Tanzania

 The Problem

  • Despite significant progress, Vitamin A deficiency (VAD) remains a widespread problem in Tanzania.
  • Tanzania is estimated to have the third highest burden of trachoma in the world with nearly one third of the population at risk.
  • Cataract is the leading cause of blindness in Tanzania, and unoperated cataract is responsible for almost 50% of all cases of blindness. 

What HKI Is Doing

Established in 1984, Helen Keller International's office in Tanzania was our first in Africa. The Kongwa field office was the cradle for research that developed into the WHO-endorsed SAFE strategy to control trachoma. Current programs include:

Vitamin A Supplementation
Helen Keller International works with partners to sustain a high-level commitment to twice-yearly vitamin A supplementation (VAS); Tanzania’s program has been very successful in institutionalizing district-driven vitamin A supplementation within the context of child survival services. In addition to advocacy, HKI helps with planning at the national and district levels; supports the training of health workers and distributors; engages in monitoring and evaluation activities; and ensures that adequate resources are allocated for VAS. This strategy has resulted in above 90% coverage since 2001. Last year, 90% of the targeted population was reached again, or 6 million children ages 6-59 months.

To structure the VAS planning process and facilitate the development of an estimated budget, HKI created a Planning and Budgeting Tool for the Vitamin A Supplementation and De-Worming Program. Instruction for use can be downloaded here.

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Zinc Supplementation
Helen Keller International and our partners provide technical assistance and advocate for the use of zinc supplementation as an adjunct therapy for diarrhea treatment. Partly as a result of these efforts, zinc treatment has been integrated into the National IMCI Guidelines for Diarrhea Management and into the National Standard Therapeutic Guidelines. 

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Maternal Anemia Control
HKI supports interventions to combat maternal anemia by working with partners to raise awareness about its prevention in mothers and pregnant women. HKI develops information, communication and education (IEC) materials for health workers and women to explain maternal anemia control (how anemia can be prevented and treated through attention to nutrition), prevention and treatment of malaria, and iron/folate supplementation. These materials will be incorporated into ante-natal care provided by health facilities.

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Orange-Fleshed Sweetpotato
Helen Keller International promotes and facilitates the production and consumption of orange-fleshed sweetpotatoes (OFSP) in 2 districts in the Mwanza region of Tanzania.  The overall goals of the Eat Orange! project are to improve the nutritional status of vulnerable populations, especially children under five and pregnant and lactating mothers, increase household income and reduce livelihood insecurity. 

The program primarily benefits 6,000 community members in 1,200 households living in the Sengerema and Ukerewe districts of Mwanza. Participants are organized into Savings and Internal Lending Communities (SILC). The SILCs are cooperative and self-managed savings and lending groups to enable poor families who have no access to formal financial services to save small sums of money and access micro-loans for income-generating opportunities, such as OFSP production. Members receive training on the storage, drying, processing and marketing of OFSP, and are linked to marketing opportunities. The SILC also serve as focal groups that provide education about nutrition.   

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Cataract Treatment/Comprehensive Eye Health
Helen Keller International has been working in the Singida and Tanga regions since 2004 to treat eye complaints and prevent blindness caused by cataract and other conditions, including trachoma and refractive error. HKI supports implementation of the VISION 2020 program’s three-pronged approach to eliminate blindness in the region by creating community-based programs, developing the human resources to deliver eye care services, and installing appropriate technology and infrastructure.

Tanzania has a large backlog of cataract cases due to an unequal distribution of ophthalmologists and cataract surgeons between urban and rural areas, and limited ability in reaching out and mobilizing remote communities in need.  Over 6,000 were blind from cataract in the region, with an additional 1,000 becoming blind each year.  

HKI helped establish an effective community outreach strategy through Direct Referral Sites to increase the access of underserved rural populations to primary eye health services and to identify patients for cataract treatment and surgery. HKI also trained surgeons and supported the construction of an eye surgery unit and patient ward at Singida Regional Hospital.  As a result of these efforts, the cataract surgical rate in the two regions has more than doubled. Real progress has been made, but more needs to be done to fully address the backlog and treat new cases of cataract blindness.  

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Trachoma Control
Working closely with the Ministry of Health and Social Welfare (MoHSW), Helen Keller International supports the implementation of the WHO-endorsed SAFE strategy (Surgery, Antibiotics, Face-washing, Environmental change) to eliminate trachoma as a cause of blindness in Tanzania. HKI targets two priority regions for trachoma control, Lindi and Mtwara, where the disease is most prevalent. 

Currently, HKI is working with Johns Hopkins University (JHU) to collaborate on a large-scale, three-year clinical trial to develop a new surgical tool to improve both the quality of the surgery and post-operative outcomes. In May 2009, HKI and JHU conducted refresher training for 27 surgeons from 10 districts of Lindi and Mtwara regions; these surgeons are the trial group for JHU’s study. Over 6,000 people came to screenings from over 300 villages in the two districts. In addition to 1,101 cases identified for trichiasis surgery, more than 600 cataract and other eye problems were identified and referred for follow-up care. 

If the trial is successful, it is likely to have global implications that will help improve post-operative outcomes for patients who have trichiasis surgery. 

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School Health
HKI partnered with the TIE and the Ministries of Education and Health to develop a school health program in the Dodoma Rural District. District officials, education coordinators and teachers in 40 schools were trained to apply a school health and nutrition curriculum in all schools. About 80% of children in 20 schools have been dewormed twice a year, and children in 20 schools have also benefited from refractive error screening. 

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