The Epidemic of Malnutrition in Tanzania - Case Study Example

The Epidemic of Malnutrition in Tanzania Introduction This report is inspired by a Biology class trip that was made to Tanzania. The focus of the report is the state of malnutrition in Tanzania. Across the globe, malnutrition, which for a long time has been associated with phenomena such as poor diet, poverty and insufficient access to health care, remains a key health issue (Juma et al., 2016). Notably, all over the world, malnutrition contributes to poor health, and is associated with about 50 percent of cases of child mortality (Juma et al., 2016). During the trip, it was observed that although Tanzania is making progress in terms areas such as infrastructure and telecommunications development, the country still faces challenges in regard to making progress in the health sector. In particular, there are many cases of malnourished children in many parts of the country, meaning that such children do due not get adequate and nutritionally balanced food or balanced diet (meal that contain all the necessary carbohydrates, vitamins, proteins, minerals, and other nutrients) (National Health Service UK (NHS), 2016) . Another notable aspect of Tanzania’s health sector is the many of the country’s hospitals (or at least those that were observed) have poor infrastructure. The implication of this is that patients end up not getting good health care, and the underdeveloped infrastructure (such as having many patients in one room) exposes patients to diseases spread easily. Another point is that most of Tanzania’s population, especially the population in the country’s rural areas, relies on rain-fed agriculture. As such, many regions of the country do not get adequate food during dry seasons, meaning that notable segment of the population stares at hunger during some times of the year. This, coupled with the fact that the varieties of food that are available do not adequately provide the balanced nutrition, have exacerbated the problem of malnutrition in the country. The report is structured as follows. To start with, the report will provide overview information about Tanzania and the Human Development Index (HDI) of the country. This will be followed by an analysis of details about malnutrition in the country. The information for the aforementioned sections will be derived from published sources and will provide an account of Tanzania state of health and malnutrition in particular. Next, the writer will present information about personal experiences during the trip in Tanzania. To sum up the discussion, the conclusion will be made about the information presented in the report. The last part of the report is the writer’s personal reflection on the project (the trip to Tanzania). Overview of Tanzania and the Country’s Human Development Index Tanzania is a country located the eastern region of Africa. It is one of the countries that form what is referred to as Eastern Africa. Tanzania has a population of 50 million people and stands at position 151 out of 188 nations in terms of HDI, going by the 2015 ranking (World Food Program (WFP). 2016). According to the United Nations Development Program (UNDP) (2015), HDI is a summary measure of average performance in regard to critical elements of human development. These elements are having a long and healthy life, being knowledgeable (i.e. having access to education), and having a decent living standard. The HDI value is based on a geometric average of normalized indices for each of the three dimensions that have been mentioned (UNDP, 2015). Being ranked 151 out of 188 countries means that Tanzania is only doing better than 36 countries out of the list of 188 countries in terms of HDI. What this means is that Tanzania is performing relatively poorly in regard to its population having a long and healthy life, the people having access to education, and people having decent living standards. In other words, considerably many people in Tanzania do not have long and healthy lives, do not have access to education, and have generally poor living conditions. Indeed, according to the WFP (2016), approximately three out of ten Tanzanians live in poverty, and one in every three people is illiterate. What this means is that because many people are poor, they cannot afford education, and in turn, this implies that such people are not knowledge. Lack of education implies that the affected people are not aware of basic health principles such as sanitation and hygiene, the need for balanced nutrition, and so forth. Living in poverty also implies that the affected people are unable to afford proper food or balanced meals. Many of the people are also unable to afford good health care, a problem that is compounded by the fact that the medical facilities that are available in Tanzania are greatly underdeveloped. The poverty conditions in many parts of Tanzania are also made worse by the fact that nearly 80 percent of the country’s population depends on subsistence farming (WFP, 2016). This makes them vulnerable to shocks resulting from climatic, economic and seasonal changes. Because of this, many people have to depend on organized food support programs such as those that are run by the WFP (WFP, 2016). The unreliable food supply in Tanzania means that there are many instance when many people have to go without food or get poor quality food. It is this state of affairs that has made malnutrition a persistent problem in Tanzania despite the country’s seemingly good progress in terms of development of communications and transportation infrastructure. The following section will delve deeper into the problem of malnutrition in Tanzania. Facts about Malnutrition in Tanzania Historical Overview of Malnutrition and its Overall Effects in Tanzania Malnutrition is one of the bigger challenges that face most of the sub-Saharan Africa countries, Tanzania included (Gardner & Halweil, 2000; Uwazi Infoshop, 2010). Tanzania has been at the forefront of enhancing it people’s socioeconomic status since 1986 (Minot et al, 2006). However, despite the improvements that have been made in regard to the economy, some sectors still lag behind, one of them being health. Of particular note, over the years, malnutrition has been a persistent problems in Tanzania (Minot et al, 2006). The underlying causes of malnutrition include household food insecurity, insufficient feeding and care practices, and the occurrence of unhealthy household environment as well as inadequate health services (IMF, 2013; UNICEF, 2013). It is estimated that over the decade that preceded the year 2010, about 600,000 children of age below five years died due to insufficient nutrition (Uwazi Infoshop, 2010). In the year 2010 alone. It was approximated that another 43,000 children would die as a result of malnutrition. When analyzed, this figure implies that in 2010, one child was dying every 12 minutes due to malnutrition (Uwazi Infoshop, 2010). That is how bad the epidemic of malnutrition is in Tanzania. According the United Nations Children Fund (UNICEF) (n.d.), even though Tanzania has made significant progress in many indicators of health over the last ten years, the country has not achieved much in terms of nutritional status. In a publication written by the International Monetary Fund (IMF) in, it was noted that malnutrition is both a challenge as well as one of the severe health problems that affect Tanzania, and the single most notable contributor to child mortality (IMF, 2011). Specifically, in children, malnutrition is associated with an insufficient diet, poor sanitation and health services, as well as inadequate care (Alderman, Hoogeveen & Rossi, 2006). Malnutrition is also the main barrier educational achievement as well as key obstacle to economic growth as a result of its negative effects on health, the capacity of the affected people (mainly children) to learn as well as people’s labor productivity (IMF, 2011). The negative effect of malnutrition on people’s ability to learn as engage in meaningful economic activity combined with adverse impact of malnutrition on health implies that malnutrition’s affects many segments of development. For instance because due to malnutrition, children are unable to go to school or to concentrate in class. Later on, such children who are largely uneducated or semi-illiterate, may not be able to secure well-paying jobs, meaning that they may not be economically productive in terms of the labor or capital that they can provide. This point is highlighted by Uwazi Infoshop (2010) through the argument that “malnutrition hurts the economy”. This statement by Uwazi Infoshop is illustrated further through the assertion that labors and farmers, mostly women, are made weak by stunting, anemia and inadequate intake of energy. Because of this, the affected individuals are not able to apply much effort in their work, which leads to smaller harvests as well as lower labor productivity. Uwazi Infoshop (2010) also argues that malnutrition also results in lost opportunities for economic growth given that adults with stunted brain development that occurs due to insufficient nutrition during their early stages in life are less able to be innovative in order to respond to the emerging market opportunities. Prevalence, Specific Effects and the Cycle of the Malnutrition Epidemic in Tanzania Although, as it has already been noted, some progress has been to ensure that Tanzanians have adequate and nutritionally balanced foods, the overall number of cases of malnourished people remains high, especially among the people who live in rural areas and the poor people living in urban areas (IMF, 2011). Notably, many children in the country are underfed or do not get nutritionally balanced meals. This argument is supported by the fact that currently, stunting among children in Tanzania stands at 42 percent of children under the age of five years. And the situation is persistent given that five years ago, stunting in children under the age of five years stood at 44 percent of children in Tanzania. Worse still, Tanzania is ranked third in sub-Saharan Africa in terms of having the highest number of stunted children, coming only after Ethiopia and the DRC (Democratic Republic of Congo) (UNICEF, n.d.). Tanzania also has one of the highest maternal mortality rates, with some of the maternal deaths being attributed to malnutrition (WFP, 2016). In particular, children, lactating mothers and pregnant mothers are the groups that are most vulnerable to the consequences of malnutrition (IMF, 2011). The death rate from maternal mortality stands at 398 deaths for every 100,000 live births (WFP, 2016). Because of the high mortality rate, organizations such as the WFP always have to step in to provide supplementary foods to mothers, and currently, WFO is the only organization that provides supplementary food to nursing and pregnant mothers and children of age below five years in Tanzania (WFP, 2016). Cases of malnutrition among children and their effects of the wider population and the economy of Tanzania are especially pronounced in some regions of the country. Overall, the country’s rate of underweight children stands at 16 percent (UNICEF, n.d.). This means that a lot of resources have to be expended in promoting good nutrition and ensuring that the affected people have access to nutritionally balanced food. Tanzania has notably remained behind in achieving the millennium development goals of reducing cases if underweight children by half by the year 2015. There are also cases of very high acute malnutrition in regions such as Zanzibar, where 12 percent of the region’s children are affected (UNICEF, n.d.). In addition, about a third of children in the age bracket of 6 to 59 months lack adequate iron and vitamin, 69 percent are anemic, and more than 18 million Tanzanians lack salt that is fortified with iodine (UNICEF, n.d.). There are also inequities in child nutrition, where for instance children in the lowest family wealth quintile exhibit the highest rate of stunted growth (48 percent) in comparison to children from the highest family wealth quintile, where the rate of stunting is at 26 percent. What the disparity means is that children from poor backgrounds are more likely to be malnourished and hence stunted, which reduces their prospects of having a good education, having a decent standard of living, and to live a long and healthy lives. In the end, such children have to live their entire lives relying on support from the government and other support organizations such as the WFP and UNICEF. Among adults, cases of malnutrition are most prevalent among women and adolescent girls. In the 15 to 49 years old age group of girls and women, about one third of the people do not get adequate iron, iodine and vitamin A. as well, about two fifths of girls and women in the same age group are anemic while 10 percent of women in the said age category are undernourished (UNICEF, n.d.). The implication of having women of child-bearing age being malnourished or undernourished is that such women are more likely to give birth to children with low birth weights, who are remained malnourished in their childhood and in their late life, and thus likely to transfer under-nutrition and malnutrition between different generations. This means that over time, the burden of having become persistent as it is it keeps on being passed from one generation to the next (UNICEF, n.d.; UNICEF, 2013). Personal Experiences of Malnutrition and Poor Health Facilities during the Project in Tanzania During the trip to Tanzania, the writer witnessed first-hand, cases of malnourished children, lack of proper or adequate food, and poor health service facilities. One incident was where the writer saw a severely malnourished boy who had been hospitalized and died while the writer was visiting the hospital. The boy’s body was boney, his stomach was protruding, his arms had curled up, and he had sunken eyes. In addition, the boy appeared to have a small face and a huge head because of his emaciated body. These are undoubtedly some of the symptoms of malnutrition. According to the National Health Service of the UK, some of the symptoms of malnutrition in children include loss of body weight (emaciation), weak muscles, a feeling of being tired, and an increase in infections or illnesses (NHS, 2015). Looking at the severely malnourished boy, it can be argued that one of the factors that could have contributed to his death was the presence of an illness of infection that could have made his already bad health condition even worse. Such illness (such as anemia) can and overall poor health result from the lack of food, poor feeding and care practices, living in unhealthy conditions, and insufficient access to health services, as noted by UNICEF (2013) and the IMF (2013). The observation of a severely malnourished boy is that just of the cases that are rife in Tanzania. In a study that was conducted by Juma et al. (2016), the authors observed cases of 63,276 children and the hospitals and other support facilities that were attending to the children. In their analysis, the authors conclude that having such a high number of children in ravaged by malnutrition in one region of Tanzania, namely Bagamoyo, is a risk that is higher than expected. Juma et al. (2016) also note that in areas with high prevalence of malnutrition such as Bagamoyo, there is need to have centralized locations to make it possible to reach thousands of malnourished children who are aged below five, which is the case at Bagamoyo District Hospital. In the current Biology trip project, the writer also noted that overall, Tanzania has poorly developed hospitals. For instance, one hospital in Arusha has an MRI machine that had broken and was therefore not functioning. Further evidence of this was seen in the fact that the hospital was not well equipped with necessary facilities such as beds, and several patients were being made to stay in an open cubical with limited services such as water taps. The risk of patients staying in such an environment is that there is a danger of spreading communicable diseases. What this means is that the conditions of malnourished people are likely to be become worse even while at the hospital because of the possibility that such people will contract other illnesses of infections while at the health care facility. Additionally, because many malnourished children are made to use the few health care facilities are available, such as Bagamoyo District Hospital, there is the risk of overstretching the capacity of the medical facilities. This in turn causes a deterioration in the quality of service that is provided by such facilities. By comparison, Tanzania’s public hospitals in urban areas such as Arusha have better facilities compared to those public hospitals located in rural areas such as Dareda. This means that malnourished people and children in rural areas in Tanzania have worse outcomes than those in urban areas with the respect having access to health services. However, compared to hospitals in the United States, even those facilities in hospitals in urban areas are much inadequate. It also appears that most of the hospitals that have very poor facilities are the public or government-owned hospitals. This is because the Biology trip also involved visiting one hospital that is funded by an American organization, and it was found that this hospital had good infrastructure. The problems with having public hospitals that are have poor infrastructure is that the situation then limits the poor people to poor health services. Since most of the malnourished people come from poor families, most of them cannot afford the cost of services of in privately owned hospitals. This means that such people have to contend with the poor services that are offered in public hospitals, with poor outcomes as seen in the case of the malnourished boy (mentioned above) who died while at a health care facility. Another issue that was observed during the Biology trip is that most of the malnourished people some from economically disadvantaged backgrounds. Many children have to rely to meals provided at school, but the school that was visited was not providing any meals to the children. As such the parents of the children had to contribute money to ensure that the children get some food while at school. Even then, the meals were not adequate and were not nutritionally balanced – which is one factor that characterizes malnutrition. Another issue that was observed in regard to malnutrition is that some parts of Tanzania do not have different varieties of food that are required to ensure adequate feeding as well as balanced nutrition. walking around Arusha, it was noted that most markets had limited varieties of food, with the food items available being fruits such as tomatoes, avocados, bananas; legumes such as red beans; and tubers such as potatoes. Although these foods may contain some of the nutrients are necessary for effective body development, they do not provide all the nutrients that are required. Notably, the lack of different varieties of protein sources such as fish, pulses, meat, eggs and other proteins, which are necessary for body growth and repair of tissues (NHS, 2016). Starchy foods such as brown rice, sweet potatoes, brown, wholemeal bread and wholewheat pasta are also important because they not only provide the energy that the body requires but also contains fiber and some important vitamin. All these foods, are required, in addition to those that are available in the local markets in Tanzania, to ensure that people are adequately fed and that they get balanced diets. However, rural areas in Tanzania seem to have very limited varieties of food. For instance, the Dareda region (rural) was seen to have fewer food varieties compared to Arusha (urban). The implication of this observation is that people in rural areas have limited options when it comes to the foods that they can have access to. Coupled with their low socio-economic status, this means that the people in rural areas in in Tanzania are the most vulnerable to malnutrition. Conclusion In conclusion, Tanzania faces the epidemic malnutrition and there is no doubt that there is need for intervention measure to be strengthened. Although the country is doing relatively well in other areas of development such as infrastructure, the fact that it ranks 151 out of 188 in terms of HDI implies that the country is doing relatively poorly in human development. This ranking indicates that the many of the country’s people do not live long lives, are not well educated and have living standards that are not decent. Proof of the foregoing statement is the fact that Tanzania has a very high malnutrition rate. With over 600,000 having died between 2000 and 2010 due to malnutrition, the rate is appalling. Notably, the observations that were made during the trip such a child dying due severe malnutrition, the lack of different food varieties, and the poor state of hospitals in the areas that were visited are indications that the epidemic still has a long way to be contained. Interventions need to involve educating people on the need to proper feeding and lactation, sanitation, and visiting health care facilities for medical assistance. More importantly, there is need to empower the poor people economically through income generating activities so that such people can be able to purchase the foods that are required for proper nutrition. Reflections on the Project The Biology trip to Tanzania was a very important part of my academic work because it gave me an opportunity to witness first-hand the problems that I have only been able to read about via the internet and watch on television. The trip enables me to see how severe the problem of malnutrition is in Tanzania. Seeing a young boy die while at a health facility to which he had been brought to seek medical care for malnutrition and other illnesses was really disturbing. The lack of food and health facilities that can adequately cater the needs of the poor people in Tanzania also compounds the problem of malnutrition. Looking back, I believe that governments such as the Tanzanian government can do more to contain the malnutrition epidemic. Since some countries and even some parts of Tanzania have excess food, the problems lies in distribution to ensure that it reaches those who are in dire need, especially the poor people. I also believe that the poor people can be empowered so that they do not have to rely on rain-fed subsistence farming, which is exposed to many types of shocks. Having the poor people empowered economically so that they can access food, education and better health care services will make them live more decent livelihoods devoid of malnutrition and the problems that are related with the epidemic. Such empowerment can be in the form of supporting rural irrigation, facilitating the creation of job opportunities through small businesses and related concepts, and ensuring that young people attend school so as to break the cycle of poverty. References Alderman, H., Hoogeveen, H., & Ross, M. (2006). Reducing child malnutrition in Tanzania: Combined effects of income growth and program interventions. Economics and Human Biology, 4, 1-23. Gardner, G., & Halweil, B. (2000). Overfed and underfed: The global epidemic of malnutrition. Worldwatch Institute. Retrieved from http://www.worldwatch.org/system/files/EWP150.pdf International Monetary Fund (IMF). (2011). Tanzania: Poverty reduction strategy paper. Washington, DC: Author. Juma, O.A., Enumah, Z.O., Wheatley, H., Rafiq, M.Y., Shekalaghe, S., Ali, A., Mgonia, S., & Abdulla, S. (2016). Prevalence and assessment of malnutrition among children attending the Reproductive and Child Health clinic at Bagamoyo District Hospital, Tanzania, BMC Public Health, 16(1094), 1-6. Minot, N., Simler, K., Benson, T., Kilama, B., Luvanda, E., & Makbel, A. (2006). Poverty and malnutrition in Tanzania: New approaches for examining trends and spatial patterns. International Food Policy Research Institute. Washington, DC. Retrieved from http://www.repoa.or.tz/documents_storage/Research%20and%20Analysis/IFPRI%20Report.pdf NHS. (2015). Malnutrition. Retrieved from http://www.nhs.uk/Conditions/Malnutrition/Pages/Introduction.aspx NHS. (2016). Eating a balanced diet. Retrieved from http://www.nhs.uk/Livewell/Goodfood/Pages/Healthyeating.aspx UNICEF. (2013). Improving child nutrition: The achievable imperative for global progress. New York: Author. Retrieved from https://www.unicef.org/gambia/Improving_Child_Nutrition_-_the_achievable_imperative_for_global_progress.pdf United Nations Children’s Fund. (UNICEF). (n.d.). Tanzania. Retrieved from https://www.unicef.org/tanzania/nutrition.html United Nations Development Program. (UNDP). (2015). Human Development Index (HDI). Retrieved from http://hdr.undp.org/en/content/human-development-index-hdi Uwazi Infoshop. (2010). Malnutrition: Can Tanzania afford to ignore 43,000 dead children and Tshs 700 billion in lost income every year? Retrieved from http://www.twaweza.org/uploads/files/Fighting%20Malnutrition%20English(1).PDF World Food Program. (2016). 10 facts about hunger in Tanzania. Retrieved from http://www.wfp.org/stories/10-facts-about-hunger-tanzania Read More