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Responding to Social and Climate Vulnerability in Dar es Salaam, Tanzania

Tomorrow is too Late: Responding to Social and Climate Vulnerability in Dar es Salaam, Tanzania, 2011.

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David Dodman, Euster Kibona and Linda Kiluma. UN HABITAT. Case study prepared for Cities and Climate Change: Global Report on Human Settlements 2011.

Seventy percent of the population of Dar es Salaam lives in unplanned settlements; and fifty percent of the residents of these informal settlements live on an average income of less than US$1/day. This fact is an important starting point for discussing the city’s vulnerability to climate change, and the strategies for adapting to this. The large number of people living in poor quality housing, frequently on land that is exposed to a variety of hazards, are socially, economically and environmentally vulnerable. The city also has severe shortfalls in its sanitation systems: estimates suggest that approximately 93 per cent of urban residents rely on pit latrines of various types, 5 per cent have access to septic tanks or sewerage, and the remaining 2 per cent have no formal excreta disposal facility. Adaptation responses need to take these issues into account if they are to respond to the threats posed by climate change – and to meet the needs of low-income urban residents.

Stroke incidence in urban Tanzania significantly higher than in developed countries

July 20, 2010 Leave a comment

The incidence of strokes in rural Tanzania is similar to that reported in developed countries, but rates in urban Tanzania are almost three times higher. These findings highlight the urgent need for community-level health screening and improved prevention measures to reduce stroke incidence in urban areas, concludes the first study in sub-Saharan Africa to include community-based identification of strokes published Online first and in the August edition of the Lancet Neurology.

Stroke is an increasing problem in developing countries, but little is known about the occurrence and burden of stroke in sub-Saharan Africa. Additionally, most data on the incidence of stroke in sub-Saharan Africa are from hospital-based studies and are not necessarily typical of the wider community. Indeed, previous research into stroke deaths in Tanzania has shown that only 56% of people in rural Hai and 30% of people in urban Dar-es-Salaam who die from stroke do so in hospital.

To provide reliable population-based data, the Tanzanian Stroke Incidence Project (TSIP) was established to investigate stroke incidence in rural (Hai) and urban (Dar-es-Salaam) Tanzania between June 2003 and June 2006. Over 3 years, all patients who had a stroke in Hai (population 159 814) and Dar-es-Salaam (population 56 517) were enrolled. The researchers identified stroke patients using a system of community-based sources—community-based investigators and staff at local hospitals and medical centres. Deaths from stroke that occurred before recruitment into the study were identified using verbal autopsy.

Over the 3 years, 636 people had a stroke, 453 in Hai and 183 in Dar-es-Salaam. Crude yearly stroke incidence rates were 94.5 per 100 000 in rural Hai and 107.9 per 100 000 in urban Dar-es-Salaam. When age-standardised to the WHO world population, annual incidence rates were almost three times higher in Dar-es-Salaam (315.9 per 10 000) compared with Hai (108.6 per 100 000).

The authors suggest: “The reasons for the higher incidence of stroke in urban areas are not yet clear, although undiagnosed or inadequately treated hypertension is likely to be a major modifiable risk factor.” Previous research has found that two-thirds of patients who died from stroke in Tanzania had a history of high blood pressure, and that people who live in urban areas in sub-Saharan Africa have higher rates of hypertension than those from rural communities.

They conclude: “Urbanisation in Africa, as in other parts of the developing world, is increasing rapidly, and the results from this study suggest that, in the absence of effective preventive measures, this is likely to lead to substantial increases in stroke incidence and mortality.”

In an accompanying Comment, Thomas Truelsen from Copenhagen University Hospital in Denmark says that these results confirm those of other studies in African populations showing high rates of hypertension, especially in urban areas, and suggest that prevention of stroke in these populations should include control of high blood pressure.

He also praises the authors on their “stepwise” approach to collection of stroke data: “The present study from rural and urban Tanzania both sets new standards for stroke incidence studies in Africa and suggests that improved prevention is urgently needed to reduce the already high stroke incidence rates in these populations.”

Source - http://www.physorg.com/news197545677.html

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Informal urban settlements and cholera risk in Dar es Salaam

April 19, 2010 Leave a comment

PLoS Negl Trop Dis. 2010 Mar 16;4(3):e631.

Informal urban settlements and cholera risk in Dar es Salaam, Tanzania.

Full-text:  http://www.plosntds.org/article/info%3Adoi%2F10.1371%2Fjournal.pntd.0000631

Penrose K, et al.

BACKGROUND: As a result of poor economic opportunities and an increasing shortage of affordable housing, much of the spatial growth in many of the world’s fastest-growing cities is a result of the expansion of informal settlements where residents live without security of tenure and with limited access to basic infrastructure. Although inadequate water and sanitation facilities, crowding and other poor living conditions can have a significant impact on the spread of infectious diseases, analyses relating these diseases to ongoing global urbanization, especially at the neighborhood and household level in informal settlements, have been infrequent. To begin to address this deficiency, we analyzed urban environmental data and the burden of cholera in Dar es Salaam, Tanzania.

METHODOLOGY/PRINCIPAL FINDINGS: Cholera incidence was examined in relation to the percentage of a ward’s residents who were informal, the percentage of a ward’s informal residents without an improved water source, the percentage of a ward’s informal residents without improved sanitation, distance to the nearest cholera treatment facility, population density, median asset index score in informal areas, and presence or absence of major roads. We found that cholera incidence was most closely associated with informal housing, population density, and the income level of informal residents. Using data available in this study, our model would suggest nearly a one percent increase in cholera incidence for every percentage point increase in informal residents, approximately a two percent increase in cholera incidence for every increase in population density of 1000 people per km(2) in Dar es Salaam in 2006, and close to a fifty percent decrease in cholera incidence in wards where informal residents had minimally improved income levels, as measured by ownership of a radio or CD player on average, in comparison to wards where informal residents did not own any items about which they were asked. In this study, the range of access to improved sanitation and improved water sources was quite narrow at the ward level, limiting our ability to discern relationships between these variables and cholera incidence. Analysis at the individual household level for these variables would be of interest.

CONCLUSIONS/SIGNIFICANCE: Our results suggest that ongoing global urbanization coupled with urban poverty will be associated with increased risks for certain infectious diseases, such as cholera, underscoring the need for improved infrastructure and planning as the world’s urban population continues to expand.

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Tanzania – Informal Urban Settlements and Cholera Risk

March 22, 2010 Leave a comment

PLoS Negl Trop Dis. 2010 Mar 16;4(3):e631.

Informal Urban Settlements and Cholera Risk in Dar es Salaam, Tanzania.

Penrose K, de Castro MC, Werema J, Ryan ET.

Department of Global Health and Population, Harvard School of Public Health, Boston, Massachusetts, United States of America.

BACKGROUND: As a result of poor economic opportunities and an increasing shortage of affordable housing, much of the spatial growth in many of the world’s fastest-growing cities is a result of the expansion of informal settlements where residents live without security of tenure and with limited access to basic infrastructure. Although inadequate water and sanitation facilities, crowding and other poor living conditions can have a significant impact on the spread of infectious diseases, analyses relating these diseases to ongoing global urbanization, especially at the neighborhood and household level in informal settlements, have been infrequent. To begin to address this deficiency, we analyzed urban environmental data and the burden of cholera in Dar es Salaam, Tanzania.

METHODOLOGY/PRINCIPAL FINDINGS: Cholera incidence was examined in relation to the percentage of a ward’s residents who were informal, the percentage of a ward’s informal residents without an improved water source, the percentage of a ward’s informal residents without improved sanitation, distance to the nearest cholera treatment facility, population density, median asset index score in informal areas, and presence or absence of major roads. We found that cholera incidence was most closely associated with informal housing, population density, and the income level of informal residents. Using data available in this study, our model would suggest nearly a one percent increase in cholera incidence for every percentage point increase in informal residents, approximately a two percent increase in cholera incidence for every increase in population density of 1000 people per km(2) in Dar es Salaam in 2006, and close to a fifty percent decrease in cholera incidence in wards where informal residents had minimally improved income levels, as measured by ownership of a radio or CD player on average, in comparison to wards where informal residents did not own any items about which they were asked. In this study, the range of access to improved sanitation and improved water sources was quite narrow at the ward level, limiting our ability to discern relationships between these variables and cholera incidence. Analysis at the individual household level for these variables would be of interest.

CONCLUSIONS/SIGNIFICANCE: Our results suggest that ongoing global urbanization coupled with urban poverty will be associated with increased risks for certain infectious diseases, such as cholera, underscoring the need for improved infrastructure and planning as the world’s urban population continues to expand.

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Tanzania – Mosquito control in Dar es Salaam

January 20, 2010 1 comment

Achieving high coverage of larval-stage mosquito surveillance: challenges for a community-based mosquito control programme in urban Dar es Salaam, Tanzania

Source: BioMed Central, 30 Dec 2009

Background – Preventing malaria by controlling mosquitoes in their larval stages requires regular sensitive monitoring of vector populations and intervention coverage. The study assessed the effectiveness of operational, community-based larval habitat surveillance systems within the Urban Malaria Control Programme (UMCP) in urban Dar es Salaam, Tanzania.

Methods – Cross-sectional surveys were carried out to assess the ability of community-owned resource persons (CORPs) to detect mosquito breeding sites and larvae in areas with and without larviciding. Potential environmental and programmatic determinants of habitat detection coverage and detection sensitivity of mosquito larvae were recorded during guided walks with 64 different CORPs to assess the accuracy of data each had collected the previous day.

Results – CORPs reported the presence of 66.2% of all aquatic habitats (1,963/2,965), but only detected Anopheles larvae in 12.6% (29/230) of habitats that contained them. Detection sensitivity was particularly low for late-stage Anopheles (2.7%, 3/111), the most direct programmatic indicator of malaria vector productivity. Whether a CORP found a wet habitat or not was associated with his/her unfamiliarity with the area (Odds Ratio (OR) [95% confidence interval (CI)] = 0.16 [0.130, 0.203], P<0.001), the habitat type (P<0.001) or a fence around the compound (OR [95%CI] = 0.50 [0.386, 0.646], P<0.001). The majority of mosquito larvae (Anophelines 57.8 % (133/230) and Culicines 55.9% (461/825) were not reported because their habitats were not found. The only factor affecting detection of Anopheline larvae in habitats that were reported by CORPs was larviciding, which reduced sensitivity (OR [95%CI] = 0.37 [0.142, 0.965], P=0.042).

Conclusions – Accessibility of habitats in urban settings presents a major challenge because the majority of compounds are fenced for security reasons. Furthermore, CORPs under-reported larvae especially where larvicides were applied. This UMCP system for larval surveillance in cities must be urgently revised to improve access to enclosed compounds and the sensitivity with which habitats are searched for larvae.

Categories: Tanzania Tags: ,

Tanzania – Health reforms result in social exclusion of the urban poor

November 24, 2009 Leave a comment

Reforms in health care systems can act as a powerful mechanism of social exclusion of the urban poor from decent health care services. This concludes WOTRO researcher Tausi Mbaga Kida. In her study she shows that the dual system of private and public health care delivery in Tanzania excluded urban poor from the better quality private care. But even more striking, also public care became less accessible for the poor due to the current subsidy structure.

In her study Tausi Kida analyses the systemic behaviour of the dynamics of the health care systems with its interaction with poverty. The deregulation and liberalisation of the health sector adopted in Tanzania from early 1990’s has brought about a dramatic shift in the system of health care delivery, from near exclusive ‘free’ public provisioning towards its extensive commercialisation that also include the liberalisation of private health care provision.

An influential view in the literature and in policy practice postulates that the commercialization of health care services will move the better off towards the private facilities in the public-private mix, thereby freeing the subsidized public health facilities for the use of the poor. However, contrary to policy intentions, this study finds out that the urban poor frequently find themselves excluded not only from (decent) private health care, but also from access to public health care, given the current subsidy structure.

Furthermore, this study reveals existence of segmentation in provision and access of health care services in the urban health care market. The segmentation mechanism is mainly the result of the systemic process of interaction of the demand and the supply sides of the health care market with widespread poverty. The study reveals that segmentation of health care delivery into a two-tier system is questionable to secure better access to health care especially for the urban poor. This is mainly because greater plurality of service provisioning in urban areas have weakened the pattern of public health care provision in general and of urban primary health care units in particular.

In this regard, this study proposes that the health reforms in practice have turned out to be quite powerful mechanisms of social exclusion of the urban poor from access to decent health care services i.e instead of being inclusionary as intended by policy. This study has therefore adopted “policy as process” approach, that has enabled a careful empirical investigation of both intended and unintended outcomes of prescribed policies – i.e. health reforms in the context of wide spread poverty.

Source – http://www.nwo.nl/nwohome.nsf/pages/NWOP_7Y4H6N

Categories: Tanzania

Stanford University – Seeking solutions to sanitation crisis in Dar Es Salaam

April 22, 2009 1 comment

tanzaniaStanford Report, April 22, 2009 – Seeking low-cost solutions to sanitation crisis in Africa

Each year, diarrhea kills an estimated 1.8 million people worldwide. More than 90 percent of the victims are children younger than 5 in developing countries. What makes the problem especially tragic is that it seems so preventable.

Diarrhea usually results from drinking water contaminated with human feces, coming in contact with a person with poor personal hygiene or exposure to a contaminated surface. About 1 billion people lack access to adequate freshwater supplies, and approximately 2.8 billion do not have access to basic sanitation, so the problem is particularly daunting.

Enter Jenna Davis and Alexandria Boehm of Stanford University. In 2006, Davis, an authority on sanitation in the developing world, and Boehm, an expert on microbial contamination in freshwater and coastal environments, were awarded a two-year Environmental Venture Projects grant from Stanford’s Woods Institute for the Environment to find solutions to the problem of diarrhea-related deaths among children in Africa.

The focus of the study is Dar es Salaam, the largest city in Tanzania. Historically, residents of the peri-urban communities surrounding Dar have relied on water from surface sources or shallow wells that are in close proximity to household pit latrines. “That means when people defecate, the waste stays under the house,” said Davis, an assistant professor of civil and environmental engineering and a fellow at the Woods Institute. “As a result, those shallow wells are very vulnerable to microbial contamination.”

To address the situation, city water and sanitation officials have drilled a series of bore wells that tap into clean aquifers deep below the surface. High-quality water is then pumped into storage tanks connected to sets of four to six taps. “Most of the water from the bore wells meets the World Health Organization guidelines for E. coli bacteria in drinking water,” said Boehm, an assistant professor of civil and environmental engineering. “Concentrations are typically less than 1 bacterium per 100 milliliters water.”

For a little money, residents can go to the taps and carry clean water back to their homes. Many people use the bore-well water for cooking and drinking. But so far, there has been little improvement in their overall health. City water officials want to know why and have turned to the Stanford team for answers.

Household surveys
In the summer of 2008, Davis, Boehm and a team of Stanford students and postgraduates traveled to Dar to study 300 households over a 10-week period. The research team hired Tanzanian enumerators to conduct surveys and interact directly with the households. The enumerators visited each household four times. On the first visit, they collected behavioral information, primarily from female heads of households (“the mothers”), and tested stored water and the hands of family members for indicators of fecal contamination.

Approximately 7,000 water and hand samples were collected during the study. Laboratory analysis revealed very high levels of bacterial contamination on the hands and in the stored drinking water of study participants, even though the deep bore-well water collected at the source was generally of good quality.

“There appears to be something in the transport and storage that is contaminating the water,” Davis explained. “It’s probably happening when people use their fecal-contaminated hands to scoop water out of their home containers. Another possibility is that the stored water containers used for fetching water are not cleaned regularly.”

A major challenge facing many households is distance. Some homes are 200 yards from the clean tap water, and a typical water container weighs 44 pounds when full. “We know that when people haul water from a distance, the first thing they do is drink it, then they cook, and then they wash their kids, themselves and sometimes their animals,” Davis said. “So they may not have enough water for adequate personal hygiene.”

For the second round of visits, the researchers separated the households into four groups. Each group was given generic information about how germs are spread through the five F’s—feces, flies, field, food and fingers. “We used pictures showing several ways to prevent the spread of germs, such as boiling or chlorinating the water,” Davis explained. “One of the four groups received only the generic information. A second cohort got the generic information plus the results of their water test. The third cohort got the generic information and their hand test results. The fourth group got everything—generic information, the water test results and the hand test results. The idea builds on basic health behavior-change theory: The more tailored and less generic the message is, the more effective it should be at motivating change.”

‘More is not better’
The preliminary results were surprising. Groups that received hand data or water data alone seemed to have a more positive response than households that got both hand and water test results. “It turns out that more is not better,” Davis said. “Even though we spent an equal amount of time discussing water-related strategies and hand hygiene-related strategies, there was a bigger behavioral change on the hand hygiene side than on the water side.”

The researchers are in the process of finalizing the survey data from their Environmental Venture Project. Meanwhile, in September 2008, Davis and her colleagues were awarded a three-year National Science Foundation grant to expand the number of households and the length of the study. “We’re aiming for a full year, which would allow us to monitor behaviors in both the dry and wet seasons,” she said. Data collection will begin in mid-2009, and the results could lead to low-cost solutions that reduce the incidence of diarrhea for tens of millions of children in sub-Saharan Africa and throughout the developing world.

Other members of the Stanford research team are Gary Schoolnik, professor of medicine and of microbiology and immunology; Abby King, professor of health research and policy and of medicine; and Cynthia Castro, research associate at the Stanford Prevention Research Center.

Mark Shwartz is communications manager at the Woods Institute for the Environment at Stanford.

Source – Stanford University News

Categories: Tanzania

WSP – Empowering Urban Areas to Better Manage Water Supply and Sanitation

February 23, 2009 Leave a comment

Empowering Urban Areas to Better Manage Water Supply and Sanitation, 2009 (pdf, full-text)

Dar Es Salaam, February 19, 2009—The Water and Sanitation Program today released a practical course manual for trainers of urban communities in Tanzania to improve water supply and sanitation management practices.

The seven modules are meant to equip communities with the tools to eliminate or reduce the major constraints in managing infrastructure and providing services. The manual also clarifies the roles and responsibilities of all stakeholders.

“Experience shows that communities who show ownership of their water supply and sanitation demonstrate a more vested interest in its maintenance and sustainability,” said Wambui Gichuri, Regional Team Leader for Africa at the Water and Sanitation Program (WSP). “This manual will allow trainers to teach communities how to do this better, and will serve as a reference tool for those communities for years to come.”

The manual was developed in collaboration with the Dar es Salaam Water and Sewerage Authority’s (DAWASA) Community Water Supply and Sanitation Program (CWSSP), but some material is applicable to other urban communities who may need to improve their management practices and increase the likelihood of a sustainable operation.

“The manual can also be a way for Government, planners, donors, and other supporters of these programs to better understand the nuances involved in rendering these services more sustainable,” Ms. Gichuri said.

The manual covers technical issues such as operations and maintenance activities—but also has a strong focus on institutional, managerial, and financial issues. The material is especially relevant for communities who have a relationship with the main water services provider and who are also committed to hiring an Operations Manager. The Operations Manager, the report says, should be a paid employee and their performance should be reviewed by beneficiaries.

Categories: Tanzania Tags: ,

Tanzania – Life in the “Ghetto”

November 24, 2008 Leave a comment

Arusha, Nov 24, 2008 (Arusha Times/All Africa Global Media via COMTEX) –
When sections of Arusha are improving and featuring characteristics of a modern town, larger parts of the urban area are fast deteriorating to sprawling filthy and stinking slums.

More and more people now find themselves living in mud shacks, without toilet facilities, water, electricity or even an access road to the shacks they call homes.

A survey by the Arusha Times has found out that if the Local Government does not intervene with basic planning activities now, in the next 10 years Arusha will be nothing but a mega slum with a small neat area east of Goliondoi and Afrika Mashariki roads to show visiting dignitaries and tourists.

Areas that are already unbearable with expansive slums, the like of Kibera in Nairobi, include Unga Limited, Ngarenaro, Kijenge, Majengo, Sanawari, Mianzini, Daraja Mbili Lemara, Sinon, Sombetini, Elerai and Mbauda. Arusha with an estimated population of 400,000 is surrounded by appalling slums in all directions unlike other cities which have shanty towns only in one or two sides of the main planned areas.

The worry of many people is that the scenic hills north of the municipality would soon be a densely populated labyrinth of shacks that will pose a threat to water sources. The trend according to John Mollel of Mianzini is that “you leave for work in the early morning and when you come back in the evening you find five shacks that have been built within hours and already occupied by families of no less than six people each.” The demand for shacks is high due to heavy migration to Arusha of people from other parts of the country seeking jobs.

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Tanzania – Need to improve human settlements

October 8, 2008 Leave a comment


In Tanzania at least 25 percent of people now live in urban areas growing at over 6 percent per annum, around twice the national rate of population growth.

There are ten major towns with populations of over 150,000 with the major city and port, Dar es Salaam, having a population of nearly four million.

According to statisticians an average of seven out of ten urban dwellers are now living in unplanned homes and according to the Ministry of Lands, Housing and Human Settlements Development “generally the state of human settlements in Tanzania is poor and needs to be improved.“

It is against this background the Government is taking measures including a programme to survey and upgrade hundreds of thousands of plots particularly in urban areas to improve human settlements.

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