Defaulting TB medication puts you & your loved ones at risk

Jedida and her family together with KMET TB Reach Program Officer, Adriano Ngaywa (far right, white shirt) when he made contact tracing.

Jedida(blue tshirt, second right) and her family  when we made contact tracing at he house.

Jedida Atieno lives a modest life in Malunga village, Siaya County with her husband and seven children. The grass thatched house is evidently too crowded for the children- the eldest 8 and youngest 4 years old.  She and her husband are subsistence farmers.
In 2013, Jedida started feeling unwell a little more often. The persistent cough and night sweat continued even after buying over the counter medication for a while. She still experienced the on and off signs prompting her to seek further medical attention.
In June, she went to Siaya County Hospital where a sputum test turned positive for TB. She was then put on medication which was to run for six months. However, she defaulted having taken her medication for June, July, and August.
She had gone to a funeral and had overstayed for two months failing to take her medication as prescribed.
In December, Jedida gathered courage and went to Ngiya Mission Hospital where a sputum microscopy was done same for HIV test. Both tests turned positive.
She was initiated to second line treatment of TB from the month of December to August 2014. During this period Jedida  became pregnant.

KMET TB Reach Quality Assurance Officer, Dennis Nyaoko talks to Jedida Atieno when she visited one of the Huduma Poa facilities for assessmentWhen the baby was born she was started on isoniazid prophylaxis for six months to prevent her from getting TB from the mother.
The child kept on getting sick with persistent fever, night sweats and did not respond to Paracetamol. The little girl was frequently admitted to Siaya County Hospital between the months of June and September continuously losing weight.
Luckily in November, a Community Health Worker (TB agent) working in the KMET TB reach program visited Jedida’s house where she revealed her predicament. She told the CHW about the babies’ situation.

When the KMET Tb reach team visited the area the CHW led them to Jedida’s residence. From there they made an assessment for the child recommending contact tracing for the husband and the children. The child was then taken to the paedtrics at Ngiya Mission Hospital where she scored nine above the normal range that is seven on the Paedtrics TB score chart.
She was immediately put on TB treatment. With time her condition has improved, she has gained weight, the fever has subsided and she is now active like any other child at her age.

“Thank you KMET for coming to my aide, my condition is getting better. I would like to advice others they need to adhere to medication so as to fight the disease” Jedida says.

In 2005, its estimated 7.6 per cent of patients in Kenya defaulted from TB treatment.


Mama KMET, Monica Oguttu displays the award to the KMET family

Mama KMET, Monica Oguttu displays the award to the KMET family

KMET Kenya has been recognized and awarded by Kenya Obstetrical and Gynecological Society (KOGS) for being a champion in Sexual Reproductive Health Rights (SRHR) in the 47 counties in Kenya.

KMET was congratulated for distinguishing itself in policy advancement, practice and providing stewarded networking with partners locally, regionally and internationally.

As she presented the award to a delighted KMET family, KMET CEO Monica Oguttu noted that the call the organization has had in reducing maternal mortality, especially those that arise from preventable causes would not be achieved if not for the team work and commitment of the staff members.

The organization has been training providers in Post Abortion Care (PAC) services, improving access to quality PAC services in underserved communities, improving access to contraceptives as well as cervical cancer screening to underserved communities since 1995.

KMET received the award at Safari Park Hotel in Nairobi during a KOGS conference where the African chapter was started for the first time.

Why opt for the services of unskilled midwives?

The Fort Ternan community during a community conversation forum

The Fort Ternan community during a community conversation forum

Every day, about 800 women die worldwide from preventable pregnancy or child related complications with most of these deaths occurring in low resource settings.

Poverty set aside, what else could be causing high maternal mortality rates in such settings?

Amongst the Fort Ternan community in Muhoroni Sub County, it is alleged that a number of expecting women would seek delivery services from old unskilled midwives and only go to the facility in case of complications.

Surprisingly enough, the midwives offer their services at a fee yet quality services at the nearby dispensary are free of charge. What could be the reason?

‘I conceived four months after my last delivery. I was ashamed to go to the facility because it was too soon so I opted to seek the services of a midwife. I developed complications and I can’t tell what could have happened if I never went to the hospital. I swear I will never seek the services of a midwife again’, revealed Beth Onyango, a woman in her late 30s.

According to Jane (name altered) who is a young mother of two, she chose the services of an old unskilled midwife during her first delivery out of fear after she heard that nurses beat up mothers in the hospital.

Her experience was not any better since the midwife too beat her when she could not follow instructions due to the labor pains.

The community members who were speaking during a community conversation forum introduced by KMET also disclosed that those expecting twins more often lose one of their babies in the hands of these midwives.

The men who had turned up in large numbers for this forum were shocked when they heard these revelations.

Despite their involvement in taking the women to the hospital during complications, they were not aware of the risks the women faced by first seeking services from the unskilled old midwives.

When all was said, the community members decided to start sensitization sessions that would emphasize on the importance of expecting women seeking all the services from the health facility.

The men even agreed to influence the others and prohibit their wives from seeing unskilled midwives for whatever reason.

KMET has been introducing community conversation forums so that communities and especially men take maternal health issues as their responsibility.

Mageta community to adopt community conversation approach in curbing teenage pregnancy

Mageta is a small cosmopolitan island of about 6.6km2 located in Lake Victoria with most of its residents engaged in fishing and fishing related activities.

A community conversation forum going on

A community conversation forum going on

Just like many other beaches around Lake Victoria, Mageta Island too records high numbers of people living with HIV, maternal health issues and teenage pregnancies despite the many interventions set to curb such issues in the area.
KMET arrived in the island to introduce community conversation as an approach involving the whole community in handling maternal health issues.
Though they found the concept of community conversation new, they embraced the idea and immediately opened up to deliberate on teenage pregnancy which they said is quite prominent.
As the discussion was underway, one community member walked in and after listening for a short while, she broke the latest news of teenage pregnancy in one of the primary schools that left everyone shocked.
She disclosed that she was just from Mitundu Primary school where she had been called to discuss what should be done to the girls who had apparently reported to school pregnant.
The community members led by their chairman Mr.Samuel Otieno noted that in the last three consecutive years, the school has been reporting high numbers of teenage pregnancy with 7 cases recorded in 2014.
This concern led them to discuss the possible causes of high teenage pregnancy and two major factors were identified.
First, they realized that most mothers sent their daughters to the market without money. The girls are then lured by fishermen who give them over ksh.1000 in exchange for sex.
The other major issue is that most of the teenagers sleep homesteads away from their parents and out of peer pressure, some engage in unhealthy relationships during the night.
They finally decided to visit the affected school as a community and talk to the pupils and teachers to find a way forward.
In their next community conversation forum, they intended to encourage parents to find ways of ensuring their children slept closer to avoid peer pressure.
They were so grateful to KMET for introducing community conversation since they realized they have been sitting back in silence as their children’s future slowly got blurred.
‘This idea of community conversation is so timely. We shall first use it to ensure our girls complete their education by reducing teenage pregnancies’, said the community chairman, Samuel Otieno.

Stolen Innocence: Defiled and assaulted at 10 years

Mary (not her real name),  a 10 year old girl, left home at around 6pm on a Friday evening to escort her friend never to be seen again. Her parents got worried and started looking for her all over in Nyamasaria town Kisumu in vain. girl at KDHWe managed to interview the father who broke down and could not continue with the interview session but according to Mary’s mother, the girl knocked at a lady’s door at around 3am. The old lady knew her parents and supported Mary back home at around 5am. She had been assaulted and defiled. She had knife-stab marks around her neck, a scar on the back of her head, marks on her lips and her face was swollen. In the process the old woman told them that the child was defiled and unable to walk. The father went on to report the case at Nyamasaria police station while the mother rushed her to the hospital. The doctor that saw her at the onset refused to carry on with the case. But another doctor took over and Mary’s mother gave an account of the events of that morning. The mother disclosed Mary’s report of how a boda boda motorist had offered her a lift after which she could not recall where the man took her and rapped her. The mother  said Mary’s account of the story was not very clear since she was hysterical and didn’t want anyone near her. We were not able to interview Mary since she was too traumatized and still in shock. The Doctor confirmed that the girl was defiled and they had put her on Post exposure prophylaxis (PEP) to take care of the risk of HIV infection. The Doctor also found traces of grass and soil inserted in the girl’s privates. Due to the girl’s swollen head and face; a CT scan or an MRI was to be done but unfortunately the parents could not afford the cost of the tests. KMET got in touch with the Kisumu County Gender Technical Working Group who came onboard to offer assistance. Due to these interventions, with the help of FIDA and PLAN international there was a resolution to airlift Mary to Nairobi women’s hospital for specialized treatment. KMET offered to Fuel the ambulance and psychosocial support to both the parents who were evidently traumatized and the girl when she gets back. The man who damaged Mary’s happy childhood life is still at large, how many more young kids will fall his prey?

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