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HEALTH-TANZANIA: A Hazardous Route to the Cradle

Sarah McGregor

DAR ES SALAAM, Apr 25 2008 (IPS) - Tatu Shabani Tumbo&#39s first born was diagnosed with strength-sapping anaemia, and died a toddler. Doctors had no medical explanation for the sudden death of her second child at age one. She then tried to get pregnant a third time, initially without success.

Tanzania&#39s president, Jakaya Kikwete, who this week announced plans to combat child and maternal mortality. Credit: Marco Castro/UN Photo

Tanzania's president, Jakaya Kikwete, who this week announced plans to combat child and maternal mortality. Credit: Marco Castro/UN Photo

"It is painful for someone to lose babies, one after the other," recalls Tumbo, a social welfare clerk at Tanzania&#39s main Muhimbili Hospital, in the commercial hub of Dar es Salaam. "Still, I needed children. The doctors said my fallopian tubes were too narrow and gave me medicine."

Tumbo had her own remedy in mind, however. "I believe a nearby witch killed them (the two children) and prevented me from pregnancy. I shifted homes."

Something worked. Tumbo is now raising four healthy teenagers.

This week, Tanzanian health authorities introduced new measures to improve the chances of survival for mothers and their newborns.

Over the past few years, the country has made some progress in this regard. The most recent official figures show that child mortality levels dropped by more than 24 percent in 2005 compared to 15 years earlier.

Annually, however, about 147,000 Tanzanian children still die before their fifth birthday, a third within the first few hours, weeks or months of birth, according to the &#39Tanzania Demographic and Health Survey 2004-05&#39. The child mortality rate is 112 deaths for every 1,000 live births; this means that youngsters under the age of five have a one-in-ten chance of dying.

Becoming a mother may, in turn, prove hazardous for Tanzanian women, who have an average of six children each.

In 2000, almost 1,500 women in Tanzania died during pregnancy, labour or shortly after delivery for every 100,000 babies born alive, says the World Bank. This marked a deterioration compared to the situation a decade earlier, when the maternal mortality rate was 770 deaths per 100,000 live births.

A United Nations report using statistics gathered in 2000 put the world average for maternal mortality at 400 deaths per 100,000 live births, and the average for wealthy nations at just 20 deaths.

Tanzania&#39s 2004-2005 demographic and health survey, which used information gathered in a door-to-door campaign, paints a slightly less dismal picture about the situation in the country. It indicates that 578 mothers die for every 100,000 live births.

"One of the most dangerous days in a woman&#39s life is the day she gives birth to a child," Norwegian Prime Minister Jens Stoltenberg told reporters this week in Dar es Salaam, in the course of a three-day visit to Tanzania.

Stoltenberg took the opportunity to help launch the &#39Deliver Now&#39 campaign in Tanzania. This global initiative is assisting poor nations to meet the Millennium Development Goals (MDGs) on reducing child and maternal deaths.

Eight MDGs were agreed on by global leaders at the Millennium Summit in 2000. Goal four aims to reduce mortality among children under five by two thirds, while goal five seeks to cut maternal deaths by three quarters, and achieve universal access to reproductive health care. The deadline for all MDGs is 2015.

For his part, Tanzanian President Jakaya Kikwete vowed to dedicate 15 percent of his country&#39s health budget to rolling out a new nationwide strategy to improve the odds of mother and child survival, a complementary initiative to &#39Deliver Now.&#39

"Children and mothers are dying of causes that are preventable," said Kikwete at the press conference attended by Stoltenberg. "We are tackling the causes so that lives can be saved."

Multiple difficulties

Various problems collide to put mothers and children at risk in Tanzania.

A third of the country&#39s 38 million people live on less than a dollar a day and the adult HIV prevalence rate is 6.5 percent – both major factors in driving down the life expectancy of mothers and their offspring.

Unsafe drinking water, poor sanitation and inadequate diets lead to disease and death. Preventable illnesses such as pneumonia and diarrhoea are the major cause of death for children, according to information sheets provided by &#39Deliver Now&#39. New mothers succumb primarily to malaria, anaemia and AIDS, while illegal abortions are also blamed for loss of life.

As elsewhere in Africa, many patients in Tanzania prefer traditional approaches to health issues over Western methods. The result is that qualified health care providers assist with fewer than half the country&#39s births – a matter of particular concern in remote settings, where complications may be difficult to treat given the long distances to health facilities and insufficient transport.

The quality of care may also be poor in public hospitals, however, as these facilities often lack medicines and equipment. Acute shortages of trained health workers mean there is only one doctor for every 20,000 people in Tanzania. By comparison, the United Kingdom has one doctor for every 440 people.

Medical experts say prevention and simple, low-cost measures are key to increasing survival rates. Disease-blocking vaccines and the distribution of multi-vitamin supplements could get babies off to a healthy start, for instance.

Each intervention would serve as a valuable step forward in this East African country, said Tumbo. "The truth is it&#39s hazardous (to have children in Tanzania), but we do it no matter what the risks. It&#39s our culture."

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