By Kizito Makoye
DAR ES SALAAM, Tanzania | 16 April 2024 (IDN) — In a hazy paediatric ward at Mlimba District Hospital, nestled in Tanzania’s eastern Morogoro region, Zuhura Mashaka cradles her two-year old daughter, Amina, in her arms as a nurse administers a jab to quell insidious infection racking the toddler’s body. With meticulous care, the nurse moistens a cotton ball with methylated spirit— gently swabbing Amina’s skin to pierce through a needle. A tang of antiseptic lingers, as she methodically rubs skin to spot a budging green vein.
With anguish etched across her face, Amina’s mother, Mashaka is concerned by her daughter’s worsening condition.
“I am quite worried by her health. She’s not getting any better,” says Mashaka.
Double Tragedy
Next to Amina lies Husna, another mother, watching over her six-year-old daughter, Aisha, ravaged by fever-induced tremors as she battles dysentery and malaria. For Husna, the anguish is twofold— witnessing her daughter writhing in agony and the danger posed by dirty rainy water likely to harm her other children.
“It all started as mild stomach pain, then came fever and many trips to the toilet,” says Husna.
Aisha, tethered to an IV drip, experiences perpetual bowel movement and irresistible urge to vomit.
Wider Crisis
The plight of Amina, Aisha and their families is just one facet of a larger crisis gripping Tanzania’s Kilombero district and other part of Tanzania where heavy rains spurred by El Nino weather phenomenon, have ushered in a torrent of waterborne diseases—diarrhoea, dysentery and Malaria—disproportionately affecting vulnerable populations including children.
In a country burdened by poor sanitation infrastructures, El Niño-induced rains and flooding continue to wreak havoc on physical structures, destroying homes, hospitals, schools and road. Swelling rivers, infested with filth and carcasses of dead livestock and trash breach their banks during floods, polluting drinking water supplies in adjacent villages— exposing people to deadly pathogens.
In Mwela village, located adjacent to the Kilombero river, where Mashaka lived with her family before moving to a make-shift camp perched on a higher terrain, hundreds of people have been displaced from their homes by the floods. With homes submerged and livelihoods shattered, the struggle against waterborne diseases takes on a personal dimension.
“We’ve lost almost everything, crops, clothes, food you name it,” laments Mashaka, reflecting on the hardships endured by her family. “Our home is underwater, and the little we salvaged is destroyed. But the real struggle began when my daughter fell ill,” she says.
With a tremble in his voice, Mashaka’s husband, Hassan echoes her concerns as he gaze at the water creeping dangerously at their submerging brick-walled house.
“We try to protect our children against diseases. But sometimes it feels like we’re fighting a losing battle,” he says.
Walking through the muddy paths in the village, faint aroma of decay hang in the air. Beneath the murky waters, stagnant pools laden with debris and carcasses of dead animals, serve as breeding ground for malaria- carrying mosquitoes.
Oblivious of lurking danger
In other parts of the village, children find respite from the scorching sun— swimming in the waterlogged terrain oblivious of the lurking disease threat. Women too, wade through the flooded terrain, salvaging remains of their homes, piecing together makeshift shelters on patches of dry land.
“I have never seen something like this before. My livelihood is totally destroyed,” says Felista Kaneno a resident of Mwera village in Kilombero.
The rise of waterborne diseases in the east African country, is intricately linked to global changes in hydro-ecological systems, driven by shifting rainfall patterns and rising temperatures.
Climate change affects ecosystems, impacting habitats and daily activities of large animals and small organisms like mosquitoes, mites, and mice. This significantly increase health risks globally, as many infectious diseases are transmitted by these small organisms, scientists say. Changes in temperature, rainfall, and humidity due to climate change potentially alter the timing, intensity, and spread of these diseases, they say.
Children and women are becoming more vulnerable as hundreds of people suffer from infectious and water-borne diseases in Tanzania’s flood-hit Morogoro region, according to local health officials.
As flood water begin to recede, which officials say may take time, the Kilombero Valley—a vast wetland—which sprawls across 7,679 square km some 200 miles(322km) southwest of Dar es Salaam, is struggling to retain its reputation as the nation’s bread basket, as flooding take its toll, becoming
Infested with diseases including malaria, diarrhoea and eye infection, local authorities say.
Diarrhoea, claiming over 2.5 million lives globally each year, with children constituting 21% of fatalities stands as a grave public health concern. In Tanzania alone, diarrhoea-related deaths numbered 17,587 in 2020, making up 5.96% of total deaths.
Rashid Mwamba, a senior clinical officer at Mlimba hospital says flooding has contaminated wells and rivers that local people rely for drinking water, causing a surge in diarrhoeal infections.
“The number of children suffering from diarrhoea has increased dramatically in recent months,” Mwamba says. “We have also seen an increase in cases of dysentery and other gastrointestinal infections among children” he says.
Public health measures
According to him, acute water diarrhoea has led some families to shun drinking water altogether in the belief that the water had been poisoned.
“We educate villagers to take proper hygiene measures and avoid mistaken beliefs,” he says.
According to Mwamba, District community health workers have been mobilising villagers to boil drinking water and wash their hands before and after eating or using a toilet.
Gesturing toward hospital shelves barren of essential medicines and sterile equipment, Mwamba complain about shortage of essential supplies.
“We have shortage of antibiotics, oral rehydration salts and even basic supplies like gloves and syringes. This affects our ability to provide effective treatment,” he says.
According to Mwamba, sheer volume of patients seeking treatment exceeds the hospital’s capacity to respond adequately.
“The paediatric ward has the capacity to hold 40 patients but currently there are 78 children with acute diarrhoea,” he says.
Mwamba also points out shortage of diagnosis facilities.
“The shortage of laboratory equipment severely hampers our diagnostic capabilities, in some cases we rely on clinical symptoms alone,” he says.
Carista Lymo, the nurse-in-charge at Mlimba hospital, told Health Policy Watch that in children, “acute respiratory infections have increased along with skin infections and gastroenteritis. The cases of gastroenteritis are mainly due to people eating foods that have not been washed and hygiene practices which have dropped. “We have run out of zinc tablets, which are used to treat gastroenteritis,” she says
As the east African country braces itself for more rains, the government is mobilising resources and expertise to cope with the looming crisis.
As part of its broader push to tame the rising wave of waterborne diseases, Tanzania’s ministry of health has instituted public health measures including raising community awareness and distributing water purification tablets to help communities afflicted by flooding.
“Waterborne diseases pose a significant threat to public health in Tanzania, particularly in rural parts of Morogoro where access to clean water and proper sanitation remains a challenge,” says Cosmas Swai, a public health specialist at Tanzania’s Ministry of Health
According to him, the government has initiated a series of public health measures to curb the spread of waterborne diseases and protecting the people’s wellbeing.
From stockpiling anti-malaria drugs to supplying essential water treatment chemicals, efforts underway to improve public health by easing the effects of floods on vulnerable communities.
Swai emphasizes the role of education and community engagement in promoting hygiene practices.
“Education is necessary in helping people to protect themselves and their communities from waterborne illnesses,” he says adding.
“Through targeted campaigns and outreach efforts, we want to raise awareness on the importance of clean water, proper sanitation, and hand hygiene,”
In the Morogoro region, local authorities highlight the government investments in infrastructures to improve access to safe water and sanitation facilities.
“We know that infrastructure development is key to addressing the root causes of waterborne diseases,” says Daniel Nkungu Chief Medical officer for Morogoro region say”
By expanding access to clean water sources and improve sanitation infrastructure in rural areas, we will reduce the risk of disease transmission and improve overall public health outcomes, he says.
Nkungu underscores the need for surveillance and response mechanisms in detecting and managing outbreaks.
“Timely identification and containment of waterborne disease outbreaks are essential to preventing their escalation,” he says.
“We have strengthened our surveillance systems and establish rapid response teams to swiftly intervene in affected communities.”
Yawning Policy gaps
The intersection of health policy and climate change in Tanzania presents significant challenges. While the country boasts a well-crafted National Health Policy, analysts argue it falls short in addressing the escalating impacts of climate change and its effects on human health.
According to these experts, the current policy lacks a comprehensive strategy to mitigate the health impacts of climate change, such as increased prevalence of vector-borne diseases, heat-related illnesses, and food insecurity.
“Climate change variability and adaptation are conspicuously missing in our health policy. It’s like missing the elephant in the room,” says Pius Yanda, professor of Geography at the Centre for Climate Change Studies University of Dar es Salaam.
Yanda argues that without proactive measures, Tanzania’s healthcare system will struggle to cope with the growing challenges posed by climate change, potentially leading to a rise in disease outbreaks and exacerbating existing health disparities.
“Urgent action is needed to integrate climate change considerations into health policy and strengthen resilience to protect the well-being of the in the face of environmental challenges.
As climate change continues to tighten its grip, extreme weather events threaten to overwhelm healthcare systems, leaving communities vulnerable to diseases.
“We used to drink water straight from the river without a second thought” says Mashaka “But now, we’re scared. The water doesn’t seem as safe anymore,”
In one of the villages in Kilombero, 57-year-old Prisca Ntwale told Health Policy Watch that a scarcity of water, food and shelter was affecting her life and that of her family, which includes six grandchildren – the youngest just two years old.
“The future is very uncertain, I don’t know what will happen when it keeps raining,” she says. [IDN-InDepthNews]
Photo: Zuhura Husein (64) holding her granddaughter while cooking on a makeshift firewood stove in Kilombero. Credit: Kizito Makoye.
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