A Case Study of Dar es Salaam City_ Tanzania by yaohongm

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       A Case Study of Dar es Salaam City, Tanzania



                           Joyce KINABO




          Paper prepared for the FAO technical workshop on
“Globalization of food systems: impacts on food security and nutrition”




                   8-10 October 2003, Rome, Italy
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Information on the Authors:

Joyce Kinabo
Sokoine University of Agriculture, Department of Food Science and Technology, PO Box
3006,
Morogoro, Tanzania




Disclaimer: Ideas expressed in the paper are those of the author(s). Mention of any firm or licensed
process does not imply endorsement by FAO. The designations employed and the presentation of
material do not imply the expression of any opinion on the part of FAO concerning the legal status
of any country, territory, city or area or of its authorities, or concerning the delimitation of its
frontiers or boundaries.




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Table of Contents

1.       INTRODUCTION .......................................................................................................................................................1
     1.1          BACKGROUND.......................................................................................................................................................1
     1.2          LOCATION AND GEOGRAPHICAL AREA ..............................................................................................................1
     1.3          ECONOMY..............................................................................................................................................................2
     1.4          POPULATION CHARACTERI STICS ........................................................................................................................2
     1.5          PEOPLE...................................................................................................................................................................2
     1.6          DAR ES SALAAM CITY.........................................................................................................................................2
     1.7          LIVELIHOOD..........................................................................................................................................................3
     1.8          LIVING CONDITIONS.............................................................................................................................................4
     1.9          TRENDS IN URBANISATION IN TANZANIA .........................................................................................................4
     1.10         INDICATORS OF GLOBALISATION........................................................................................................................5
     1.11         COMMUNICATIONS...............................................................................................................................................5
     1.12         TRANSPORTATION................................................................................................................................................7
     1.13         BANKING ...............................................................................................................................................................7
2.       ROLE OF GLOBALISATION AND URBANISATION ON DIETARY CHANGE................................7
     2.1          GLOBALISATION AND DIETARY PATTERN.........................................................................................................7
     2.2          EVOLUTION OF URBAN FOOD SUPPLY................................................................................................................8
     2.3          CURRENT ROLE OF IMPORTED FOODS AND ROLE OF TRADITIONAL FOODS..................................................9
     2.4          IMPORTANCE OF STREET FOODS AND EMERGENCE OF SUPERMARKETS AND FAST FOOD CHAINS ............9
        2.4.1       Street foods......................................................................................................................................................9
        2.4.2       Supermarkets................................................................................................................................................ 10
        2.4.3       Fast food chains.......................................................................................................................................... 11
3.       IMPACT OF GLOBALISATION ON LIFESTYLE IN URBAN AREAS ............................................... 11
     3.1          SEDENTARY WORK AND LEISURE .....................................................................................................................11
     3.1          TRANSPORTATION SYSTEMS.............................................................................................................................12
     3.2          CRIME ..................................................................................................................................................................12
     3.3          SMOKING AND ALCOHOL CONSUMPTION ........................................................................................................12
        3.3.1        Alcohol consumption.................................................................................................................................. 12
        3.3.2        Smoking......................................................................................................................................................... 13
     3.4          A DVERTISING......................................................................................................................................................14
     3.5          CHANGING ROLE OF WOMEN AND IMPACT ON CHILDCARE AND FEEDING..................................................14
4.       PREVALENCE OF MALNUTRITION (OVER/UNDER/MICRONUTRIENT) IN URBAN AREAS
         15
     4.1      TRENDS FOR CHILDREN .....................................................................................................................................15
     4.2      TRENDS FOR ADULTS.........................................................................................................................................16
        4.2.1   Micronutrient deficiencies......................................................................................................................... 17
     4.3      EVIDENCE OF URBAN POVERTY........................................................................................................................17
5.       TRENDS IN HEALTH STATUS IN THE URBAN AREAS/ENVIRONMENT .................................... 18
     5.1          INFECTIOUS DISEASES – HIV/AIDS, TB.........................................................................................................18
     5.2          NON-COMMUNICABLE DISEASES (NCDS).......................................................................................................18
     5.3          HEALTH PROBLEMS IN SLUMS ..........................................................................................................................20
6.       PROGRAMMES THAT HAVE TRIED TO ADDRESS FOOD AND NUTRITION ISSUES ........... 20
     6.1      PROGRAMMES.....................................................................................................................................................20
        6.1.1    Reduction of economic inequalities......................................................................................................... 20
        6.1.2    Food security for all................................................................................................................................... 20
        6.1.3    Provision of social services....................................................................................................................... 20
     6.2      INTERVENTION PROGRAMMES TO CONTROL POOR NUTRIT ION....................................................................21
     6.3      SECTORS THAT NEED TO COME TOGETHER IN ORDER TO EFFECTIVELY ADDRESS THE PROBLEMS.........22
        6.3.1    Local Government Authorities at the level of individual, family and community............................ 22



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       6.3.2         At the level of the Ministry of health and Health research institutions............................................. 22
       6.3.3         At the level of sectors other than the health sector............................................................................... 22
       6.3.4         At the level of government, i.e. macroeconomic policies..................................................................... 22
7.     CONCLUSION .......................................................................................................................................................... 22
8.     REFERENCES .......................................................................................................................................................... 23




List of Tables

Table 1 Information and communication statistics of Tanzania ................................................6
Table 2: Food supply trend of fresh foods entering Dar es Salaam (Metric tons) .....................9
Table 3: Prevalence of some non-communicable diseases and their associated risks .............18



List of Figures

Figure 1: Map of Tanzania.........................................................................................................1
Figure 2: Dar es Salaam population change from 1967 to 2002................................................3
Figure 3: Dar es Salaam population pyramid 2001 ...................................................................3
Figure 4: Trends of urbanisation in Tanzania from 1975 to 2005 .............................................5
Figure 5: Annual per capita cigarette consumption in Tanzania (1970 –1999).......................14
Figure 6: Trend of nutritional status of children in Dar es Salaam..........................................15
Figure 7: Trends of nutritional status of infants in Dar es Salaam ..........................................16
Figure 8: Trends of common non-communicable diseases in Dar es Salaam over the past 5
     years. ................................................................................................................................19




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          A Case Study of Dar es Salaam City, Tanzania

                                     Joyce KINABO


1.     Introduction
1.1    Background
       Tanzania is a United Republic consisting of the former Tanganyika and the Islands of
Zanzibar and Pemba. Tanganyika was under British rule and became independent in 1961.
Shortly after Tanganyika’s independence and that of Zanzibar in 1963, the two countries
united to form Tanzania in 1964, and today Tanzania is a growing multiparty democracy
with over 35 million people.

1.2    Location and geographical area
        Tanzania is located in the Eastern African region between longitudes 290 and 410
East, latitude 10 and 120 South of the equator. Tanzania has frontiers with Kenya and Uganda
to the North, Rwanda, Burundi and the Democratic Republic of Congo to the West, Zambia,
Malawi, and Mozambique to the South and Indian Ocean to the East as shown on Figure 1.

Figure 1: Map of Tanzania




                                                 2
        Tanzania has a total area of 945,087 m , of which the area covered with water is
          2
59,050 km . The climate varies from tropical along the coast to temperate in the highlands.
Most of Tanzania lies above 200 metres above sea level. Mount Kilimanjaro rises to more
than 5,000 metres above sea level, the highest point in Africa.

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1.3    Economy
       Tanzania has a mixed economy in whic h Agriculture plays a dominant role.
Agriculture contributes the largest share to the gross domestic product (GDP). The GDP has
been increasing since early 1990s. It was 3.4 in 1991 and is currently 5.6. However, the
contribution to GDP from Agriculture has been declining from 48% in 1991 to 44.8% in
2002 (PHDR, 2002).

1.4    Population characteristics
        The population of Tanzania is 35 million people (2002 Census). About 33 % of the
population live in urban areas. The rate of urbanisation is 8% per annum. Popula tion
characteristics according to functional groups is as follows: 0 - 4 years of age 20.4%; 5 – 14
years 28.7%; youth 15 – 24 years 18.8%; 25 – 60 years 26% and the elderly population
(above 60 years) account for 6.1%. The proportion of the latter segment of the population is
increasing due to improved living conditions. The average life expectancy at birth is 45.8,
total fertility rate is 5.2, the infant mortality rate is 90 per 1000 live births; under five
mortality rate is 141 per 1000 live births, and maternal mortality rate 530/100,000.

        The population structure of Tanzania shows that the proportion of children below 14
years is more than 48%. The dependency ratio has increased from 98% in 1967 to 116% in
2002. This is indicative that the economic burden on persons in the reproductive age groups
has not changed significantly over the last 30 years.

1.5    People
        The ethnic groups in Tanzania include native African (99%) of which 95% are Bantu
consisting of more than 130 tribes. The remaining 1 percent consists of Asian, European, and
Arabic origin. In mainland Tanzania, religions include Christians (45%), Muslims (35%),
and indigenous beliefs 20%. In Zanzibar, 99% of the population are Muslims and 1%
belongs to other denominations.

1.6    Dar es Salaam City
       Dar es Salaam is located along the Indian Ocean coast and covers a total area of
139.3 km2 . Administratively, the city is divided into three municipalities; namely Kinondoni,
Temeke and Ilala.

         Dar es Salaam is the commercial city of the country; it is one of the fastest growing
cities in Africa. It has a population of 3,497,940 (census, 2002) with an inter-censual growth
rate of 4.3% (1988 – 2002). Dar es Salaam population (Figure 2) is fuelled partly by an
influx of unemployed youth from the rural areas looking for better opportunities in urban
areas. On average, 16% of the city population are migrants from other places in Tanzania
and have migrated within the last six years. Birth rate is estimated at 4.5% per annum.




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Figure 2: Dar es Salaam population change from 1967 to 2002




               4000000

               3500000

               3000000
  Population




               2500000

               2000000

               1500000

               1000000

                500000

                     0
                         1967     1978           1988      1992   2002
The Population figure for 1992 is based on estimates


Figure 3: Dar es Salaam population pyramid 2001




1.7              Livelihood
        The average income earner in Dar es Salaam is responsible for four people, this is a
significant burden given a low level of earnings. Most workers are self-employed rather than
wage earners. The majority of the poor are proprietors of small businesses and account for
20 to 40% depending on the area of the city. Petty traders or street vendors are 15 to 20%
and consists mainly of male youth between 20 and 29 years of age. Skilled workers account
for 20% of the labour force. Unskilled labourers are 10 to 30% (PHDR, 2002). Seasonal
fluctuations in incomes leave many households through out the city particularly vulnerable

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when food prices are high. However, the urban poor often maintain a link with their rural
background either in form of a plot or food remittances from time to time. This acts as a
coping strategy when the situation gets harsh.

1.8    Living conditions
        Problems facing the urban poor include rudimentary housing, unhealthy environment
and dilapidated physical infrastructure. Few families own houses in the dense areas of the
city, where rents can be high. Few homes have indoor bathrooms and instead they use
common pit latrines, which are poorly maintained. Hygiene practices are poor among the
urban residents particularly in densely populated areas. Garbage disposal is poor and what is
not collected is usually dumped on the street. The situation is likely to worsen as the city
becomes more congested.

         Public services have deteriorated and private services are emerging but tend to be far
less accessible to the poor because of high cost, and are frequently staffed by unqualified
personnel. Poor living conditions, (overcrowding, poor housing, poor health and water
facilities and services) leave the population more susceptible to diseases. Adequate health
care is becoming increasingly inaccessible to the poor due to budgetary reduction in health
services and introduction of cost sharing policies in the health sector. In addition, the urban
poor tend to have lower level of education than the middle-income urban people; they have
low level of awareness on how to make use of health care facilities. This leads to high
incidences of diseases especially in children. Child malnutrition is a severe problem and
about 40% of the children in Dar es Salaam are stunted (CARE 1998; IFPRI, 1999). High-
income groups, however, tend to have access to all the basic services and facilities. But they
suffer more from diseases of affluence.

1.9    Trends in urbanisation in Tanzania
       The proportion of people living in urban areas has increased from less than 10% in
1975 to 33% in 2003 (Figure 4). The trend in rural areas has been declining indicating that
migration is also contributing to urban population growth. Tanzania’s rapid urbanisation rate
is among the highest rates in the world. As a result, pressure is placed on the capacity of
urban services and on the growth of opportunities for gainful employment in and around the
urban centre. Currently, the urban labour force is 16.8% of the total labour force in the
country.




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Figure 4: Trends of urbanisation in Tanzania from 1975 to 2005

         100
          90                                                             urban
          80                                                             rural
          70
          60
         50
Percentage
          40
          30
          20
          10
           0
                1975    1980    1985     1990       1995   2000   2002     2005




1.10   Indicators of globalisation
         Globalisation is a complex process that involves political, economic and socio-
cultural changes across the globe (Lubbers & Koorevaar, 1999). It should be noted however,
that globalisation is not a completely new phenomenon. It has been there since the time of
exploration as people moved from one continent to another in search of land and
commodities. This is evidenced in change in European diets as a result of exploration
(Washington, 1996), as new foods were being introduced in Europe from all over the world.
At the end of the Second World War, the world was fragmented and divided into a number
of poorly integrated and non- integrated groups. Therefore, there were clear boundaries with
sovereign states and distinct national economies. Globalisation therefore is manifested in a
shift from a world of distinct national economies to a global economy in which production is
internationalised and financial capital flows freely and instantly between countries (Tobin,
2000; Stiglitz, 2000; Lubbers and Koorevaar, 1999).

        Features of globalisation include shift from distinct national economies to a global
economy, internationalised production through trans-national and worldwide companies,
free and instant financial capital flows between countries, multinational organisations and
companies with vast economic power over states and therefore state’s relative loss of control
and power to manage their national affairs. Improved telecommunications and development
of electronic communications network such as the Internet has helped to overcome the
barriers of physical distances. Indicators that are used to determine the influence of
globalisation include communication, transportation, banking system and electronics.
Essentially globalisation has to do with the evolution of humanity, communication and
science and technology development.

1.11   Communications
       Communication as used here includes telecommunication and electronic
communication and is related to information access. Accessibility to information in Africa is
low, one in every 5,000 people have access to information in electronic form (Raychudhuri,
1999). The situation is worse in rural areas where the necessary facilities for accessing the
information are lacking. Accessibility is increasing in urban areas but at a very slow rate and


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only for a small proportion of the population. On average, there are 142 radio sets per 1000
people and 23 televisions for 1000 people (UNESCO, 2002)

          In Tanzania, similar trend is observed. Immediately after independence and up to
early 1990s, Tanzania had one state owned telephone company, one radio station, no
television station in the mainland and one television station in Zanzibar. Table 1 shows some
statistics regarding communication in the country. It should be noted however, that most of
the facilities are located in urban areas. This is because of low development of
telecommunications infrastructure in rural areas and exorbitant telephone tariffs charged to
telephone subscribers.

Table 1 Information and communication statistics of Tanzania
Service                                       1990         1995         2000          2002

Telephone lines/1000                            3            3            5           5.3
Telephone lines in large cities/1000                                     23            35
Mobile phone/1000                              0             0            5             8
Internet users/1000                            0             0           115          120
Mobile lines operators                         0             0            0             4
Radio /1000                                   141           280          290          356
Television/1000                                0            17           20            23
Personal computers                             0                         2.8          >2.8
Television stations                            0             0            3             7
Radio stations                                 2             2            4            30
Internet service providers                     0             0            6            13
Internet cafes                                 0             0            0          1000+
Satellites                                     0             0            0             1

        The increasing trend in both the size and quality of services has been due to
investment by private companies in the sector. Trade liberalisation policies led to increase in
the number of private companies and service providers. These are concentrated mainly in
urban areas (towns and cities). This shortfall in rural areas is partly offset by greater use of
radio. At the current rate of 356 radios sets per 1000 people, the use of radios in Tanzania is
significantly above the average of 196 for sub-Saharan Africa.

        Despite huge improvement in terms of numbers of various facilities, the
infrastructure is still poorly developed. In addition, the cost of Internet remains a strong
deterrent to significant improvement in services. Although there is increased private sector
ISPs, service provision has not improved significantly. This is because service provision is
through the government phone company whose service is inadequate in terms of robustness,
low bandwidth, congestion and noisy lines. Consequently, some local service providers use
ISPs in the USA and Europe and this makes the service very expensive. Poorly developed
infrastructure (telecommunication and electricity) makes the service even more expensive. In
urban areas, accessibility to information is hampered due to frequent electricity interruptions.

        Information technology offers the opportunity to disseminate information to a wide
population and therefore influence peoples’ behaviours and practice. However, language
barrier preve nts many people from understanding what is beamed on the Internet.
Information available through ICT is mostly in English, which the majority of Tanzania

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(Africa) rural as well as urban communities cannot understand. In addition, there is lack of
local content in the Internet. In 1999, for example Africa generated only 0.4% of global
content. There is marked shortage of relevant materials in local languages on the Internet
that respond to the needs of users. In addition, the literacy and basic skills level of the
general population is low, therefore accessibility will also remain low. There is a clear link
between development of skills and gains on the technology (ICT). However, despite
tremendous gains on ICT, there exists social inequality on gender. Already disadvantaged in
access to education, credit and land, women are also marginalized in all areas of ICT.

1.12   Transportation
       The country has a total of 88,200 kilometres roads from feeder roads to highways. Of
these 3,704 are paved with tarmac and 84,496 are unpaved. Only 12% of the roads are
passable throughout the year. The rest are only passable during the dry season and partly
impassable during the rain season. This has a significant influence on the movement of
people and commodities from one area to ano ther. There are 3,569 km of railway lines
running between Dar es Salaam and Kigoma, Dar es Salaam and Moshi and Dar es Salaam
and Zambia. In addition, the country has 12 ports and 126 airports and airstrips.

1.13   Banking
        Before 1991, the financial sector comprised only 6 state owned banks namely
National Bank of Commerce (NBC), Cooperative and Rural Development Bank (CRDB),
Tanzania Investment bank (TIB), Tanzania Housing bank (THB), the Bank of Tanzania
(BOT) and the Peoples Bank of Zanzibar (PBZ). Insurance companies comprised one giant
government insurance company, the National Insurance Corporation (NIC), and three
government owned pension funds, Parastatal Pension fund (PPF), National Social Security
Fund (NSSF) and Public Service Pension Fund (PSPF). In 1991, parliament passed a new
financial institution and banking act, which allowed for the establishment of private
commercial banks, financial institutions and foreign bureaus.

        Liberalisation of the banking sector removed monopoly of the state-owned banks and
financial institutions by allowing participation of the private sector through privatisation and
or establishment of new ones, thus creating competitiveness and hence efficiency in banking
activities. Formation of the Dar es Salaam Stock Exchange (DSE) paved the way for
increased role of private sector in production as well as mobilisation and utilisation of
domestic resources. Foreign banks led by Barclays, Standard Chartered, South Africa
(ABSA and Stanbic) and Citibank now account for a third of the market. Currently, there are
21 commercial banks and 12 financial institutions.


2.     Role of globalisation and urbanisation on dietary change
2.1            Globalisation and dietary pattern
       Globalisation is influencing food habits and dietary patterns in many parts of Africa
(and the world in general) especially in urban areas. Globalisation has increased free
movement of processed foods and other commodities such as soft drinks biscuits, cakes,
sweets and chocolates and ready to eat foods. These have become readily available in the
market and consumption of these foods has increased significantly in urban areas of Africa.
The dietary intake pattern is now changing rapidly from a traditional diet of high
carbohydrate, high fibre to one containing many manufactured, processed and non-

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traditional foods. This trend is accelerated by the increased rate of urbanisation. Currently,
the rate of urbanisation is estimated to be about 8% per annum (World Population Report,
1999). It is estimated to reach about 15% by the year 2015 (United Nations DELSA, 1995).
Increased urbanisation and changing food habits and lifestyle have created additional burden
of nutrition problems in Africa. For example, in 1930 there was no incidence of diabetes in
Kenya, but by late 1970s diabetes had become common. This phenomenon occurs
independent of socio-economic change (Popkin, 1994; Drewnowski & Popkin, 1997).

        Nutritionists in Africa have to deal with three different types of problems. First is the
rural under-nutrition, which is caused by consumption of traditional diets deficient in energy
and micronutrients. However, problems of over-nutrition are also increasing in rural
communities. The second group is the middle and low-income urban people who are striving
to consume the new foods instead of the traditional foods, but cannot afford due to poor
accessibility (low incomes). This results in serious MN deficiency also energy insufficiency.
The third group comprises the urban elite (executives, politicians and business people) that
has changed its lifestyle and food habits completely; they no longer consume the indigenous
foods. They have increased consumption of highly refined energy dense foods (fat and
sugar), meat and alcohol (Garine, 1969; Drewnowski & Popkin, 1997). Nutritional related
problems for this group include obesity, diabetes and CVDs.

        The analysis by Drewnowski & Popkin (1997) shows that there is major shift in the
structure of the global diet. The global availability of cheap vegetable oils and fats has
resulted in increased fat consumption among low- income countries. As a result, the
problems of dietary related diseases occur at lower levels of the GNP than hitherto. This is
also accelerated by urbanisation. Those working to improve the nutritional well-being of the
poor in developing countries are now confronted with an additional challenge on how to deal
with the emerging crisis of excess nutrition and chronic dietary related diseases without
drawing much resource from the traditional problem of under-nutrition and poverty. It
should be noted that, the ultimate goal is to have adequate nutritional status for all
populations irrespective of their economic status (rich or poor).

        One of the opportunities of globalisation and market liberalisation is that it allows
diet diversification. Traditional diets of Africa and Tanzania in particular are based on a very
limited number of foods and often consist of more starchy roots and coarse grains, less fat
and high fibre, and offer little in terms of diversity or variety. This means that these diets
supply very little amounts of essential nutrients such as minerals and vitamins, which is one
of the major causes of micronutrient deficiencies in these communities. With introduction of
foods from other regions of the world, there is a shift from high carbohydrate staple to a
more diverse diet ensuring availability of more nutrients even those that are known to be
deficient in foods produced from the local soils. Movement of foods from one region to
another allows exchange of nutrients between regions and helps to supplement or
complement the missing nutrients in the local diets.

2.2    Evolution of urban food supply
         Crop production data (URT, MAFS, 2003) show that Dar es Salaam region can only
attain 6% of its food sufficiency; therefore 94% of the food requirements are obtained from
other regions and through imports from other countries. Limited production and trade
liberalisation paved the way to the proliferation of food based investments such as
supermarkets and food merchants as evidenced by the food supply trend at Kariakoo market

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(Table 2) and from food imports data recorded by the Ministry of Agriculture and Food
Security (2003)

Table 2: Food supply trend of fresh foods entering Dar es Salaam (Metric tons)
Commodity            1999           2000           2001           2002          2003 (July)

Vegetables            161.8          26390         32939          39645         23774
Fruits                4260           8412          13283          11948         9361
Fish                  2609           2904          2030           1669          1027
Roots & Tubers        11940          12203         15623          18864         16259
Source: Kariakoo market records, 2003.

        Supply of fresh foods especially of fruits and vegetables has been increasing annually
since 1999. This is due to increased production and improved transportation, which has been
brought about by globalisation. Under globalisation, many people are now free to produce
and market their products anywhere in the country with minimum restrictions unlike during
the period before liberalisation. Similarly, imports have been increasing year after year. For
example, in 1999/2000 importations of non-cereal products was 21,137 metric tons, it
increased to 221,258 tons in 2001/2002. However, importation of cereal products has been
declining with time from 426,253 tons in 1999/2000 to 380,548 tons in 2001/2002. This
could be attributed to higher price charged on imported cereal compared to local cereal. In
addition the taste of imported cereals is quite different from what people are used to and
therefore imported cereals just serve a small proportion of the populations mainly those of
the Asian origin. Total food imports have been increasing from 447,390 in 1999/2000 to
689,187 tons in 2002 simply because of the increasing importation of non-cereal food items.

2.3    Current role of imported foods and role of traditional foods
       With increasing importation of processed and convenient foods, which require less
time and skill to cook compared to the traditional foods, the traditional staples and side
dishes are being abandoned in favour of the new diets containing higher proportion of sugar
and vegetable and animal fats (WHO, 2003). In urban areas and among the high- income
groups, traditional meals are no longer common.

2.4    Importance of street foods and emergence of supermarkets and fast
       food chains
        2.4.1 Street foods
        Street foods account for 70% of the total calorie intake of the urban low and middle-
income groups. In a survey carried out in Dar es Salaam (Mjawa, 2003, unpublished), it was
observed that on average 168 people visit one street food vendor per day. This was not the
situation about 20 years ago. Men, from low- income group, account for 70% of all
consumers of street foods. Take away meals from street food vendors are also becoming
very popular in urban areas (Nkurlu, 2000). Many households buy food from vendors to save
on the cost of food ingredients and cooking fuel, preparation time and to experience the new
tastes and varieties, as well as getting away from monotonous diets. This is mainly observed
in the low- income groups especially among men. However, the higher socio-economic
groups also eat in western type fast foods (such as Steers, and Burger King).




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        The types of foods served by street food vendors include rice, stiff porridge from
maize flour, plantain, and maize cooked with beans. Other foods include fried potato chips,
cassava chips and sweet potato chips, roast and fried chicken, roast pork, beef and goat meat.
Foods sold in western type fast food restaurants include fried chicken, beef burgers, pizza,
potato chips and soft drinks. All these foods have high proportions of oil, salt and sugar,
therefore higher in calories than in other foods.

        Generally street food vendors serve vegetables but the amount is very small. Fruits
are not served at all or very rarely. But increased demand for fruits (Table 2) is due to
increased fruit vendors selling fruits and fruit juices. In addition, there are fast foods kiosks
that sell fruit juice. These data correlate well with increased incidences of hypertension,
diabetes and cardiovascular diseases among the city residents; and increased prevalence of
micronutrient deficiencies. The most common is anaemia, which is 80% among adult males
and 74% among adult females (Ngwego, 2003, Unpublished).

        Urbanisation coupled with low wages offered to employees and labourers has led to
proliferation of street food vendors who offer commercial meals but of high microbial
contaminants due to poor hygiene and handling methods. Vendors’ stalls are usually located
outdoors or under a roof, which is easily accessible from the street. They have low-cost
seating facilities, which are sometimes rudimentary. Their marketing success depends
exclusively on location and word of mouth promotion. Individuals or families usually
operate street food business, but benefits from their trade extend through out the local
economy. Vendors would buy their fresh food locally, thus linking their enterprise directly
with small-scale farms and gardens in the urban areas. These have partly contributed to the
expansion of urban agriculture in Dar es Salaam (Christopher et. al, 1994).

        Street foods are available at all places of work where they are required, such as
factories, construction cites, offices (deliveries), schools, transit points and market places.
They are the most accessible to those working away from home and they also provide
variation (Dawson, 1998), and represent the traditional local cultures. With urbanisation on
the increase, street foods will increasingly become even more important, hence there is a
need to do more research in this area and identify ways of improving, preparation and
handling of these foods.

        2.4.2 Supermarkets
        Supermarket growth in Tanzania took off in 1990s and early 2000. In the 1980s, the
Tanzania state operated public sector retail operations RTC and HOSCO. These were
privatised in 1990s when trade liberalisation was taking place and were rapidly replaced by
proliferation of private mini- markets, and small groceries in the mid 1990s. In the late 1990s,
the supermarket sector began to develop quickly. Since liberalisation, Tanzania has seen a
mushrooming sector of supermarkets. In 2000, ‘pick n pay stores’ were introduced in Dar es
Salaam an offshoot of Score supermarket of South Africa. However, in the late 2002 it sold
its operations to Shoprite, also South African-based. Currently, there 11 supermarkets in Dar
es Salaam, and these include two domestic chain supermarkets Imalaseko, and Shoppers’
plaza. About 80% of the foods sold in supermarkets are imported, and only 20% originates
from Tanzania. This small proportion is actually achieved through a regulation, which
requires supermarkets to include local foodstuffs on their shelves. However, access by
farmers to these supermarkets is very limited.



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        2.4.3 Fast food chains
        Up until the mid 1990s, multinational fast- food chains had more or less ignored the
East African market especially Tanzania and Uganda, where the middle class, the target
group, only recently began to develop a liking for fast food. The entry of fast food chains has
stimulated a lot of business in urban areas, especially in Dar es Salaam. Currently, there is
tremendous expansion of the major fast food companies in Africa such as Steers, Nando’s
and Innscor and residents in urban areas are succumbing to the “hamburger assault”. In a
period of four years, the food licensing board issued 35 new licences and 23 in the past one
year (2002/2003). Fast food outlets concentrate on few foods, which are usually prepared by
frying, e.g. hamburgers, chicken, potato chips and pizza. Some of these food items are
imported. Owners, who in most cases are foreign investors, usually have a franchise
arrangement with trans-national company, which also controls provision of raw materials,
the menu and mode of preparation. No wonder all hamburgers taste the same all over the
world. Per se, fast foods do not have a direct link with the local economy and the foods do
not offer much variation. In addition, they promote foods that contribute to poor nutrition,
and non-communicable diseases. Obesity, among young children is increasing at a rapid
pace.

        Increased consumption of fast foods especially among the young population is linked
to increased market activity associated with marketing of these products. Advertisement is
playing a key role in expanding and stimulating demand among the young generation. Sales
promotions are also utilised by soft drink and fast food companies to stimulate consumer
demand. Such promotions increase purchase frequency by giving consumers an incentive, a
gift or a prize to drink or eat more. Sales promotions do drive frequent purchasing
particularly amongst children. These are carried out even in rural areas. It is common to find
an advertisement for coca cola in remote villages of Tanzania. This is a clear indication that
these multinational corporations have penetrated the country so deeply that they have also
influenced the pattern of consumption. Thus, instead of drinking fruit juice or any other local
healthy drinks, many people have switched to drinking coke. This is offered even to patients
in hospitals, even though they need freshly prepared foods rich in vitamins and minerals.


3.     Impact of globalisation on lifestyle in urban areas
3.1    Sedentary work and leisure
         Walking to and from work places was a common site in 1980s and early 1990s when
importation of cars was restricted. In addition, there has been significant reduction in
physical activity at work and home due to availability and ability to buy household
equipment that reduces most of the activities in the household such as dish washers, washing
machines, hovers, mopes, etc. for the high income group. Therefore, women’s workload in
high- income group has diminished significantly. Even without these gadgets, high- income
families can afford to hire several workers to help with the household chores. Thus, leisure
time has increased and this time is usually spent watching television, talking or reading but
not doing much physical work. The level of activities in other income and age groups is also
low compared to that in rural areas. Consequently, obesity and cardiovascular diseases are
on the increase. To alleviate this problem, people have been encouraged to incorporate
physical exercise in their lifestyles. This has led to proliferation of gyms and health or fitness
clubs in Dar es Salaam. These facilities are not free, and serve only those who can afford
access. Low-income groups, who also tend to be obese, they cannot afford to access these
facilities.


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3.1    Transportation systems
        Increased importation of cars has improved the transport system in Dar es Salaam
and in other urban areas of the country. In the early 1980s, the transport system was virtually
collapsing. Movement of people and commodities was difficult and prices were high due to
high transportation costs. Immediately after trade liberalisation there was a huge influx of
cars; mainly reconditioned cars from Japan and Korea. Currently, most urban areas have
public transport run by private individuals. The private transportation industry is something
like the informal street food industry; even unskilled illiterate persons operate taxis or mini
buses. Therefore it is a collection of several cars, which are owned by various individuals
(civil servants, unemployed people mainly retirees). There is no formal transport company
that has taken up to operate urban transportation industry. The state owned company is
operating under very difficult conditions because of stiff competition; actually, it is on the
verge of collapse. Transport situation has eased very much in most urban areas. It is common
to see long cues of cars on the roads during peak hours especially in Dar es Salaam city.
Increased number of cars has also increased pollution of the environment from car
emissions. There has also been a proliferation of fuel stations something that was not visible
before liberalisation.

3.2    Crime
         Crime rates have increased significantly over the past twenty years. The most
prevalent crime is burglary with about 43% of the households reporting being burgled over
the last five years period. Simple theft is the second most frequent crime. Theft of livestock
and crops is common in the rural areas of the city. Hijacking and vehicle theft rates are very
low, but theft of external motor vehicle fittings is common. This has been experienced by
19% of the people surveyed. There are also high (16%) levels of assault. The rates of violent
crime, in Dar es Salaam and other urban areas of the country are lower than those found in
other cities like Durban where similar studies have been carried out (Robertshaw, 2000).
Increased crime rates are due to unemployment and lack of alternative income- generating
activities in both the rural and urban areas. Because of increased cost of living and changing
lifestyle those without employment resort to burglary as a means of raising income.

3.3    Smoking and alcohol consumption
        3.3.1 Alcohol consumption
        Production of bottled beer has gone up greatly in the last few years. Beer is much
more available now than it was in the early 1990s. Tanzania Breweries Limited (TBL) in
Dar es Salaam produces most of the bottled beer sold in Tanzania. This company had been
started by Kenya Breweries Limited in 1930s. It was nationalised in 1967. The unavailability
and unreliability of the company’s product were symptomatic of the general failing economy
in the 1980s. As a result of liberalisation the state owned corporation could not compete with
imported beers. In 1993, the Government entered into a joint venture with South African
Breweries Limited to run TBL. This move increased production from 529,955 hectolitres in
1988 to 1,221,307 hectolitres in 1996. However, because the cost of living has been
increasing, people buy less beer now than they did although they have more varieties from
which to choose. The average per capita consumption is 0.6 litres about 10% of that of
Europe. This accounts for 20% of total beer production in the country. However, this does
not mean that people in Tanzania do not drink. Small local producers produce 80 % of the

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alcohol consumed in the country. In Dar es Salaam, the common local brew is made from
palm sap and sold illegally.

        Drinking pattern has changed significantly. Most of the alcohol made in the past was
not made for sale. People drank for rituals and in social settings (ceremonial) and only the
elderly men were allowed to drink not women and younger men. Currently, drinking has
become commercialised and people drink without a purpose. In a way this opened up one
avenue for women to generate income. As result most producers of local brews are women.
This is an example of a self-driven, sustainable and community based enterprise, which if
improved could benefit women and therefore their families. However, these brews have
health problems associated with their production.

       Alcohol consumption has become common and drinking places are established
anywhere even in residential areas. Alcohol consumption is depleting the meagre resources
of the household. Women and children become the victims of malnutrition; their general
health declines and schooling for children suffers. This has forced many children into petty
crime, petty business, and dropout from school, prostitution and involvement in substance
abuse. There is a need to conduct a study to establish the proportion of household income
spent on alcohol and how that affects the well being of household members.

        3.3.2 Smoking
        There are no validated comparable population based data available to indicate the
trend of smoking in Tanzania (Jagoe, et.al, 2002). Information about smoking or tobacco use
in Tanzania is sparse and is based on scattered surveys mainly carried in urban areas. In
addition, most of the studies on smoking or tobacco use have focused on occupational or
other selected groups such as hospital patients.

        In Dar es Salaam, the prevalence of smoking is 27% for men and 5% in females. The
prevalence of smoking in adolescent males is 12.6%, and has higher rates of inhalation of
solvents (17.5%) compared to their counterparts in Harare (8.5%) and Cape Town (5.9%).
The main reason being that Tanzanian youth have less disposable income and therefore
cannot afford to buy alcohol so they resort to the alternatives. Smoking is more common in
males than in females. However, increased market activities of tobacco companies are
targeting females especially in urban areas. As many cultural prohibitions on women are
easing with effects of globalisation, it makes women a high-risk population for increases in
smoking prevalence.

        Figure 5 shows that overall per capita cigarette consumption has been declining since
1970. It is currently at 170 sticks per annum despite increased production and availability of
cigarettes. The reason is not clear but this could be related to health campaigns that have
been going on over the last two decades.




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Figure 5: Annual per capita cigarette consumption in Tanzania (1970 –1999)



         400


         350


         300


         250


         200


         150


         100


          50


           0
                   1            2             3            4            5




3.4    Advertising
        Compared to the early 1990s, advertising is now a booming business, and many
companies are operating in Dar es Salaam and other urban areas. Modalities include TV
advertisement, billboards, radio, newspapers, brochures and leaflets and sponsorship of
special events. Nevertheless, the fees involved are high, and therefore, many small
businesses cannot afford to advertise. For example, promotion of local foods and other
products from small enterprises and indigenous knowledge and practices are difficult to
promote.

3.5    Changing role of women and impact on childcare and feeding
        Since the late 1970s, there has been a rapid rise in the number of female employees.
Between 1977 and 1984 the number of female employees in the public sector rose by 200
percent. During the period of economic adjustment, there was a large increase in the number
of establishment in the informal sector following massive retrenchment that was initiated in
the late 1980s. In 1988, 81% of informal sector units were established in Dar es Salaam and
76% in Arusha (Maliyamkono and Bagachwa, 1990). Women have been active in the
informal sector. Self-employment has been a more important type of income earning activity
for women than wage employment. Most of them are self-employed and started business or
joined the informal sector during the adjustment period 1982 – 1988 (Tripp, 1992). Under
globalisation, even more women have joined the informal sector. This is also observed in the
rural areas where non-farming activities have become important components of the
household survival strategy. Participation of women in the informal sector has given them
more independence but has also increased their responsibilities for providing cash income
while maintaining their traditiona l role in the family.

       Participation in the informal sector obviously reduces the time for childcare. Coupled
with influences of globalisation and urbanisation brings with it, increased education and

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increased employment for women. Consequently, both prevalence and duration of
breastfeeding have declined in most urban areas (RCHS, 1999; Popkin & Bisgroove, 1998).
Less breastfeeding and earlier weaning in urban populations contribute to earlier faltering of
growth (Atkinson, 1992).

        Other influences in urban areas that contribute to breastfeeding decisions are the
increased promotion and availability of infant formula. Globalisation has caused an increase
in the importation of foods including breast milk substitutes. In addition, presence of
marketing activities may have caused a switch from breastfeeding to formula feeding by the
educated and a switch from breastfeeding to feeding other commercial breast-milk
substitutes by uneducated mothers. Such behaviour is considered trendy and therefore
prestigious.

4.     Prevalence of malnutrition (over/under/micronutrient) in
       urban areas
4.1    Trends for children
        Basing on the 1991/92 and 1996 Tanzania Demographic and Health survey, and 1999
Tanzania Reproductive and child Health survey data, the trend of malnutrition as indicated
by underweight, stunting and wasting has been increasing in Dar es Salaam and other urban
areas of Tanzania. Underweight increased from 23 per cent in 1991/92 to 26 percent in 1996
and 28.7 percent in 1999 (Figure 6).

Figure 6: Trend of nutritional status of children in Dar es Salaam

           50
           45                                               42.643.8
           40
                                                        34.4
           35
                             28.7
           30            26.4
Percentage 25       23

           20
           15
                                      8.4 9.6
           10                                   5.9
            5
            0
                 weight for age       weight for      height for age
                                       height

        The proportion of stunted children has also increased from 34.4 percent in 1991/92 to
43.8 percent in 1999. In a recent study conducted in Dar es Salaam, it was observed that the
rate of stunting has increased to 47.6 percent (Rashid, 2003, unpublished).

       The prevalence of wasting has declined from 9.6 in 1996 to 5.9 percent in 1999.
These results indicate that stunting and underweight are major nutritional problems in Dar es
Salaam. The trend however, does not reflect the increasing trend of GDP, one of the

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indicators of the performance of the economy, which has been increasing during the same
period. GDP was 5.0 billion US$ in 1991 and increased to 9.1 billion USD in 2000. GDP per
capita has also been increasing from 0.6 in 1991 to 3.0 in 2000. Per capita income is often
used as a proxy indicator of nutritional status. Countries with high GDP also tend to have
fewer problems with under nutrition, suggesting a strong link between the strength of the
economy and well being of the people. However, this is not the case for Dar es Salaam,
because indicators of nutritional status in children have been decreasing despite increased
per capita GDP. This suggests two things, first increased income inequality among Dar es
Salaam residents and increased unemployment, poor living conditions and inaccessibility to
health and water facilities and services. Reduced budget on health, water and education, a
typical feature of globalisation, coupled with increased population may explain the
deteriorating trend in Dar es Salaam. The deteriorating nutritional status could also be due to
high prevalence of HIV/AIDS and other infectious diseases such as malaria and diarrhoeal
diseases. It could also be due to reduced time for childcare as more and more women are
forced to engage in income-generating activities (encouraged by globalisation) so as to raise
household incomes.

        The nutritional status of infants (0-12 months) has also been deterio rating over the
years as shown in Figure 7. The trend shows that the rate of severe stunting has been
increasing from 8 percent in 1991 to 20.8 percent in 1999. Similarly, the rate of moderate
stunting and underweight has shown an increasing trend. This could also be attributed to the
factors mentioned above.

Figure 7: Trends of nutritional status of infants in Dar es Salaam

                   45
                   40
                   35
                   30                                                      1991
      percentage




                                                                           1996
                   25
                   20                                                      1999
                   15
                   10
                   5
                   0
                         -3         -2    -3         -2   -3         -2

                              W/H              H/A             W/A




4.2                Trends for adults
        Most of the information on the nutritional status of adults in Tanzania in general and
Dar es Salaam in particular is based on spot surveys. There has never been any systematic
assessment of the nutritional status of adults in large population groups. In addition,
nutritional status of adults has not been included in the demographic and health surveys in
Tanzania. However, results from various studies (Rweyendera, 1993, unpublished; Kitange,
2000; Rashid, 2003 unpublished) have shown that overweight and obesity is increasing
among the urban populations. Females in the low- income group are more affected than
males, and males are more affected than females in the high- income group especially
executives and members of parliament. In Dar es Salaam the prevalence of overweight and

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obesity was observed mainly in low- income group women above 40 years of age (Rashid,
2003 unpublished). These tend to perform less physical activities as most of them are
engaged in light activities such as weaving (mat), fish mongering and street food vending, all
of which involve minimum physical movement. For the executives and members of
parliament they also spend a minimal amount of time on physical activities.

       In Tanzania, however, overweight and obesity among women is looked upon with
such admiration, that in the past, the man with the fa ttest wife was highly respected because
he had the most beautiful wife. Overweight and obesity in men is a sign of wealth and
commands high status in the society, hence admirable. Slimness among adults was never
admired and it is currently associated with HIV/AIDS. Therefore people prefer a fat body to
avoid being suspected that they are having AIDS. This has increased the prevalence of
overweight and obesity among the adult population especially in urban areas.

        Kitange (2000) observed that, about 78% of the population in Dar es Salaam had low
body mass index (BMI = 18.5). The results also showed that males were more affected than
females especially among the low- income groups. This is contrary to the conventional belief
that women are usually more vulnerable and therefore more affected than males. The
situation is not different for the adolescent group; males in urban areas tend to have lower
BMI than females. Except for a small group of female adolescents who aspire for the beauty
pungent title. These prefer small body size because it is one of the requirements to qualify
for entry in the contest. Excessive advertising and media coverage of the event is influencing
the attitude and perception of girls towards nutritional status. Most of them restrict food
intake so as to attain the desired body size. This is often achieved at the expense of
micronutrient nutrition of the adolescent girls.

        4.2.1 Micronutrient deficiencies
        The common micronutrient deficiencies of public health significance in Tanzania are
vitamin A, iron, and iodine. Iodine deficiency is not very common in Dar es Salaam as most
people consume sea fish and fish products, which contain significant amounts of iodine. The
most wide spread problem is iron deficiency anaemia. Prevalence of anaemia in Dar es
Salaam is 80 percent in males and 74 percent in females (Rashid, 2003 unpublished). Males
have higher prevalence than females. These results and those by Kitange, (1993), show that
anaemia is also prevalent in men, although for a long time it has been thought that males do
not suffer from anaemia. However, risks are more in women than in men. Causes of anaemia
in Dar es Salaam include high prevalence of malaria, hookworms and low intake of foods
rich in iron for example, green leafy vegetables and animal source foods. Men and children
are particularly affected because their level of intake of green leafy vegetables is lower
compared to women (Christopher, et.al., 1994)

4.3    Evidence of urban poverty
        The results of the household budget survey of 2000/01 have shown that overall the
level of income poverty has declined slightly between 1991/92 and 2000/01 (HDR, 2002),
and income poverty has declined significantly in Dar es Salaam and only slightly in other
urban areas. No significant change in rural areas. The percentage of households living in
poverty i.e. below the basic needs poverty line in Dar es Salaam has decreased from 28
percent in 1991/92 to 19 percent in 2000 and below the food poverty line from 14 percent in
1991/92 to 8 percent in 2000 (HBS, 2000/01). The data on household poverty do not reflect
the successes in macro-economic data, which suggest that the economic growth has not been

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equally shared among the general population as depicted by the Gini coefficient for Dar es
Salaam of 0.30 in 1991/92 to 0.35 in 2002. Dar es Salaam had the highest rise in income and
therefore seems to score better on almost all the indicators as defined in the poverty
reduction strategy. However, there are specific problems in urban areas and specific social
groups, which are at greater risk of falling back into deep poverty. Some of the problems
include youth unemployment, a large informal sector, inadequate urban infrastructure,
people living in unplanned settlements, on the streets and those involved in precarious
economic activities in addition to women, children and the elderly.


5.        Trends in health status in the urban areas/environment
5.1       Infectious diseases – HIV/AIDS, TB
        In Tanzania, the HIV epidemic began in the early 1980s. A steady increase in
infection levels among pregnant women occurred up through the mid 1990s. There is some
evidence of a decline in recent years (UNAIDS, 2000) although the epidemic remains a
serious problem. Females are infected at younger ages than males and rural areas are less
affected than urban areas. Since the mid 1990s, HIV seroprevalence among pregnant women
in Dar es Salaam has remained at around 14 percent. In 1998, prevalence levels among
female blood donors in Dar es Salaam were 32 percent. Female STD clinic patients in Dar es
Salaam had generally higher HIV seroprevalence levels than the male patients. HIV-1
seroprevalence among female STD patients in Dar es Salaam has been fluctuating between
20 and 40 percent since 1988 to 1997. Tanzania has cumulative total of 660,000 AIDS cases
and prevalence of 7.8% since 1983 when the first AIDS cases were diagnosed in the country.
Male and females are equally affected but peak number of AIDS cases in females is at the
age of 25 – 29 years while most affected males are in age group 30-34 years. This means
individuals acquire HIV infection at an earlier age compared to males. The main mode of
transmission remains heterosexual, accounting for 77.2% of all cases.

5.2       Non-communicable diseases (NCDs)
        NCDs are already a major health problem for adults in the poorest countries of the
world. Demographic data show that age-specific death rates from NCDs in Tanzania are
higher than in wealthier countries. Mortality rates for some NCDs, such as stroke, are
particularly high. However, while NCDs account for 80 percent of adult deaths in developed
regions, the figure is less than 30 percent in Tanzania, reflecting the continuing burden of
infectious disease. Thus, Tanzania suffers the 'worst of both worlds'.

      Prevalence of some non-communicable diseases and their associated risk factors in
Tanzania are shown in Table 3.

Table 3: Prevalence of some non-communicable diseases and their associated risks
Diseases               Prevalence %
                       Male                 Female             All
Hypertension           2.6 - 10.5           3.4 - 14.6         3.0 - 12.8
Diabetes mellitus      0.6 - 1.7            0.5 - 0.8          0.6 - 1.1
Obesity                0.1 - 2.1            0.8 - 10.6         0.7 - 6.6
Cigarette smoking      8.6 - 42.0           1.3 - 3.9          5.4 - 16.9


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Alcohol drinking        12.2 - 77.8           4.1 - 75.6             7.8 - 76.1
High cholesterol        0.4 - 7.1             0.8 - 8.2              0.6 - 7.8
High triglycerides      8.1 - 16.4            7.7 - 11.8             7.9 13.2
Source: Kitange, 2000 AMMP


       Table 4 shows that NCDs constitute a significant public health concern in Tanzania.
These diseases were non-existent but now they are increasing. It is likely to continue to
worsen as cheap imported replace healthier local staple foods. As mentioned earlier, NCDs
are more prevalent in urban areas than in rural areas (Health Statistics, 1998). It has also
been shown (Mwaluko, et. al., 1991; Kitange, 2000) that prevalence is higher among the
high executives and the Indian community than in other groups. In 1995, the prevalence of
diabetes was 12.2% and of hypertension was 48.9 percent among African executives in Dar
es Salaam. Average prevalence was 1.1 percent for diabetes and 10.4 percent for
hypertension among adult population in Dar es Salaam.

        Diabetes places a severe strain on the limited resources of developing countries. In
Tanzania, average annual direct cost of diabetes care in 1990 was 280 United States Dollar
(USD) per patient requiring insulin and 130 USD for a patient not requiring insulin.
However, with implementation of the cost sharing policy on health services, diabetic patients
have now to bear an increasing large share of the cost of treatment. It is likely that this will
be reflected in the increased level of morbidity and mortality in the diabetic population.
Similarly the cost of treating hypertension was, in 1996, about 8,200 USD. This is an
enormous strain on the health budget.

Figure 8: Trends of common non-communicable diseases in Dar es Salaam over the
          past 5 years .

          3500

          3000

          2500
  cases




          2000
                                                                                        Diabetes
          1500                                                                          Hypertension

          1000

           500

             0
                 1998     1999        2000         2001       2002               2003




        Figure 8 shows that cases of diabetes and hypertension have been increasing annually
(Kitange, 2002) over the last five years. NCDs were among the 6th cause of admission for
ages 5 years and above in Tanzania in 1997. Diabetes mellitus was among the top ten causes
of death in Tanzania mainland in 1997 (Kitange, 1999). This epidemic of NCDs causes
significant national and personal costs and employment opportunities.


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5.3    Health problems in slums
        The most common cause of death among adults and children in the slums include;
malaria, tuberculosis, HIV/AIDS, acute respiratory infections, diarrhoea and cholera. Two
out of ten children in the slum will die before they are five years from the above- mentioned
diseases. Cervical cancer rates are increasing and 30% of pregnant women are diagnosed
HIV positive.


6.     Programmes that have tried to address food and nutrition
       issues
6.1    Programmes
        6.1.1 Reduction of economic inequalities
         Reduction of economic inequalities was implemented through regulating wages by
progressive taxation system and introduction of subsidies for production inputs for farmers
and some basic food subsidies and price control. However, the situation has changed after
the introduction of economic reform programmes in the early 1980s. Subsidies have been
removed, and liberalisation of the economy has resulted in cessation of control over prices.
The market forces now determine prices. Moreover, retrenchment of public servants in an
attempt to downsize the civil service and the public sectors, consequently reducing the
national wage bill has reduced considerably the purchasing power of most people. This may
have a significant influence on the nutritional status of the people. An analysis is needed to
establish how these reforms have influenced the nutritional status of the people.

        6.1.2 Food security for all
        Food security for all in 1970s meant food sufficiency, and therefore all programmes
that were implemented were geared towards food sufficiency. Some of these programmes
included the National Strategic Food Reserve, Early Warning System, The National Maize
and National Food Strategy and Comprehensive Food Security. The impact of the
programmes was reflected in increased food production. However, this did not correspond
with improvements in health or nutrition. Actually, infant mortality rate remained high even
in regions with high food supplies. This suggested that apart from food supply alone, there
could be other factors that are responsible for the nutritional status of the people. In this
regard, food supply alone was seen to be insufficient to ensure good nutrition. Later it was
realised that access to the available food was a necessary factor.

        6.1.3 Provision of social services
        Tanzania adopted a policy of providing free social services to all as a right. Therefore
provision of clean water, health, sanitation and education services was free for all citizens
irrespective of all other factors. Among other things, this policy contributed to improved
nutrition during the late 70s and 80s. Economic strategies have changed and so have the
policies. Now there is an element of cost sharing in all public services and full cost for the
private services. Evidently, this may be a constraint to vulnerable groups of the society
including resource poor households.

        However, free services are still provided for programmes like maternal and child
health clinics and childhood immunisation. In addition, the Primary Health Care Programme
under the Health sector emphasises health education, promotion of food supply and basic
sanitation, elements that are key to the prevention of most communicable diseases. Other


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programmes include the Essential Drugs Programme, Control of Infectious diseases,
Hygiene Education and Sanitation and School Health and Nutrition.

         Despite all efforts to improve the situation, achievements have been limited, due to a
number of factors. One of the factors is perception of nutrition issues at national and
individual levels. At national level nutrition issues have been perceived to belong to health
and agriculture sectors; the health sector, because of the diseases that arise due to under
nutrition and the agricultural sector because it deals with food production. At individua l
level the perception is the same. People cannot appreciate that there is a link between food
and certain diseases. Some people believe that all diseases must be treated in a hospital or by
a traditional healer and it has nothing to do with food. There is an assumption even among
dieticians that nothing will go wrong with food-body interaction, nutrients that are present in
food are available to the individual without complications. Food cannot cause diseases. Such
a scenario calls for advocacy and lobbying to change the perception of individuals and that
of decision- makers at national level with regard to nutrition issues. To ensure success in
nutrition improvement there is a need for a solid multi-sector collaboration and articulation
of broad based policies, since it is now recognised that nutrition issues cannot be addressed
by the health and agriculture sectors alone. This will also ensure inclusion of nutrition
considerations in other sectors of the economy.

6.2    Intervention programmes to control poor nutrition
        As indicated in the preceding sections, there have been some interventions to control
poor nutrition in Tanzania. Interventions have ranged from supplementation programmes,
where a pharmaceutical preparation of a specific nutrient is given to individuals who are
suffering from that nutrient deficiency. This has included distribution of vitamin A capsules
and iodised oil capsules. Another intervention has been in form of fortification, whereby a
nutrient is added to a widely consumed food vehicle. In Tanzania, salt has been used as a
suitable food vehicle for iodine. There is a universal declaration that all salt meant for human
consumption should be iodised.

        One of the contributing factors to poor nutrition in Tanzania is lack of dietary
diversification. Diets are monotonous and composed of very few items. The diets are
composed of one staple and one type of relish, either legume, meat, fish or vegetables. A
typical meal, consists of only two dishes. Fruits are not consumed during meal times. They
are considered to be snacks and therefore not very important. This is unfortunate because it
is well known that there are complementarities in the supply and utilisation of nutrients.
        Thus, it is imperative that efforts be made to:

? Encourage diet diversification to increase the amount and variety of nutrients. This is
  necessary because nutrients tend to interact in function and utilisation in the body.
  People should not depend on one staple only since Tanzania has a wide variety of foods,
  which if properly utilised by all people there would not be food insecurity.
? Develop food and nutrition guidelines based on the types of foods available in the
  country (if possible local areas) and provide information regarding the nutrient content of
  the different foods to allow people to make informed decisions on food choices.
  Nutritional information of foods is important especially in a diet-diversified situation.
? Develop simple to prepare recipes using indigenous foods. This is crucial because
  sometimes people fail to use certain foods, which are not familiar, simply because they


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  do not know how to prepare or cook them. Development of recipes would enhance and
  probably help to increase diet diversification.
? Provide nutrition education as an important tool of providing people with access to
  knowledge and information to help improve their nutritional status and health. Nutrition
  education particularly to girls and women on food preparation, proper hygienic practises
  and nutrient requirement of different age groups would build their capacity as mothers
  and caretaker of a large family.

6.3      Sectors that need to come together in order to effectively address the
         problems
             Local Government Authorities at the level of individual, family and
         6.3.1
             community
? Provide nutritional education, particularly to women and girls
? Provide adequate knowledge on the HIV/AIDS pandemic and encourage HIV positive
  individuals to eat well.
? Encourage individuals to reduce use of tobacco and introduce community based
  interventions that discourage use of tobacco

         6.3.2At the level of the Ministry of health and Health research
              institutions
? Initiate educational and research programmes on nutrition in primary and secondary
  schools.
? Determine the magnitude of the burden of poor nutrition and all possible risk factors
? Carry out controlled studies to develop targeted and effective prevention methods

      6.3.3 At the level of sectors other than the health sector
? Develop policies that will improve the agricultural sector, the road sector and food
  processing industries
? Create an environment conducive for investment in agro-based and food processing
  industry.

          6.3.4 At the level of government, i.e. macroeconomic policies
?     Strengthen the capacity of relevant Research & Development institutions and universities
      so that they can generate and package information regarding food and nutrition in the
      country for the purpose of improving the nutritional status of the people. Much needed
      information includes, nutrient composition of foods and nutritional requirements of
      people living in disease prone areas in the tropics.


7.       Conclusion
        Poverty, food and nutrition insecurity is increasing in urban areas and this is partly
due to global policies, which seem to effect people’s behaviour and practices with regard to
access to food, and health facilities. Globalisation is influencing people’s income, livelihood
and therefore access to the necessary public services. It also influences diets and disease
patterns. Problems arising due to under nutrition and over nutrition are increasing. This has
created an additional burden in the health systems of Africa.




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