots and surveillance constraints contributing to recurrent epidemics in Tanzania. BMC Res Notes 12, 664 (2019). https://doi.org/10.1186/s13104-019-4731-0

UNICEF, (2004). Responding to the cholera crisis: UNICEF in Malawi. (www.unicef.org/wash/files/malawi), accessed on 9^th/10/ 2013.

Wahed T, Moran AC, Labal M (2013). Knowledge of attitude toward and preventive practices relating to Cholera, study in Dhaka, Bangladesh BMC Public Health 13.242.

Camilli, A., Nelson E, J., Morris J., M., Harris J. B., Calderwood S, B. (2009). Cholera transmission, the host pathogen and bacteriophage dynamic” Nat Rev Microbial, Volume 7, p 693-702.

Jones-Lopez E, Ellner J. Tuberculosis and Atypical Mycobacterial Infections. In: Guerrant, R; Walker D; Weller P, eds. Tropical Infectious Diseases. 3rd ed. New York: Saunders Elsevier; 2011: 228-247.

Shin S, Seung K. Tuberculosis. In: McGill, A; Ryan, E; Hill, D; Solomon, T, eds. Hunter’s Tropical Medicine and Emerging Infectious Diseases. 9th ed. New York: Saunders Elsevier; 2012: 416-432.

Centers for Disease Control and Prevention: Tuberculosis

World Health Organization: Tuberculosis