These are sachets of PUR used to treat water and make the water highly purified. One sachet of PUR can treat 10 liters of water. It is affordable, effective and safe to be used by all categories of peoples. Tujikomboe Group distribute each sachet at Tshs: 250/= Press your order now.

A 10 liters water can with a flock at the bottom after application of PUR which treat and at the same time purify drinking water. One sachet of 4gm of PUR can treat 10 liters of water.

A cross section of participants who attended a National Workshop on Universal Birth Registration organized by Tujikomboe Group with support from Firelight Foundation at Land Mark Hotel-Dar es Salaam

Organization Advisor for Tujikomboe Group Mr. Shamsi Mhina was trained as National Facilitators on Home Based Life Saving Skills(HBLSS) by the International Facilitators from American Collage of Nurse Midwives(ACNM)

After received a project report on community mobile registration; the depute minister was in a happy mood with Organization Advisor for Tujikomboe Group

Group photo: Depute Minister for Community Development Gender and Children(Ms. Ummy Mwalimu0 and Tujikomboe Group staffs at Tujikomboe Group sub-office located at Jamaa Road Tanga

The most significant changes contributed by Tujikomboe Group in the lives of vulnerable children and families in Kilosa and Muheza Districts manifested at both local and national levels; where the government through its birth registration agency-RITA adopted the National Birth Registration Strategy for under five year’s children. This achievement is the results of Tujikomboe Group national advocacies conducted through workshop, meeting and media that requires changing of birth registration system and procedures toward holistic and free birth registration to all children in Tanzania. The fact that RITA accepted the proposed amendments of birth registration system and procedures is a real significant change that will pose positive effects not only to children residing in Muheza and Kilosa Districts; but also children all over Mainland Tanzania. The under Five National Birth Registration Strategy (<5NBRS) outlines the key operational interventions and activities that are deemed necessary for the realization of the <5NBRS. The <5NBR system implemented by piloting three options for one year in nine regions. The best practices will be adopted and rolled-out countrywide as an established national birth registration system. Under option one, the current system of using the health system infrastructure will be maintained but the registration process will be linked to the child immunization program at health facilities. Under option two, the Streets and Village Executive officers will undertake the registration process while under option three a hybrid of option one and option two will be tried out. In all the three options, form B1 will be replaced with issuance of a free hand-written birth certificate. The entire birth registration system will be decentralized to the Local Government Authorities (LGA) in keeping with the LGA reforms which entails among others, services decentralization. Printed Birth Certificates will be issued at the LGAs or RITA. Not only that; under this <5NBRS; “Automatic Data Capturing System” will replace manual data recording. Optical Marker Recognition (OMR) or Optical Character Recognition (OCR) technology will be used for scanning the hand-filled registration forms from all the registration points at the LGAs.

Tujikomboe Group realized that; it will take years for Tanzania to reach all villages and urban areas with clean and safe water. At the same time, the proportional of <5 years children and pregnant women who dies as a results of water bone diseases is on the increase. Boiling of water is still for those who are educated and have money. Although, it is not surprise to see primary school teacher who is educated not boiling drinking water; meaning that; hygiene and sanitation education is essential and can not be supplemented by formal standardized education classes of a person. While the cost of boiling water is significantly higher( One tin of charcoal costing Tanzanian shilling- Tshs: 1,000/= equal to USD $ 0.6); while the cost of treating water using the PUR- Purifier of water is four times less( that is Two Hundred and Fifty Tanzania Shillings-Tshs: 200/= equal to USD $ 0.12) for the purchase of one packet of PUR. Conduct social marketing of PUR-a purifier of water in rural and semi-urban areas is the best strategy in promotion of household water treatment. The aim is to reduce water bone diseases at the family and community level. PUR has been tested and found to neutralize all harmful minerals found in water such as lead. This kind of mineral (lead) which found in many water sources; if not well treated to the neutrality level can cause kidney and liver disorder of a person. Tujikomboe Group conduct promotion campaigns with loudspeakers to reach each village in Tanga District and in Kilosa District. Village meetings are done in order to explore local practice and coping mechanisms in treating their drinking water. Several probing questions are asked to the villagers such as (1) how many people per ward boiling drinking water? (2) How many people using water guard or shub to treat and purify water? (3)   Is there any existing local technology of treating and purify water? (4) How many people reported at health facilities to have diarrhea in the past four days (5) how many people reported at health facilities to have typhoid in the past three months? (6) How many people reported at health facilities to have cholera in the past three months? (7) how many people reported at health facilities to have urinary transmission infections (UTIs) in the past three months?

However; introduction of a new brand of purifier of water knows as PUR to villagers is done simultaneously with the water treatment and hygiene survey at each ward. Demonstration testing is done by Tujikomboe Group staff in the presence of villagers. By follow instructions elucidated in each PUR-PURE packet, villagers see all the dusts and mud (flock) settle down leaving clean treated water. The facilitator then filters the water using clean cotton cloth, after that water is ready to drink. It should be noted that; in many villages, water sources is not protected nor treated, the use of open traditional shallow well is predominant. It is advised to use PUR to treat hand washing water and drinking water in schools and at the community. Therefore, introduction of PUR (see photo below) is a glorious move of Tujikomboe Group to end water bone diseases prevailing at the villages and sub urban areas.

Description of PUR-Purifier of water

PUR –Purifier of water is manufactured by P & G Procter & Gamble; B-233/234, H.I.T.E, Hub, Baluchistan-Pakistan. PUR is the trade mark of The Procter and Gamble Company. The product is packet in carton. Each carton contains 240 packets of 4gms (0.14 oz). Each packet treats 10 liters of water equal to 2.5 gallons. The manufacturer of PUR has a website of www.PurPurifierOfWater.com. PUR has EPA reg. No. 3573-90 and EPA Est. No. 3573-PAK-001. In Tanzania PUR is imported by Segerea Pharmacy located in Segerea area-Dar es Salaam. The Chief Government Chemist and the National Bureau of Standard have approved PUR to be used by all categories of people with no side effects. These laboratory tests also describe the effectiveness of PUR in fighting E. coli virus and other harmful pathogens. PUR is more efficient than the traditional water purifiers because, it treats and at the same times purifies the water to the highest standard. PUR does not causing smell to the treated water. Many water sources in Tanzania contain harmful minerals such as lead which cause kidney and liver disorders. By treat such water with PUR all lead will be neutralized to harmless. Not only that; PUR can purify fluorinated water to non hazardous level. The market price of one packet of PUR as promoted by Tujikomboe Group is Tshs: 200/= meaning that one carton of 240 packets is Tshs: 48,000/=.

Celebrating World Women Day; Get understand of women and bay problems

Half a million women die from complications related to pregnancy and childbirth each year, with 99% of these deaths occurring in developing countries (Hill et al. 2007; WHO, 2008). The major direct obstetric causes of maternal death include hemorrhages (25%), pre-eclampsia/eclampsia (8%), sepsis (15%), prolonged/obstructed labor (12%), and complications of abortion (13%) (Khan et al 2006). Millennium Development Goal 5 (MDG5) aims to reduce maternal mortality by 75% worldwide by 2015. Unfortunately, maternal mortality has decreased by less than 1% per year from 1990 to 2005, lagging far behind the target (United Nations, 2007). In addition, each year, 15 million women suffer severe or long-lasting complications related to pregnancy including: (1) infertility, (2) depression, (3) debt resulting from medical fees, (4) increased violence related to marital disharmony, and (5) obstetric fistula (Hindin, 2007).

Neonatal mortality is also a global health problem with four million babies dying and another 3.3 million stillbirths each year. Neonatal mortality rates are highest in Africa and South Central Asia at 41 and 43 per 1000 live births, respectively. Causes of neonatal and perinatal deaths include: (1) poor maternal health, (2) inadequate care in pregnancy, (3) mismanagement of pregnancy and birth complications, (4) poor hygiene practices during childbirth and after, and (5) lack of newborn care. Neonatal mortality accounts for 40% of under-five mortality and is thus essential to address to achieve MDG4 of reducing child mortality by two-thirds by 2015 (WHO, 2006).

MATERNAL AND CHILD HEALTH INDICATORS IN TANZANIA & TANGA

Neonatal, Infant and Under Five Mortality Rate

Neonatal mortality measures the probability of dying in the first month of life, while Infant mortality is the probability of dying before the first birthday and Under-five mortality provide probability of dying before the fifth birthday. These indicators reflect a country’s level of socio-economic development and quality of life. Analyzing these three indicators it can potentially predict the overall performance of the health sector. The rise or decline of these indicators is attributed to various social economic factors. Preliminary results from TDHS 2009/10 shows significant decline of child mortality in Tanzania specifically infant (IMR= 51/10,000) and Under Five Mortality Rate (U5MR= 81/10,000). However, high neonatal deaths remain a significant challenge, accounting for 32% of all under five deaths in Tanzania. In Tanga Region, infant mortality reported to be 96/10,000 live births while under five mortality were 140/10,000 births.

Maternal Mortality Ratio

Maternal mortality ratio is measured periodically through Tanzania Demographic and Health Surveys (TDHS). The latest estimate from TDHS 2004/05, estimated Maternal Mortality Ratio (MMR) at 578 maternal deaths per 100,000 live births. Preliminary results from TDHS of 2009/10 shows MMR has declined to 454 deaths per 100,000 live births. This is a notable improvement but relatively the maternal deaths are still high requiring more effort to attain MDG goal which is 265 per 1000,000 live births. Also, the same goal is used for the MKUKUTA target. The new estimates concede with the general trend observed from facility data which provide proxy estimates. It is categorized as a proxy indicator because it is only portion of all deaths which occurs at health facilities. Hence, the value reported is understated compared with community based information. However, in Tanga Region; Maternal Mortality ratio measured was 286/100,000 as reported in the year 2005 at health facilities and Traditional Birth Attendants.

Proportion of births attended in health facility in Tanzania and Tanga Region

This indicator measures the number of deliveries conducted in health facilities as the percent of the projected number of births. Basing on the 2009 HMIS/ Reproductive and Child Health (RCH) data, on average, 54% of deliveries in Tanzania were attended in health facilities. The 2009 data implies that health facility deliveries increased from 51% and 52% in 2007 and 2008, respectively. The 2005 TDHS results revealed that 37.5% of expected births took place in government facilities; 3.1% in non-profit facilities and 6.4% in private-for-profit facilities (making 47% overall). Recent TDHS 2009/10 preliminary result shows the proportion of births attended by trained personnel in health facility is 50.6% and 50.2% delivered in a health facility. In Tanga Region particular, in the year 2009, there were 65,939 total live births; where those delivered at health facilities were 38,397 and therefore, the percentage of delivery in health facility was only 58.2 percent. The general conclusion is that Compared with the 2015 HSPSIII target of 80%, this entail more effort is required to achieve 2015 HSSP III target.

PAST EXPERIENCE IN REDUCING MATERNAL AND CHILD MORTALITY IN TANGA:

The Case of Traditional Birth Attendants (TBAs) Supported by JICA in Tanga Region.

Reports shown that, 54.3 percent of all registered births in Tanga Region happened either in the health facility or under administration of the Tradition Birth Attendants (TBA) during the year 2006. A total of 227 trained traditional birth attendants (TBAs) were trained by JICA in order to enable them provide safer delivery service using sterilized delivery kits. MCH in Tanga Region, cost recovery for delivery was introduced, and 85 percent of the community women desired assistance from TBAs who were trained by JICA. Thus, it was expected that the activities of TBAs could ensure safer delivery if the TBA kits (hygienic and safer delivery kits, among which the consumable items are paid for by the beneficiaries) in trial use were permanently established. However, the current Tanzania Health Policy requires all births to be done at dispensaries, health centers or hospitals. Home delivery by use of TBAs is not that much promoted. When emergency home delivery occurs, it is really an emergency and not planned action; such delivery will reflect the real concept and application of Home Based Life Saving Skills (HBLSS) as proposed in project. In another scenario, the Government of Tanzania through Ministry of Health and Social Welfare provide free delivery kit for every pregnant mother; meaning that; pregnant mothers have been restricted to bring delivery kit to health facilities, all delivery kit are supposed to be provided to the health facilities.

TAKE ACTION TO PREVENT MATERNAL AND CHILD MORTALITY IN TANGA REGION: LINKING HOME-COMMUNITY AND HEALTH FACILITY THROUGH HOME BASED LIFE SAVING SKILLS (HBLSS) TRAININGS.

TUJIKOMBOE GROUP is inviting partners and donors to work together in by conducting Home Based Life Saving Skills (HBLSS) trainings in Tanga Region; in order to build capacity of District Home Based Life Saving Skills Facilitators (D-HBLSS Facilitators-who shall be Medical Officers, Registered Nurses and Nurse Midwives from Bombo Regional Hospital, District Hospitals and Health Centers); so that after been trained, they will be able to conduct HBLSS trainings to Dispensary workers and community health workers to the extent that will enable localization of HBLSS training down to the family level with the aim of reducing maternal and child mortality in Tanga region.

It has been found that; both maternal and neonatal mortality can be improved with the use of skilled delivery care; utilization of a skilled birth attendant is therefore a critical intervention to achieve MDG4 and 5. However, in the least developed countries, only 35% of births were attended by trained providers (WHO, 2007), making it essential to develop and test programs that focus on evidence- based interventions including a continuum of care, skilled attendance at birth and access to emergency obstetric care (Maine and Rosenfield, 1999; Freedman et al., 2005; Rosenfield et al., 2006). The provision of successful emergency obstetric care is dependent on the reduction of five major delays including: (1) delay in recognizing the problem, (2) delay in receiving emergency first aid, (3) delay in deciding to seek care at the onset of the emergency, (4) delay in seeking timely care, and (5) delay in getting quality, appropriate and effective care (Thaddeus and Maine, 1994; Miller et al., 2006). The first four delays occur at the household or community level, highlighting the importance of home and community-based interventions.

Home-based life saving skills (HBLSS), has been developed by the American College of Nurse Midwives (ACNM) Department of Global Outreach (Buffington etal. 2004), is a community-based, family-centered program developed with the aim of reducing maternal and newborn deaths. Objectives of the HBLSS program include :( 1) decreasing delays in recognition and response to major complications,(2) increasing access to emergency maternal and neonatal care, and(3)encouraging timely, appropriate emergency referral where referral is possible. HBLSS tend to increases access to basic life-saving care with the home and community. Home-Based Life Saving Skills (HBLSS) represent a critical rethinking of conventional community-based approaches in several ways, such that: take into account the social context of childbirth, focusing on the pregnant women, her family caregivers and the home birth attendant as a team: addressing the challenges of responding to unpredictable life-threatening complications, this includes problems recognitions, first aid care, referral decision-making and knowing where to get help. HBLLS also enhanced family and community to negotiate safe, feasible, acceptable actions that will be take in the home setting when life-threatening complications occurs.

HBLSS is a skills-based program designed for low or non- literate participants. Knowledge is disseminated through a training cascade starting with HBLSS District Trainers, HBLSS guides/Dispensary workers and finally family and community members. Emphasis is placed on respectful consideration of local knowledge; a key component is negotiation to come to agreement on actions to take during an obstetric or neonatal emergency. A variety of teaching strategies are utilized to promote the transfer of knowledge including: (1) skills checklists, (2) story-telling, (3) role-playing, and (4) ‘Take Action Cards’ (TAC). TAC is pictorial representations of a particular problem on one side with six small pictures of actions to take in response to the problem on the other side. Family and community members receive TAC following the HBLSS meetings.

HBLSS TOPICS TO BE COVERED

There are five topics of Home Based Life Saving Skills

1. Introduction(History of HBLSS, Its training cascade, Situation analysis of maternal and neonatal mortality in Tanzania and in the project area)
2. Basics information on women and babies(problems)
3. Prevent women and babies problems
4. Referrals: Women referral and Baby referral
5. Strengthening HBLSS training to community and family level and follow up strategy

 Previous Experience of Tujikomboe Group on works related to reduction of maternal and neonatal deaths in Tanzania.

Tujikomboe Group represented by its Founder & Organization Advisor-Mr. Shamsi Mhina; has been contracted by Plan International to train Medical Officers, Midwives Nurses and Registered Nurses in Kisarawe District-Coast Region and Ilemela District-Mwanza Region. This was done by training District-TOTs on Home-Based Life Saving Skills (HBLSS), who then trained Dispensary workers and Community Health Workers (CHW) on skills necessary to reduce maternal and neonatal deaths. Objectives of the HBLSS program include :( 1) decreasing delays in recognition and response to major complications,(2) increasing access to emergency maternal and neonatal care, and(3)encouraging timely, appropriate emergency referral where referral is possible. HBLSS tend to increases access to basic life-saving care with the home and community. HBLLS also enhanced family and community to negotiate safe, feasible, acceptable actions that will be take in the home setting when life-threatening complications occurs.

NOTE: TUJIKOMBOE GROUP IS A MEMBER OF WHITE RIBBON ALLIENCE FOR SAFE MOTHERHOOD.

WELL COME; JOIN OUR EFFORTS AND CONTRIBUTE TO THE STRATEGIC PROGRAM OF HBLSS THAT WILL ENHANCE TANZANIA TO REDUCE MATERNAL AND CHILD MORTALITY. CALL US 0754-677893 & 0718-603705: E-mail: mfusi@yahoo.com

Founder & Organization Advisor for Tujikomboe Group-Mr. Shamsi Mhina working at Tujikomboe Group Office.