TB in Children: Why Zimbabwe Must Act Now

By Chief K.Masimba Biriwasha | iZiviso Editor-in-Chief

Harare, Zimbabwe – Tuberculosis (TB) is a major public health problem in Zimbabwe yet very little is known about the impact of the disease on children. Without a functional health-care system and research into pediatric TB, Zimbabwe is likely to continue losing its children to this hidden epidemic.Image

Among African nations, Zimbabwe is one of those most heavily affected by TB. The 2009 Global Tuberculosis Control Report from the World Health Organisation (WHO) ranks Zimbabwe 17th among 22 countries worldwide with the highest TB burden.

Zimbabwe had an estimated 71 961 new TB cases in 2007, with an estimated incidence rate of 539 cases per 100,000 people. While, Zimbabwe has fought TB fairly successfully since attaining statehood in 1980, in the past few years the disease has re-emerged as a leading killer, especially among people living with HIV, who are often not identified through long-established TB tests. Put simply, the TB control programme has been adversely affected by a lack of adequate financial, human and material resources.

As it is, there’s very little epidemiological data on the extent of TB among children in the country. Experts say that child TB is widely under-reported and can represent as much as 40% of the TB caseload in some TB high burden settings such as Zimbabwe. Children are at high risk of TB, are prone to disseminated disease and the diagnosis of paediatric TB may be difficult, since complaints often are unspecific and contacts may not been known.

To make matters worse, the HIV epidemic has affected TB in children enormously, as it has adults. It has increased the risk that infants and young children will be exposed to TB, since many adults with TB-HIV are young parents.

HIV-infected children have a 20-fold risk of developing TB compared to HIV-uninfected children. It also makes diagnosis and treatment more complicated and increases the risk of TB-related death about 5-fold.  The HIV epidemic has also orphaned many children (with or without TB-HIV themselves).

Unfortunately, Zimbabwe’s national tuberculosis programme has historically not given child TB high priority because of diagnostic challenges (e.g., children under 10 have difficulty producing enough sputum for microscopy and the majority are smear-negative); children are not a major source of the spread of the disease; resources are limited; recording and reporting forms did not include boxes for recording ages 0–4 and 5–14 until 2006.

“Our ability to even assess the magnitude of the problem is severely hampered by the lack of diagnostics in children. The problem is that diagnostic tools, both current and in development, do not adequately take into account the special requirements for assessing children,” said Dr Steve Graham, chair of Stop TB’s Child TB Subgroup of the DOTS Expansion Working Group.

Once infected with TB, infants and young children are at greater risk than adults for developing active TB disease, as well as of having the TB disseminate throughout the body, including to the brain, where it causes meningitis. This type of TB is often fatal or leaves the child with major disability.

Many health workers regard the management of a child with suspected TB as ‘difficult cases’, especially with regard to diagnosis. Children are thought of as needing specialised care.

Against this background, TB case-finding efforts should target children under 5 years of age living in a household with a sputum-smear positive adult. If the children are well, they should receive isoniazid preventive treatment (IPT) to help prevent their developing active TB disease.  If they are not well, TB treatment should be considered and a clinical examination is recommended.

Suggestions for national tuberculosis programmes include:

  • Establish a dedicated child TB working group that includes National Tuberculosis Control Programme (NTP) staff and national child TB experts.
  • Use the working group to set practical priorities and goals, develop guidelines, implement activities for child TB, support health workers managing child TB and raise awareness through advocacy and health education.
  • Include the needs of child TB in routine NTP activities, such as training, drug procurement, strategic plans and recording and reporting.

Zimbabwe’s Newspapers Shortchange Readers

By Chief K.Masimba Biriwasha

SINCE June last year, Zimbabwe’s print media sector has experienced significant growth but how much of this growth is benefiting citizens’ right to information remains in doubt. Among the independently-owned daily newspapers registered and operating since 2010 up to date include: NewsDay, Daily News and The Mail. This bring to seven daily newspapers published in Zimbabwe including the two state-owned dailies, The Herald and The Chronicle and tabloids H-Metro and B-Metro.

Add to this a batch of weeklies including The Sunday Mail, The Zimbabwe Independent, The Standard, The ZimbabweanThe Worker, The Zimbabwean on Sunday, The Financial Gazette, The Manica Post and The Patriot among others.

In fact, according to media analysts, the Zimbabwe Media Commission (ZMC), a government body responsible for media registrations, licensed a total of 22 publications but it’s telling that no broadcasting license has been issued as the same time.

However, the state-run Zimbabwe Broadcasting Corporation remains the sole broadcaster in the country and its coverage is largely in favour of President Robert Mugabe’s ruling ZANU-PF party.  There is also a flurry of South African-based newspapers that are encroaching into the Zimbabwean market including The Sunday Times, Mail & Guardian and Business Day. At the same time, several Zimbabwe-focused online newspapers have emerged during the past ten years. Examples of online news platform include http://www.NewZimbabwe.com, http://www.ZimDaily.com; http://www.ZimEye.org; http://www.ZimOnline.co.za; http://www.ZWnews.com among others.

“The arrival of new players is refreshing but whether they are contributing to the public sphere is another matter. However, there’s an opportunity for more voices and opinions to be heard, but whether this is happening is another issue altogether,” said Eernest Mudzengi, Executive Direction at the Media Centre in Zimbabwe.

Suffice to state that while there’s a semblance of diversity in the print media sector, a critical analysis shows that the newspapers are not really serving the information needs of audiences. The coverage of issues in the newspapers is highly predictable.

“It has become very easy to predict what appears in most newspapers without reading the whole paper – save for sports pages, which actually give the best coverage despite the fact that most disciplines are not widely covered,” said Leonard Kari, an avid newspaper reader.

“On the first page of most of our newspapers we have not seen much diversity in terms of coverage. It largely more of the same. We need from the new papers a preferring of alternatives from the same-old polarised politics,” said Mudzengi, adding that much of the reportage in the local newspapers lacked exuberance and vibrancy. “There is a continuation of polarisation in the media. We need more media debate around political issues and key processes such as constitution-making in the country. We need more in terms of analysis because some of the stories especially on the first pages are predictable.”

Mudzengi said that it was not enough to only license newspapers because the most effective medium to reaching out to Zimbabweans was radio. He cautioned that the registration of the newspapers could be a cosmetic reform, and that the newspapers had to be vigilant in their coverage of issues.

Most of the newspapers merely mirror the polarized nature of Zimbabwe’s political arena which is dominated by ZANU PF and the Movement for Democratic Change (MDC) at the expense of telling compelling stories that are of relevance to the lives and livelihoods of Zimbabweans.

Government-owned papers have exploited their hitherto dominance on the market to act as cheerleaders for Mugabe, 87, and to denigrate Movement for Democratic Change leader Morgan Tsvangirai, according to a report on Zimbabwe’s new print media in the Global Post. On the other hand, the independently-owned media have a coverage stance to criticize President Mugabe and ZANU PF.

Further, experts and sources quoted in the newspapers are quite predictable. It appears that the newspapers lack ambition to expand the circle of the so-called experts that comment on issues of national relevance.

To make matters worse, the distribution of newspaper products in Zimbabwe is largely urban-centric. The majority of the population – approximately 70 percent of the population – are effectively left out. According to Dr. Ibbo Mandaza, a former newspaper publisher, 80 percent of the newspaper sales take place in Harare, Zimbabwe’s capital city. It is not surprising that the voices of rural folk are marginalized in newspaper reports. To state it bluntly, the rural folk are a missing voice in the new print media in Zimbabwe. One hardly gets to hear what is happening in Zimbabwe’s rural areas in the new print media.

Mandaza noted that the cost of many of the newspapers which range form US fifty cents to two dollar were still beyond the reach of many Zimbabweans. While there is batch of newspapers now the Zimbabwean market, advertising – the mainstay of newspapers – is very low in most of the publications raising questions about the sustainability of the enterprises.

“The arrival of new newspapers was long overdue but its too early to tell whether the papers will proffer and alternative and whether they will be financially viable. What is happening in Zimbabwe is not new – it happened in Malawi, Zambia and Tanzania but it’s to early to tell,” said Mandaza. “It’s hard to believe that many of the newspapers will survive beyond a year. The newspaper are limited in terms of reach and spread. The print media is limited in terms of its impact nationally.”

Mandaza said that there was a failure by the new print media to understand the reader. He added that in terms of technical capacity, the government-owned newspapers were far stronger that the new newspapers.

According to Kari, many voices are being left out in the national conversation.

“Many voices are left out in the national political dialogue and many voices have been silenced and have died a silent death. There are very few development stories which one can glean from our publications. Headlines are obsessed with politics yet very few people are benefitting from this kind of news coverage,” said Kari.

Kari suggested that local newspapers should revisit their mandate which is to inform, educate and entertain while ensuring a plurality of voices and a diversity of issues covered in order to influence a new conversation in the country.

Social Media Not All That Hot In Zimbabwe

By Chief K. Masimba| AfroFutures.com Global Editor At Large

IN the wake of the political protests in North Africa, Vikas Mavhudzi made history by becoming Zimbabwe’s first “Facebook arrest”. He had posted a comment on Prime Minister Morgan Tsvangierai’s Facebook page on February 13. It read: “I am overwhelmed, I don’t want to say Mr. or PM what happened in Egypt is sending shockwaves to dictators around the world. No weapon but unity of purpose worth emulating, hey.”

A Facebook user told the police about the comment. Officers found the comment on Mavhudzi’s mobile phone, which he had used to post the message, and arrested him. He was accused of “advocating or attempting to take-over government by unconstitutional means”. Mavhudzi was incarcerated and a court case was filed against him. He is currently out on bail, after being held for over 35 days. The government’s response shows that it is taking no chances on social networking sites.

Social networking websites obviously fuelled the political protests inNorth Africa and other Arab states. As a result, oppressive governments have become suspicious of new media technology. At the same time, experts say that that democracy will increasingly depend on access to the Internet and technology in the 21st century.

In Zimbabwe and other African countries, however, one should not overstate social websites’ potential for transforming governance. While it is true that they offer a low-cost and relatively low-risk way to engage in protest, Zimbabwe’s technological infrastructure is not sufficiently developed to make web-based expressions of dissent reach many people. According to the World Bank, only around 1.5 million Zimbabweans – 12% of the people – have some kind of internet access. Internet literacy is underdeveloped, and there is not much web content that relates specifically to Zimbabwe.

Access to the net, moreover, is largely urban-based. Most people in the cities, however, can only use computers at their workplace, which obviously restricts their scope for independent action. In terms of technology, Zimbabwe is currently estimated to be five years behind other countries in the region. The main reason is the lack of investments in technology in the past 10 years.

Too slow

Mobile internet access, however, is beginning to make a difference. In recent months, there has been exponential growth in this field. Over 600,000 people can access the web via their mobile phones now, and their number is growing daily. Nonetheless, the cost of hand-held devices and web access remains a limiting factor. Moreover, internet connections tend to be too slow to support video or podcast streams.

The internet is likely to play a greater role in the future. Zimbabwe is being connected to the undersea cable. Fibre-optic infrastructure is being set up across the country. It is expected that the nation will have ubiquitous connectivity and low-cost access to data by 2014. New opportunities are thus likely to arise, in terms of both business and politics.

The most popular website among Zimbabweans is Facebook. Sometime in the not too distant future, this sort of social media tool could facilitate spaces for people to openly express themselves in defiance of censorship, circumventing both state-owned and privately-owned media. The tech-savvy young generation could play a leading role.

But we are not there yet. At the moment, Zimbabwe’s technological infrastructure does not facilitate social media with a wide reach, enabling activists to mobilise a mass public. So far, the internet poses no real challenge to the status quo. It has not changed habits and patterns of news consumption and information sharing. Basically, the government still controls what information people get.

History of suppression

Zimbabwe’s government has a track record of suppressing dissent. It is likely to pass laws to allow it to cut off communication services. The arrest of Mavhudzi not only showed that the government is prepared to quash dissent on social networks; it also proved that technologies like the internet and mobile phones are useful for spying.

Governments can interfere with websites and e-mails. They even possess the power to switch off the internet, as was briefly done in Egypt before the old regime fell. The New York Times reported that governments in North Africa used communications technology to track down activists. It stated that Facebook accounts were hacked in Tunisia and that Egyptian authorities used technology that turned mobile phones into furtive listening devices.

A crucial issue for democratic change is whether people dare to speak up. In Zimbabwe, fear is quite common, however. People may shy from using social media for protest purposes because they think they may be under surveillance. The memory of brutal violence during the various election campaigns of 2008  is still very much alive. Unless such fears are overcome, there will be no democratic change. In Egypt, the people had to brave tanks and guns in Tahrir Square to topple their dictator, and that was certainly not an exercise in virtual reality.

To complicate matters in Zimbabwe, leaders in the pro-democracy movement have not always been adept at providing clear positions and leadership. Tsvangirai promised democratic change when he was running against President Robert Mugabe in 2008. Mugabe only prevailed in office because he unleashed unprecedented violence, and afterwards an odd coalition of the  adversaries was formed, brokered by other African leaders. It is not a good omen that Mavhudzi ran into trouble because he posted a message on Prime Minister Tsvangirai’s Facebook page.  This is, after all, the leader who says he is the alternative to the autocrat.

The internet and social network sites will not suffice to bring real democracy to Zimbabwe. Active citizens are necessary to achieve that goal. The opportunities for using up-to-date communications technology are likely to improve in Zimbabwe, and they are likely to give some scope to activists. But unless there are courageous people to grasp such opportunities, things will not change.

Is Blogging Worth the Pain?

A friend of mine recently started a blog, and she wants to make it grow. This got me nibbling my mind. What are the indicators of succesful blogging? How do you measure it? Why blog? How do you make your blog stand out amidst the clog of online content? Undoubtedly, blogging has revolutionised the concept of freedom of expression but what’s the point of expressing yourself freely when no-one is paying attention. Or when attention spans are as short as a rabbit’s yawn. Granted, self-expression is good food for the individual soul. But, question mark, is blogging worth the pain?

First things first, blogging is an overrated fad, with some analysts suggesting that it’s dead. There is a general belief that social networking sites such as Facebook and Twitter have accelerated the demise of blogging. Many people prefer the ubiquitous and transient nature of exchanges on Facebook and Twitter while blogs are regarded as static, and somewhat, convoluted.

It may be good at this point to revisit the definition of blog: according to Wikipedia, a blog (a contraction of the term “web log“) is a type of website, usually maintained by an individual with regular entries of commentary, descriptions of events, or other material such as graphics or video. Entries are commonly displayed in reverse-chronological order. “Blog” can also be used as a verb, meaning to maintain or add content to a blog. Continue reading