15 November 2012

Zimbabwe: Eczema - a Silent Health Monster

AN itchy red-brownish rush crusted on her face and scalp, creating a scurvy skin that itched with every minute that ticked away. At 14 years old, Ruvimbo Machingauta (not her real name), had learnt to live with it and accepted her fate. The situation is worse in the morning, where a combination of shaking off the lethargy of sleep, the dawn of a new day and going to school, irritates both her skin and soul.

"I dread the mornings when I want to go to school as they remind me that I am different from others. My peers tease me and playing in the school grounds is a mere dream as it becomes a dosage of a somewhat flaming pain in my skin," she says.

This has turned her into an introvert, because other children shun playing with her. The rude ones have called her all sorts of names and whatever she does, she now feels dejected and a ghostly figure of her real self.

Ruvimbo -- like many children -- silently suffers from an allergy called eczema, which most people are ignorant of and yet invites discrimination.

Eczema is a skin disease that has become common among children and adults in Zimbabwe. It is prevalent in infants and children within the 0 to 15 age group, but can also be found in adults. The exact cause is not known, but it is believed that it results from a combination of family hereditary genes and a variety of living conditions.

Eczema presents a range of emotions both for sufferers and their loved ones. Children suffering from eczema can be fussy and difficult, as they cannot help scratching and rubbing themselves. Eczema has proved difficult as most people associate the disease with other ailments such as HIV and Aids and witchcraft among others.

There are myths and misconceptions which contribute to stigma and discrimination suffered by the victims and their families.

One particular incident is that of a child from Chinhoyi, who was sent packing out of school because he was scratching a lot and the school personnel thought his condition could disturb other pupils.

The general feeling was that he was suffering from an unknown contagious disease. But eczema is not contagious. Children suffering from eczema often face challenges at school or within the society and find it difficult to have friends due to stigma and discrimination.

Founder of Eczema Association of Zimbabwe Trust Mr Odwell Gwengo recently had a sponsored walk from Marondera to Harare in a bid to raise awareness and funds, saying the public was ignorant of the condition and continued to discriminate against the affected people, especially children who are still building confidence in their lives.

Mr Gwengo said there was a worldwide increase in the prevalence but in Zimbabwe, data was lacking, making it hard to implement interventions.

"Currently, there are no statistics because the condition is recorded as other skin conditions on the T3 Form available from the Ministry of Health. We have since written to them seeking permission to access the information.

"The purpose of the exercise is to establish the prevalence and type of allergic diseases in Zimbabwe, Situation Analysis of eczema and Asthma including data, current services in management and control of eczema," he said.

Mr Gwengo also said he was inspired to start EAZT after his son had been diagnosed of chronic eczema.

"I approached several dermatologists (skin specialists) until I met one doctor who gave me a lecture on eczema, its causes, how to manage it, live with it and that there is no treatment for eczema.

"Locally, we met a number of children like him (his son) so I realised the need to impart the same information to their parents and caregivers and probably establish a centre for information. The long-term objective is to establish a skin clinic in Zimbabwe because there is no such clinic in the country at the moment.

"We have received assistance from Government through the Ministry of Health, whom we are working with in implementing our programme though we haven't received financial support yet," he said.

The EAZT founder reckons that eczema is more prevalent than previously thought.

"Judging by the numerous cases attended to, eczema is common in our communities than we had anticipated. Two thirds of the children with a new diagnosis of eczema had a family history of asthma or allergies. Some cases were very severe that although it was not planned in the programme we ended up sourcing anti-itching creams and moisturisers for severe cases and these were given to the patients for free," he said.

"Staff from the four polyclinics in Chitungwiza requested for similar programmes at their clinics because some of the cases are reported at their clinics daily without further management and control.

"The age groups of children screened during the programme ranged between 0 and 14 years with at least 22,.7 percent cases reported in girls and 77,3 percent cases reported in boys, and feedback showed most mothers did not know how to cope with eczema," he added.

Clinical Immunologist, Allergologist, Professor Elopy Sibanda, said that up to 30 percent of all visits to general practitioners or paediatric consultations were because of allergies and diet played a crucial role in the manifestations of these ills.

"One out of three infants and young children with eczema has underlying allergy and may benefit from a diet or other form of avoidance to what they react to.

"Our diet plays a crucial role and there are over 70 percent of allergic patients who say they feel limited in their daily activities which is burdensome to the economy of the country," he said.

Prof Sibanda said prevalence and incidence of the condition was rife in children who make up 15-30 percent, while 2-10 percent occurrence was recorded in adults.

"It is present at infancy and can last a lifetime, 85 percent affected are under five years but is lower in rural areas than urban areas which may be attributed to lifestyle and environment," he said.

The World Allergy Organisation write-up recommends governments to create a more integrated and holistic approach to the diagnosis and management of allergic diseases.

Governments are also implored to increase public awareness of allergic diseases and their prevention and provide greater education at the primary healthcare level and to non-allergy-oriented secondary care specialists.

"Countries should train medical students and other health care professionals to collaborate with specialists in providing integrated care for allergy patients and promote institute environmental control measures by the lowering of indoor and outdoor air pollution, tobacco smoking, and allergen and drug exposures," part of the document read.

It also read that the economic burden for countries like South Korea, USA, Australia and Israel for all allergies was US$267,78 billion, US$19,7 billion up to US$20,9 billion, A$9,4 billion, and US$250 million respectively.

Eczema falls in the category of other non-communicable diseases like cancer and diabetes, which are increasingly taking lives each day across the world and much is yet to be done by the Zimbabwean Government to mitigate their harm.

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