Unsafe Abortions Put Women’s Lives At Risk in Zimbabwe

By Chief K.Masimba Biriwasha || Global Editor At Large | @ChiefKMasimba | January 21, 2014

An estimated 46 million women throughout the world, 11% of whom are in Africa, have induced abortion each year. In Zimbabwe abortion is illegal, with exceptions in cases of rape, incest, fetal impairment or preservation of the mother’s health.

Despite the stigma around abortion, illegal, self-inflicted abortions are rife in Zimbabwe and put the lives of women at risk. Unicef estimates that 80 000 illegal abortions take place in the country every year.

Pregnancy Imperils Zimbabwean Women’s Lives

By Masimba Biriwasha | Global Editor-At-Large | @ChiefKMasimba | 07 January 2013

A Zimbabwean woman, Tendai Chitsinde, 24, died recently while giving birth to her first child. According to news reports, hospital staff called off a Caesarian section operation which could have saved her and her baby’s life. Because she was a television presenter, her death made news headlines and an outpouring of grief.

But Chitsinde is only one of an estimated 3,000 women and girls who die each year in Zimbabwe due to pregnancy-related complications. That’s 8 women dying every day of the year.

Additionally, 26 000 to 84 000 women and girls suffer from disabilities caused by complications during pregnancy and childbirth each year.

Maternal and neo-natal health services in Zimbabwe face severe shortages which hampers the delivery of quality services. As a result, the maternal mortality rate alarmingly stands at 960 maternal deaths per 100 000 live births – three times higher than the global average and almost double that of the Sub Saharan averages.

Maternal mortality is defined as the death of a woman while pregnant or within 42 days of termination of pregnancy, regardless of the site or duration of pregnancy, from any cause related to or aggravated by the pregnancy or its management.

The consequences of maternal mortality are felt not only by women but also by their families and communities. Loss of women during their most productive years also means a loss of resources for the entire society. At least 1.23 per cent of GDP is lost annually due to maternal complications in the country, according to UN.

Most of what needs to be done is already known. However, Zimbabwe’s decade-long political, economic and social fallout has had a terrible impact on the public health delivery system, significantly reducing the quality of services provided to pregnant women.

Many women, particularly in rural areas cannot afford the transport costs required to make frequent travels to health centers during and after pregnancy. Rural women opt to deliver at home which significantly increases chances that they will die, especially when the delivery requires surgical intervention, or is carried out by non-skilled persons.

Shortages in personnel, equipment and supplies continue to plague Zimbabwe’s healthcare infrastructure, putting the lives of pregnant women at risk.

According to WHO, most maternal deaths are avoidable, as the health-care solutions to prevent or manage complications are well known.

It is particularly important for health care workers to be well trained so they can properly meet the medical requirements of pregnant women.

Unless significant action is taken to improve health services, pregnancy will continue to imperil the lives of Zimbabwean women.

Rape Victims Find Healing in Telling Story

By Masimba Biriwasha | OpEd | January 02, 2013 | @ChiefKMasimba

The healing power of telling your story while receiving loving attention is probably one of the most portent forms of medication under the sun. But can it heal the trauma of rape?

According to a recent study reported in the Washington Post, telling stories can help rape victims heal. The study says that reliving the rape experience through repeated telling of the story of the rape experience can help victims to overcome psychological distress.

“The results are the first evidence that the same kind of “exposure therapy” that helps combat veterans haunted by flashbacks and nightmares also works for traumatized sexually abuses teens with similar symptoms,” the Washington Post reported.

According to the report, simply offering victims comforting words and encouraging traumatized girls to forget their ordeals is not helpful because it lets symptoms fester.

University of Pennyslavia psychologist, Edna Foa, who developed a “two-part treatment known as prolonged exposure therapy which involves having patients repeatedly tell their stories and then visit places that remind them of their trauma” said that many of the patients are relieved that somebody wants to hear their stories.

Foa exposed sixty one girls ages 13 to 18 who had been raped or sexually abuses randomly assigning them to 14 weeks of counseling or prolonged exposure therapy.

The idea is that by telling and retelling their trauma, victims can developed a psychological distance from the real event and develop a sense of closure as opposed to repression of negative memory.

“They get a new perspective of what happened. They get used to thinking and talking about the memory and realizing that it was in the past, that its not in the present anymore,” said Foa.

In Zimbabwe and Africa Cigarette Smoking Grows Despite Health Dangers

By Chief K.Masimba Biriwasha | iZiviso Global Editor At Large

HARARE, Zimbabwe – A man slowly crosses a busy street in Harare, Zimbabwe’s capital, puffing away at a cigarette, and then nonchalantly flicks the cigarette butt onto the tarmac.

The butt rolls away to the edge of the tarmac as the man gets swallowed by the crowd, a trail of smoke hovering behind his head.

In Zimbabwe, as in many parts of Africa, cigarette smoking is growing. According to experts, Africa is expected to double its tobacco consumption in 9 years if current trends continue. The surge in smoking is seen in young people under the age of 20 that constitute the majority of the continents population.

Zimbabwe – as one of the world leading producers of tobacco – has been more focused on te dollar sign over and above the negative consequences of smoking to te public. The government has been reluctant to put in place anti-smoking legislation. Tobacco has long figured prominently in the Zimbabwean economy – tobacco exports bring in a significant share of the country’s export earnings.

Cigarettes can be found everywhere – at street corners and in shops – at ridiculously cheap prices. Alex Madziro lives in Harare. He smokes an average of ten cigarettes a day. He says he has tried to quit but without success. “I just buy single cigarettes at street corners; it helps me to keep the habit in ccheck. I wish I could quit but it’s now very difficult,” he said in an interview. Cigarette companies can still advertise in the media. While the adverts contain health warnings, these have not been sufficient to stem smoking in the country. To put it bluntly, none of the adverts make note of the fact that smoking harms nearly every organ of the body.

According to a 2008 World Health Organization (WHO) survey, twenty-one percent of men in Zimbabwe smoke cigarettes.Across Africa, it is estimated men constitute of 70-85 percent of smokers. For many, smoking starts at a young age. It starts with peer pressure, being exposed to second hand smoking, having parents and best friends who smoke. While it’s almost taboo for women to smoke, the habit is slowly picking up among young women who regard it as a fashion statement.

Globally, tobacco kills more than 14,000 people each day – nearly 6 million people each year. Included in this death toll are some 600,000 non-smokers who are exposed to second-hand smoke. In 2004, children accounted for 31% of these deaths. Almost half of children regularly breathe air polluted by tobacco smoke. There are more than 4,000 chemicals in tobacco smoke, of which at least 250 are known to be harmful, and more than 50 are known to cause cancer.

Without urgent action, deaths from tobacco could reach 8 million by 2030. 63% of all deaths are caused by non-communicable diseases, for which tobacco use is one of the greatest risk factors. A jarring statistic is that around half of all smokers alive today will be killed by tobacco. Tobacco is the single most preventable cause of death in the world today.

On the streets of Harare, smoking continues unabated: how much it is a public health problem is yet to be known. In fact, it is regarded low in the priority of public health issues affecting the country today. The death rate from smoking in Africa where treatment options are absent is high but smoking is not a priority in African public health strategies.

“Tobacco is way down in the public health concerns we have. There is malaria, malnutrition, HIV-AIDS, and tuberculosis. So, tobacco comes as something we know to be harmful, but we are not ready to handle at this time because of the limited resources that are available,” Dr Adamson Muula, a senior lecturer of public health at the University of Malawi was quoted by Voice of America in an interview on the ravages of smoking in Africa.

Just like Zimbabwe, very few countries in Africa have tobacco control acts to protect citizens from adverse effects of smoking, second hand smoking and the rate of new addictions.

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.

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.

Help Me Raise A Voice For Africa’s Pregnant Women

WHILE governments in sub-Saharan Africa continue to dole out money on military hardware, teargas canisters and baton sticks etc., pregnant women in the region are dying in droves due to lack of proper healthcare. Paradoxically, women and girls are the main caregivers for the sick in the absence of proper health systems. Yet when they need care the most during pregnancy it is not available, a scenario made worse by gender inequities that put the lives of women and girls at risk.

The statistics are downright shocking. In sub Saharan Africa, 1 in 16 women is likely to die as a consequence of pregnancy and childbirth, according to a recently published report titled “Measure of Commitment: Women’s Sexual and Reproductive Risk Index for Sub-Saharan Africa”.

For many women in the region, particularly in underserved remote and rural areas, getting pregnant is akin to a death sentence.

“Pregnancy is dangerous business in Sub Saharan Africa where a woman is 100 times more likely to die from pregnancy related complication than in a developed country,” states the report.

Uganda Steps Backward with Anti-Gay Legislation

News from Uganda that the government is seeking to reaffirm penalties for homosexuality and criminalize the “promotion of homosexuality” will only serve to drive people of same-sex orientation underground. The implications for public health efforts are dire, and there is no doubt that if the bill is passed into law, it will deal a body blow to HIV prevention efforts.

In Uganda, as in many parts of Africa, the health of Lesbians, Gays, Bisexuals, Trans and Intersexual Peoples is marginalized. This sub-group is already faced many challenges including HIV, STDs and STIs, and mental health problems due to lack of access to services.

“This bill is a blow to the progress of democracy in Uganda,” said David Kato of Sexual Minorities Uganda. “Its spirit is profoundly undemocratic and un-African.”

According to the International Gay and Lesbian Human Rights Commission the Ugandan Parliament is now considering a homophobic law that would reaffirm penalties for homosexuality and criminalize the “promotion of homosexuality.”

The Anti-Homosexuality Bill of 2009 targets lesbian, gay, bisexual, and transgender (LGBT) Ugandans, their defenders and anyone else who fails to report them to the authorities whether they are inside or outside of Uganda.

The proposed law will effectively criminalize homosexuality, and consequently bar any person of same-sex orientation from seeking public health services.

Diabetes in Africa: The Silent Killer That’s Everyone’s Business

Diabetes is a silent killer in Africa. In comparison to other diseases such as AIDS or malaria among others, diabetes rarely makes any news headlines. Neither does it attract funding. Yet, the statistics of people affected by the disease in the continent are quite shocking and merit public health and policy-making and funding attention.

According to the World Health Organisation (WHO), approximately 10 million people in Africa have diabetes. The disease is also ranked as the fourth leading cause of death in developing countries, and the number of people suffering from diabetes is expected to rise to almost 20 million by 2025.

The International Diabetes Federation (IDF) contends that diabetes is already a major public health problem in Africa and its impact is bound to increase significantly if nothing is done to curb the rising rate of impaired glucose tolerance (IGT), which now exceeds 16% in some countries.

In addition, IDF projects that the prevalence rate will shoot up by 95 percent by 2010 from the current 0.5 to 3 percent range across the continent.

“Many people, including children, die from lack of insulin, and it is likely that many die of diabetes before even being diagnosed, let alone treated,” states the IDF. “Still more suffer debilitating consequences of diabetes such as amputation and blindness.”

For many people in Africa, diabetes is not a major concern. Compounded with little public health information about diabetes, many people wait until it’s too late to seek medical attention for diabetes.

The Great Vasectomy Fear

For most men, the idea of vasectomy, a surgical procedure to cut and close off the tubes that deliver sperm from the testicles, is a complete no-can-do associated with being sexually dysfunctional in the male psyche.

According to the latest issue of Population Reports, titled “Vasectomy: Reaching Out to New Users,” published by the Johns Hopkins Bloomberg School of Public Health, vasectomy is simpler and more cost effective than female sterilization and offers men a way to share responsibility for family planning.

“The most entrenched and powerful rumors concern manhood, masculinity, and sexual performance. Many men confuse vasectomy with castration and fear, incorrectly, that vasectomy will make them impotent,” says the report.  But in fact, “Castration involves removal of the testicles. In contrast, vasectomy leaves the testicles intact, and they continue to produce male hormones.”

The procedure which typically takes from 15-30 minutes and usually causes few complications and no change in sexual function is one of the most reliable forms of contraception. Though it does not offer protection against sexually transmitted infections or HIV, for couples it is a way for men to be directly involved in family planning. Family planning has been largely seen as the responsibility of women but vasectomies allow men to play a part.

The report states that the largest number of vasectomized men are in China, where almost 7% of women in relationships — or more than 17 million couples — rely on vasectomy for birth control.

Can Bicycling Really Damage the Environment?

Contrary to popular opinion, bicycling can potentially damage the environment due to the increased longevity of people engaged in physical activity, says Karl Ulrich, a Wharton Business School professor. 

Ulrich argues that the greatest environmental peril society may face is the looming prospect of slowing the aging process, and bicycling potentially contributes to slowing aging.

 

Put simply, Ulrich says there is an underlying conflict between human-powered transportation, longevity, and environmental impact, which needs to be highlighted as the world seeks to find green solutions.

 

“The bicycle is a remarkable machine, allowing humans to transport themselves much more efficiently than by most other means. At the same time, physical activity, fitness, and health are almost axiomatically worthy objectives,” says Ulrich.

 

“And yet, the steady improvements in human health and longevity have a tremendous impact on the energy use and environmental impact of the human population.”

 

In a paper titled, “The Environment Paradox of Bicycling,” Ulrich argues that energy savings due to the use of human powered transportation may be offset by the increased energy used by living longer due to better health.