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Background

Tanzania is a country located on the eastern coast of Africa. It is home to Africa’s highest peak, Mount Kilimanjaro and the world’s second deepest lake, Lake Tanganyika. The United Republic of Tanzania was established as a sovereign nation in 1964 through the amalgamation of Tanganyika (located on the mainland) and Zanzibar (an archipelago). There are more than 120 different indigenous African ethnic groups in Tanzania; however, some of the smallest ethnic groups are gradually disappearing due to modernization and politicization. The official languages spoken are Swahili (kiSwahili), part of the Bantu languages and English, though there are several Bantu dialects that give rise to variation in Swahili speaking [1]. About two thirds of the population identifies as Christian and one third as Muslim [2]. 


Corruption and governance issues, limited access to education and healthcare, infrastructure constraints, and high rates of poverty all contribute to the migration of Tanzanians to America [3,4] A notable percentage of Tanzanians immigrated to America, settled in East Missouri/West Illinois [5]. A consensus data in 2022 shows the East African immigrant population to be around 10,000 in Missouri [6].

Health Beliefs

Overall, Tanzanians exhibit receptiveness to Western biomedicine. Nevertheless, each ethnic group possesses intricate indigenous healing systems, which address challenges arising from limited access to Western medicine [7]. These systems are mirrored on a holistic approach health that aims to treat the mind, body and spirit as an integrated system:

  •  “Mganga” is the traditional healer who plays an important role in healthcare [7].

  • Herbal remedies have established pharmaceutical efficacy [7].

    • These include: garlic, ginger, honey, carrots, avocado seeds, bit roots, wood charcoal, papaya seeds, lemons, onions, aloe vera among others [8].

  • Faith healing is prominent among some Christian sects [7].

  • Islamic healing practices are prominent among some Muslim sects [7].

Social Traits

  • Gender roles

  • Patriarchal 

  • Age hierarchy/Respect for the elderly

Implications for Health Practitioners/Health Questions 

Greeting: Greetings in Tanzania typically take time, as there is a cultural emphasis on valuing individuals and relationships. It is deemed impolite to initiate a conversation without inquiring about the other person’s well-being, work, family, and/or other aspects of life. Occasionally, individuals may extend their hand for a handshake and maintain the grasp for a longer duration. This gesture is simply a sign of camaraderie [9].

 

In line with the cultural emphasis on respecting elders, Tanzanians hold their elders in high regard and greet them with reverence. When engaging with someone older, the customary greeting is "Shikamoo", which serves as a gesture of respect and honor [9].

 

Mental Health: Mental health is a stigmatized topic in the Tanzanian community. Some young people link mental health problems to drug use, while adults commonly associate mental health issues with spiritual causes or witchcraft [8]. Some Tanzanians feel as though mental illness is not a real illness, and some refuse to befriend those who have mental illness [10]. Therefore, patients may find it difficult or uncomfortable to disclose information regarding mental well-being to strangers. 

 

Diet: Tanzanians rely on staple carbs like corn, rice, cassava, sorghum, or plantains for their meals, with preferences varying by region. These staples are typically paired with fish, beef, goat, chicken, or mutton stew, accompanied by various vegetables and condiments such as beans, leafy greens, pumpkin, or sweet potatoes. Breakfast options range from bread and sweet rolls to coffee or tea to a variety of finger foods like fried plantains, roasted corn, and samosas, reflecting their heritage [7].

Questions/Education

Questions/Education:

  • Healthcare challenge:

    • Aside from Western medicine, what other medicine do you use?

      • Patients may supplement with traditional medicine/home remedies. Ask to ensure that none of the ingredients they utilize would interact with the prescribed medication [7].

    • Increase health literacy through dialogue and provide appropriate medical handouts/brochures in their preferred language. 

      • High prevalence of communicable diseases such as malaria, HIV/AIDS, and tuberculosis, which require extensive resources for prevention and treatment [11].

      • Limited awareness and education about non-communicable diseases (NCDs) such as diabetes, hypertension, and cardiovascular diseases, leading to late diagnosis and poor management [11].

  • Social History:

    • What are your thoughts about smoking/drinking?

      • In the elderly population, asking a patient to stop smoking/drinking may be difficult due to strong cultural habits.

      • Social problems related to alcohol abuse are prominent and becoming increasingly recognized in Tanzania [7].

  • Women’s Health:

    • Allowing female patients to choose their preferred provider might be ideal in certain situations associated with sexual health and childbirth. 

    • Be considerate of cultural sensitivity surrounding discussion of women’s sexual and reproductive health that may be deemed private or taboo.

Health Challenges

Noncommunicable diseases are a growing major cause of death and disability for Tanzanians. In 2019, 34% of deaths were due to cardiovascular disease, chronic respiratory disease, cancer, and diabetes [11].

 

Alcohol consumption in Tanzania is prevalent, with various traditional and modern alcoholic beverages being consumed across different regions and cultural groups. However, excessive drinking can lead to health and social issues, including alcohol-related diseases, accidents, and interpersonal conflicts [7].

 

Relevant to families that travel to Tanzania, the country has a high burden of tuberculosis and malaria. First, mortality rates related to tuberculosis show a decreasing trend in 2023. Next, about  8 million cases of malaria have been reported in 2021 with a rising trend in incidence rates since 2018 [11].

 

Tanzania is making strides in achieving the 95-95-95 goals for HIV/AIDS (95% of people living with HIV are aware of their status, that 95% of diagnosed individuals are receiving antiretroviral therapy (ART), and that 95% of those on ART achieve viral suppression), with a high percentage of people knowing their status, receiving treatment, and achieving viral suppression [11].

Women's Health

  • There is a dire need to increase health literacy among women and girls in Tanzania so that they are able to make informed decisions about their health and understand their rights to healthcare services.

  • Maternal death rates are associated with high fertility rates, low socio-economic status, and lack of autonomy that women have over their own health (socially speaking, men may have more say over women’s sexual & reproductive health due to their role as head of household, economic & educational advantages over women) [12].

  • Be considerate of cultural sensitivity surrounding discussion of women’s sexual and reproductive health that may be deemed private or taboo.

Family Structure

  • Family structure is often characterized by strong bonds among its members and a sense of collective responsibility. Multi-generational households are common, with extended family members playing integral roles in childcare and support. Respect for elders is emphasized, and grandparents often have significant influence within the family unit [7,9].

  • The man is typically seen as the head of the household, while the woman tends to gain respect through her children [7].

Conclusion

  • Tanzania's cultural diversity offers both challenges and opportunities in healthcare.

  • Acceptance of Western biomedicine coexists with deeply rooted indigenous healing practices, reflecting a holistic view of health.

  • Social norms, gender roles, and respect for elders significantly influence family dynamics and healthcare decisions.

  • Dismantling mental health stigma and promoting health literacy, especially among women, are crucial for improving health outcomes.

  • Tanzania faces challenges such as infectious diseases and noncommunicable diseases but the country is progressing toward healthcare goals.

  • The resilience and determination of the Tanzanian people and healthcare system are evident in their efforts to overcome obstacles.

Resources for Patients

This information was read and approved by Mr. David Wairimu, the representative of Bomas of Thairu Farms. The Bomas of Thairu farms is “an African farm, a place, a system, a vehicle for upward mobility for the community. A learning institution, a cultural marketplace and a platform for self-actualization.” This place serves as a helpful and welcoming community for the African immigrant population in the East Missouri/West Illinois region. 

References

(1) Mascarenhas, A. C. , Bryceson, . Deborah Fahy , Ingham, . Kenneth and Chiteji, . Frank Matthew (2024, April 10). Tanzania. Encyclopedia Britannica. https://www.britannica.com/place/Tanzania 

(2) 2022 Report on International Religious Freedom: Tanzania. (2023, May 15.). U.S. Department of State. Retrieved April 10, 2024, from U.S. Department of State. https://www.state.gov/reports/2022-report-on-international-religious-freedom/tanzania

(3) Rahman, K. (2019, September 30). Overview of corruption and anti-corruption in Tanzania. Transparency International: the global coalition against corruption. Retrieved April 10, 2024, from https://knowledgehub.transparency.org/assets/uploads/helpdesk/Country-profile-Tanzania-2019_PR.pdf

(4) Moshi, H.P. (2010). Migration in Tanzania: Patterns, Characteristics and Impact. Eastern Africa Social Science Research Review 26(1), 91-109.  https://doi.org/10.1353/eas.0.0013.

(5) Lorenzi, J., & Batalova, J. (2022, May 11). Sub-Saharan African Immigrants in the United States. Migration Policy Institute. Retrieved April 10, 2024, from Migration Policy Institute.

https://www.migrationpolicy.org/article/sub-saharan-african-immigrants-united-states-2019

(6) Missouri: Demographics & Social. (2022). Migration Policy Institute. Retrieved April 10, 2024, from Migration Policy Institute. https://www.migrationpolicy.org/data/state-profiles/state/demographics/MO 

(7) Tanzania. (2007, January 28). Every Culture. Retrieved April 10, 2024, from Countries and Their Cultures.

https://www.everyculture.com/Sa-Th/Tanzania.html 

(8) Anthony Liwa, Rebecca Roediger, Hyasinta Jaka, Amina Bougaila, Luke Smart, Stacey Langwick, Robert Peck, "Herbal and Alternative Medicine Use in Tanzanian Adults Admitted with Hypertension-Related Diseases: A Mixed-Methods Study", International Journal of Hypertension, vol. 2017, Article ID 5692572, 9 pages, 2017. https://doi.org/10.1155/2017/5692572

https://www.hindawi.com/journals/ijhy/2017/5692572/ 

(9) Darrah, P. (2018, March 28). Dos and Don'ts in Tanzania: Etiquette Tips for Travelers. World Nomads. Retrieved April 10, 2024, from https://www.worldnomads.com/explore/africa/tanzania/etiquette-in-tanzania#greetings

(10) León-Himmelstine, C., Samman, E., Kyungu, E., Roche, J. M., Festo, C., Plank, G., Amani, E., Samuels, F., Pellini, A. (2021, December 14). ODI Report: Mental health and psychosocial well-being among adolescents in Tanzania1 . ODI. https://odi.org/en/publications/mental-health-and-psychosocial-well-being-among-adolescents-in-tanzania-baseline/ 

(11) World Health Organization Regional Office for Africa. (2023, August 29). Country Disease Outlook - Tanzania. https://www.afro.who.int/publications/country-disease-outlook

(12) PPIUD Team. (2015, November 5). Women's Health in Tanzania. The PPIUD Project in the Department of Global Health and Population in Sri Lanka, Nepal, and Tanzania. https://projects.iq.harvard.edu/ppiud/womens-health-tanzania

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