Health in Tanzania

First, it must be said that most people remain well throughout their time here, particularly if they follow a few simple guidelines.

1. Try to eat an adequate, well-balanced diet with at least one good meal every day.  Even if you are very busy, don’t make do with snacks.
2. Store and cook food in clean surroundings.  Always wash your hands before preparing food.
3. Avoid eating in dubious looking hotels or street stalls.
4. Boil and filter all drinking water and don’t drink drinking water in hotels – it’s rarely been boiled.  When travelling carry sterilizing tablets in case you can’t boil your water.
5. Maintain a high standard of personal hygiene.
6. Get plenty of sleep and try to take some exercise each day.
7. Take malaria prophylaxis as prescribed (i.e. daily/weekly) and don’t forget to keep up to date with immunization (hepatitis, rabies, etc.).
8. Avoid self-diagnosis and treatment unless absolutely unavoidable.
9. Find out which is the best health facility (e.g. clinic, hospitals, etc.) near you and who is generally regarded as a competent doctor.  Don’t be afraid to discuss with the doctor any anxieties you may have about the treatment which he/she has prescribed for you.
10. Always tell someone (e.g. a friend or colleague) that you are ill so that they can keep an eye on you.
11. Take all precautions possible to decrease your chances of exposure to HIV virus (AIDS) e.g. sticking to safe sex, avoiding injections, carrying your own needles/syringes, etc.

With sensible precautions most people remain well but please don’t take risks.  Living in a tropical climate exposes you to additional risks so TAKE CARE OF YOURSELF!

VACCINATION SCHEDULE FOR TANZANIA

Here follows a vaccination schedule for travelers and residents in Tanzania.
If in doubt about your vaccination requirement, please come and discuss this with one of the IST Clinic doctors.

N.B. Valid Yellow Fever Certificates are no longer required for entry to mainland Tanzania, however it is still required for Zanzibar (i.e. Unguja and Pemba), and several countries neighboring Tanzania. Possibly it may become a requirement again soon for mainland Tanzania as well.

EMERGENCY MEDICAL KITS
Possibly you may have acquired emergency medical kits on your departure to Tanzania. It is important to check these kits on a regular basis to make sure the medicines and materials are within the expiry date. The IST Clinic has emergency medical kits available which can be used for trips upcountry. These contain a supply of clean needles and syringes, IV fluids and a small supply of bandaging material and medicines.

General Advice for use of Drugs

1. Avoid self-diagnosis. Take medicine on the advice of a medical person.
2. All drugs should be kept in a clean dry place. They should be protected from light. Drugs should be kept in an airtight container which should be clearly labeled with name and expiry date.
3. All drugs should be kept under 25 degrees C.  Do not put drugs in the freezing compartment.
4. Check the expiry date. Out of date drugs should be disposed of by bringing them to the IST Clinic. Waste from the IST Clinic is brought to a special incinerator for medical waste.
5. If tablets have become damp, mouldy or discolored, do not take them.
6. Always take a full course of a drug. If you develop severe side effects, see a doctor. If after 36 hours of starting a treatment you feel no better, the diagnosis may be wrong. Return to the doctor.

CONTRACEPTION AND PREGNANCY
Interruption of your monthly cycle
Some women experience an interruption to their periods during the first three to four months in-country. This is your body reacting to the changes you are undergoing e.g. very different climate, changes in diet, and changes in daily routine. Once you have acclimatised to the changes and settled down, your periods will resume again as normal. However if your have any concerns, speak to the IST doctors.

Contraceptives

Condoms
We do not recommend that you buy unknown brands from local suppliers.  Condoms should be stored in a cool place and away from bright light. Normal storage temp is 25 C. Check the date of manufacture, and do not use any which are more than 3 years old or if proper storage is uncertain.
Condoms are not infallible.  Estimates range from 2 to 6 women out of 100 using this method for a year will become pregnant.  The morning after pill is available at the IST but do not expect to find it at any other clinics up-country.

Oral contraceptives
There are various types available at the IST Clinic. If you require advice contact one of the IST doctors.

Pregnancy Testing
Pregnancy tests can be done at local clinics throughout Tanzania. You can also get one done in complete confidence at the IST clinic in Dar es Salaam. Home testing kits are not recommended, although available in some parts of Tanzania, as the reagents are unreliable in tropical climates.

INFORMATION ON SOME SPECIFIC DISEASES

MALARIA
Please refer to the separate topic covering malaria

RABIES
Rabies is a viral infection transmitted to humans via the bite or scratch of a rabid animal. The virus is excreted in the animals’ saliva and can only penetrate broken skin. All warm blooded animals can harbour the virus  but the disease is mainly transmitted by dogs and to a lesser extent cats.
Incubation time varies greatly. The disease causes inflammation of the brain and nerves.  Once the symptoms appear the outcome is always fatal –  there is no known cure.

Recently rabies has become more prevalent in dogs and cats in Dar es Salaam. Any uknown animal should be treated with caution at all times and unnecessary contact with animals in the street is not advised.

Prevention
Whenever possible you should avoid stray dogs and cats. If you decide to keep an animal, have it vaccinated yearly against rabies. The vaccine is effective if kept up to date and is widely available.

Pre-exposure immunization
To achieve proper pre-exposure immune status you must complete your course injections.

Day 0, Day 7 and Day 28. After one year a booster injection is required, followed by booster vaccinations every five years.
Pre-exposure vaccine gives you time to get to medical facilities for post-exposure treatment but you must still get treatment as soon as possible after a bite.

What to do after a bite
If you are bitten by a stray or strangely behaving animal  YOU MUST ASSUME IT TO BE RABID and carry out the appropriate treatment as described below. Even if the owner of the dog is known and s/he says that the dog has been vaccinated against rabies, then it is best to err on the safe side and take treatment.

Immediately flush and wash the wound thoroughly with soap and water or detergent. Then apply either 40-70% alcohol (if not available Konyagi, whisky etc. is better than nothing), iodine or a disinfectant such as cetrimide (remove all traces of soap before applying cetrimide, which is neutralized by soap.)
Thereafter contact the IST Clinic IMMEDIATELY. You may need to return to Dar es Salaam as soon as possible.

You may also need an anti-tetanus booster.

Rabies post exposure  treatment in the pre-immunized individual
You will still need to have 2 or 3 booster injections. These should ideally start on the day of the bite, particularly if the bite is severe and high up on the body (i.e. face neck). Apart from the specific anti-rabies treatment a tetanus booster or antibiotics may be needed as well.

Rabies post exposure treatment in the non-immunized individual
In case you have not had previous rabies vaccinations, you will need a series of five vaccinations. These should be started as soon as possible and are divided over a period of 28 days. In addition rabies immunoglobulin injections should be given as well in case it concerns a bite of a highly suspicious animal.

HIV/AIDS

AIDS is now the leading cause of death amongst these aged 15-59 years in Tanzania. The most common method of transmission is by heterosexual intercourse.  However, as few hospitals can test blood and standards of sterility cannot be guaranteed, blood transfusion and contaminated needles and syringes are also responsible for transmission of the virus.  Mosquitoes and other blood sucking insects do not transmit the virus.

As stated, the major risk of contracting AIDS is through sexual intercourse.  “Abstinence is still the best weapon, followed by limiting the number of sexual partners.  A condom should be used during all sexual intercourse – females should insist on this.  Please think about AIDS very carefully, and if anyone thinks these precautions are too much to abide by, it is better to decide not to go abroad at all rather than acquiring a potentially fatal disease!  More than with any other aspect of health the responsibility for your well-being is with you.”

1. You are advised to travel with personal emergency medical kits which contain needles, dental needles syringes, sutures, and so on. These should be carried with you on journeys.  The IST Clinic has replacement stocks for these.  Make sure your kit is complete.  Take the kit with you when you visit a clinic, unless you know for certain they have high standards of sterility.  Refuse to be treated with suspect needles, lancets etc.  However most hospitals/clinics will accept your needles gratefully.
2. You are advised to use only those dental facilities which are known to have high standards of sterility.

Testing and Counseling Facilities
HIV testing is available in Tanzania at several hospitals, and can be arranged confidentially by the doctor.  The tests are however not always reliable and false positive could cause enormous distress.  At the IST Clinic counseling is felt to be essential, to discuss the implications of a positive outcome.  The patient must then decide for themselves whether they wish to have the test. At present HIV testing is not normally carried out until three months after possible exposure, but with the arrival of a new test we hope that this period can be shortened considerably in the near future.
Post exposure HIV prophylaxis
In case of high risk exposure to HIV/AIDS you are advised to contact the IST Clinic as soon as possible to discuss possible benefits of starting post-exposure prophylaxis : anti-retroviral medicines for the period of one month to attempt to reduce the risk of infection for the exposure. The sooner you start the better so discuss this as soon as possible with one of the IST doctors.

MENINGITIS

Meningitis cases have been reported in N, NE, West and Central regions and in Dar es Salaam.  Meningitis can be caused by various pathogens, but the dangerous forms are most commonly caused by meningococcal infections. This can be prevented by the meningitis A/C vaccination, which provides coverage for a period of 2-3 years. Meningitis A/C and Meningitis C vaccinations (for newborns) are available at the IST Clinic.

GIARDIA

Giardiasis is caused by the intestinal protozoa Giardia intestinalis. It is a water- and food borne infection that is very common throughout Tanzania. It causes gradual onset symptoms of fatigue, decreased appetite, bloating, loose frequent bowel motions and occasionally abdominal discomfort. Although the symptoms are generally mild and giardiasis is not immediately dangerous, it is still advisable to take medication, as the chronic inflammation to the intestinal wall can interfere with uptake of nutrients and minerals and by doing so it can undermine the immune response of the body.
The diagnosis is made by testing a stool sample. However Giardia can at times be difficult to detect and a negative stool sample does by no means exclude an infection. Therefore at times the infection is treated on the grounds of the clinical symptoms and not only on the result of the stool test.
Tinadazol ( Fasigyn) is the usual treatment for Giardia.  The drug can make you feel a bit nauseous, but it is important to complete the course to prevent recurrence.

AMOEBA

Amoebic dysentery is caused by the intestinal protozoa Entamoeba histolytica. It is a water- and food borne infection that can cause severe abdominal cramps, accompanied with frequent bowel motions, mixed with blood and mucus. It can cause complications to the intestines as well as abscesses to the liver and therefore needs proper treatment. At times the protozoa can encapsulate and be dormant in the intestinal tract for months, only to flare up later.

The diagnosis is made by testing a stool sample. In the early stages of the infection the E histolytica protozoa can be difficult to detect and in case of clear clinical suspicions, treatment is usually not delayed.
Metronidazol (Flagyl) is commonly used for the treatment of amoebic dysentery. It can cause side effects of nausea and vomiting. It should be used for at least one week, preferably longer. Alternative medications are Tinidazol and Gabbroral. Following treatment it is recommended to retest the stool sample to be sure that the infection has been  cleared.

BUBONIC PLAGUE

Each year there are outbreaks of plague in Lushoto district and Tanga region.  The disease is carried by rat fleas and quickly spreads in infected areas.  It is treatable with Tetracycline. Treatment should be under medical supervision as it involves high doses.  Tetracycline – 1 x 250 mg tablet 4 times daily for one week after the last exposure – is also an effective prophylaxis, so if you are living in or traveling to an area known to be infected you should make sure you have a good supply of this drug.  There is a vaccine available on prescription in the UK but it has nasty side effects and is only recommended for those living in an affected area.

HEPATITIS A, B+C

Hepatitis is inflammation of the liver. Occasionally this can be caused by alcohol and some drugs, but usually it is the result of a viral infection. There are many types of virus which can cause hepatitis. Each of these viruses acts differently. Infection is caused in ways very similar to HIV transmission. Additionally it can be contacted through contaminated water and contact with faeces, depending on the virus.

Signs and symptoms
People may have no symptoms at all, but they can still pass on the virus to others. Symptoms may include:
• a short, mild, flu-like illness;
• nausea and vomiting;
• diarrhoea;
• loss of appetite
• weight loss;
• jaundice (yellow skin and whites of eyes, darker yellow urine and pale faeces);
• Itchy skin.

Most of the symptoms of hepatitis settle after a few weeks, although some people can feel tired for a number of months after infection. There is the possibility of chronic liver damage and chronic carrier state (where a person remains chronically infected).Serological tests can assist in determining the exact cause of a viral hepatitis, but there is often a time lag between the onset of the symptoms and the tests results becoming positive.