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Dar es Salaam. When it comes to determining whether or not tobacco consumption leads to Non-Communicable Diseases (NCDs), the renowned anti-tobacco activist, Ms Lutgard Kagaruki, remains categorical, “Even a single stick may kill or leave one sick,” she says.
“One may be smoking a pack, but dies earlier than the one who was smoking four or five packs…it all depends on a person’s immunity, but all in all, there is no safe level,’’ says Ms Kagaruki who has been researching on the impact of tobacco consumption in Tanzania for years.
Most experts, who have been interviewed by The Citizen, argue that the problem is not how many cigarettes a smoker can consume per day.
Social smokers or passive as the case maybe, have the same risk as that of a chain smoker as they all inhale the same kind of smoke and this has already been proven by researchers as fatal.
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, according to The World Health Organisation (WHO).
About 14.1 per cent of all Tanzanians smoke tobacco daily while the product remains to be a major risk factor for the NCDs, government statistics show.
In 2010, a study published in the Journal of National Cancer Institute found that cigarette smoking was associated with increased risk of cancer of the oesophagus in white men and women.
“Smoking cessation was associated with reduced risks,’’ says the study titled: Cigarette Smoking and Adenocarcinomas of the Oesophagus and Oesophagogastric Junction.
Ms Kagaruki urges that it would be better for any smoker to quit now—when there is still time—to save himself or herself from the bad consequences of consuming tobacco products.
She speaks at a time when the WHO, medics in Tanzania and across the world are discouraging all forms and all manner of cigarette smoking, mentioning the tobacco contained in the cigarettes as a risk factor for “almost all NCDs.”
“The common question we usually ask patients whom we suspect of cancer, heart disease or chronic respiratory disease, is whether they have a history of smoking cigarettes or not,” says Dr Obadia Nyongole, a surgeon at the Muhimbili National Hospital(MNH).
“If they have been smoking, it gives us a clue on what to expect. Often, it turns out to be they were smoking, tobacco is a risk factor that must be controlled,’’ he says.
However, campaigns against tobacco consumption in Tanzania are yet to bear fruit considering the lack of a well-established legal framework, reveals Ms Kagaruki, who leads the Tanzania Tobacco Control Forum (TTCF).
In 2007, Tanzania, a member of WHO signed a Framework Convention on Tobacco Control (WHO FCTC), which is the pre-eminent global tobacco control instrument, containing legally binding obligations for its parties.
WHO- FCTC was meant to set the foundation for reducing both demand for and supply of tobacco products and providing a comprehensive direction for tobacco control policy at all levels.
To assist countries implement effective strategies for selected demand reduction related articles of the WHO FCTC, the WHO introduced a package of measures under the acronym of MPOWER.
The WHO recently reported the progress member states are making against the MPOWER measures in the WHO Report on the Global Tobacco Epidemic 2013.
However, until today, Tanzania has not enacted a law—to align with the FTCT.
The law would strictly prohibit the use of tobacco in public places and there are so many gaps in the existing regulations, says Ms Kagaruki.
Although experts consistently warn that tobacco use causes more harm than good, the government and some growers of the crop in the country are banking on it for their livelihoods and economic benefits.
Cigarette smoking has continued to flourish, in the country fuelled by the growing tobacco industry, campaigners say.
Only recently, the ministry of Health, Community Development, Gender, Elderly and Children said it was engaging in talks with the Prime Minister’s Office to see if the country can come up with a common stand on how to handle the conflict of interest.
Speaking exclusively to The Citizen’s sister paper Mwananchi, Health Minister, Ms Ummy Mwalimu, said efforts were ongoing, through her docket, to find ways of limiting tobacco farming and its eventual consumption, in an effort to protect the health of the people.
Tanzania is among the developing countries facing the major challenge of Non-Communicable Diseases (NCDs). Despite efforts being made by health stakeholders in fighting the diseases, more is yet toPhoto Gallery | Session Video | Publication
Tanzania is among the developing countries facing the major challenge of Non-Communicable Diseases (NCDs). Despite efforts being made by health stakeholders in fighting the diseases, more is yet to be done.
In an exclusive interview, The Citizen’s reporter Herieth Makwetta speaks to the minister for Health, Community Development, Gender, the Elderly and Children, Ms Ummy Mwalimu, who explains what the government is doing to implement strategies and policies aimed at countering the diseases.
What does it mean when we speak of NCDs and how has Tanzania repo- sitioned itself in countering them?
In 2010, the World Health Organisation (WHO) released a report titled, ‘Global status report on non- communicable diseases: Description of the global burden of NCDs, their risk factors and determinants that stated that the diseases were affecting 47 per cent of patients and that, out of the 100 that died, 60 died of NCDs.
These statistics show that if concerted action is not taken to fight the diseases by 2020, the statistics will go up from 47 to 60 per cent and the death rate will also shoot up from 60 to 73 per cent.
Here in the country, we get a picture about NCDs through a study conducted in Dar es Salaam,
Mara and Kilimanjaro regions in the 1990s, but I would not like speak about that as for now we are using a study carried out in 2012 by the National Institute for Medical Research (Nimr).
Nimr carried out the study in collaboration with the WHO, the Ministry of Health and health stakeholders as it is the one that we have been using to date, giving us a summary on NCDs.
The findings of the research show that 15.9 per cent of Tanzanians
use tobacco and this includes cigarette smokers that are a catalyst for respiratory diseases, 29 per cent are alcohol drinkers that are considered one of the main causes of the diseases, 26 per cent are obese and overweight, 26 per cent have raised cholesterol in their body and 33.8 per cent have raised triglycerides, the main constituents of natural fats and oils.
The findings of the study also show that 9.1 per cent are diabetic while 25.9 per cent suffer from hypertension.
The government launched a campaign called ‘Afya yako, mtaji wako’ that sensitised people to engage in physical exercises so as to fight NCDs. Has the campaign brought about positive results?
The campaign was a result of the study carried out in 2012, whereby a quarter of interviewees said they were neither exercising nor doing laborious jobs. Out of those interviewed, four said they neither engaged in any physical exercises nor did any physical work and this gave us a picture of NCDs in the country.
Is there any current policy or guidelines for fighting NCDs currently?
In 2016, the government designed and launched a five-year national strategy for fighting NCDs. The strategy has already identified the areas that we will work on.
Tobacco consumption is one major risk factor for NCDs. What is the government doing on tobacco control?
Tanzania is a member of WHO as we have signed the 2007 framework convention on tobacco control.
Besides that, what efforts are being made?
I’m very happy to hear that ques- tion as two weeks ago a meeting was called by the Prime Minister’s Office that the time had come to agree with one another on how we can have a common stand as a country and as a government in controlling the use of tobacco.
However, we as a Ministry of Health have said that since there is no law and the one existing is outdated, we will neither ban nor go against tobacco farming and eventually contributes to medical care bills, hence sugar is taxed.
We will educate members of the public about the effects of tobacco use. That is our main objective.
To avoid spending huge sums of cash on treating the diseases, what is the government doing on prevention?
Even in the 65th conference of health ministers from East, Central and Southern Africa, we discussed that the main risk factors of NCDs is the use of tobacco and excessive alcohol consumption.
Also the issue of a life style was highlighted as many people don’t walk long distances. All these risk factors are worked upon.
Do we have a recent study on NCDs?
A special study was conducted in 2012, almost six years ago, but when you look at the number of patients going to health centres due to NCDs have been increasing.
Now, what’s the next plan as we look ahead?
We have repositioned ourselves in three big areas: first on preven- tion, second on early diagnosis and third on medical treatment.
Currently, we are focused on preventing people from falling a victim to NCDs by educating them through awareness programs.
As part of low-cost interventions, WHO recommended a minimum amount of money that should be allotted to every Tanzanian in fight- ing NCDs? If so, is it sufficient?
What we get is a budgeted disbursement from the Central Government.
But, we need to find ways of improving the funding. For instance, in South Africa sugar is taxed because of its massive use and it is a contributing factor to NCDs
This is the story of Dr Martin Sebalua, whose life took a U-turn after hewas diagnosed with diabetesPhoto Gallery | Session Video | Publication
This is the story of Dr Martin Sebalua, whose life took a U-turn after hewas diagnosed with diabetes
Dar es Salaam. It was 7am. An elderly man sits slumped on the met-al benches, eyes closed, outside the doors of a dialysis room. The nurse from across the hall informs that the room is finally ready. With seven other patients, the elderly man is assisted by his helper to get ready for his routinely treat-ment. “It’s not as bad as it looks,” says the 67-year-old retired doctor, Mar-tin Sebalua. “But it’s something I wouldn’t wish even my worst ene-my,” he adds. Dr Sebalua, reclining on his bed, looked comfortable, but the tubes connecting to his dialysis machine were not readily noticeable. As he lifts his white bed sheet, nar-row transparent straw-looking tubes are connected to a dialysis machine that sits on his left carrying blood in and out of his body. This looked painful, uncomfortable and pricking.Dr Sebalua is a diabetes patient for 22 years now. He was diagnosed with end-stage chronic renal disease causing both his kidneys to fail in 2015.
He is among 422 million people in the world living with diabetes, a non-communicable disease claim-ing at least 1.6 million lives per year, as stated by the World Health Organ-isation. “Nobody likes to spend time in the hospital, at least not three times a week,” he says. “But you have to come for this treatment because your life depends on it.” For three years now, Dr Sebalua comes for his dialysis sessions three times a week on Tuesdays, Thurs-days and Saturdays and spends at least four hours on the bed for the session to complete. “Dialysis might have given me mobility and hope but I know deep inside my body has given up as there is no cure for this disease (diabetes) – it’s not easy to live a life dependent on the machine,” he says sympatheti-cally. Dr Sebalua explains that dialy-sis is a draining process. “You see this machine works like an artificial kidney. I’ve reached a point where I have zero output of urine and by-products. So the dialysis machine removes blood from the body where toxins and excess fluids are removed, then returns the filtered, clean blood back into the body,” he explains. It works like a rollercoaster where the treatment performs round-the-clock kidney function in those three sessions per week.Diabetes turned a doctor into a patientDr Sebalua was everything one might imagine a doctor would be in his 40s. He was at his peak in his career, confident and doing very well as a medical officer in charge at the Lushoto District Hospital, Tanga.
Yet, 22 years ago, his life took a complete U-turn when he was diag-nosed with diabetes. He had struggled with constant sluggishness, frequent urges to uri-nate, muscle pains and episodes of repeated thirst. These were the symptoms. Though Dr Sebalua cannot exactly pinpoint one cause, he knew his daily routine was not healthy. “The reason I fell victim to dia-betes was completely behavioural, it had nothing to do with my family history,” he confesses, “My alcohol intake was excessive, I liked drink-ing beer, my diet of course was unhealthy, no physical exercise, the work was demanding and exposed me to a lot stress and yes, I was prob-ably obese for my age at that time.”He remembers thinking, “Here I’m running a hospital, telling people how to lead a healthy life and be cau-tious while the irony was that I was unhealthy, exhausted and ill.”There was not one but perhaps many factors that led Dr Sebalua to develop diabetes, which also led to further deadly complications. By this time, he was married and had four children. His family and col-leagues suggested he takes precau-tion and that is when he began rou-tinely exercising and taking meas-urements in what he eats. “When you have to suddenly change the way you eat and live after 40 years of your life, it is difficult – almost depressing. It feels as if you are isolated from your closed ones – you have separate meals cooked and a different way of life. I had to completely cut down carbohydrates, refined sugar, fats and instead opted for unpolished cereals and food,” he tells.
In 2013, his life took a U-turn
Seventeen years after being diag-nosed with type 2 diabetes, Dr Sebal-ua’s kidneys began to fail – one of the most common complications of diabetes here in Tanzania. “I saw myself puff and swell. And I knew that there was something wrong.” Chronic kidney disease is a major determinant of poor health outcome of major non-communica-ble diseases. “I went under depres-sion, it hit me hard,” Dr Sebalua tells, “all these years, I was taking care of myself with full of good intentions from losing weight to a healthy diet, but they all fell by the wayside.”Diabetes has no cure. When Dr Sebalua came to Dar es Salaam for further check-up and consultation, a nephrologist told him that he had chronic renal failure-stage 5, which is basically the end stage. That year, Dr Sebalua retired as a doctor. “I was told to find a donor for a kid-ney transplant,” that was the solution sought. “Fortunately, back then the Ministry of Health had affiliations with hospitals in India whereby they could sponsor patients like myself for kidney transplants but that doesn’t happen anymore,” he says, echoing the voices of many patients in Tanzania who are living with end stage renal disease but cannot seek possibly the best treatment for a kid-ney failure, a transplant. This is due to its cost related to it. One of the other reason that patients with a kidney failure, espe-cially the low-income patients don’t know about transplants is because their doctors do not communicate to them that it’s an option hence mak-ing them vulnerable to dialysis for a long period of time and making them less viable as transplant candidates.
“My second-born, her name’s Martha told me after learning about the possible treatment for the failed kidneys. She said and I still remem-ber, I don’t care father if I have to live with one kidney all my life – I want to make sure you recover from this and that you are okay. And so she agreed to donate one of her two kidneys to me,” he tells. So why is Dr Sebalua still under-going dialysis while he was sponsored by the government through public hospital referral to go to India for a transplant? “In Dar es Salaam, doctors missed a very important diagnosis that was revealed by tests and scans in India,” Dr Sebalua tells, “I had a blockage in my heart, another diabetes compli-cation.” Dr Sebalua spent seven months in India, spending over Sh47 million recovering from the heart surgery to repair and unblock the blood ves-sel in the heart that made him too weak and vulnerable for the kidney transplant. He was told to go back to Tanzania to recover and rest. “It’s too late for a transplant now, I’m aged and I don’t want to put my daughter’s life at risk anymore,” Dr Sebalua says he has given up.
The challenge he faced after
In 2015, circumstances made him to move cities for the dialysis serv-ices. Not a single hospital or health centre in Tanga, where him and his family used to reside have a dialysis machine – forcing many families like his to either opt to move to big cities or lose hope. “Coming to Dar es Salaam was an expensive move, not only because of the change in standard of life but we had to start all over again, bearing in mind also that dialysis sessions came with its own different expense,” he says.Each dialysis session costs about Sh350,000 to Sh450,000 – where patients end up spending almost Sh4.2 million to Sh5.4 million per month. “I don’t think I would have been able to afford this service if it weren’t for the insurance cover, but I’m confident that an informa-tion gap still exists among the low-income families on the benefits of insurance and treatment options,” he says, reverberating concerns of those with a similar condition like his.
“In my career span, I have wit-nessed the magnitude of NCDs ris-ing, it is an epidemic, especially dia-betes. And the focus should definite-ly be on improving how we live our lives by eating right, regular screen-ings and exercising daily but I also urge the government on two things.First, all regional hospitals in the country should have dialysis machines to avoid over-crowding and forced migration and second; talk to people to bridge the informa-tion gap on NCDs, available treat-ment and prevention,” Dr Sebalua pleads. As the nurses and doctor came to check on how Dr Sebalua, still on his dialysis bed, was doing, he says; “They are my lifeline, they take care of me. It pricks me a little, but again look, it’s not so bad.” Dr Sebalua is currently getting dialysis services in a private hospital in Dar es Salaam through the Nation-al Health Insurance Fund where each session costs him Sh365,000, and represents the many patients whose life has taken a toll because of preventable and modifiable lifestyle factors.
In recent years, stakeholders in Tanzania have come up with various initiatives to raise awareness on cancer prevention and treatment. However, concerns have been raised about the sustainability of such campaigns. To know what it takes to run the campaigns, The Citizen’s Reporter John Namkwahe interviewed the Managing Director of the Tanzanian Cancer Society (Tacaso), Mr Franklin Mtei.
For how long have you been running awareness campaigns against cancer, and, are your efforts paying off?
We have been doing it since August 2014. To a great extent, our efforts are paying off. At least now, almost every other person, especially the youth, know a thing or two about cancer, thanks to our campaigns on social media.
Do you think there is a need to step up the campaigns? If yes, why?
Most definitely! At least people in urban areas know a thing or two about this disease and a great emphasis has to be made to reach the majority who are in rural areas. These people have limited access to popular media and they are the ones who, for centuries, believed cancer is incurable and that it’s some kind of a curse. Their belief about cancer is awfully wrong.
We have great approaches at our disposal on how to reach them, building up from what we have been doing so far with an online audience. We only call upon donors to support our programs/ projects.
About lifestyle and cancer. How should people live a life that keeps them away from cancer?
Simple! Eat and drink right, rest right, be active and work out right! Get regular checkups. They should learn the truth about cancer and its association with lifestyle. By doing this, they will know the risk factors and how to avoid them, as well as get to know what type of cancers are in their bloodline and whether they are inheritable or not.
What mainly causes people to die of cancer in Tanzania? What can be done to prevent this?
As it is worldwide known that there is no clear single cause of cancer rather than a number of risk factors, I can’t really pin point one reason.
However, lifestyle as well as infectious diseases, poverty and lack of cancer education play a major role. Most people I have come across as well as in researches have had no right information about cancer.
As a result therefore, they went to traditional healers for the cure that did not materialize, not realising that the disease kept progressing.
About 80 per cent of cancer patients come at very advanced stages. The survival rate for this is very low.
Poverty is a culprit in this, in which not only do most poor are not educated, but also when they get diseases, they hardly go to hospital on time.
The food preferences of many Tanzanians are said to be among the risk factors for cancer. What feeding habits need to change?
People should stop buying processed and canned foods. Too much chemicals in these products could be harmful, they should stick to our natural foods. Fast foods are a disaster.
As an expert in radiotherapy, what are the commonest challenges—in terms of awareness, social and socio-economic life, that you have seen among cancer patients seeking care at your facility?
Most people are poor, and they had no prior knowledge of the dis- ease. Some refuse radiotherapy treatment because they were told they would die of it. This is the greatest misconception about this cancer treatment modality.
So the only thing the family members remember is, after the irradiation [process by which a cancer patient is exposed to radiation as a treatment option], their relative passed on in a week, a month or several months later.
But in fact, we only do that as the last option available that would improve their quality of life for the little time they were left with to live. Cancer patients need psycho- social support.
If you give them an ear, you will be very sympathetic and wished you could do something to assure them. Almost everyone, regardless of the stage of their disease, think they are going to die.
How do you help them to deal with the challenges?
The government is doing very great at ensuring all cancer patients are treated without paying. I don’t know of any other country that offers free cancer treatment to their citizens!
However, I saw a gap in other aspects of the fight against this disease along with complications resulting from it.
So, to compliment the efforts done by the government, I registered an NGO with a vision to create the world where every person in Tanzania will have access to the best possible cancer services.
About health-seeking behavior. Quite often, we see more women seeking cancer care, compared to men. What do you think holds the men back?
This is some what hard to answer with certainty. But women, for their nature, aren’t afraid to seek for medical advice unlike men who resort to such services after quite a long time of pondering.
Thousands of women have died of cervical and breast cancer in the country and worldwide. Campaigns to fight these diseases have been successful. Plus symptoms for most of their disease are obvious due to their physiology.
Most cancers associated with men come later in life, and the myth on how to test for prostate cancer makes it worse. But in recent times, we campaign to reduce these by demystifying the misconceptions.
But, there are more awareness campaigns targeting cancer in women than men. Do you think this has an impact on how men perceive cancer?
I don’t know the main reason for this, but like I said above, signs and symptoms of cancers associated with women like cervical are obvious and worrisome, and well campaigned. So it’s natural that they’d seek medical advice.
Men on the other hand, ignore some signs, as in prostate cancer. Most go to hospitals when the signs are severely advanced.
And the prostate cancer target those with 50 years old and more. A fraction of the male population. But generally, the campaigns we lead, target both genders and children.
There is a pressing need to shift our mindset from believing that Non-Communicable Diseases (NCDs)—also referred to as lifestyle diseases—are a health challenge that should be tackled in hospitals. We are increasingly seeing the need to address the problem at community level.NCDs are here with us and it is our duty to face them. The World Health Organisation (WHO) released a report in 2010, showing that NCDs are contributing 47 per cent of patients at health facilities, yet, out of 100 who died, 60 of them suc-cumbed to any of the NCDs.There is cause for concern and in fact, the WHO reports are telling us that if no action is taken to fight these diseases by 2020, the statistics will go up--probably from 47 to 60 per cent and the death rate will also shoot up from 60 to 73 per cent.This means that we have to take action right now. But, to be able to reach every member of the society, we need to create a strategy going down from health care workers to individuals-ensuring; that this is a matter that can be discussed even at dining tables.NCDs, by their nature, are mostly attributed to how we live—what we consume as well as daily activities. So, in our advocacy plans, this is what we have to bear in mind. And, that’s where, as medical doctors come in—to educate and research on what’s feasible in bringing about positive change.
Where do we start from?
For many years, doctors have been engaging policy makers on how to curb the rising trend of NCDs, more so, through various conferences that were organised by the Medical Asso-ciation of Tanzania (MAT). The resolutions that we came up with at the conferences have always formed the basis for interventions. The Ministry of Health, Community Development, Gender, Elderly and Children, has been our main stake-holder of our research and expert opinions—this is to be lauded.However, we are working hard to see if innovative ideas which we publish in our research journal— the Tanzania Medical Journal—can fur-ther be transformed into active poli-cies that can revolutionise the way we tackle these diseases.
This will also require the medi-cal fraternity—meaning we the doc-tors and others, to now shift gears by researching more, speaking more during our science forums and writ-ing more to influence change. Like I said earlier, NCDs require a community level approach. I have always been pleased each time I see a fellow medical doctor taking time to talk to patients about how they should be managing their lifestyles to avoid suffering from diseases such as diabetes, cancer, chronic respiratory illnesses and heart complications.I must state that in Tanzania, most people are trapped in the vicious cycle of ill-health. This means that a patient visits a hospital to get treated of a certain disease but later on goes back to live in the conditions that caused him/ her to become sick.
Take an example of malaria - an infectious disease that has always troubled our country, even way before these NCDs became an agenda. People live in places that are breeding grounds for mosquitoes, they don’t use mosquito nets and end up catching malaria.So, what they see as a solution is to go to a doctor to get medications. And, when the medications are prescribed, they go back home to live in the same environment that put them at risk of the same disease.This vicious cycle needs to be broken, even now as we address NCDs. I am saying this because ill-health leads to reduced productivity, resulting in poverty. This eventually leads people into poor living conditions, malnutrition, and illiteracy. Looking at this from the angle of NCDs, it means that we, as doc-tors have the duty to take the right information forward because we are the ones who see the patients every day, talk to them, lead them and by the way, we have huge influence in whatever they decide to do or not to do.A mere talking to them about how they can prevent diabetes, cancer or high blood pressure, makes a huge difference.As the Medical Association of Tanzania, we have embarked on this. We have a collaborative project with the Tanzania Diabetic Association (TDA) where we work to help Tanzanians screen for early signs of NCDs.
It’s an initiative that has helped us gain access to what people in communities think about NCDs, act to prevent them, their exact mindset and so on. But, it has been a platform that helps the patients to discover their illnesses and avert them in the earliest stages possible. Imagine a person who had been living with high blood pressure without knowing. Imagine an old person who had been getting visual disturbances without knowing that he had diabetes that had started damaging his eyes! These are the cases we encounter, as we strive to educate and screen. Organizations dealing with health need to team up to make this a sustainable programme. We, at MAT, are ready to work with any of them with the goal of ensuring a better life for all Tanzanians. With all that said, I would wish to tell all people in this country that best health choices and right mindset can take us miles far in tackling our major health challenges.
Dar es Salaam. Over the recent years, the world has witnessed an alarmingtransitionindiet.
Food has been going through many processes with calories from meat,sugar,oilandfats alsoincreas- ing atanalarmingrate, living those nutritiousfood intakedeclining.
Consequently, this transition has seen on the increase in the global prevalence of non-communicable diseases (NCDs). Studies have shown a close link between food, nutrition and diet to be a variable risk factor of most NCDs where- as specific nutrient deficiency or excess trigger the development of NCDs and that appropriate dietary changes may reduce the risk of NCDs. Tanzania like many devel- oping countries has been exposed to food and diets that have put its people at a high risk of being over- weight and obese, a major risk fac- torforanumberofchronicdiseases, including diabetes, cardiovascular diseasesandcancer.
The Tanzania Demographic and Health Survey (TDSH) 2015-2016 report shows that nine per cent of adults are diabetic and 26 per cent are obese.
Deborah Esau, a Nutritionist based at The Partnership for Nutri- tion in Tanzania (Panita) says that dieting habits are a big issue and a risk factor for most NCDs in our country.
In most cases, people still hold the belief that eating well means con- sumingjunkfood, sheadds.
“If you don’t control your eating habits, you are likely to get these chronicdiseases. Mostpeopleliving in town are exposed to junk food and most of them think that is eat- ing well. However, the case is differ- ent when you go to villages where the prevalence of such diseases is low and the reason is because most of them don’t eat lavishly - they either don’t have enough to eat or whatever food they have, they cook it simply,’ says Ms Esau.
Most poor eating habits have highly being attributed by the kind of job that people in the city do that do not allow them to have enough timetopreparethepropermeals.
The consequence is missing out onmicronutrientsthatwegetfrom fruits and vegetables, explains Ms Esau. “The thing about foods which are being cooked on streets is that we don’t know how much salt or if the salt used is the one recom- mended or the type of cooking oil used is healthier, but you just have to eat since you are hungry. Most junk food have empty calories and so with time and no exercise, sed- entary life, one is likely to get obese, which is a risk factor for many NCDs,” shesays.
Eating the right food
Ms Esau says staying healthy requires determination and com- mitment to improve our lifestyle which is the best way to avoid catchingsuchdiseases. Shesaysone should prioritise health and keep in mind the damage that could come along with poor lifestyle. “First,we need to change our eating habits by starting to eat healthier - this includes moving from eating the only two types of food staple--ugali andrice-- todiversifyingfoodvarie- ties. Also we should pay should not overcook our food while paying attention to the quantity of cooking oil, salt and even sugar. Everything should be used in moderation,” Ms Esau advises. For those who are working, Ms Esau suggests that instead of opting for fast food , they can try to prepare their own food forlunch.
“We shouldtryasmuchaswecan to carry food from home, especially when our office surroundings don’t give us enough options to buy food which is well prepared and health- ier. Also we should learn to eat as a king in the morning and eat as a slave in the evening meaning eating little buthealthierfood.”
Being physically active is some- thing Ms Esau emphasises on, for instance, walking at least 20 min- utesadayforthosewhoareworking can also help reduce the risk. “You cannot be sitting in your office the wholeday. Exercising helps in blood circulation and keeping the body fit andweshouldalsolearntotakeeve- rything in moderation such as the amount of alcohol we consume,” saystheexpert. Understandingthat the risk factors are not the same for everyone, as some people are more prone to getting diabetes while oth- ersaremorevulnerablewithcancer or high blood pressure and so on, she says getting regular check-ups canhelpdetectandtreatsuchthese diseasesearlier.
National nutrition strategy
The government developed the National Nutrition Strategy (NNS) toputforwardtheprioritiesfor July 2011 to June 2016. This strategy aimed at ensuring that the nation and its people are properly nour- ished. Thestrategywasin-linewith, and will contribute to, the National Development Vision 2025, Mkukuta (National Strategy for Growth and PovertyReduction), theAfrican Regional Nutrition Strategy (2005- 2015) andthepoliciesandstrategies ofthe Tanzanian government.
The goal of the strategy is that all Tanzanians attain adequate nutri- tional status, which is an essential requirement for a healthy and pro- ductive nation. This goal will be achieved through policies, strate- gies, programmes, and partner- ships that deliver evidence-based and cost-effective interventions to improvenutrition.
On the other hand, in 2015, the World Health Organisation (WHO) convened a technical meeting of global experts on how to design financial policies on diet. The Glo- bal Action Plan for the Prevention and Control of Non-communicable Diseases 2013–2020 proposes that as appropriate to national context, countries consider the use of eco- nomic tools that are justified by evidence and may include taxes and subsidies, to improve access to healthy dietary choices and create incentives for behaviours associat- ed with improved health outcomes and discourage the consumption of lesshealthyoptions.
It was concluded that there is
reasonable and increasing evi- dence that appropriately designed taxesonsugarsweetenedbeverages would result in proportional reduc- tioninconsumption.
Healthy eating pyramid
The Healthy Eating Pyramid also addresses other aspects of a healthy lifestyle—exercise, weight control, vitamin D, and multivitamin sup- plements, and moderation in alco- hol for people who drink—so it’s a useful tool for health professionals’ and health educators.
The Healthy Eating Pyramid is a simple visual guide to the types and proportion of foods that we should eat every day for good health. The foundation layers include the three plant-basedfoodgroups: vegetables and legumes, fruits and grains. The middle layer includes milk, yoghurt, cheese and alternatives, lean meat, poultry, fish, eggs, nuts, seeds, legumes food groups.
The top layer refers to healthy fats because we need small amounts every day to support heart health and brain function.