ST.

JOSEPH UNIVERSITY IN TANZANIA College of Health Sciences, Boko Campus

DOCTOR OF MEDICINE PROGRAMME COMMUNITY MEDICINE (MC 400)

DEPARTMENT: PUBLIC HEALTH AND COMMUNITY MEDICINE

VISEZI DISPENSARY REPORT (21ST FEBRUARY – 25TH FEBRUARY 2022)

SUPERVISED BY:

Dr: DOMINIC TIBYAMPASHA (MPH)

 PARTICIPANTS:

No

NAME

REGISTRATION NUMBER

PETER MAGAMBO

18631102041

MARIA RUMISHO

18631102042

PETER MALUNDE

18631102044

BARAKA CHIKOLA

18631102045

VICTOR MICHAEL

18631102046

Table1. Showingthe group members

ACKNOWELDGEMENT
We appreciate and thanks GOD for his guidance all over our fieldwork period at Visezi Dispensary
which was conducted from 21st February to 25th February 2022. Also we would like to thanks our
parent/guardian for prayer and their economic support.

Sincerely as a group we would like to thanks, Dr. Dominick Tibyampasha (Head of Department of
Community Medicine, St. Joseph College of Health Sciences) for his guidance and constant
supervision as well as for providing necessary information regarding the project & also for his
support in completing the project, the principal of St. Joseph College of Health Sciences, Prof
Elizabert Popova and all staff members for organizing and supervising our fieldwork.
As a group we would like to extend our sincere thanks to Mrs. Mary Batwazi (Assistant Clinical
Officer, in Charge at Visezi dispensary) and Mrs. Bibie Ahmed (Medical Attendant) and Marium Ally
(community health worker)for their kind co-operation and encouragement which helped us in
completion of this project. We would like to express our special gratitude and thanks to the Village
and ward Health committee members and the Chairperson of Visezi Village.

Also we would like to extend our appreciations to the Head of VISEZI PRIMARY SCHOOL

and other staffs for a good welcoming and for allowing us to give heath education to their

students.

ABBREVIATIONS MOHCDEC: Ministry of health community development elderly and children.

MRDT: Malaria rapid diagnostic test MTUHA mfumo wa taarifa za uendashaji wa huduma za afya
OPD OUT-patient department PITC PROVIDER-initiated testing and counseling ARV: anti-retro viral
CHMT: council health management team CTC: care and treatment clinic RCH: reproductive and child
health services ANC: ante-natal clinic STIS:sexual transmitted infections D.M.O: district medical
officers SHP:school health program TB tuberculosis AFB: acid-fast bacilli DH: district hospital
HIV/AIDS:human immunodeficiency virus, acquired immunodeficiency syndrome NTLP:national
tuberculosis and leprosy program

BACKGROUND
Dispensary is health facility which offers health services as first level in primary care on outpatient’s
basis. A standard dispensary consists of outpatient, maternal, child health services and community
health services within its catchment area. Each village is supposed to have a dispensary, due to rapid
population growth one dispensary have to serve more than one village. As future DMO it is
important understand the pattern and kind of health services provided from dispensary level to the
country level. Also get to know the challenges faced during provision of health services and the way
they are being tackled.

OBJECTIVE

Ability to apply epidemiological methods in studying and diagnosing the diseases of a rural
community in relation to the specific ecological, socioeconomic, political and cultural factors. To
describe the practical application of methods and programs for control of major health problems of
a community at the primary, secondary and tertiary prevention level within the framework of the
existing medical delivery systems and according to national and local priorities and to acquire the
practical knowledge and understanding of the structural organization of the medical services in the
country and the interrelated function of the medical unit at different levels, with particular emphasis
on rural health services.

METHODS

The methods of collecting data were through direct observation, interviews as well as reviewing the
documents and records which were available at the dispensary. It included all patients that visited at
the dispensary during our stay, the staff at the health facility and the local government officials at
Mboga village.
8 INTRODUCTION

Dispensary is the first formal health unit of level one health services in Tanzania. By it being the

first level of primary health care and part of the district health system they are intended to serve

5,000 people and the health policy targets having one dispensary for every village.

Mboga is registered Dispensary under the  Ministry Of Health, Community

Development, Gender, Elderly And Children which among other responsibility the
ministry is mandated to Formulation Of Health-Related Policies. located at the eastern
zone in pwani region at bagamoyo district (chalinze council) with registration number
104621-8 Mboga dispensary intended to care target population of 7166 in which 712 are
under 1 year , 1228 are 1-5 years and 5226 are above 5 years but it serves population of
2134 people of an average of 177 people per month where per year (pregnant 76 annual
birth 76, surviving infants <1year 76, children under 1 year are 128 in which girls 66 and
boys 62 , 1-5year it serves 1126 patient in which male are 520 and female are 606 and
above 5years are 880 Also as the health facility It provides comprehensive primary health
care services which includes; diagnosis and treatment of diseases, RCH, CTC, TB and
leprosy, health education and minor procedure example wound dressing and rapid laboratory
services (MRDT) Due to limitation of services available at mboga dispensary, it has referrals
system whereby patients with complicated cases or suffering from illness that requires further
investigation and management are referred to higher level facilities including, MSOGA
health center and TUMBI hospital.

During the whole period of our field work at MBOGA dispensary we participated in different
activities related to health activities, such as clerking and diagnosing patients, prescribing
medications, educating people about primary prevention of the top ten diseases around the
village. The challenges facing the dispensaries were identified and mostly those which were
hindering provision of adequate health services to the community.such there was no
immunization facilities hence there is no immunization to children at mboga dispensary

As future DMOs, we are supposed to understand how the administrative system of

dispensary in relation to health system works, by being oriented with how the dispensary
operates as an independent health facility but as well as its functions in the district health
system. Also it helps us to determine the challenge facing health care delivery and how to
improve and sustain the quality of care in the peripheral health facilities.
OBJECTIVES:

1) Ability to apply epidemiological methods in studying and diagnosing the Health disease of
rural community in relation to the specific ecological, socioeconomic, political and culture
factors.

i. Interrelation of factors, which influence health.

a) To be able to collect data on

i. Demography, village population, catchment area and dispensary population density.

ii. Distance from the first aid post (km) or walking hours.

iii. Distance to the health center (km).

b) Environmental
i. Identify different water sources and means of protection.

ii. Latrine types and percentage coverage

iii. Garbage pits and percentage coverage.

c) Agricultural subsistence crops

i. Cash crops

ii. Average production of food and cash crops per family.

iii. Average production of the communal farm.

iv. Average income year per family.

d) Social and culture practices

e) Daily attendance rate, number of deliveries per year.

f) Number of traditional practitioners.

g) Number of traditional birth attendants.

h) Other means of getting health care.

ii. Survey of health status

a) Identify the top ten problems of dispensary attendances from registration book.

b) Identify the top ten problems of dispensary attendees during our stay.

c) Identify the nutritional status of the under-fives attending the dispensary and detecting 5the
children who are at risk group.

d) Elaborating the reliability of the above two parameters as a measurement of the health
status and elaborating on any discrepancy between the two.

2. To describe and learn the practical application of methods and programs for control of
major health problems of a community at the primary, secondary and tertiary prevention level
within the framework of the existing medical delivery systems and according to national and
local priorities.

i.

Primary prevention of disease in the community

1. Identifying national priorities for prevention of disease.

2. Listing the common preventable health problems in the dispensary

3. Analyzing what could be done with the available resources and what is done to implement
primary prevention in the community from the dispensary services.
ii. Secondary prevention of disease at the dispensary

a) Identify limitations to the diagnostic facilities at the dispensary and how can we improvise
particularly to tuberculosis and leprosy.

b) Identifying the applicability of the ministry of health drug list.

c) For TB/Leprosy listing the activities covered in the NTIP, which are not carried out at the
dispensary. Identify the re-attendance rate, what are the reasons for reattendance

3) To acquire practical knowledge and understanding the structure organization of the

medical services in the country and the interrelated function of the medical unit at different
levels, with particular emphasis on rural health services.

a) Identifying the different types of staff needed at village level according to the national
health policy and identifying the function according to the national policy and its role in
development.

b) Identifying the major organization problem, we came across in the dispensary. Identifying
the reasons and possible solutions within the available resources.

c) Identifying the referral system used by the community first aider and dispensary to
secondary medical care (health center, district hospital, regional hospital).

d) Describing how to initiates any self-help program in improving the health status of the
country.

11 METHODOLOGY
The methods of collecting data were through direct observation, interviews as well as
reviewing the documents and records.

Observation of the dispensary daily activities which were conducted at OPD, RCH, and
Dispensing roomas well as waste management at the dispensary. The economic activities,
water sources and their protection, waste disposal and social determinants of health of the
community were also observed.

Interviews were done with the staff at the dispensary which included the Assistant clinical
officer nurses,medical attendants, community health workers, village committee and some
members of the community who were attending at the dispensary.

MTUHA books and other documents and records available at the dispensary as well as the
village office were reviewed as well.

RESULTS GENERAL DESCRIPTION OF THE VILLAGEVISEZI VILLAGE

Mboga is among the village located Msoga ward at chalinze district council in pwani region
In Tanzania. Located between latitude -6.507325 o south and longitude 38.313845o east -It
has 7 sub villages which are; Kiloleni, kudidege, chanitambe,chinirodi,picha ya ndege,dioto,
Mikoroshini. According to the census, Mboga village has a population of 3121, the mostly
tribes found at Mboga village are Kwere, Masai,sukuma and zigua and others. The language
spoken here mostly is Kiswahili.

There is one government dispensary providing health services at Mboga village which is
Mboga dispensary.
There are one governments’ primary schools which called Mboga primary school; there is
one secondary school Mboga Secondary school

Ways of transport and communication are available such as rough road for cars, motorcycles,
bicycles and pedestrians. Mobile networks are also available for mobile phones. Source of
power in the village is from solar energy and electricity from TANESCO.

FACTORS INFLUENCING HEALTH STATUS AT MBOGA

ECONOMIC ACTIVITIES.

Mboga villagers are involved in different a economic activities such as small scale agriculture
including maize, cassava, rice cultivation and livestock keeping small scale business vendors,
boda-boda,shopkeepers.There are also public and privet employees.

Most of these activities mentioned above done by Mboga villagers play a great role in
promotion of health for example the crops such as maize, cassava, , vegetables and livestock
keeping provide nutrients required for stability of health status of the villagers. Also
transportation means like bodaboda help in transportation of patients to the dispensary for
treatment.and industry activities such as sayona industry

However, activities such as maize cultivation and industries cause diseases among the
villagers such as skin allergies due to exposure to pollen and upper respiratory system
diseases due to smoke from industries as to lack of knowledge on how to prevent themselves
when in plantations And poor location of industry this accelerated the rate of infection

The average total income per family is 150,000 -2,100,000 Tanzania shillings per year

SOCIAL FACTORS

In Mboga village some of cultural practices that were performed previously had negative
impact to the community health, currently this practices have been reduced examples the
cultural practice of giving birth to traditional birth attendance since currently the villagers
who fall sick regularly visit the dispensary after experiencing symptoms compared to the past
where they could attend the traditional healers.

Also practices such as early marriages have been discouraged due to the fact that now most
girls attend school as compared to the past where they stayed home thus getting married at
young age as a result being prone to birth complications in case of early pregnancy and
sexually transmitted diseases.

15 ENVIRONMENTAL-FACTORS WATER SOURCE.

In Mboga village the main source of water is underground water well, DAWASCO and rain
water which collected from roofs into the clean container but the reserved water is not treated
by chlorine. Sometimes due to scarcity of water, the villagers obtain water from the ponds
and dams.

Water affects health in a different way: ▪ The scarcity of water leads to transmission of water
washed diseases such as diarrhoea, and skin disease due to lack of water for personal
hygiene; organisms causing water-borne diseases e.g. typhoid, cholera and amoebiasis are
carried by water ▪ Also water is necessary in the lifecycle of some vectors of disease for
water related disease such as malaria also sharing water with livestock lead to water pollution

LATRINES
Most of the villagers in Mboga (95%) use pit latrines which are not protected and not
cleaned well due to the scarcity of water, some of them (4%) use flush toilets and few of
them they don’t have toilets. In the dispensary they use flush toilet that is kept clean most of
time.

The disposal of excreta is very important because infective organisms for different diseases
maybe found in faces and urine. For the community sanitation to be improved, households
should construct latrines that are cost effectively but should be effective and with standards to
prevent disease transmission or causation
GARBAGEAND WASTE MANAGEMENT AT VISEZI

Most households at the village have garbage pits and for shopkeepers along the road, which
uses to dispose their homemade wastes