adminThe rainfall season is upon us! The season of plenty.
As one walks down the streets of Harare, trolleys full of fruits and vegetables line the pavements. All you have to do is pick the most affordable or the most appealing to the eye.
For the past month or so, trucks full of mazhanje have appeared on every roadside and fruit stalls.
But believe it or not, while people may wash apples or pears before eating them, no one ever thinks of washing mazhanje.
The norm is when you get your small plastic with your purchase of mazhanje, you immediately get one and eat it. To taste if the batch is sweet.
And once you start eating the little fruits, you cannot stop until the batch is finished or you have developed scratches on the side of your cheeks.
While we do not swallow the outer skin and the seeds, people usually pop the whole thing into the mouth then spit out the stuff that cannot be swallowed.
No one has ever thought about the implications of eating them in such a way.
Why should these nutrient packed fruits given to us by nature cause us harm? One might ask.
The fruit itself has no problem if consumed in moderation like every other fruit. It is the unhygienic way we eat it.
Usually when the vendors gather the fruit from the trees, they pick the ripe ones from the ground.
If the tree is shaken and a fruit does not fall to the ground, it simply means the fruit is not yet ripe for picking. But those that are ready will easily fall to the ground and will be picked and taken to the market.
But the ground is a haven for many organisms, good and bad.
These include roundworms, hookworms and whipworms also referred to as soil transmitted helminths.
Almost everyone knows that these intestinal worms exist, and many have suffered an infection before, but rarely do we think of it as a dangerous disease.
According to the World Health Organisation, soil-transmitted helminth (STH) infections are among the most common infections worldwide with an estimated 1,5 billion infected people which represents 24 percent of the world’s population.
These infections affect the poorest and most deprived communities with poor access to clean water, sanitation and hygiene.
The intestinal worms are transmitted by eggs that are passed in the faeces of infected people.
Adult worms live in the intestine where they produce thousands of eggs each day. In areas that lack adequate sanitation, these eggs contaminate the soil.
So when our mazhanje and many other fruits and vegetables fall to the ground and we pick them and eat them without washing them, we inadvertently ingest the parasites that cause the infections.
Also eggs that are attached to vegetables can be ingested when the vegetables are not carefully cooked, washed or peeled. Contaminated water sources can also cause infections.
Hookworm eggs can also hatch in the soil, releasing larvae that mature into a form that can actively penetrate the skin when people walk barefoot on the contaminated soil.
People with light soil-transmitted helminth infections usually have no symptoms but heavy infections can cause a range of health problems, including abdominal pain, diarrhoea, blood and protein loss, rectal prolapse, and physical and cognitive growth retardation.
Between 576 million and 740 million people in the world are infected with hookworm while an estimated 1,2 million people in the world are infected with roundworms and up to 795 million people with whipworm.
The WHO says there is no direct person-to-person transmission, or infection from fresh stool, because eggs passed in faecal matter need about three weeks to mature in the soil before they become infective.
In some areas of Zimbabwe, it is known that as young boys herd cattle, they can relieve themselves just under the tree, it can be a muzhanje tree.
In other areas, those who sell mazhanje have been said to mark their territory by defecating around the trees that produce the best fruits.
This could be true or myth, but it is known that faecal matter can be found under wild fruit trees.
So it is possible that people are ingesting these parasites regularly.
Soil transmitted helminths are among the 20 neglected tropical diseases (NTDs) identified by the World Health Organisation.
Neglected tropical diseases (NTDs) are a diverse group of conditions that are mainly prevalent in tropical zones.
They are caused by a variety of pathogens including viruses, bacteria, parasites, fungi and toxins.
These diseases cause devastating health, social and economic consequences to more than one billion people in the world.
In Zimbabwe, 14 NTDs have been targeted for elimination by the Government, and intestinal worms are part of these.
According to National Institute of Health Research director Professor Nicholas Midzi, the country conducted a baseline survey to establish the prevalence of STH in 2010 which revealed that the prevalence of the disease was at 5,5 percent.
In 2018, prevalence had gone down to about 0,7 percent following a series of targeted interventions to treat people in endemic areas.
However, disruptions in mass drug administrations encountered during the Covid 19 period reflected in the increase in prevalence of STH to 1,9 percent in 2021.
“Currently Manicaland is the highest burdened province with 4.4 percent prevalence whilst at baseline in 2010 Mashonaland East recorded the highest prevalence of 18.3 percent,” he said.
Prof Midzi said the reason for this high prevalence in Manicaland province could be the high prevalence of open defecation in the province while other factors such as low health seeking behaviours among religious objectors and lack of clean water sources also contributed.
“For infected girls and women of reproductive age, blood loss exacerbates iron deficiency anaemia and increases the risk of maternal and infant mortality and low birth weight. Infected children are nutritionally and physically impaired,” said Prof Midzi.
To control the infections, Zimbabwe has over the years conducted periodic deworming to eliminate infecting worms using Albendazole and mebendazole.
However, Prof Midzi said the treatment is accompanied by health education to prevent re-infection while authorities look into providing improved sanitation to reduce soil contamination with infective eggs.
Clean water supply for handwashing is also important and educating people to properly wash fruits and vegetables before consumption.
While the prevalence of STH has declined since 2010, Government has taken a targeted approach to ensure that the intestinal worms, along with the other NTDs can be eliminated by 2030 in line with global targets.
The national NTD programme which is housed in the Ministry of Health and Child Care has implemented the various treatment programmes targeting to reduce endemicity in the country.
In 2016, the country had managed to treat over 3 million children.
“The programme implemented an impact assessment survey in 2017 to see if the country had reduced endemicity of SCH and STH and results showed there was indeed a decline,” said Mr J’ose Alves Phiri, the assistant co-ordinator in the NTD Programme.
The WHO has supported the global community by developing a comprehensive set of normative guidance to support the planning, financing, implementation, monitoring and evaluation of NTD interventions from global to community level.
Member states, Zimbabwe included, have made commitments to address the burden of NTDs through integrated, cohesive approaches.
While the first NTD road map (2012–2020) delineated milestones and targets, the new roadmap for 2021–2030 sets out key actions and programmatic shifts to drive progress towards a world free of NTDs by 2030.
And Zimbabwe is on course to meet these.
What is needed now is a multi-sectoral approach to the programmes to ensure complete buy-in by all stakeholders, the communities included.
With community participation, NTDs like intestinal infections can be eliminated.
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Peter Tanyanyiwa
Online Reporter