School of Natural and Social Sciences

Department of Natural Sciences

BSc Environmental Health
FIELD ATTACHMENT REPORT
COVER PAGE
Name of student

SULIMAN HABIB ISSA

Student Reg No.

BENVH/2/14/0064

Email address

binhabib92@gmail.com

Course code and Title

PT 1201

Department

Natural Sciences

Field attachment Period

Start date: 13/7/2015

Attachment institution

DHMT-MKOANI PEMBA

Field Supervisor

ZUBEIR TALLIB SEIF (DMO-MKOANI)

Academic Supervisor

MADAM AZIZA & DR HASSAN RASHID

End date: 4/9/2015

Declaration
I, SULEIMAN HABIB ISSA Declare that, the work contained in this report is my own, except where the original sources have
been acknowledged.
Student Signature

Date

(Note: Reports should be submitted in hard and soft copy)

For official use only
Date Received .

Received by ..

Signature of Recipient .

ACKNOWLEDGEMENTS
SUZA would like to acknowledge dedication and willingness of various health units stakeholders who have
worked to make this field final report to be successful. SUZA would like also to acknowledge contributions
of environmental health professionals as well as community who have advised on develop report, particularly
Mr. Zubeir Tallib Seif (DMO), Ali Salum Khamis (DHO), Juma Bakar Shoka (DAO), Mrs. Beshuu Faki
Mohd (DSO), Mrs. Bimkubwa Kheir Makame (PHO), Abdallah Haji Khamis (district veterinarian) Mr.
Salum Ali Khatib and Saleh Juma Mohd (PHO) in a NTDs unit. The generous support provided by
supervisors from State University of Zanzibar that make report acceptable significantly, includes Madam
Aziza and Dr Hassan Rashid, is most thankful.

ELLIPSIS
BCC:

Behaviour Change Communication

BCG:

Bacilli Calmette-Gurein

DAO:

District Administrative Officer

DHO:

District Health Officer

DMO:

district medical officer

DSO:

district surveillance officer

EPI:

extended program of immunization

FMDs:

foot and mouth diseases

LSDs:

lamp skin diseases

MDA:

massive drug administration

MDVP:

malt dose vial policy

IPC:

infection prevention and control

IV:

intra venous

OPV:

oral polio vaccine

PCV:

pneumococcal polysaccharide conjugative vaccine

PDs:

pregnant diagnosis

PHCU:

primary health care units

PHO:

professional heath officer

RCH:

reproductive and child health

VVM:

vaccine vial monitoring

ZAWA:

Zanzibar water authority

ZMC:

Zanzibar municipal council

Table of Contents
ACKNOWLEDGEMENTS................................................................................................................ii
ELLIPSIS...........................................................................................................................................iii
SUMMARY.........................................................................................................................................1
1.0 INTRODUCTION.........................................................................................................2
1.1 AIM AND OBJECTIVES.................................................................................................................2
1.1.1 Aim.............................................................................................................................................2
1.1.2 Objectives...................................................................................................................................2
1.2 MKOANI DISTRICT HEALTH MANAGEMENT TEAM PROFILE..........................................2
1.2.1 The District health sectors.................................................................................................4
1.2.2 Geography and Demography.............................................................................................. 5
1.3 Mkoani District economic issues............................................................................................... 5
1.3.1 Agriculture..................................................................................................................................5
1.3.2 Livestock....................................................................................................................................5
1.3.3 Fishing........................................................................................................................................5
1.4 Water.......................................................................................................................................... 6
1.5 Housing and Sanitation............................................................................................................... 6
1.6 Hotel and restaurant.................................................................................................................... 6
1.7 Mkoani district health status...............................................................................................................6
1.7.1 Top ten causes of death all ages 2015................................................................................6
1.8 Mkoani DHMT staffs and Organization........................................................................................................7
1.8.1 Mkoani DHMT staffs........................................................................................................7
1.8.2 MKOANI DHMT- ORGANIZATION CHART................................................................8
1.9 DISTRICT HEALTH SYSTEM....................................................................................................................8
1.9.1 Achievements.....................................................................................................................9
1.9.2 Challenges.........................................................................................................................9
1.9.3 Way forward......................................................................................................................9
1.9.4 Activities planned year 2015- 2016...................................................................................9
2.1 DIRECT OBSERVATION.................................................................................................................11
2.2 WORKPLACE INSPECTION..........................................................................................................11
2.3 LABORATORY ANALYSIS............................................................................................................11
2.4 TRAINING........................................................................................................................................11
2.5 DATA CROSS METHOD.................................................................................................................12

2.6 INTERVIEW.....................................................................................................................................12
3.0 FIELD WORK DISCRIPTION...................................................................................................................13
3.1 INSPECTIONS.................................................................................................................................13
3.1.1 INSPECTION OF SLAUTER HOUSES AND SLABS.................................................13
3.1.2 MEAT INSPECTION (ANTI-MORTEM AND POSTI-MORTEM INSPECTION)......13
3.1.3 INSPECTION OF PREMISES........................................................................................15
3.2 EXTENDED PROGRAM OF IMMUNIZATION (EPI)............................................................................16
3.3 THE HOSPITAL WASTE MANAGEMENT ACTIVITY...........................................................................20
3.4 NEGLECTED TROPICAL DISEASES (NTDs)........................................................................................22
3.5 HEALTH EDUCATIONS AND HEALTH MOBILIZATION....................................................................24
3.6 HOUSE HOLD WASTE MANAGEMENT SYSTEM...............................................................................25
3.7 HEALTH INFORMATION MANAGEMENT SYSTEM (HIMS).............................................................26
3.8 LECTURED ON TB AND LEPROCY.......................................................................................................26
3.9 OCCUPATIONAL HEALTH AND SAFETY.............................................................................................28
3.10 CHALLENGES, LESSON LEARNED, STRENGTH AND WEAKNESS OBSEVED DURING THE
VISIT.................................................................................................................................................................29
CHALLENGES............................................................................................................................29
STRENGTHS................................................................................................................................30
WEAKNESSES............................................................................................................................30
LESSON LEARNED....................................................................................................................30
4.0 RECOMMENDATIONS....................................................................................................32
4.1 TO RELEVANT AUTHORITY..............................................................................................32
4.2 TO STATE UNIVERSITY OF ZANZIBAR...........................................................................32
4.3 SUGGESTIONS FROM FOCAL PERSON, HEALTH PROVIDER OR COMMUNITY....32
5.0 FOLLOW UP..........................................................................................................................34
REFFERENCES................................................................................................................................................35

SUMMARY
With exception of theoretical knowledge university students acquiring during class lessons, much university
gives to students opportunity of doing practical training at the end of each years regarding to lesson learned
during class period. Then students write final report related to activities conducted in a field. This guide is the
field final report of environmental health activities performed since 13/7 /2015 up to 4/9/2015 under
supervision of Mkoani DHMT. The report tend to explain all pace visited and activities conducted during
field works, challenges, strength and weakness, lesson learned, recommendation and things to follow up for
next field. All activities attached to students planed and prepared by State university of Zanzibar to improve
professionals of environmental health that is mostly required in our community.

1.0 INTRODUCTION
1.1 AIM AND OBJECTIVES
1.1.1 Aim

To be appreciate practical training on environmental health actions that form relationship with learned
lectures at a class.
1.1.2 Objectives
i.
ii.
iii.
iv.
v.
vi.
vii.
viii.

To understand general health related activities in a district and community level.

To be familiar with community health problems caused by environment and the strategies that
can
be used to prevent or control the problems.
To be able to recognize community perspective on health problems associate with environment.
To be able to discover challenges and restrictions on implementing health determination in a society
and environment in general.
To be able to doing cooperation with society and be confidential on solving health problems.
To be knowledgeable on data collections, correctly report writing and send to the relevant section.
To understand ministry of health implementing programs that ensure peoples acquire good health.
To get the working experience, be confidence and learning time management in a working section.

1.2 MKOANI DISTRICT HEALTH MANAGEMENT TEAM PROFILE

These documents comprise the details district information according to DAO, concerning with
health and health related issues for the previous years. The following map is Mkoani District map
with ward, Roads and location of health facilities.

Map 1.0

Mkoani district map offered from DHMT.

1.2.1 The District health sectors.

The table bellow indicates District health facilities and health services.

District Health facilities

Son
FACILITY
NAME
1
Kangani

TYPE

CATEGORY

LEVEL

POPULATION

Public

URB/RURA
L
Rural

Medium

PHCU

8,811

Kengeja

Public

Rural

Medium

PHCU+

8,617

Chambani

Public

Rural

Medium

PHCU

6,299

Makombeni

Public

Rural

Low

PHCU

1,908

Makoongwe

Public

Rural

Low

PHCU

1,501

Shidi

Public

Rural

Low

PHCU

1015

K/Panza

Public

Rural

Low

PHCU

3,190

Bogoa

Public

Rural

High

PHCU+

13,442

Mtambile

Public

Rural

High

PHCU

13,867

10

Mwambe

Public

Rural

Medium

PHCU

9,998

11

Shamiani

Public

Rural

Low

PHCU

983

12

Kiwani

Public

Rural

Medium

PHCU

4645

13

Ukutini

Public

Rural

Low

PHCU+

2,839

14

Mtangani

Public

Rural

Low

PHCU

3,305

15

Wambaa

Public

Rural

Low

PHCU+

6045

16

Tasinikiwani

Public

Rural

Low

PHCU

3125

17

RCH Mkoani

Public

Urban

High

9758

18

IBNI-SINA

Private

Urban

High

1.2.2 Geography and Demography.

Mkoani District is the one among 4 District of Pemba Island other Districts are Chake-Chake, Wete and
Micheweni. The District has an area of 207 sq kilometers with 5 constituencies, 18 wards, 33 ward and196
Villages. The district is situated in the South of Pemba Island and is bounded with Chake-Chake
district in North, Indian Ocean in South, West and East.
Also the district comprises of Small Island off shore i.e. Makoongwe, Kisiwapanza and Shaniani, other two
small Islets are Kwata and Matumbini on which used for cultivation and fisherman camps. According to 2012
projection census the table bellow show demographic level of Mkoani District.
TOT.POPLN

UND 1 YR

UND 5 YR

WRA

SURVI. INFANT

101132

5057

17,295

27,913

4,799

1.3 Mkoani District economic issues

1.3.1 Agriculture
Agriculture is the main sector which provides large income comparing with other sectors in Mkoani district;
it plays an important role in providing both food crops as well as cash crops. It provides employment the
large proportion of the district population. More than 65 % of the district population is engaged in this
activity. The role of agriculture in Mkoani district is significant. About 90% of rural house hold is involved in
agriculture.
Cash crops, the main food crops in Mkoani district is cassava, sweet potatoes, yams, rice, maize and bananas,
Bread food. About 9,660, hectors of land are planted with cassava which is presenting 67% of the total area
planted nationally. About 3,568 tones were harvested, equal to 24.6% of the national harvest of cassava. A
total of 84.5 hectors were planted with sweet potatoes and 3,125 hectors planted rice equivalent to 8.40% of
the total area planted. About 4,387 hectors of land are used for cultivate banana. About 10,286, tones were
harvested, which is equal to38.8% of national harvest.
1.3.2 Livestock
Livestock breeding is another economic activity in the district, there are 347 cattle male 171 and female 244,
Milk goats 261 male 202 female 121.
1.3.3 Fishing
Nearly all districts are surrounded by Indian oceans most of people use this Indian Ocean making fishing and
took second economic activity in the district. About 2,980.5 tons were harvested equivalent to Tsh
8,121,346,540 Most of fish sent to Zanzibar for export to increase income.

1.4 Water
According to 2011/12 HBS, about 80 percent of households in Mkoani district had access to piped water.
Distance to a drinking water source, particularly during the dry season is large, In this season about 20% of
households in Mkoani district 2012/13 walked less than a kilometer to drinking water thus is difficult on
participation on economic activities and generating income for the household.. Therefore borehole water is
needed.
1.5 Housing and Sanitation
The type of toilet facilities used is a traditional pit latrine, by means of which about 43 percent used by
households. Over half of households (58percent) and 8percent used the seashore had toilet. The number of
latrines increases from 13,274 in 2012 to 13,586 in 2013, whereby refuse collected in specials containers,
then taken away in special vehicle to the one final disposal point at Chokaani selected dump site in urban
area, while in rural refuse are burned in local pits. Number of houses are 33,586. Whereby temporary
buildings are 14,654 =43.6% and permanent buildings are 18,932=56%.
1.6 Hotel and restaurant
Mkoani have three Hotels which are Fundulagoon available in Wambaa, shamiani and Emereldbey available
in Chokocho and one restaurant which is Jondeni restaurant exist at Mkoani. All are Private which served
services to Residents and foreigners. Average double room prices are 410 to 160 dollars; tea and lunch are 3
and 10 dollars. The numbers of stuff are 107 up to 8.

1.7 Mkoani district health status

1.7.1 Top ten causes of death all ages 2015
In the table 1.1 pneumonia and hypertension diseases are the leading causes of death in institutional
admission above five years ,To reduce Number of death early dictation of the case ,early and proper
treatment, changing of behavior e.g. Avoid alcoholism to due exercise and avoid smoking.
Table 1.1
Diagnosis
Cases
%
Pneumonia
9
11.11
Hypertension
9
11.11
Intestinal Obstruction
6
7.41
Cerebra Vascular Accident (CVA)
6
7.41
Severe Acute malnutrition
5
6.17
Congestive Cardiac Failure
4
4.94
Diabetic Foot
3
3.70
Head Injuries
3
3.70
Anemia Severe (<7 gm/dl)
2
2.47

Asthma
Hepatitis
Diabetic
other diagnosis
Total

2
2
2
28
81

2.47
2.47
2.47
34.57
100.00

1.8 Mkoani DHMT staffs and Organization

1.8.1 Mkoani DHMT staffs

Table 1.1.1
TITTLE TOTAL
DMO
1
DAO
1
DHO
1

TITTLE
DRCHCO
DMM
DATA
CLARCK

TOTAL
1
1
0

TITTLE
DSO
DRIVER
SUPPORT
STAFF

TOTAL
1
1
1

1.8.2 MKOANI DHMT- ORGANIZATION CHART

DMO
DISTRICT MEDICAL OFFICER

DHO

DAO

DRCHCO

DMM

DISTRICT HEALTH
OFFICER

DISTRICT ADMININSTRATIVE
OFFICER

DISTRICT REPRODUCTIVE AND

CHILD HEALTH CORDINATOR

DISTRICT MATERIAL
MANEGER

DSO & DM

CLARK

DISTRICT SURVILANCE OFFICER AND DATA

MANEGER

DRIVER
ADSO
SURVILANCE OFFICER AND
DATA MANEGER

CLEANER

1.9 DISTRICT HEALTH SYSTEM

The health system in district has been categories into two major level; that is secondary
level (district hospital) and primary level (Primary health care unit). In primary level is further
divided into first line and second line PHCUs. Among them twelve(12) are fist line which
provide outpatient are productive health services while four (4) are second line PHCUs which

provide additional services maternal and new born care, laboratory, dispensing and dental
services.
Also there is one reproductive clinic which offers only reproductive and child health
care. The District Hospital has capacity of 80 beds which offers in and out patients, General
surgical, orthopedic, gynecologist and obstetric, ENT, Dental, Pediatric and Eye cases. Aballah
Mzee hospital acts as referral hospital for Pemba, due to the present of eight Chinese specialists.
Mostly all surgical cases are operated. There are eight specialists of different cadres such as
General surgeon, orthopedic, gynecologist, Pediatrician, ENT, Physician, Radiologist, and
Anesthesiologist.
1.9.1 Achievements

Availability of HMIS Data

Installation of Internet services in DHMT office
Replacement of new solar Refrigerator in Ukutini PHCU
Construction of new PHCU at Mtangani

1.9.2 Challenges

Shortage of skilled staffs

Difficult to getting community data
Low coverage of Hospital delivery
Shortage of instruments Eg, Dressing instruments, BP Machine and RCH Commodities
Low coverage of Latrine
Some of women are not attend in Clinic for post natal services
Poor condition of District Transport (Car)

1.9.3 Way forward

HMIS should conduct quarterly data evaluation to keep update data

Ward leaders should keep registers for death and update
DHMT should increase awareness to pregnant mother to delivery at Hospital
Increase delivery point from two to three.
Increase coverage of Latrine From 42% 2014 to 45% end 2015

1.9.4 Activities planned year 2015- 2016

Conduct 96 supportive supervision (8visit per month) in16PHCUs

Distribute vaccine, RCH commodities and other logistics supplies in 17 PHCU monthly.
Purchase IPC materials and distribute for 17 PHCUs
Support ongoing outreach services in 20 villages.
Purchase Furniture for 16PHCUsand distributed
Regular monthly services and maintenance of existing transport.
Purchase essential equipment and supplies used for delivery services and

distributed in a delivery points.

Conduct Inspection services of staff andfoodpremisesat23 wards.

2.0 METHODOLOGIES USED

During field practical activities variety of methods have been used on conducting
different environmental health issues, that under supervision on DHMT and other
institutions, departments and organizations concerning on health based activities as outlined
in a checklist.
The following are amongst the methodologies used in a field work practical related on
activities conducted:2.1 DIRECT OBSERVATION
This method was used during supervision of the following activities

Expanded program of immunization

Hospital waste management activities
House hold waste management activities
Inspection of human settlement

2.2 WORKPLACE INSPECTION

This method was used when controlling the following activities

Inspection of food premises and food handlers

Inspection of slaughter slabs and butchery
Meat and food ante-mortem and post-mortem inspection
Inspection of human settlement

2.3 LABORATORY ANALYSIS

This method was exhausted while management of the following activities

Diagnosis of TB
Diagnosis of urinary tract infection and infestation e.g. scchistosoma haematobium

2.4 TRAINING
This method was used during supervision of the following activities

Occupational health and safety e.g. doing medical examination

Health education and mobilization

2.5 DATA CROSS METHOD

This method was used when conduction of the following activities

Health information management system (HIMS)

report collection from PHCU and PHCU+ to Mkoani DHMT

2.6 INTERVIEW
This method was used during inspection and disease intervention programs (neglected tropic
disease, TB and Leprosy)

3.0 FIELD WORK DISCRIPTION

3.1 INSPECTIONS
Inspection is the process of examine closely in order to discover defect and prevent nuisance
so as for abatement. The purpose of inspection is to assess public health problems, to record
public health problems, to report the relevant authority and to use expert knowledge for the
remedy and recommendation. The types of inspection can be initial survey inspection, casual or
incidental inspection, house to house or routine inspection and house inspection. During the field
work practice were given training on inspection of different substances including inspection of
human settlement, inspection of food premises, inspection of slaughter houses and slabs and
meat inspection (ante-mortem and post-mortem inspection). And we successful to visit areas and
did inspection.
3.1.1 INSPECTION OF SLAUTER HOUSES AND SLABS
Slaughter slabs is a huts designed for slaughtering process. The slaughter houses and
slaughter slabs are differ only by size. The slaughter houses are a large in size compared to slabs
and contain different partition. The slaughter houses actually contain lei rage (collecting pan) is
area for collection of animals by ant- mortem inspection and dressing room that used by staffs to
prepare for slaughtering process. The slaughter houses and slabs are deferred according to area,
consumers and owner preference. In Mkoani district there have no slaughter houses, when there
is only two slaughter slabs available at Kinyasini and Kengeja village. For others remaining
village peoples slaughtering animals anywhere their want. The routine inspection of slaughter
slab was performed in a Kinyasini slaughter slab under supervision of district veterinarian DR
Abdalla Haji Khamis with cooperation of other staffs. The inspection was intent to look on floor,
rolls, pose, water, and outlet pit dung pit and staffs physical appearance. The floor should be
smooth and contain at least 2% slope. This enables animals to fall down easily and to avoid
contention of blood. The rolls are used put a hooks and hooks used to hung up a meat for antemortem inspection. The two or more pose is used for evisceration and dehiding process. The
outlet pit is used remove out blood and other condemnation parts after inspection. The dung pit is
used for evisceration of stomach. During inspection limitations such as floor is chipped, lack of
rolls and hooks, lack of dung pit and outlet pit and lack of personal protective equipment for
staffs are discovered. After inspection the staffs and owner advised to use protective equipment
and to put tools required in a slab to achieve standard. Also report is deployed to DHMT on
planning of availability of slaughter slabs in each village.
3.1.2 MEAT INSPECTION (ANTI-MORTEM AND POSTI-MORTEM INSPECTION).
The routine inspection of meat conducted at Kinyasini slaughter slabs for greater corporation of
district veterinarian and other staffs. An anti-mortem inspection is the inspection of animals
before slaughtering. During anti-mortem inspection the hard of animals collected in special place
called lei rage and stay here for 24 or at least 12hour. In a lei rage animals not give any type of

food to avoid migration of bacteria from the food to meat. When Kinyasini slaughter slabs
animals were placed outside the slabs for anti-mortem inspection. The inspection was done by far
and close examination, also superficial and clinical sing considered. The far examination was
done by let animal to move, so that the abnormal condition such as laminas of animals was
looked in the movement. Then close examination is following to prove that the abnormal
condition detected during the far examination caused by wound, injury, abscess, or red tick
(rephencephelus appendiculatus). The close examinations also performed by checking hide of
animals, lacrimaltion and muzzo (mouth and nose region). In a hide, the abnormal condition such
as plucked, patch and LSDs was looked. For lacrimaltion, more secretion of tears is abnormal
condition and noticed. A muzzo region, the dryness of nose, salivation (froth oozing) in a mouth
is a disease related problems. The dryness of nose for cattle was related to abnormal condition of
temperature, when 38.5 0C is normal, 37-36 0C is subnormal and 39-40 0C is abnormal, hence
problem was suspected. In a close examination also rash, wound at the mouth, FMDs, PD, and
disease such as anthrax was considered.
The post-mortem inspection is the inspection of animals after slaughtering. The post-mortem
inspection was performed to confirm abnormality detected during anti-mortem inspection.
According to DR Abdullah it is restricted to refuse some part of animal to use it is it before
inspection. During post-mortem inspection all part of animal including head, limbs and visceral
organs was inspected. The inspection was made by visual (observation), palpation and incision.
The head and limbs were inspected by visual, palpation and incision of lymph nodes; include
parotid lymph nodes, leteropharyngial lymph nodes, mandibular lymph nodes and puplitio lymph
nodes. The lymph nodes were incised to look inside it, if there is a puss or worm named cyst
suckers bovine. If the puss or worms appear the body part was removed by partial condemnation.
Also the tongue was inspected by incised to look cyst suckers bovine. Then inspection of visceral
organs includes lungs, liver, kidneys, spleen and bile duct done. If abnormal conditions such as
color change and swelling of visceral organs seem, the organ was incised and partially
condemned. The photo bellow indicates post-mortem inspection of head and visceral organs.

Image 1: show post-mortem inspection of meat conducted by Suleiman Habib in Kinyasini slaughter slab.

During inspection, problems such as froth oozing, puss in lymph nodes hemorrhage in a lungs
and TB discovered. The owner advised to bring their animals earlier to give them the time of
relax and recommended to refuse to use some body part if detected to be a problems after
inspection.
3.1.3 INSPECTION OF PREMISES.
A premise is anywhere that includes, land, buildings, vehicles and open space. In premises
inspection succeed to perform inspection of hotel, restaurant, shops, bakery and human
settlement. The routine inspection of hotel is performed in EMERALD BAY HOTEL at
Chokocho shehia. The inspection was considered on external environment include drainage
system, latrine and solid waste disposal. Also inside the building kitchen room, store, server
room, dining room and bed room was inspected. The store should contain 10-12ft, also
equipment such as refrigerator, tasteless, shelving, vegetable rake and weighing scale must be
obtained. Is also the distance between the beds, the ventilation in a bed room, distance from
kitchen room, server room to dining room, and staffs condition was considered. Below is a image
of bakery preparation room and condition of staff.

Image 2: above is condition of staff in bakery preparation room.

Then inspection of food premises is held, when availability of license, license number, license
issues, street, areas, date of issues and date of expire date, medical checking and personal
hygiene of staffs all considered. The food premises include restaurant, shops and bakery. The
inspection was focus on store; sever room, dining room and washing room. During the inspection
the floor, ceiling, doors and windows was looked. The limitation such as chipped floor and
contain allot of dust, walls cracked and covered with cob webs, ceiling surging and leakage,
lighting no artificial or natural light and the was too dark, ventilation no natural or artificial
ventilation, no weighing scale for weigh items and no uniforms for staffs. The owners and staffs
of premises advised recommended on modify of areas, to use uniform and mask for their own
health and to do medical checking. Subsequent, report sent to DHMT to take measures legally
identifiable. The challenges during inspection were to lack professional identity that gives
permission of doing inspection and lack of awareness for some staffs.
3.2 EXTENDED PROGRAM OF IMMUNIZATION (EPI)
Immunization is the provision of vaccine or biological preparation that improve immunity for
particular diseases. The vaccine provided contain the agent that resemble to diseases causing
micro-organism and its often made from weakened (alive attenuated) or killed form of microbes,
its toxin or its surface protein. This activity was conducted for different health care unit. There
are various vaccines and provision of vaccine depends on age of consumers. The tables 1.2
indicate types of vaccine, age, way, amount of vaccine required.

Table 1.2
Ages
Once after birth

Types
BCG

6 week

OPVO
OPV1
PCV1
Pentavalent1

10 week

Rota1
PCV2
Pentavalent2

14 week

OPV2
ROTA2
OPV3
Pentavalent3
PCV3

18 month

Measles

18 month

Measles

Ways
Inside the skin right
shoulder.
Oral
Oral
Inside the muscle
right thigh
Inside the muscle left
thigh
Oral
Inside the muscle
right thigh
Inside the muscle left
thigh
Oral
Oral
Oral
Inside muscle left
thigh
Inside muscle right
thigh
Beneath the skin left
hand
Beneath the skin left
hand

Amounts
0.06ml
Two drops
Two drops
0.5ml
0.5ml
0.5ml
0.5ml
0.5ml
Two drops
1.5ml
Two drops
0.5ml
0.5ml
0.5ml
0.5ml

The DHMT receive vaccine from main branch of Chakechake, then distribute to all PHCU and
PHCU+. The transportation of vaccine was under specific condition known as cold chin. A cold
chain is a recommended temperature required to transport vaccine from the sources to the target,
to protect it from heat and to increase life. A DHMT vaccine was putted in a vaccine carrier and
refrigerator. The recommended temperature in a refrigerator is +2 to +8, and recorded by specific
instrument called fridge-tag (temperature recorder).

Image 3: is fridge-tag or temperature recorder.

During the outreach the vaccine are putted in a special box known as cold box, inside it there
is Ice Park or cold park soon name, cold park protect vaccine in a cold box for long time without
impaired. Bellow is photo of cold box used to carry vaccine during outreach.

Image 4 & 5 are cold box and child clinic card.

The all transportation procedure was follow up to ensure the vaccine is secure until to
consumers. The consumers of vaccine were children bellow 2years and the women that capable
to give birth. A vaccine was provided in a Clinic and some secondary schools of district for
WBA, and also for special groups such as injured persons. In a vaccine delivery site (Clinics),
there are weighing scales that was used to measure weight of children's and parent to know the

development of their children's. Then the weight of children's was filled in Clinic card, the clinic
card contain color, when each color translate certain types of children's development.
The tables 1.3 bellow show colors appeared in children's clinic card and its meaning.
Colors
Red
Green
White
Black

Meaning
Development of children is worse
Development of children is better
Children have over weight
Children development is intermediate

According to development of children's, the parents was advised and recommended on breast
feeding of their children's and kind of food that is better for their children's health.
Before provision of vaccine the supplier was consider the following to ensure that vaccine is
secure:- the stages of VVM, expire date, freeze, safety of syringes, position of consumer and
children not required to acquire vaccine. The VVM is a vaccine vial monitoring that observable
in each cork of vaccine vial used to indicate situation of vaccine, which is either acceptable or
not acceptable to use. Bellow is example cork of vaccine which indicates stages of VVM some of
vaccine vials.

Image 5 & 6 are stages of VVM and vials of vaccine.

That consideration enable vaccine provider to produce secure vaccine and consumers get safe
and better vaccine. The childrens would not get some vaccine particularly BCG and MEASLES
are the children's that born with HIV positive and hyper sensitivity children's. The development

of vaccine program initiate policy known MDVP that allow vaccine to be reuse even was used if
VVM is not changed.
3.3 THE HOSPITAL WASTE MANAGEMENT ACTIVITY.
The hospital waste management activity specialty known as IPC (infection prevention and
controls). This activity conducted in ABDALLAH MZEE HOSPITAL together with Mr. Kassim
Juma as a PHO of that hospital. The IPC try to prevent the health of patients, clients, hospital
staffs and environments. The objectives of IPC are to prevent nosocomial infections in patients
or clients, to protect health workers from occupational infections, to protect community from
infectious diseases and to prevent environment from pollution. When IPC process continued, the
patients, clients and staffs learned on nosocomial infections. Nosocomial infections (hospital
acquired infections) are any infections in which patients, clients and heath workers acquired from
hospital. The key contribute factors (causes) of nosocomial infections are devises or equipment if
not sterilized or standard, infections which are contaminated fluids (IV fluids), over use of
antibiotic which leading resistant on cured, unsafe and frequently unnecessary injections,
increasing number of peoples in health care facilities, overcrowding in a wards, impaired
immunity (age and illness), new organisms (HIV and Ebola viruses) and shearing of beds. A
good example was there is insufficiency space and shearing of beds in children's ward and
maternity ward, something which make some patients and their clients to sitting down in a
corridor. The photo below show conditions of some patients and their clients.

Image 7 & 8 is condition of patients in ABDALLAH MZEE HOSPITAL.

The impacts of nosocomial infections includes emotional stress, functional disability, reduced
quality of life, increasing cost of health care services through increasing length of
hospitalization, use of expensive medication, and use of laboratory tested and X-rays. The
prevention methods of nosocomial infections are standard precaution and prevention of transmit
ion of highly suspected such as air (tuberculosis), droplets (mump and rubella), and contacts
(hepatitis A, B and C). Standard precaution is a primary care taken to prevent patients, clients
and community from infections. The action of standard precaution in IPC are consider every
persons (patients or staffs) as a potential to infectious and suspect to infections, hand hygiene
include hand washing and hand antiseptics, hand scrabbles, and PPE such as gloves, mask,
goggles, gown, boots and apron. Also appropriately handling of shapes, patient care,
resuscitation equipments, recycling equipments and liners and patients environmental cleaning.
In addition safe disposal of infectious waste materials to prevent injury and spread to community
and processing instrument by decontamination and cleaning by sterilization or high level of
disinfections using recommended procedures. A part from IPC was participating on health care
waste management (HCWM). Health waste is the total waste stream from health care or research
facilities that include both potential health risk and known risk waste materials. Risk and hazards
in health care waste are needles, stick injury, transmit ion of infectious or diseases, examples
cholera and HIV/AIDs. Re use some types of waste e.g. syringes and needles, environmental
degradations such as water air and soil, and exposure to radiation e.g. x-rays and fire and public
new sense on offensive smell. There are steps which were used in health care waste management,
this steps includes waste minimization, waste segregation (sorting), handling and storage,
transportations, treatments, distraction and disposal. In ABDALLAH MZEE HOSPITAL more
developed on waste segregation, where by four types of waste in health care were sorting and
segregating according to COLOR CORD SYSTEM. The four categories of health care waste are
non-infectious waste (non-risk waste), infectious waste, highly infectious waste and sharps
waste. So that each types of waste were putted in a specific colored containers as developed
methods of waste management.

Image 9: is containers used for health care waste disposal.

The non-infectious waste are waste that not potential to cause risk, e.g. paper, packaging
materials, plastic bottles and foods. And its always were putted in a black or blue containers.
Infectious waste are the waste that capable to cause infections, e.g. goose, dressing, gloves,
pharmaceutical waste, bloods and IV given sets, all this types of waste were putted in a yellow
equipments. Highly-infectious wastes are the waste that is more easily to cause infections, that
includes anatomical waste e.g. tooth and placenta and pathological waste e.g. sputum container,
test tube specimens containers, its always putted in red equipments. Sharps waste this include
infusion needle, lancet, broken slides, broken vials and broken ampoules, that waste were always
disposed in a safety box. The final disposal methods done to ensure wastes were permanently
eliminated so that it no longer risk to the health of the workers and community. The final
disposal methods were burying, burning and barrier, and placental pit.
3.4 NEGLECTED TROPICAL DISEASES (NTDs)
These activities were performed at Chakechake for cooperation of Mr. Saleh Juma as PHO of
NTDs office together with others staffs. In this activities were participates on prevention and
control of various diseases. Many of NTDs were caused by careless for peoples. Some of NTDs
which were deals with are haematobium schistosomiasis, intestinal helminthiasis, trachoma,
yellow fiver and dengue fever. Haematobium Schistosomiasis was in control stages which
include BCC and MDA, and not preventive stages. This control stage is to control vectors by
reducing population of sac aria. BCC is behaviours change communication, to communicate with
community to change their behaviours in order to accept the schistosomiasis control programs.
MDA is massive drugs administration, this is provision and delivery of schistosomiasis drugs to

the community. The vector of haematobium schistosomiasis is Bolinas snail, and haematobium
schistosomiasis caused by haematobium. The image bellow is types of snail that cause
haematobium schistosomiasis.

Image 10: Are snails that cause haematobium schistosomiasis.

Haematobium produce egg in water called merasidia, merasidia capable to stay in water for
24hour away from bulinus more than that die. So if someone come into direct contact to water,
merasidia penetrate in the body of persons through the skin. When enter the body merasidia is
hatched and known as sacaria, sacaria circulate in the blood stream to the lungs, kidney and
finally to the gall bladder as a dedtination. The symptoms of haematobium schistosomiasis are
blood in urine (haematuria), inching before urination, painful during urination, frequent
urinalysis, nausea, temperature may increase and loss of body weight. The incubation period is 4
to 7 weeks. The ways were used to prevent haematobium schistosomiasis are to avoid to use
contaminated surface water, to build and to use toilet, to make drainage system in a farms,
availability of laboratory for diagnosis to treat affected persons, provide health education and to
initiate program that controls the problem, e.g. MDA the diseases were treated by giving peoples
called Praziquantel. A part from haematobium schistosomiasis other NTDs is intestinal
helminthiasis. Intestinal helminthiasis are helminthiasis that alive in intestine of human or
animals, it is available in the soil and enter the body of human or animals through fecal oral or
skin. Some intestinal helminthiasis which were deals with are intestinal worms,
paracympastemum, cyst suckers bovine and ovine. The complication of intestinal helminthiasis
is pneumonia, haemoroid and treturiasis. The diseases were treated by using Albendazole,
mebendazole and cetasole. The peoples were advised to eating disposal and use toilet. Other
NTDs is which were focused on is trachoma. Trachoma is eye problem caused by bacteria called
trachoma chlamidiasis, the vectors of trachoma is simullium (type of fly). It is transmitted by

mechanical contact of fingers, bed, clothes and tears, so one problem of trachoma may cause
more several problems. Trachoma was looked in different stages which are stage1: TI is
trachoma infections. Stage2: TF is trachoma fluid. Stage3: TT is trachoma turpitude. Stage4: TS
is trachoma scar. The first and second stages of trachoma are treated by tetracycline while third
and fourth stages are treated by surgical. The trachoma was controlled by mass campaign
program, to avoid shearing of equipments, to improve personal hygiene and to distributing of
antibiotics for all community. The complication of is cataract and blind. Also yellow fever and
dengue fever was looked. Yellow fever was available in district, the disease is more common in
most tropical Africa and South America, and its endemic for the country available in those areas
e.g. Sudan, Brazil, Colombia, Senegal Ethiopia and Ghana. Yellow fever is acute infection and
under quarantine diseases, it is caused by Arbor viruses and transmitted by female mosquitoes
called Aides Egypt which live at apex of stems and leaf. The diseases cause haemoregic
manifestations and albeneurium. The incubation period is 3 to 6 days. The dengue fever also
caused by arbor viruses like in yellow fever.
3.5 HEALTH EDUCATIONS AND HEALTH MOBILIZATION
This activity was conducted with greater cooperation of Mr. Hamadi Simba as head of unit of
health education and Mrs. Bimkubwa Haji as PHO of Bogowa PHCU+. Health education was
deals with changing of behaviour for peoples, so it needs scientific evidence and data collection
of that you talking about for peoples. Also talking of peoples it need critical thinking and to
arrange, because the words that you talking is impossible to return back again. During the field
activities several days were participate to provide health education in Bogowa PHCU+ for
patient and client that attend and provide mobilization during home visiting activity. The health
education was focused mostly on non-communicable diseases such as cancer, diabetes,
cardiovascular diseases, blood pressure and dental diseases which is serious problem in the world
and our county today. Health education performed at Bogowa PHCU+ and health mobilization
conducted at Michenzani shehia where there is water source (dug well) surrounded by houses
and no specific areas for disposal solid waste.

Image 11& 12: is Suleiman providing health education in Bogowa PHCU+ and inspection of water source
(well) surrounded by houses.

During provision of health education 7C considered to ensure that peoples understand

easily and accepted to that you talking. This 7C are 1C is complete, 2C is clear, 3C is
correctness, 4C is concise, 5C is consideration and 6C is courtesy. Peoples were advised on
different prevention, causes, effects, and treatment on methods of non-communicable diseases
and give their comment on those problems.
3.6 HOUSE HOLD WASTE MANAGEMENT SYSTEM
This activity was conducted in a Mapinduzi houses at Mjini Mkoani with cooperation of director
of ZMC. In house hold waste management activity was supervised waste from production site,
transportation and final disposal area. The main type of waste which was produced is biogradable
waste such as spoilage food, vegetable, unused paper and some food containers. The peoples was
collect waste in dust been or special containers at most 24hour, then disposed in a slabs, then the
municipal staffs pick up and loaded in to car for transportation process. The slabs used for
collection of waste available in the urban areas. Thus the municipal staffs was ought to visit the
slabs to pick up the waste for transportation. The limitation such as small of car, dropping out of
waste, and lack of equipment for ZMC staffs e.g. rain bout, gloves and masks. The waste
transported up to final up to final disposal methods which is Chokaani dumping site. The
dumping area was so large and its approximated to take 20-25years more.

Image 13: is Makaani dumping site, transport facilities and condition of staff.

The municipal staffs recommended using uniform and personal protective equipment during
working conditions and to doing medical checkup, it help them to prevent from various health
problems.
3.7 HEALTH INFORMATION MANAGEMENT SYSTEM (HIMS)
A health information management system also called data management system is a system
concerned on collection of health related information in district and international level. This
activity was performed at Mkoani district and Mkoani DHMT under supervision of Mrs. Beshuu
as DSO of Mkoani DHMT. In this activity was participating on collecting data from different
report and to enter the data in a system. A report which was participate to collect include monthly
disease surveillance report, reproductive child health report (RCH), sexual transmitted infections
report (STI), HIV/AIDs report, post exposure prophylaxis report, home based care report and TB
report. All this report was collected from all health care services (PHCU and PHCU+), then
joined to form one district report. The district report then was entering in the data base system for
other department concerning to health. So that the HIMS evaluate the type of diseases that
emerge more frequently in a district in order to take measure before complication of the
problems.
3.8 LECTURED ON TB AND LEPROCY
Tuberculosis (TB) is a chronic infectious diseases caused by mycobacterium
tuberculosis which is also called Acid First Bacilli (AFB) as they resist discoloration with acid or

alcohol. It is also caused by mycobacterium bovine by drinking unpasteurized milk products. It is

transmitted from one person to another through the air. It is air born diseases so person can suffer
pulmonary TB through coughing, sneezing or speaking. The types of TB are pulmonary TB and
extra pulmonary tuberculosis, the pulmonary tuberculosis it affect inside the lungs and extra
pulmonary TB affect outside the lungs. The sign and symptoms of pulmonary tuberculosis are
coughing more than two weeks and sometime with blood (haemoptysis), periodic fever and
excessive night sweating, visible weight loss, loss of appetite and breathlessness. The symptoms
and sign of extra pulmonary TB is similar to pulmonary TB, but specific symptoms and signs
depend on the site of diseases such as in a bone, brain (meninges), vertebral column, placenta
and kidney. The diagnosis of TB was by laboratory examination of sputum for AFB which is
reliable examination; other diagnosis is by chest X-ray which would not inclinable. The risk
factor for TB are hospital staffs because spend more time to infectious persons, to expose in the
area where bacteria easily survive e.g. poor ventilation in closed space and obstacles of UV-light,
the peoples which immune system compromise e.g. HIV, measles, diabetes, malnutrition and
ages under 5years and above 65years. TB is related to HIV/AIDs that all diseases weaken
immune system, and it is more easily for someone to get TB when suffering HIV/AIDs. The
management (treatment) of TB is for patient which is the first time to suffering TB is 6month,
and 8month for repeated treatment (retreatment). The patient treated by given combination of
drugs called fixed dose combination specialty known as RHZE ( refampicin, isoneazide,
pyrazine amide and ethambutol), for retreatment patient was treated by steptomycine injection.
Retreatment patient of TB can be relapse i.e. after two years patient suffering TB again, failure
i.e. after 5month the patient continue suffering TB, list to follow i.e. the patient does not follow
treatment appropriately, others i.e. if chronic cases appear to patient. The 90% of TB infected
persons would no longer infection if follow dose frequently. The methods that were used on
prevention of TB are early diagnosis, detection and treatment in a community, loss congation in a
service and peoples advised to build the houses that is well ventilated. Leprosy is a diseases
caused by mycobacterium leprae it is transmitted by air i.e. airborne diseases. The sign and
symptom of leprosy are the patch which loss sensitivity and numbness. The patient of leprosy
was diagnosed by sensation taste, physical examination and laboratory examination. The patient
was earlier treated by given dapson but now is by using fixed dose combination of clofeamine
rifampicin and dapson. There are two groups of leprosy which are multi bacilli (MB) and paucity
bacilli (PB). The multi bacilli leprosy consist more than five patches which loss sensation and
paucity bacilli leprosy the patient contain bellow five patches which loss sensation. The
complication of leprosy is claw finger, lagophthalmos, and foot drop and panties ulcer. The
peoples were advised with full participation of community and active case finding, early
diagnosis, detection and treatment.

3.9 OCCUPATIONAL HEALTH AND SAFETY

The health is the one of the right of all peoples. The development of services is to
promote health and help to prevent the major enemies of development which are poverty,
ignorance and diseases. The aims of health services is to provide medical care both preventive
and curative for all peoples, all ages and where ever their live. A part from all overall aim, health
services may be provided by special groups of peoples who are known to have medical problems
such as pregnant mothers and small children, or people suffering from special diseases such as
tuberculosis and leprosy for which treatment over long period is vital. Workers are other groups
for whom to get special services this is because, they exposed to special heath risk at their place
of work. They may work in very isolated areas where no other health services are available, or
there may be many people at one work place so it is more economical to bring services to them
rather than to make them go to and outside of the health facilities. Thus occupational health
prevents the health of the workers (employees), from the problem that is not easily treated. In
this activity under supervision of Mr. Nassor Abeid as head of unit of occupational heath were
participate on filling checking heath (to make them medical examination) different employees
and to fill medical examination forms. The medical examination is head to toes examination and
each part of the body was examined and checked variety of diseases and problems. Bellow is
example of medical examination form which was participating to fill it.

Image 14 & 15 is medical examination form and diagnosis of diseases in a blood.

The following are description of some medical examination factors:-

A physique: physical appearance of examined people e.g. Abnormality and discipline in a

wearing and talking.
Lungs: to examine abnormality of lungs by listen sound e.g. wheezing sound for asthmatic
patient and crappy sound for pneumonia and TB patient. Sound was listening by using
instrument called stethoscope.
Heart: blood pressure and heart rate were examined by using sphygmomanometer and by
counting heart rate for one minute.
Abdomen: it is examined by visual shape, tendanance, palpation and auscultation using
stethoscope of enlarged organs such as pancreas, liver and spleen.
Urine: abnormality in urine was examined color, ph, protein and pass.
Hernia: the peoples were examined have no hernia, either inguinal or umbilical hernia.
Sugar: also sugar were examined both random blood glucose (RBG), amount of glucose in a
blood after eating and first blood glucose (FBG), amount of sugar in a blood before eating. A
sugar was checking by using instrument called glucometer. Then peoples were advised and
recommended on preventive measures of their health. The challenges such as low of staffs, lack
of computer, photocopy machine and transport were discovered in health education unit.
3.10 CHALLENGES, LESSON LEARNED, STRENGTH AND WEAKNESS OBSEVED
DURING THE VISIT.
CHALLENGES
The some owners of food premises e.g. shop keeper didnt allowed giving contentment
for doing inspection because of identification.
The obscene of some activities listen in check list in Mkoani district that make to travel to
Chake-chake district to conduct those activities.
Absence of transport, equipment and resources e.g. Computer and printing machines it
deteriorate working condition.
Some activities are periodic e.g. water analysis, which is conducted after each 3months
for ZAWA that make to lack to doing that activity.
The political situation it makes some peoples in a community to lack awareness on health
issues and to give cooperation.
Some activities listen in check list not supervised by DHMT that led to write application
letter and waiting for long time without answer. E.g. port health issues are under
supervision of Zanzibar port authority.
The some health units in Mkoani district available in island so there is water transport
problem that act as barrier to reach it.

STRENGTHS
The most activities listen in check list available in Mkoani district that easier to
participate practical training appropriately.
The greater cooperation for DHMT staffs and other health unit give desire and confidence
during conducting activities.
All workers at DHMT works in discipline because all time there is no aquarelle
discovered.
Presence of computer and wireless in Mkoani DHMT that easier data management
system (HIMS) is development condition.
Presence of health officers in health units gives me support to conduct activities.
Availability of specific time e.g. each Monday 07:30am for provision of health education
in Bogowa PHCU+ is imitation behaviour for both PHCU and PHCU+ on improvement
of community health.
Transport availability in Mkoani DHMT used for data collection process and provision of
vaccine during outreach.
WEAKNESSES
Loss ability of working for health unit staffs caused by age. E.g. almost health units
staffs are above 45years for female and above 50years.
The shortage of PHCU and PHCU+ in Mkoani district due to expand of towns and
increasing population.
The cooperation between ZMC staffs and their director is nearly poor that reduce
effectively working condition.
The some equipment e.g. electronic microscope in TB unit is impaired that hindering in
diagnosis of TB.
Lack of identity for heath officers act as problem during inspection.
The collection of monthly health data from some PHCU+ and PHCU is not on time due
to transportation problems.
LESSON LEARNED

Obtain experiences on providing health education in a groups or individual in a

community.
Learned cooperation between heath workers and community which is important on
preventive and control health problems.
How to perform inspection of premises e.g. food premises and meat inspection both antemortem and post-mortem inspection by following procedure.
Be knowledgeable of detect defects and provide recommendation during inspection
process.

How to manage vaccine e.g. cold chain and VVM to ensure that vaccine are secure for
consumers.
How pack vaccine in vaccine carrier and to fill child clinic card.
Leaned on variety of diseases caused by careless of peoples NTDs e.g. schistosomiasis,
intestinal helminthiasis and how prevention and control measures provided.
More experiences on health care waste management system according to color cord
system and prevention of infection in health care services (IPC).
How to control NTDs by massive drug administration controlling program e.g. provision
of albendazole and Praziquantel in a community.
Learned importance of preventive measure of problems in a community for active case
finding with fully participation of community

4.0 RECOMMENDATIONS
4.1 TO RELEVANT AUTHORITY

 The DHMT should be improve the plan of increasing and develop PCUC to PHCU+ to
ensure adequate availability of health services.
Occupational health unit should be parches computer and photocopy machine to improve
and easier excessive availability of services.
Professionals health officer should be find identification in order to easier to get
contentment to perform inspection.
Mkoani district ZMC with cooperation of DHMT should be prepare plan on availability
of at list one standard slaughter slabs in each ward it help community to eat inspected
meat.
The ministry of health and social welfare should increase health workers particularly
heath officers mostly in Mkoani district to overcome the problem of heath workers and to
solve heath problem effectively.
The port health and ZAWA authority should be give opportunity and favor for students
that need to get training on concerning activities, despite the reagent used in water
analysis is more expensive.
The ministry of health and social welfare must be involvement mostly on donating
financial for solving health problems.
The DHMT must be hurry up to take action soon the problems discovered after inspection.
4.2 TO STATE UNIVERSITY OF ZANZIBAR
The SUZA should be prepare check list that is concise and clear that show all activities
required to do according to class lessons.
The students particularly EH students must be give practical training after class lessons
even shortly, it help them to get good ideas for final field work.
The SUZA should be made temporary identification that give students contentment and
permission of performing inspection and other activities during practical field work.
The students supervisors initiate to visit field work areas before deploying students, this
help to know and avoid obstacles that hindering students to conduct field work activities.
4.3 SUGGESTIONS FROM FOCAL PERSON, HEALTH PROVIDER OR COMMUNITY.
The DHO of Mkoani DHMT suggested that SUZA should be planning to prepare check
list that explain what students needed to do in each activity.
The some Community leaders give congratulation for SUZA to produce and distribute
EH students that is more required to provide knowledge on environmental health that is
important knowledge in daily life.
The PHO proposed that the check list should be containing only activities leaned during
class period.
It importance for government to take action to any problem discovered during
inspection one of the shop keeper idea.

5.0 FOLLOW UP
o The next field work expecting to visit the unit of Neglected tropic diseases (NTDs).
o Also the house hold and health care waste management system.
o Furthermore is inspection of food premises and meat inspection both anti-mortem and
post-mortem inspection.

o In addition is diseases intervention program and extended program of immunization

(EPI).

REFFERENCES
Arnold, E. (1993). A new short textbook of prevention medicine for the tropics third ed. the Bath
Press, Avon; Singapore.
Ministry of Health and Social Welfare. (2010). Reproductive and child health: Student manual

Stefanie_knopp1. Diagnosis, epidemiology and control of soil-transmitted helminth

infections in Zanzibar retrieved from http://digitallibrary.ihi.or.tz/2493/1/Stefanie_Knopp1.pdf
EPI/MOHSW. (2009). Comprehensive Mult Year Plan Zanzibar retrieved from
http://www.who.int/immunization/programmes_systems/financing/countries/cmyp/Zanzibar_cM
YP_2010-2014.pdf