Why nutrition and family planning programs need to be integrated

Finah Chemiat with her son Levy on her first visit to the clinic

Finah Chemiat with her son Levy on her first visit to the clinic

On the month of November while on routine supervisory visit in one of the Huduma Poa franchise facilitates in Trans-Nzoia County, I met Levy a 3 year old who was extremely malnourished.

His eyes were clear and full of life, only that his body betrayed the look in his eyes. He was frail and only weighed 7 kilograms. A child Levy’s age should be weigh 11 to 12 kilograms.
This day he was feeling unwell and had been brought to Seed of Hope Clinic for treatment by the mother.
The mother is a 22 year old housewife with two children; the first born being Levy and last born a 3 month old girl.
Finah and her husband live a modest life in a small center off Kitale town. The two dropped out of primary school and have no steady source of income. At times the husband works as a grounds man in the clinic compound.
The income he earns is insufficient to take care of his family’s basic needs he says. Their meals are mainly composed of ugali made of maize flour and kales; sometimes they take a mixture of beans and maize and Levy grew up taking lots of maize flour porridge for meals.
The boy was severely malnourished, which led to delayed milestones and stunted growth. He looked like a 6 month old child and when I talked to the mother to inquire about the possible causes of her child’s condition she said: “Nimejaribu kumlisha lakini sioni mabadiliko.” (I have tried to feed him but his condition has not improved).
After a lengthy conversation with Finah, she saw the need to call her husband who came from home and joined us in a health talk. I talked to the couple regarding nutrition and family planning in relation to quality of life since they were not on any contraceptive.
The husband was enthusiastic about the idea of contraception and encouraged the wife to start using any method of family planning but Finah said she would think about it. She felt that the health of her the boy was more of a priority this day.
Levy was referred to Namanjalala Health Centre for further management which comprises of nutritional counselling and food offered by prescription to the child.
After a month, Finah came back to the clinic a happy woman thanking the provider for the health messages we shared. She reported that the boy had improved and was in good health. She was ready to take up a contraceptive method and settled on a 3 year Implanon.

She was hopeful that her 3 months old baby will not be malnourished like the first born.
In the view of health workers, the primary cause of malnutrition is poor feeding, especially at the time of weaning and up to the age of five years.
Even though efforts are made to teach mothers the principles of a balanced diet and the importance of suitable weaning foods given frequently during the day, the ability of parents to provide the right nutrition plays a major role in managing malnutrition and emphasizing family planning as a way of spacing birth and controlling child birth to a number a couple can manage will come a long way in improving quality of lives.
The key to sustaining this momentum lies in the health education and mobilization forums that give the clients an opportunity to share their fears, myths, misconceptions and experiences about family planning and cervical cancer screening.
By Beatrice Amayo
Quality Assurance Officer, KMET

Bridging the gap of unmet contraceptive needs and cancer screening among HIV-infected women

Joshua Adhola, a Huduma Poa demand creation officer offers a health talk at Osani Heallth Centre during an event day.

Joshua Adhola, a Huduma Poa demand creation officer offers a health talk at Osani Heallth Centre during an event day.

“Three years ago, Kenya was ranked the fourth country with the highest HIV epidemic in the world. Although HIV prevalence among the general population has fallen in Kenya, women continue to be disproportionately affected by the epidemic.

Homa Bay County where I work as a Demand Creation Officer records the highest HIV incidence rate in the country with a prevalence rate of 27.1 percent compared to the national average of 5.6 percent according to the 2012 Kenya Aids Indicator Survey Report (KAIS).

The survey also indicates that 6.9 percent of women were living with HIV compared with 4.2 percent of men. With these facts in mind, most health interventions in the county therefore focus on reducing the prevalence rate.

Located in Ndhiwa Sub County, approximately 45 kilometers from Homa bay town is Osani Community Health Centre which is one of the health facilities in the County that offer comprehensive care to HIV clients.

Client queue to receive health services at Osani Community Hospital

Client queue to receive health services at Osani Community Hospital

Being a member of the Huduma Poa social franchise some of the other core services offered at the facility include family planning; HIV Testing and Counseling; and Prevention of Mother to Child transmission of HIV.

The nurse in charge of the facility acknowledges that since they joined the franchise in 2012, clients accessing family planning services have been on a steady rise which she attributed to the Huduma Poa event days.

Despite the gains, there had been a forgotten group in provision of family planning and cervical cancer screening services. Initially the facility attended to HIV positive client who are on care and treatment without any deliberate attempt to directly involve them in the activities of the event days.

Conversely during the last quarter (October –December, 2014), clients from the HIV care and treatment centre were involved in the event days that were held in the facility. The change of tact resulted to more women who are aware of their HIV status receiving implants and other contraceptives as well as cervical cancer screening.

As we get into a new year we purpose to strengthen the ‘Supermarket approach’ so that HIV care and treatment and reproductive and child health services are not seen as independent services in the facilities but mutually inter-dependent. Going by the lessons of the last quarter, attempts to deliberately target known positives should be scaled up.

This will be in tandem with Kenya Aids Indicator Survey Report (2012) which recommends that, efforts should be directed at further reducing the unmet need for family planning, with a focus on HIV-infected women and that there is need to scale up cervical cancer screening in women of reproductive age— among both HIV-infected and HIV-uninfected.

By Joshua Adhola, Demand Creation Officer, KMET

Rose’ story of poor housing conditions and risk of TB infection

Rose’ family at her house during a contact tracing follow up visit by the KMET team

She wakes up very early in the morning to prepare breakfast for the seven children she lives with in her house at one of Kisumu’s informal settlements. She then kneads dough that she will later on use to make chapatti by the roadside.
Rose a 38 year old single mother lives in Nyawita where she cooks and sells chapatti for a living. The mother of two; eldest child 10 and the youngest 2years, is also HIV positive and shares the predicament of most slum dwellers in terms of housing.
Rose’ house is nothing different from most of the houses in her neighborhood, it’s not only modestly limited in space but has neither windows nor ventilation. Rose is a mother of two but lives with four of her elder sister’s children together with a younger sister who also has a child.
In the year 2006, Rose was diagnosed with TB after she could not bear a persistent cough and tremendous weight loss despite using antibiotics that was prescribed for her in a pharmacy.
She dutifully took her medication for eight months and recovered.
Eight years down the line, she was spotted at the roadside where she cooks chapatti by a KMET community health worker (TB Agent), Damaris Akinyi, who had noted that Rose had been coughing for a while.
Damaris booked a date with her and together with KMET’s TB Reach Programme Officer, Adriano Ngaywa’’, they paid her a visit in her home.
Rose and her younger sister were given a health talk, screened and they happened to present TB symptoms like chest pains, sweating at night and coughing.
They were referred to KMET’s Corkran clinic for further lab tests where Rose was once again found to be TB positive and immediately initiated into medication. Her sister on the other hand was negative.
Given the nature of their house and the number of occupants, the children were at high risk of getting infected hence they were later screened too and fortunately they were TB negative.
Rose say she is not ignorant about the importance of proper aeration in TB prevention and her only plea is to the landlords of the slum houses to install windows since even if she wanted to, she cannot afford well built houses. Adriano says the area is considered a key population since statistics show that majority of the residents are HIV positive weakening their immune system hence making them susceptible to TB infection.
In the subsequent quarter, KMET has planned to carry out outreaches in the area and other informal settlements within the city to give TB health talks, screening and collect sputum samples from door to door.
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Menopause blood or Cervical Cancer?

At Ahono Primary School in Siaya County a long queue of clients waited to access integrated reproductive health services that had been brought closer home. It was a Huduma Poa community based event day set aside for contraceptive services, cervical cancer screening and HIV testing and counseling.

In the queue was Teresa Adhiambo, waiting patiently just like the other women for her turn to get into the room and see a reproductive health personnel. For the last two years Teresa has not been having her monthly periods until they reappeared in September 2014 with intense waist pains and continuous profuse bleeding.

Teresa Adhiambo aged 43 years is a widow with a perfect story of the ruggedness of life one wouldn’t tell by just looking at her composed self, especially on a day like this.

The mother of seven, the oldest being 16 years and the youngest 10 years, was widowed in the year 2000 after her husband succumbed to a fatal road accident.

The following year she was inherited by her brother-in-law according to the Luo customs. After only two years in union, her new husband and the co-wife passed on after a series of prolonged illnesses.

Out of a mixture of fear, suspicion and caution she went for a HIV test, this being the second time. She turned out HIV positive.

Teresa somberly recalls how she insisted that the brother in law and her get tested first before their union which he accepted due to her persistence. They both turned out to be negative then.

Her predicament distressed her each day as she questioned how she came to get the virus. She says she suffered a period of regrets, self-blame and desperation.

‘I had a feeling my brother in law knew his HIV status earlier and had struck a deal with the nurse in charge not to disclose to me when we went to be tested. I would never have allowed him to infect me because I have children to take care of’, she discloses.

While still on her path to emotional healing, another complication arose. Her monthly periods reappeared after two years of no signs of bleeding only that this time she experienced intense waist pains and continuous heavy bleeding.

When she could not ignore the condition anymore she went to seek medication and without being tested, she was prescribed drugs to reduce the pain. Her condition did not improve despite being on medication and she continued to bleed for three months.

She says a nurse once told her that those were signs of approaching menopause.

Her face fills with melancholy as she recalls how she had to sell a goat to buy medicine costing 1300 shillings yet she still lived with the worst agony a single mum without a source of income

On this particular day she had come to seek a second medical opinion after her sister who lives in Sagam informed her of KMET’s Huduma Poa event day at Ahono Primary School.

After a cervical cancer screening she was found to have an advanced cervical cancer and she has been bleeding because her cervix tissues had already become cancerous.

The news shook her. She went quiet for some minutes and the first thing she uttered during counseling was where she would get money for her medication since she was referred to the nearby Yala Sub-County Hospital for examination under anesthesia and possible biopsy for histology. To her, this was a great reprieve “I hope all will be well and thank you KMET, you should come out here more frequently to help people like me”

By Pamela Nyagol,

 

TB screening in prison saves warden’s family from infection

jela ya saya

She was on her official day-off, she planned to relax at home and catch up with her children but then she heard that a medical team was coming to test in-mates and staff of tuberculosis. She abandoned her initial idea and reported to Siaya Prison.

32 year old Maria is one of the few female wardens at the correctional facility based in Siaya County. She had been coughing and experiencing chest pains. She had gone to a nearby pharmacy and bought some septrin tablets which she took for a week or so.

Her condition did not get any better and she had trouble sleeping citing discomfort and experiencing night sweats. “I used to cough so much and sweat a lot at night just like a work mate of mine who was once diagnosed with TB,” she says.
A month before this day she had visited a clinic within town and later on was referred to a government facility where she was diagnosed with pneumonia and started on antibiotics. The mother of two notes that though she had a slight improvement after taking the antibiotics, she was still worried at the slow progress of her recovery.

The team of medics from KMET TB Reach program in collaboration with the Ministry of health officials in Siaya camped at the facility for three days talking to staff and inmates about tuberculosis infection, management and prevention as well as screening them for the infection.

mariah siaya

Maria willingly accepted to be screened for TB on the first day since she wanted to ensure whatever was ailing her was not TB. She did not wish to infect her family, especially her six months old baby having learnt that it is an airborne disease.
She was scheduled for tuberculosis tests. The results came the following day and unfortunately her fears were confirmed; the tests were positive.

To ascertain that the family was safe, Maria’s husband and two children were requested to come for Tb screening and tests to ensure they had not contracted TB too. The tests were negative

Maria was started on anti TBs and her six months baby was put on drugs too in a bid to reduce chances of the baby contracting TB from the mother.

Maria had been misdiagnosed and was on the wrong drugs for a month. Denis Nyaoko, the KMET TB-reach program coordinator confirms that there are other diseases with similar symptoms as TB such as pneumonia, bronchitis, or influenza.
In Kenya Approximately 3 million cases go undetected each year and the country is ranked 15th among the 22 high burden countries that collectively contribute about 80% of the world’s TB cases.

Denis says they are taking services to people in prisons and even slums ‘key population’ since their environment make them to be at high risk of TB infection and due to lack of information as well as misconceptions about TB, rarely take the initiative to walk into a facility for screening until it is late.

He adds that a well aerated environment is key in preventing TB infection, yet it is one thing that the people within the key population group find a luxury too expensive to afford.

By Dennis Nyaoko.

How long does it take to get pregnant after stopping a contraceptive method?

contraception
As more women in Kenya appreciate the need to plan pregnancy using modern family planning methods, more concerns by the same group has risen regarding long term effects of contraceptives.
Lots of women ask these questions: After using contraceptives, will I be able to fall pregnant as soon as I come off it? Will using birth control for a long period of time affect my fertility?
The answer to these questions lies in the type of contraceptive method or the family panning method one has decided to use.
It is adequately documented by experts that some contraceptive methods have no impact on your fertility once you come off them, and you can fall pregnant as soon as you stop using the method.
With others, especially those that introduces hormones in your body, it takes slightly longer time to return to fertility which means that even when you stop using them, it could take some time to fall pregnant.
The common methods that women use in Kenya are the 3-month injection known as Depo Provera; the contraceptive implants that are inserted on the upper arm; daily oral pills and intra-uterine device (IUD) commonly known as the coil.
All the methods mentioned above use hormones to prevent pregnancy from occurring except the IUD.
According to Dr. Stephen Gwer a medical doctor and a lecturer of Obstetrics and gynaecology at Maseno University School of medicine, hormonal contraceptives (the pill, implant and injection) all contain a small amount of man-made hormones that are released into the bloodstream at a slow and steady rates.
The hormone thickens the cervical mucus and thins the womb lining. This makes it harder for sperm to move through your cervix, and less likely for your womb to accept a fertilised egg.
While the injection or Depo as its commonly known, is the more popular and relatively convenient to use method (you only need one injection every three months), experts say the method presents the worst side effects of most contraceptive methods.
Moses Ojwang Suna West Sub County Reproductive Health Coordinator qualifies this assertion saying the method introduces a larger amount of hormones into your body therefore it may take a longer time as compared to other methods to get out of your body. It can take up to 9 months after stopping use to get pregnant.
“We wouldn’t recommend this method for you if you want a method that is less hormonal and has a faster return to fertility especially if you have never given birth before” he adds.
The implant, which is inserted under your skin is effective for up to three or five years depending on the type used; has a relatively faster return to fertility rate.
Once the small rods are removed from the upper arm the ability to give birth should return to normal immediately according to manufacturers. There have however been few cases where women have had to wait for up to three months, according to Oscar Okoth a reproductive health quality assurance officer working for the USAID Health Communication and Marketing Program in Kisumu County.
The daily oral birth control pill also introduces hormones to your body and it may take anything up to 9 months to return to fertility.
This leaves you with only one method that assures you of an immediate return to fertility which is the IUD or coil. Despite the fact that it offers protection up to ten years, one can get pregnant immediately after removing the IUD.
So when you are thinking about birth control ask yourself these questions: how long do I want to be protected against unwanted pregnancy and how long am I willing to wait until I can fall pregnant after stopping a contraceptive method?

How long does it take to get pregnant after stopping a contraceptive method?
As more women in Kenya appreciate the need to plan pregnancy using modern family planning methods, more concerns by the same group has risen regarding long term effects of contraceptives.
Lots of women ask these questions: After using contraceptives, will I be able to fall pregnant as soon as I come off it? Will using birth control for a long period of time affect my fertility?
The answer to these questions lies in the type of contraceptive method or the family panning method one has decided to use.
It is adequately documented by experts that some contraceptive methods have no impact on your fertility once you come off them, and you can fall pregnant as soon as you stop using the method.
With others, especially those that introduces hormones in your body, it takes slightly longer time to return to fertility which means that even when you stop using them, it could take some time to fall pregnant.
The common methods that women use in Kenya are the 3-month injection known as Depo Provera; the contraceptive implants that are inserted on the upper arm; daily oral pills and intra-uterine device (IUD) commonly known as the coil.
All the methods mentioned above use hormones to prevent pregnancy from occurring except the IUD.
According to Dr. Stephen Gwer a medical doctor and a lecturer of Obstetrics and gynaecology at Maseno University School of medicine, hormonal contraceptives (the pill, implant and injection) all contain a small amount of man-made hormones that are released into the bloodstream at a slow and steady rates.
The hormone thickens the cervical mucus and thins the womb lining. This makes it harder for sperm to move through your cervix, and less likely for your womb to accept a fertilised egg.
While the injection or Depo as its commonly known, is the more popular and relatively convenient to use method (you only need one injection every three months), experts say the method presents the worst side effects of most contraceptive methods.
Moses Ojwang Suna West Sub County Reproductive Health Coordinator qualifies this assertion saying the method introduces a larger amount of hormones into your body therefore it may take a longer time as compared to other methods to get out of your body. It can take up to 9 months after stopping use to get pregnant.
“We wouldn’t recommend this method for you if you want a method that is less hormonal and has a faster return to fertility especially if you have never given birth before” he adds.
The implant, which is inserted under your skin is effective for up to three or five years depending on the type used; has a relatively faster return to fertility rate.
Once the small rods are removed from the upper arm the ability to give birth should return to normal immediately according to manufacturers. There have however been few cases where women have had to wait for up to three months, according to Oscar Okoth a reproductive health quality assurance officer working for the USAID Health Communication and Marketing Program in Kisumu County.
The daily oral birth control pill also introduces hormones to your body and it may take anything up to 9 months to return to fertility.
This leaves you with only one method that assures you of an immediate return to fertility which is the IUD or coil. Despite the fact that it offers protection up to ten years, one can get pregnant immediately after removing the IUD.
So when you are thinking about birth control ask yourself these questions: how long do I want to be protected against unwanted pregnancy and how long am I willing to wait until I can fall pregnant after stopping a contraceptive method?

By Oyier Emmanuel

Disclosure: don’t children born with HIV virus have a right to know?

aids

I really appreciate the interventions that have been made by both the government and NGOs in Kenya to counter the spread of HIV/AIDS. Various campaigns have been held across the country whose aim is to equip people with information on infection, care and prevention of new infections. Indeed I salute these reasonable and necessary steps that have been taken to curb the pandemic.

Despite my appreciation, I happen to have a concern about HIV/AIDs that keeps stinging me like a bee whenever I observe my society.
In a remote village in Seme, in a family of five, both parents and two of their children are HIV positive.
The daughter who is ten years and HIV negative plays with two of her younger siblings who are HIV positive outside their small hut. One of them gets a cut from a razor blade and the responsible older sister sucks blood from the cut surface. What if the older sister had a cut in the mouth?
Other children from the neighborhood join the game and they continue playing with the razor blade that had cut the other child. How many children get infected in this manner especially in the village?
In another village in Bondo is a 16 year old girl, an orphan, HIV positive, in form one and staying with her grandmother. All the girl knows is that she is taking drugs because of her chest problems and the porridge flour she is being given at the hospital is to boost her immune system for those drugs she has been taking since she was young. This girl also happens to be in a relationship with the son of their neighbor.
After observing these two scenarios, I believe my fear and concern about HIV in our country today can now be understood. I understand that ethics during HIV testing and counseling demands that the client or the parent of the client, in the case of minors, has a choice to disclose or not to disclose their HIV status to whomever whenever they wish. As we protect that right, could we be putting others at risk?
I tend to believe that a number of children born with the virus could be infecting others including their own siblings unintentionally while they are playing since they are not aware of what is happening to them. Since most parents tend to keep it a top secret, the children grow into teenagers and probably since they are virgins they don’t imagine they could be having the virus. Just like the scenario in Bondo, parents still don t disclose to their HIV positive children their status and explain why they are on drugs.
The children who get infected from their fellows when young get a big shock when they finally get tested. They may not be sexually active, none of their immediate family members HIV positive nor have they been transfused with blood. They wonder how they got infected!
I chose to share this fear with Amos Onderi from KMET, the officer in charge of the program that has HIV/AIDS interventions; he shared my worry concerning this serious but not yet identified matter. To confirm my fear, he also narrated to me the story of a 10 year old girl in Bondo who was found HIV positive after being tested in school. Since she did not believe the results, she went to be tested again and the results were the same. She was in shock given that her parents and siblings were all negative. Maybe she contracted the virus after sharing a sharp object with an infected child while playing.
Amos agrees with me that we need to package our information in a palatable manner to reach the very young ones. Parents too need to accept the reality and disclose to their children their HIV status early enough to reduce the number of children and teenagers getting infected.

It is my opinion that children born with the HIV virus have a right to be told why they are on medication and how they should take care of themselves and others around them as soon as they can comprehend. I rest my case!

By Lynette Ouma