Saturday, May 1, 2010

Another Quiet Epidemic in Tanzania

There is unnoticed epidemic of diabetes creeping up in Tanzania as well as in other low income countries. Few practitioners in Dar have cautiously voiced their grave concerns in this new epidemiological trend. Kwamba, eventually we will have to address the growing morbidity and mortality rates of chronic non-infectious diseases. Of which our health systems have been understandably ignoring because of the burden of infectious diseases. I have been trying to figure out what has happened that wabongo are getting diabetes in high numbers. It is important to figure this out right away because chronic diseases are expensive to manage, and prevention is always the best approach. Besides, our healthcare system is so crippled that once this Diabetes thing has caught full steam, we are toast.

I have noticed that 1)we consume a lot of sugar, baiskeli za Azam Ice-Cream zipo kila kona, and they are dirt cheap. Na joto hili la bongo, it makes sense for people to go overboard on sugar. Same as soda, na juice baridi, which are available kwenye kila kona ya nchi. 2) There is are link between TB and Diabetes—kwamba if you are infected with TB (not necessarily diseased) it changes carbohydrates mechanism and lead to impaired glucose tolerance. Essentially, having infected with TB, it increases your risk of getting diabetes. This is an interesting finding because Bongo is a TB endemic country, and chances are majority of us are infected with TB (Latent TB). I’m sure most of us have positive Mantoux test, I know I am. It makes sense that as we consume so much sugar and majority of us have the TB infection, diabetes epidemic is inevitable.

Moving forward, MOH has to start a countrywide surveillance on new and old Diabetes cases, so as we can have the data ready for future studies. And initiating bottom-up community awareness campaign on diabetes, people have to understand the implications of going overboard on sugar especially, when they are already at risk. Obviously there are other risks for Diabetes that will also have to be addressed as well, but it has to start now, because we simply cannot afford another epidemic.


Anonymous said...

I agree, we definitely cannot afford another epidemic; however, as sad as it may sound-it is I agree, we definitely cannot afford another epidemic; however, as sad as it may sound-it is inevitable! We are soon going to hit rock bottom as far as chronic disorders are concerned as evident through the different research works that have been published. (see reference below)

My spiel is that in order to curb diabetes as well as other chronic diseases in our society we need to sensitize the people into understanding the importance of changing our way of living. I mean we need to cut down on the amount of cooking oil we consume or pick better/healthier meal preparations. If you haven’t noticed yet, we are big on heavy foods, with lots of nyama choma and frying almost everything on the face of the earth. In addition, we need to engage in preventive care. It is within our culture for people to wait until the manifestations of chronic diseases reach advanced stages(as evident by many people seeking medical attention when they have stage 4 foot ulcers, diabetic neuropathy or when their kidneys are partially or completely (end-stage)failing.) Moreover, I think that exercising does not seem to be a major concern in our communities because there is already that idea that we already engage in many activities most of which are physical labor in nature: mama ntilie, wabeba michanga, wafugaji, wafanya kazi za ndani, daily chores etc. Despite this notion, I think we need to emphasize exercise especially in older women and women of child-bearing age because diabetes affects more women compared to men. I guess women are twice at risk due to our God given anatomical tendency to carry more fat than men! Lastly, a desirable African woman, has for as long as I can remember, been the voluptuous, rounded and fully figured female. The tales I used to hear of wanawake wa kichagga, they would get fattening and heavy soup after giving birth or when they get married(someone correct me for I can’t remember exactly the scenario), but our culture is vested in this image which propagates women’s desire to eat in certain ways in order to live up to that cultural expectation. These are some of the challenges that will need to be addressed when we are thinking of combating diabetes.

While we are at it, we need to remember that simple tasks such as reading food labels or planning balanced meals and reducing our consumption of trans fat might not be so easy for the average Tanzanian. Therefore, we need to focus on age-appropriate, gender-sensitive, and academic-relevant approaches in order to reach the target groups. Otherwise, if we don’t address individuals in a health-conscious language that they will understand, basi we will not affect that change we are looking for.

My recommendations, start with the women! I can attest to it that mama yangu affected my choices of eating to a great extent as a child and even today. Therefore, if we focus on teaching women healthy eating habits, importance of exercise and preventive cares, we have reached out to 1)the higher affected population in numbers 2) an even larger group cause women influence their children as well as the rest of the family in one way or the other.



Njelekela, M. A, Mpembeni, R., Muhihi, A., Mligiliche,N.L. Spiegelman, D. Hertzmark, E., Liu, E., Finkelstein, J. L.,Fawzi,W. W, Willett, W.C & Mtabaji, J. (2009).Gender-related differences in the prevalence of cardiovascular disease risk factors and their correlates in urban Tanzania. BioMedCentral Cardiovascular Disorders 2009, 30,9, 1-8

If you have access to EBSCO host perma link:

salama said...

Great analysis!

And thanks for bringing this up~
It's obvious that we're killing ourselves softly with our lifestyle, changing it and exercise,(as delivered) is our best bet but, it might be easy and would work better mainly, to those in urban areas. How about those in typical country?(If I can bring this one up)as we know, a big number of them likely can't afford to get the most nutritious food. Most of them consume lots of carbs and very little minerals and other substances that promote health, and all that starch/white/fine flower turns to sugar when it's broken down. They have an active life but, as someone said that's not enough, may be they should be another solution.
The good side about us is that, we can always get organic food, and for that case it's up to us to decide on what we want to put inside our bodies. Also, portion is another thing to consider. Someone can try and eat as healthier as they can but if portions are not moderate inakuwa buree!

Anon, I think it'll be better to start educating a healthy life styles to both men and women. A family is built up well and healthy if both a man and a woman participate fully and accordingly to their families, women may seem to be more responsible for their families well being but, if this's turning out to become an epidemic in our country, everybody need to take action and be responsible.

For the record.
(Most beer have lots of carbs but there's some with few calories~at least some good news~kwa wale tunaopenda kinywaji)

Thuwein said...

Changing in lifestyle and urban sprawl are also major reasons for this trend. If you have noticed especially in Dar, affluent folks don't buy their food in local markets anymore. They hit those supermarkets in Mbezi, Masaki, City center au Mlimani City. This has been so puzzling, why would someone buy food in a supermarket while there are fresh food in kariakoo and fresh fish Ferry? And supermarkets food are unhealthy.

In order to get our hands on this mess, we need to do a better job in surveillance and collecting enough data on new and old cases. This is critical because with data, you can do research and come up with evidence-based policies and interventions. We need to have a capacity to do this accurately. And an all-out community outreach and education, this will help. Its going to be tough kumwambia mtu apunguze kiti moto and ndovu, but the long term implications of not doing it are huge.

Salama, you are on-point, folks in rural areas are malnourished. They are unhealthy for wrong reasons they lack micro-nutrients in their diet. It is sad because something as simple as Vitamin A supplements can have enormous consequences on their overall healthcare outcomes. Things like plants/sugar/salt fortification or applying mineral enriched fertilizers can be efficient tools to meet their dietary requirements. And it is dirt cheap.

Kwa wale wa kinywaji, ndovu chupa ndogo is so appropriate.

Anonymous said...

Asanteni jamani, this is a good discussion and even better contributions!
Salama, We are on the same page. Thank you for emphasizing nutrition as a way forward. Let me dig a little deeper and ask, Je tatizo la watu wa vijijini ni ‘ not being able to afford nutritious foods’ ama ‘lacking the knowledge of choosing heart-healthy, low-sodium food choices?’ or is it a combination of both? I am asking because you did mention that we have access to organic foods but we just don’t have good judgment as far as what “we want to put inside our bodies”. So concerning ndugu zetu wa vijijini mimi nashauri we need to impart that knowledge on how to select good foods from what they have, because if we use lack of affordability (poverty) as a road block, we will not reach our objectives. So a solution I guess ni kuwaelimisha to make the most out of the crops/ food sources that they have while we think of another solution to curb the mineral deficiencies that they may be lacking; as Thuwein pointed out.

Again, we do need to educate the society! Not just women. My recommendations were based on the fact that women are more afflicted with chronic disorders (esp. Diabetes). Secondly, because of the famous notion that educating a woman is educating the society. I do support what you said that both men and women have a responsibility towards the general health of the society and everybody needs to take action starting at the individual level, lakini nasisitiza tu kuwa hili janga linasumbua zaidi wanawake zaidi ya wanaume. Either way, I agree with educating everyone!:)

Thuwein, I didn’t think about the whole idea of moving ‘masoko from kariakoo to Masaki, lol”. You are right, in a public health perspective, it is alarming, and does not make any sense! I think that there are different reasons that push people to the choices that they make/ prefer. In this case, one of the reasons is ‘keeping up with the jones” ama “social status”. I am just throwing this out there jamani, its not the only reason ila, I think the whole idea of supermarkets is fairly new to our society and for some people, it is almost prestigious to push a shopping cart and feel the cool air from the freezers, lol. As funny as this seems, it is unfortunate that our people get easily swept away by ‘trends’ rather that ‘healthy choices’. On a different note, supermarkets huwa zinauza organic foods as well, so for those who can afford it (kwani prices huwa set at astronomical levels), they would prefer the convenience of location (Masaki –to Masaki, or Mikocheni to Mikocheni) at a higher price for purchasing the same item you would get at Kariakoo for a way cheaper cost. I am sure there are other explanations out there and what i said does not speak for each individual.

Shauri yako Thuwein, na lile vumbi/jua kali la Kariakoo…lol! Utaishia mwenyewe kwenye matenga ya nyanya. Hehe, ama tutakutana Shoppers Plaza? An interesting new topic thuwein, lets digest ORGANIC FOODS vs. GMOs….next. I am sure tutajifunza mengi.
Have a good day people!

salama said...

Did I really wrote ' put inside our bodies' lol!, I guess it was a direct translation from 'kuweka ndani/kula, n'ways ndo iyo iyo, mladi na muimu ielewekea sio.....

Thanks for clarifying and providing us with necessary info. That's so real, the more we age the more our bodies loose muscles, then it gets replaced and stored as fat(especially on that mid-section area which tend to accumulate tons of it)this's why it's imperative to watch what we "put inside us" and exercise regulary. But this exercise thing is somehow an 'issue' to a lot of people, more often utasikia mtu anakwambia hana wakati, I totally disagree, I don't think there's anybody who has almost all the time in the world than us!
People don't have to start running a marathon or, all of the sudden start pumping and try to get that Schwarzenegger look(lakini uongo mbaya, guys mtapendeza like that)
But, on a serious note, if we decide to be careful with our diet and start engaging even in simple exercises like, walking a lot, skipping an elevator and take stairs(if they're safe) or even working on our yards(ourselves) and give that shamba boy a break once in a while. That can have a good effect on our lifestyle.

On our folks in the countryside, It's more about educating them. They have real good, natural food and, as thuwein pointed out, it's dirt cheap!, so if they just use it accordingly, I don't think they'll face issues like diabetes or other chronic diseases associated with food or malnutrition.

The 'social stutas' thing is true, I overheard someone saying a while ago,"aka babu mie siku hizi siendi uko kwenye vumbi" meaning the local market. Ukisha kuwa juu ndugu kushuka utaona shida. Most of us passes by the next door grocery stands to go couple of miles away where it's even more expensive. I would agree though on safety and confort issues, some folks don't feel safe and confortable standing in a hot crowded area especially somewhere in Dar, but also, we all have to agree that, we're possessed and are suffering from another chronic disease of Neophila.


And its more evident ukienda the spot famously known as ZHONG HWA...pale victoria. Utakuta ma yanki kibao ambao wako kwenye mwaka wa pili wa employment wamekaa kaa kihasara hasar na vitambi ...vya bia na of course the intake of red meat isnt helping either

Sasa kuhusu dada zetu ndio usiseme

Kama kweli mtu anataka kuanzisha biashara mji huu basi afungue proper fitness centre maybe folks our age might start to think differently.

Inasikitisha sana kwa kweli.