Ethnicity and Child Health in Northern Tanzania: Maasai Pastoralists Are Disadvantaged Compared to Neighbouring Ethnic Groups

The Maasai of northern Tanzania, a semi-nomadic ethnic group predominantly reliant on pastoralism, face a number of challenges anticipated to have negative impacts on child health, including marginalisation, vulnerabilities to drought, substandard service provision and on-going land grabbing conflicts. Yet, stemming from a lack of appropriate national survey data, no large-scale comparative study of Maasai child health has been conducted. Savannas Forever Tanzania surveyed the health of over 3500 children from 56 villages in northern Tanzania between 2009 and 2011. The major ethnic groups sampled were the Maasai, Sukuma, Rangi, and the Meru. Using multilevel regression we compare each ethnic group on the basis of (i) measurements of child health, including anthropometric indicators of nutritional status and self-reported incidence of disease; and (ii) important proximate determinants of child health, including food insecurity, diet, breastfeeding behaviour and vaccination coverage. We then (iii) contrast households among the Maasai by the extent to which subsistence is reliant on livestock herding. Measures of both child nutritional status and disease confirm that the Maasai are substantially disadvantaged compared to neighbouring ethnic groups, Meru are relatively advantaged, and Rangi and Sukuma intermediate in most comparisons. However, Maasai children were less likely to report malaria and worm infections. Food insecurity was high throughout the study site, but particularly severe for the Maasai, and reflected in lower dietary intake of carbohydrate-rich staple foods, and fruits and vegetables. Breastfeeding was extended in the Maasai, despite higher reported consumption of cow''s milk, a potential weaning food. Vaccination coverage was lowest in Maasai and Sukuma. Maasai who rely primarily on livestock herding showed signs of further disadvantage compared to Maasai relying primarily on agriculture. We discuss the potential ecological, socioeconomic, demographic and cultural factors responsible for these differences and the implications for population health research and policy.     

Nutritional Consequences of Wealth Differentials in East African Pastoralists: The Case of the Datoga of Northern Tanzania

Among African pastoralists evidence that wealth is associated with other measures of household success is scant and the significance of wealth differentials for family welfare remains poorly understood. Predictions that wealth in livestock is associated with increased adequacy of household food supply and with improved child nutrition are tested with longitudinal data on herd size, household composition, food supply, and anthropometric status collected in 1992 for a sample of traditional Datoga households (n = 20) living in the Eyasi basin in northern Tanzania. Although a majority subsisted below poverty cutoffs estimated for east African pastoral populations, there was large variation among households in measures of wealth and resource availability. Individuals in relatively wealthy households did not appear to benefit either in terms of adequacy of household food supply or in terms of average growth performance of young children. Theoretical and methodological challenges in the study of the relationship between wealth and health in nomadic pastoralists are discussed.     

Class formation among East African pastoralists: Maasai of Tanzania and Kenya

Peter Rigby is Professor of Anthropology at Temple University, Philadelphia, Pennsylvania.     

Herding Strategies of the Datoga Pastoralists of Tanzania: Is Household Labor a Limiting Factor

Datoga herding follows a cyclical pattern depending on the availability of grazing and water. This analysis focuses on two questions: (a) Is the herding strategy followed by individual households limited by the amount of labor available to that household? and (b) does the herding strategy followed by individual households influence the dynamics of cattle herds? The results show that the availability of labor on a household level does not influence either the herding strategies used by individual households, or the dynamics of cattle herds. This suggests that once minimum labor requirements are met, livestock productivity is insensitive to additional labor inputs.     

The Epidemiology of Chronic Kidney Disease in Northern Tanzania: A Population-Based Survey

Background

In sub-Saharan Africa, kidney failure has a high morbidity and mortality. Despite this, population-based estimates of prevalence, potential etiologies, and awareness are not available.

Methods

Between January and June 2014, we conducted a household survey of randomly-selected adults in Northern Tanzania. To estimate prevalence we screened for CKD, which was defined as an estimated glomerular filtration rate ≤ 60 ml/min/1.73m2 and/or persistent albuminuria. We also screened for human immunodeficiency virus (HIV), diabetes, hypertension, obesity, and lifestyle practices including alcohol, tobacco, and traditional medicine use. Awareness was defined as a self-reported disease history and subsequently testing positive. We used population-based age- and gender-weights in estimating prevalence, and we used generalized linear models to explore potential risk factors associated with CKD, including living in an urban environment.

Results

We enrolled 481 adults from 346 households with a median age of 45 years. The community-based prevalence of CKD was 7.0% (95% CI 3.8-12.3), and awareness was low at 10.5% (4.7-22.0). The urban prevalence of CKD was 15.2% (9.6-23.3) while the rural prevalence was 2.0% (0.5-6.9). Half of the cases of CKD (49.1%) were not associated with any of the measured risk factors of hypertension, diabetes, or HIV. Living in an urban environment had the strongest crude (5.40; 95% CI 2.05-14.2) and adjusted prevalence risk ratio (4.80; 1.70-13.6) for CKD, and the majority (79%) of this increased risk was not explained by demographics, traditional medicine use, socioeconomic status, or co-morbid non-communicable diseases (NCDs).

Conclusions

We observed a high burden of CKD in Northern Tanzania that was associated with low awareness. Although demographic, lifestyle practices including traditional medicine use, socioeconomic factors, and NCDs accounted for some of the excess CKD risk observed with urban residence, much of the increased urban prevalence remained unexplained and will further study as demographic shifts reshape sub-Saharan Africa.     

The Determinants of Traditional Medicine Use in Northern Tanzania: A Mixed-Methods Study

Introduction

Traditional medicines are an important part of healthcare in sub-Saharan Africa, and building successful disease treatment programs that are sensitive to traditional medicine practices will require an understanding of their current use and roles, including from a biomedical perspective. Therefore, we conducted a mixed-method study in Northern Tanzania in order to characterize the extent of and reasons for the use of traditional medicines among the general population so that we can better inform public health efforts in the region.

Methods

Between December 2013 and June 2014 in Kilimanjaro, Tanzania, we conducted 5 focus group discussions and 27 in-depth interviews of key informants. The data from these sessions were analyzed using an inductive framework method with cultural insider-outsider coding. From these results, we developed a structured survey designed to test different aspects of traditional medicine use and administered it to a random sample of 655 adults from the community. The results were triangulated to explore converging and diverging themes.

Results

Most structured survey participants (68%) reported knowing someone who frequently used traditional medicines, and the majority (56%) reported using them themselves in the previous year. The most common uses were for symptomatic ailments (42%), chronic diseases (15%), reproductive problems (11%), and malaria/febrile illnesses (11%). We identified five major determinants for traditional medicine use in Northern Tanzania: biomedical healthcare delivery, credibility of traditional practices, strong cultural identities, individual health status, and disease understanding.

Conclusions

In order to better formulate effective local disease management programs that are sensitive to TM practices, we described the determinants of TM use. Additionally, we found TM use to be high in Northern Tanzania and that its use is not limited to lower-income areas or rural settings. After symptomatic ailments, chronic diseases were reported as the most common reason for TM use which may be particularly important in Northern Tanzania where non-communicable diseases are a rapidly growing burden.     

Use of indigenous ecological knowledge of the Maasai pastoralists for assessing rangeland biodiversity in Tanzania

This paper incorporates the indigenous ecological knowledge (IEK) of the Maasai pastoralists and ecological methods to assess effects of grazing and cropping on rangeland biodiversity at macro‐ and micro‐landscape scales in northern Tanzania. The joint surveys with pastoralists identified indicator plant species and their associations with micro‐landscapes and livestock grazing suitability (i.e. for cattle and small ruminant grazing), while traditional calf‐pasture reserves (alalili pl. alalilia) were evaluated for preservation of rangeland biodiversity. The macro‐landscapes comprising the cool high plateau (osupuko pl. isipuki) and montane forest highland (endim) were included in the survey. At micro‐landscape scales, the osupuko was classified into uplands (orkung'u), slopes (andamata) and dry valley bottomlands (ayarata). The micro‐landscapes were assessed in terms of herbaceous plant species and woody species richness and risks of soil erosion. Biodiversity varied at both the macro‐ and micro‐landscape scales and in accordance with the land‐use types. Greater plant species diversity and less erosion risks were found in the pastoral landscapes than in the agro‐pastoral landscapes. The calf‐grazing pastures had greater herbaceous species richness than the non‐calf pastures, which in turn had more woody species. The study concludes that the indigenous systems of landscape classification provides a valuable basis for assessing rangeland biodiversity, which ecologists should incorporate into ecological surveys of the rangelands in East Africa in the future.     

The Representation of African Pastoralists: A Commentary

The Seattle Art Museum has been fortunate to have received major collections of African, Asian, and Northwest Coast Native American art, which now make up the bulk of its permanent collection. The display of this “other” art poses problems for curators who wish to eschew what they term an anthropological presentation yet provide context for the viewer. For the recent exhibition of “Art from Africa: Long Steps Never Broke a Back,” the museum invited several artists, performers and scholars, all of whom were members of the cultures whose art was on display, to add their curatorial voices to the presentation. The central premise was to create an immersion experience of African art for the visitor, as defined by indigenous voices. Those voices came through an audio tour compiled from interview tapes with no added narration, and lengthy interviews on computer monitors. Some objects could be recognized through performance videos played as wall-sized projections. None of the artworks was identified by individual labels. During the exhibition, visitors were asked to complete comment questionnaires. Although many had positive things to say about the image of Africa gained through the exhibition, others expressed dismay at what they saw as negative stereotypes. The severest criticism came from Africans who had not been part of the advisory team. This article analyzes the responses, and questions the way in which one's personal image of Africa, whether one is curator or visitor, acts as mediator of experiences gained from an exhibition.     

Recurrence of Preeclampsia in Northern Tanzania: A Registry-Based Cohort Study

Objective

Preeclampsia occurs in about 4 per cent of pregnancies worldwide, and may have particularly serious consequences for women in Africa. Studies in western countries have shown that women with preeclampsia in one pregnancy have a substantially increased risk of preeclampsia in subsequent pregnancies. We estimate the recurrence risks of preeclampsia in data from Northern Tanzania.

Methods

A prospective cohort study was designed using 19,811 women who delivered singleton infants at a hospital in Northern Tanzania between 2000and2008. A total of 3,909 women were recorded with subsequent deliveries in the hospital with follow up through 2010. Adjusted recurrence risks of preeclampsia were computed using regression models.

Results

The absolute recurrence risk of preeclampsia was25%, which was 9.2-fold (95% CI: 6.4 - 13.2) compared with the risk for women without prior preeclampsia. When there were signs that the preeclampsia in a previous pregnancy had been serious either because the baby was delivered preterm or had died in the perinatal period, the recurrence risk of preeclampsia was even higher. Women who had preeclampsia had increased risk of a series of adverse pregnancy outcomes in future pregnancies. These include perinatal death (RR= 4.3), a baby with low birth weight (RR= 3.5), or a preterm birth (RR= 2.5). These risks were only partly explained by recurrence of preeclampsia.

Conclusions

Preeclampsia in one pregnancy is a strong predictor for preeclampsia and other adverse pregnancy outcomes in subsequent pregnancies in Tanzania. Women with previous preeclampsia may benefit from close follow-up during their pregnancies.     

From Mukogodo to Maasai: Ethnicity and Cultural Change in Kenya

From Mukogodo to Maasai: Ethnicity and Cultural Change in Kenya . Lee Cronk. Cambridge, MA: Westview Press, 2004. 172 pp.     

The Church of Women: Gendered Encounters between Maasai and Missionaries

The Church of Women: Gendered Encounters between Maasai and Missionaries . Dorothy L. Hodgson. Bloomington: Indiana University Press, 2005.     

Etiology of Severe Non-malaria Febrile Illness in Northern Tanzania: A Prospective Cohort Study

Introduction

The syndrome of fever is a commonly presenting complaint among persons seeking healthcare in low-resource areas, yet the public health community has not approached fever in a comprehensive manner. In many areas, malaria is over-diagnosed, and patients without malaria have poor outcomes.

Methods and Findings

We prospectively studied a cohort of 870 pediatric and adult febrile admissions to two hospitals in northern Tanzania over the period of one year using conventional standard diagnostic tests to establish fever etiology. Malaria was the clinical diagnosis for 528 (60.7%), but was the actual cause of fever in only 14 (1.6%). By contrast, bacterial, mycobacterial, and fungal bloodstream infections accounted for 85 (9.8%), 14 (1.6%), and 25 (2.9%) febrile admissions, respectively. Acute bacterial zoonoses were identified among 118 (26.2%) of febrile admissions; 16 (13.6%) had brucellosis, 40 (33.9%) leptospirosis, 24 (20.3%) had Q fever, 36 (30.5%) had spotted fever group rickettsioses, and 2 (1.8%) had typhus group rickettsioses. In addition, 55 (7.9%) participants had a confirmed acute arbovirus infection, all due to chikungunya. No patient had a bacterial zoonosis or an arbovirus infection included in the admission differential diagnosis.

Conclusions

Malaria was uncommon and over-diagnosed, whereas invasive infections were underappreciated. Bacterial zoonoses and arbovirus infections were highly prevalent yet overlooked. An integrated approach to the syndrome of fever in resource-limited areas is needed to improve patient outcomes and to rationally target disease control efforts.     

A Plague of Paradoxes: AIDS, Culture, and Demography in Northern Tanzania

. Plague of Paradoxes: AIDS, Culture, and Demography in Northern Tanzania. Philip W. Setel. Chicago: University of Chicago Press, 1999.308 pp.     

Prion protein (PrP) gene polymorphism in Red Maasai and Black Head Persian sheep breeds in Tanzania: Consistent profile regardless of locations

The status of scrapie in Africa is largely unknown. The susceptibility to scrapie and its pathology is determined by amino acid polymorphisms at positions 136 (A/V), 154 (R/H) and 171 (Q/R/H) of the ovine PrP gene (PrP genotype) of the animals. Despite the widely studied PrP gene polymorphisms worldwide, limited data is available on PrP genotypes of sheep from the African continent. Previously, we have reported six PrP genotypes derived from four different alleles in Red Maasai and Black Herd Persian (BHP), the ARQ/ARQ genotype being more frequent in the Red Maasai than in the BHP sheep. The highly susceptible VRQ allele was not found in any of the sheep breeds; the ARR allele was absent in the Red Maasai or occurred at a low frequency in the BHP. The lack of the highly susceptible VRQ alleles among Tanzanian sheep examined, necessitated further examinations on genetic susceptibility in sheep of the same breeds, but originating from an entirely different part of Tanzania. Consistently, ARQ/ARQ genotype was observed in 88% of Red Maasai and 64% of BHP sheep, ARQ/AHQ genotype was present in 12% in Red Maasai and 36% in BHP. Neither the highly resistant (ARR/ARR), nor the highly susceptible (VRQ/VRQ) genotypes were found. The ARQ and AHQ were the only alleles observed. The ARQ allele constituted 94%, 82% and 67% in the Red Maasai, BHP and cross-bred sheep, respectively. The AHQ constituted 6%, 18% and 33%, respectively. Data reported here, provide additional information on genetic susceptibility of the Red Maasai, BHP and their crosses; they may be helpful in policy formulation for future prevention of scrapie.     

Spatial Clustering of Porcine Cysticercosis in Mbulu District,Northern Tanzania

Background

Porcine cysticercosis is caused by a zoonotic tapeworm, Taenia solium, which causes serious disease syndromes in human. Effective control of the parasite requires knowledge on the burden and pattern of the infections in order to properly direct limited resources. The objective of this study was to establish the spatial distribution of porcine cysticercosis in Mbulu district, northern Tanzania, to guide control strategies.

Methodology/Principal Findings

This study is a secondary analysis of data collected during the baseline and follow-up periods of a randomized community trial aiming at reducing the incidence rate of porcine cysticercosis through an educational program. At baseline, 784 randomly selected pig-keeping households located in 42 villages in 14 wards were included. Lingual examination of indigenous pigs aged 2–12 (median 8) months, one randomly selected from each household, were conducted. Data from the control group of the randomized trial that included 21 of the 42 villages were used for the incidence study. A total of 295 pig-keeping households were provided with sentinel pigs (one each) and reassessed for cysticercosis incidence once or twice for 2–9 (median 4) months using lingual examination and antigen ELISA. Prevalence of porcine cysticercosis was computed in Epi Info 3.5. The prevalence and incidence of porcine cysticercosis were mapped at household level using ArcView 3.2. K functions were computed in R software to assess general clustering of porcine cysticercosis. Spatial scan statistics were computed in SatScan to identify local clusters of the infection. The overall prevalence of porcine cysticercosis was 7.3% (95% CI: 5.6, 9.4; n = 784). The K functions revealed a significant overall clustering of porcine cysticercosis incidence for all distances between 600 m and 5 km from a randomly chosen case household based on Ag-ELISA. Lingual examination revealed clustering from 650 m to 6 km and between 7.5 and 10 km. The prevalence study did not reveal any significant clustering by this method. Spatial scan statistics found one significant cluster of porcine cysticercosis prevalence (P = 0.0036; n = 370). In addition, the analysis found one large cluster of porcine cysticercosis incidence based on Ag-ELISA (P = 0.0010; n = 236) and two relatively small clusters of incidence based on lingual examination (P = 0.0012 and P = 0.0026; n = 241). These clusters had similar spatial location and included six wards, four of which were identified as high risk areas of porcine cysticercosis.

Conclusion/Significance

This study has identified local clusters of porcine cysticercosis in Mbulu district, northern Tanzania, where limited resources for control of T. solium could be directed. Further studies are needed to establish causes of clustering to institute appropriate interventions.     

The Epidemiology of Alcohol Use and Alcohol Use Disorders among Young People in Northern Tanzania

IntroductionAlcohol use is a global public health problem, including as a risk factor for HIV infection, but few data are available on the epidemiology of alcohol use and alcohol use disorders (AUD) among young people in sub-Saharan Africa.MethodsWe conducted a cross-sectional survey among 4 groups of young people aged 15–24 years old (secondary school students, college/university students, employees of local industries and casual labourers) in two regions (Kilimanjaro and Mwanza) of northern Tanzania. Using a multistage stratified random sampling strategy, we collected information on demographics, alcohol use, and behavioural factors. We screened severity of alcohol use using the Alcohol Use Disorder Identification Test (AUDIT) and estimated the quantity and frequency of alcohol consumption using the timeline-follow-back-calendar (TLFB) method.ResultsA total of 1954 young people were surveyed. The prevalence of reported alcohol use was higher among males (47–70% ever users and 20–45% current users) than females (24–54% ever users and 12–47% current users). Prevalence of use was substantially higher in Kilimanjaro than Mwanza region. In both regions, participants reported high exposure to alcohol advertisements, and wide alcohol availability. College students reported the highest prevalence of current alcohol use (45% among males; 26% among females) and of heavy episodic drinking (71% among males; 27% among females) followed by casual labourers. Males were more likely to have AUD (an AUDIT score ≥8) than females, with 11–28% of males screening positive for AUD. Alcohol use was associated with male gender, being in a relationship, greater disposable income, non-Muslim religion and a higher number of sexual partners.ConclusionsAlcohol use is a significant problem among young people in northern Tanzania. There is an urgent need to develop, pilot and deliver interventions to help young people delay initiation and reduce levels of harmful drinking, particularly among college students and casual labourers.     

The influence of cultural framing on play in the trust game: a Maasai example

The effects of cultural framing on behavior in experimental games were explored with a trust game and the Maasai concept of osotua. Maasai use the term osotua to refer to gift-giving relationships based on obligation, need, respect, and restraint. In the trust game, the first player is given money and an opportunity to give any portion of it to the second player. The amount given is then multiplied by the experimenter, and the second player has an opportunity to give any amount back to the first player. Fifty trust games were played by Maasai men at a field site in north central Kenya. Half of the games were played without deliberate framing, and half were framed with the statement, “This is an osotua game.” Compared to games with no deliberate framing, those played within the osotua rhetorical frame were associated with lower transfers by both players and with lower expected returns on the part of the first players. Osotua rhetorical framing is also associated with a negative correlation between amounts given by the first player and amounts returned by the second. These results have implications both for the experimental game method and for our understanding of the relationship between culture and behavior.