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.

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7 billion people and you: What’s your number?

By iZivisoMag Contributor

Harare, Zimbabwe – Imagine, we are 7 billion holding hands round the world, and then imagine what your spot will be right down to the number. According to the UN, this years marks a milestone in human history. For the first time, the world population will reach 7 billion. The UN has put up an online calculator which is counting up to the milestone, and it’s currently sitting at the 6.999bn mark – it should surpass 7bn pretty soon.

The BBC has set up an online tool to help the world get some perspective on what 7bn actually means. You simply enter your date of birth and it tells you your position in the world’s population:

I tried it. When you I was born, I was the 4,100,006,916th person alive on Earth and the 78,477,598,034th person to have lived since history began. Try it out and check your digits.

Zimbabwe Tops List of Nations With Illegally Copied Software

Zimbabwe topped the list of African nations with the highest illegally copied software with a 91 percent rate, according to a new report from the Business Software Alliance (BSA). Georgia, which has a 93 percent rate, was ranked as the number one culprit of software piracy in the world and Bangladesh, Moldova and Yemen were tied for third with 90 percent.

The nations with the lowest rates were the United States (20 percent), Japan (20 percent), Luxembourg (20 percent) and New Zealand (22 percent).

The most common form of software piracy is buying a single license for a program and installing it on multiple computers: 60 percent of users incorrectly think this is legal at home, and 47 percent think it is legal at work (including 51 percent in emerging economies). Worldwide, pirated software usage rose to 43% from 41%.

According to the report titled, “2010 Global Software Piracy study,” $59 billion worth of software was stolen across the globe in 2010, and the driving force behind the trend is piracy in the world’s emerging economies, where the personal computer market is growing fastest.

The BSA’s eighth annual study said that piracy rates on the African continent are on the rise. Zambia, Nigeria, Cameroon and Algeria all maintain piracy numbers of 82 percent at a total commercial value of more than $300 million.

Other countries, such as Libya, Senegal, Kenya and Tunisia have their figures between 72 percent and 88 percent. Egypt and Morocco have one of the lowest software piracy rates of 60 percent and 65 percent.

“The software industry is being robbed blind,” said BSA President and CEO Robert Holleyman. “Nearly $59 billion worth of products were stolen last year — and the rates of theft are completely out of control in the world’s fastest-growing markets. The irony is people everywhere value intellectual property rights, but in many cases they don’t understand they are getting their software illegally.”
“Software piracy is an urgent problem for the whole economy, not just the software industry, because software is an essential tool of production,” Holleyman said. “Businesses of all sorts rely on software to run their operations. Properly licensed companies are being unfairly undercut when their competitors avoid overhead costs by stealing software tools.”

Tedmore Bvunda, a technoligist in Harare said that copying of software was expedient because Zimbabwe did not have access to online payment processes which made it difficult to purchase genuine software on time.

“Open source software is vital for developing countries who have already a lot against them in terms of balance of payments. In the most radical sense, its the same as how the west took away our resources and are continuing to do so,” said Bvunda.

“In Zimbabwe, accessibility of licensed software is not easy compared to other countries. Its easier for people to share a copy of Microsoft Windows, for example. Affordability is also an issue,” said Soul Kabweza, founder of TechZim.
“There’s no go-to place to get software so what do you get people just share and use and if there were goto places for computer software you’d find that people can’t afford genuine copies,” he said.

Kabweza added that open source software could help to rectify the situation in Zimbabwe because it is free to use and redistribute.
“What using open source means is that you use a legal product and you get all security updates for it and support from the open source community,” he added.
However, Kabweza said use of illegal pirated software had serious disadvantaged because such software is ineligible for  security updates which exposes users to malicious software attacks.

“There are open source alternatives for most of the commercial software that people illegally use. the problem is people are not aware of the alternatives,” he said, adding that the premise of the BSA study was rather flawed because Zimbabwe is not a major market for major software companies.

Mike Mwale, Managing Director for Trenworth Business Solutions and Software Architects said that he was not surprised that there were high rates of software piracy in the country.

“There has been a proliferation of cheap PCs and laptops from China and Dubai, and people just opt to pirate software because they cannot afford the huge cost of software. Take for example, Microsoft Office costs almost US$500, and that’s just the dealer price, excluding taxes – and that’s just for one one license,” he said. “Software is out reach for corporate and ordinary people on the street so they definitely resort  pirated software.”

Wikileaks: Foe or Friend to Open Society?

Chief K.Masimba Biriwasha| AfroFutures.com Global Editor-At-Large| Harare

THERE was furore in Zimbabwe’s highest political circles when WikiLeaks – an international non-profit organisation that publishes submissions of private, secret, and classified media from anonymous news sources, news leaks, and whistleblowers –published classified US state department diplomatic cables on Zimbabwe. The leaks made news headlines and reflected, more than anything else, biases in editorial stance of state and privately-owned media outlets.32

In spite of Wiki Leak’s founder, Julian Assange’s belief that total transparency is for the good of all people, the impact of the spillage of US secrets has been controversial to say the least.

Like in Zimbabwe, the publication of the US state department diplomatic cables caused serious political fallouts in many countries around the world, including the United States itself, Belarus, Palestine, Tunisia among others. In a discussion held recently at the Columbia University Journalism School in partnership with Index on Censorship, one of the world’s preeminent advocacy organizations, panelists put the spilling of United States government secrets under the spotlight.

Mark Stephens, a lawyer who represented Assange at his extradition hearings, explained how Assange redefined society’s traditional view of whistle-blowers.

“The genius of Julian Assange was to recognize a gap in the market,” he said, arguing that Assange pioneered a new way of handling classified information. He also suggested that WikiLeaks has raised questions about how to handle an organization that exists outside of sovereign states’ regulations.

Panelist, P.J. Crowley, a former Assistant Secretary of State for Public Affairs, argued that Wikileaks had backfired against open expression.

“In pushing out 251,000 documents without regard for what was in them, Assange put in danger the very [democratic] activists he thought he was empowering. Possible consequences of this mean less information in cables, less information in discussions, so you have a less informed public service,” said Crowley.

In the wake of the WikiLeaks’ release in Zimbabwe, The Standard newspaper reported on alleged secret diamonds deals involving First Lady Grace Mugabe and the Reserve Bank Governor, Gideon Gono. The First Lady slapped the newspaper with a whooping US$15 million dollar lawsuit. In addition, the state media reported that the attorney general launched a probe to investigate Prime Minister Morgan Tsvangirai’s involvement in western sanctions following media reports of a classified US state department cable relating his meetings with Western ambassadors.

Nhlanhla Ngwenya, Media Institute of Southern Africa-Zimbabwe director said that both the state- and privately owned local media had failed to report objectively on the WikiLeaks saga. He said that local media used the cables to buttress their editorial positions.

“The state media used the Wikileaks to sustain their editorial position against the opposition without noting that the leaks merely consisted of subjective assessments by individuals and not the official position of the US government. The private media did not make an effort to seek comment from the implicated sources,” he said.

“The thing is when you report on a personal opinion it should be balanced; the cables consisted of diplomatic opinions. If you report opinion as fact, there’s a problem.”

According to media analysts, Wikileaks risks “collateral murder” in the name of transparency. In other words, it can be used as a tool to suppress what its leader claims it stands for.

Liesl Louw-Vaudran, an associate editor at the Institute for Security Studies, a South Africa-based think tank was quoted by the Voice of America as saying that the spilling of the secrets could lead to destabilization in Zimbabwe. As events in Zimbabwe have revealed, the information leaked by WikiLeaks can potentially be used as a “political tool.”

“Certainly for southern Africa, the WikiLeaks Zimbabwe revelations are most significant, and I don’t think it’s an exaggeration to say they could destabilize Zimbabwe – and thus the region – even further in the months to come,” she said.

“I am not for one second saying WikiLeaks did not have the right to make the information public; I am merely exploring the possible ramifications now that this information is out there,” she added.

However, US Ambassador to Zimbabwe, Charles A. Ray, was more blatant, calling Assange an opportunist.

“Mr Assange is an opportunist who has used this information for self-promotion. Along with freedom of the media is responsibility. Freedom of the press does not allow you to yell fire in a crowded theatre. It goes along with responsibility,” said Ray while addressing journalists at the Gweru Press Club.

“You need to be careful who you hold up as exemplars of a free press. Assange is certainly not a champion of freedom of the press, and he’s certainly no champion of people when he was told that the lives of some of the people in the leaked cables could be killed and his response was if they deal with the Americans then they probable deserve to be killed. I don’t even call him muckraker, I call him muck.”

At the panel discussion in New York, Richard Cohen, weekly columnist for The Washington Post posited that the massive leak of classified material will actually work against the Wikileaks’ goals of greater transparency in the long term.

“Assange proceeded without thought of the people affected. A lot of what was revealed was interesting but didn’t change any minds. It will intimidate people [in the future] from talking honestly,” he said.

In Zimbabwe, Women Face Baby Pressures

By Masimba Biriwasha| AfroFutures.com Global Editor-At-Large

When Maidei Tavaziva (30) consciously chose not to conceive for approximately five years after getting married, she experienced a barrage of salient remarks from her relatives suggesting that time was up for her to reproduce.

“My aunts, my grandmother and my other relatives started telling me that I needed to have a baby. I suspect that my husband’s relatives were also talking behind my back. My grandmother would say that she now wanted a grandchild. I’m definitely convinced that in Zimbabwe, there is social pressure to produce a baby once you enter into marriage,” said Taziva.

Tavaziva added that though some of the comments appeared innocuous on the surface, the intent was clearly to influence her to get pregnant.

“Of course, I knew that what my relatives wanted was for me to get pregnant and deliver a healthy infant, preferably a boy, so that I could secure my relationship with my husband, and increase my status,” she said.

Unlike most women, Taziva said that she did not bow down to the pressure; she stuck to her guts not to have a child early in marriage because she needed to first complete her educational studies without the pressure of having to look after a baby.

According to traditional norms in Zimbabwe, a woman has a responsibility to expand the clan of her husband once she is married. Babies are often regarded as sealers of marriage – but not just any baby – women are generally expected to give birth to a baby boy who will carry the family name and inheritance.

“A woman who has a first-born child who is a girl is not as revered as one with a boy. So women are under pressure to produce baby boys,” said Betty Makoni, Global Advocate for CNN for protecting the powerless and CEO of Girl Child Network Worldwide.

However, a woman who has a child outside of a recognized and socially sanctioned sexual union faces the risk of being ostracized by family, the community and religious organizations to which she belongs.

“Girls who fall pregnant force themselves into marriage or are forced into marriage. Many women are married because they’ve fallen pregnant,” said Makoni.

For most newly married women in the country, the desire to fulfill social expectations to conceive immediately after marriage supersedes efforts to engage in proper family planning.

“I have friends whom after marriage have experienced pregnancy check-ups from their relatives. They will start to check the skin tone, whether you have nausea and at family gatherings they expect to see you with a bump. Society still expects women to follow the conventional trajectory of dating, marriage, and then children,” said Buhle Makamanzi, a development sector consultant and mother of three.

“This is not to say that motherhood is a bad thing; for me, there is nothing in this world as fulfilling as being a mother – your heart certainly grows bigger.”

According to a Women and Law in Southern Africa Research and Educational Trust (WLSA) study titled “Pregnancy and childhood: Joy or despair?” women’s sexual lives are mediated by those of men.

“Women must conform to male strictures or so they believe. Thus, if their sexuality is perceived as a reproductive resource by males and is controlled by male norms and values, women who are dependent on males will seek to conform to those norms and values,” states the study.

But as Tavaziva revealed the pressure on her came mainly from her female relatives, and that may have been no coincidence.  According to the WLSA report, women often use their reproductive capacity to support their entitlement to benefit from resources held by men.

“This reliance on reproductive roles means that women are obliged to fill that role and produce children to secure their membership in their marital families and build up status that secures their entitlements in that family in their later years,” says the study.

The study also noted that women’s sexual integrity may be demanded and enforced by their natal families to maximize their opportunities for successful marriages.

Makamanzi commented that as women become more independent-minded due to increased access to educational opportunities, social expectations about the timing of pregnancy within marriage are beginning to shift, albeit, slowly.

“One major factor is whether the husband succumbs to pressure, if he does, then as a woman, you’re forced to try for a baby even if it wasn’t your plan. With the buzz on women’s empowerment, some women are beginning to think outside this box. However, pregnancy borne out of societal and family pressure is still rampant even among the so-called career women,” said Makamanzi.


Breast Ironing: Say What?

BREAST ironing, an old-age practice that is likened to the widely condemned practice of female genital mutilation, is widespread in many parts of West and Central Africa, including Cameroon, Chad, Togo, Benin, Guinea-Conakry among others.

Breast ironing is aimed to flatten the breast tissue of pubescent girls. The procedure is carried out specifically to make young women less attractive to men and boys. According to Wikipedia, the most widely used implement for breast ironing is a wooden pestle normally used for pounding tubers; other tools used include bananas, coconut shells, grinding stones, ladles, spatulas, and hammers heated over coals.

According to the UN, approximately 3.8 million or 1 in 4 girls in Cameroon alone, face the risk of having their breasts ironed often by their mothers. Unfortunately, many governments in the region do not have any policies or programmes in place to stem this heinous practices aimed at reversing pubescent growth. The onus rests on the government to empower women and make them more enlightened Continue reading

Caregivers Come At A Cost

While community home based care is the preferred means of providing care for people living with HIV in many parts of Southern Africa, it comes with massive costs especially to caregivers in terms of time, effort and commitment, according to a study published recently in the Journal of the International AIDS Society.

According to the study which focused on Botswana, providing caregivers with financial and material support is an urgently required public health imperative. The study revealed that providing caregivers of people living with HIV and AIDS with financial and material support will ensure that caregivers are not demoralized in rendering care services to their clients as well as attract more people into caregiving. Continue reading