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?