Activity Report Kenya 2012

international staff: 3

local staff: 51

areas of intervention: Infectious diseases,HIV/AIDS, malnutrition, mother and child

geographical areas of intervention:Msambweni county in Coast area, Garissa county inNorth Eastern Province

Kenya belongs among the countries with lowincome and a food deficit; its GDP is 865 USDper capita (World Bank data, 2012). In the UNDPHuman Development Index statistic, Kenyawas among the countries with average humandevelopment and it ranked in the 145th place amongthe developing countries (total 187 countries).Kenya’s population is 40 million people. Progresstowards Kenya’s attainment of the MDGs is slow anduncertain, with only education registering significantprogress. Poor infrastructure, weak institutions andpoor regulatory enforcement are key developmentchallenges. Rural and urban poverty remaina challenge. Analysis of the data from the 2005-2006 Kenya Integrated Household Budget Survey(KIHBS) indicates that national absolute povertydeclined from 51 % in 1997 to 46.1 % in 2005 – 2006.While this decline in poverty compares well withother Sub‑Saharan African countries, it can stillbe considered high in comparison to neighboringcountries such as Tanzania (about 36 %) and Uganda(about 31 %). In rural areas, overall poverty declined from 53 % to 49 %, while in urban areas, povertydeclined from 49.2 % in 1997 to 34 % over thesame period. Key health impact indicators suggeststagnation or decline in the health status. The rate ofunder-5 mortality has stagnated between 93 in 1993and the current 92 per 1,000 live births. Maternalmortality ratio has worsened from 365 in 1994 to 414in 2003, and maternal death is the leading causeof death in women of childbearing age (15 %).

In2008 – 09, infant mortality and under five mortalitystood at 52 and 74 deaths respectively per 1000 livebirths, which is an improvement from the 2003 figureof 77 and 115 deaths respectively per 1000 births.Immunization coverage also rose from 75 % in 2003to 81 % in 2008. This stagnation is attributable tothe high disease burden due to existing, and newconditions, and an inadequate response to managethe disease burden. The health impact indicatorsalso suggest wide disparities in health across thecountry, closely linked to underlying socio‑economic,gender and geographical disparities. Lowimmunization coverage and cross-border socialdisturbances in the recent past have also seen therecurrence of measles and polio, conditions that hadin the past been brought under control.According to last estimates from 2011, there are1,6 million people with HIV/AIDS in Kenya, withnew adult and child infections recorded at 104,000.Annual AIDS deaths were reportedly 62,000, whichamounts to 6,3 % of the population. In that, 130thousand are children under 14 and 800 thousandare women of childbearing age above 15 years.Women account for up to 60 % of infected adultpopulation above 15 years of age. Statistics as wellas actual data about the occurrence of HIV/AIDS and information about specific regions are notavailable or are inaccurate. Despite some good news,the situation remains to be alarming – the overalldecrease of the occurrence of HIV/AIDS in the totalpopulation for less than 5 % of the stabilized increaseof new infections, with the number of new infectionsremaining high at about 100,000 people Theevaluations of the implementation of the nationalstrategic plan regarding HIV/AIDS are a cry for theincrease in medical and social services and theirreliable and continual financing. According to figuresfrom 2011, around 300 Kenyans die daily becauseof HIV/AIDS, 600,000 receive ARV treatment eventhough 500,000 are in need of it, and the numberof orphans that lost their parents due to HIV/AIDS isfrom 990,000 to 1.4 million.The main source of infection in children is the motherto child transmission (MTCT).

The transmission canoccur during pregnancy, labor or during breastfeeding.During pregnancy, 5–8 % of children are infectedthrough the placenta. During labor the risk of infectionis bigger, around 10–20 %. If the mother decides tobreastfeed, 10–15 % of children are infected. Statisticsshow that without breastfeeding and without ARV,15–30 % infants are infected. If the mother decidesto breastfeed, the percentage is around 25–45 %,depending on how widely spread the virus is.A significant problem is that a lot of infected childrenreceive ARV treatment too late- without this treatment,70 % of HIV positive children die before they reach1 year of age. It is therefore extremely important toidentify the virus in time, so that the treatment andhence the elongation of life can be implemented.The situation is complicated by the fact that themajority of the population (83 %) in Kenya is notaware of their HIV status. High prices of food aresignificant in the everyday life of the Kenyans. Anestimated 5.6 million people face uncertainty abouteveryday food supplies due to the rise in prices offood and fuel. To overcome the price increase everyday, people must decrease daily food intake or buycheap, available food. There are many critical casesof malnutrition. As far as 25 % of children suffer fromacute malnutrition in some Kenyan districts.Approximately 31 % of children under the age of5 shows insufficient growth development andabout 20 % suffer from malnutrition.

The level ofstunted growth development and underweightchildren is about 10 % higher in the countrysidethan in urban areas. Furthermore, 3 in 4 children inthe above-mentioned age are anemic, along with50 % of women and one in 5 men. Almost half ofKenya’s children under the age of 5 and women in thereproductive age also face lack of zinc.The lack of vitamin A is prominent among childrenand women in general, along with specificsubgroups of men. Significant problems in termsof public health are caused by a wide lack of manymicroelements and also by the lack of vitamin A,zinc and iron. Estimations say that the deaths ofmore than 23 thousand children are connectedwith increased predisposition to infections which iscaused by the lack of vitamin A and that about 70 %of children in Kenya grow up with reduced immunity.In general we can say that the nutrition situation ofthe population in Kenya is still desperate.

The year 2012 for MAGNA project in MsambweniDistrict brought many challenges but also successes.One of the main improvements was the fact thatdue to high needs of our HIV/AIDS services, MAGNA instead of one health facility in Msambweni DistrictHospital continued to provide decentralize care forHIV/AIDS patients to another two health facilities– Lunga Lunga Dispensary and VitsangalaweniDispensary. The high number of people in need ofour services made us to stretch our programs andto bring support to the remote areas, closer to ourpatients. MAGNA project improved the workingsystem with daily counseling services in CCC(Comprehensive Care Clinic) for HIV patients in all3 facilities and done effective changes in pediatricward of Msambweni District hospital, where wehave set up in-patients stabilization centre formalnourished children. The significant change wasnoticed in care of HIV patient and their relation toHIV illness. The number of defaulters dropped from30–35 % per a month to 3–5 %. The trust in medicaland supporting staff working in MAGNA supportedCCC clinics plaid an important role in patients regularmedical check ups.Program aims was to maximizing retention andenhancing the quality of care for HIV positive childrenand adolescents in Msambweni District Hospital,Lunga Lunga Health Center and VitsanglaweniDispensary. The program integrated medicaltreatment, patient education, emotional and socialsupport in a comprehensive solution. It increasescommunity involvement in the treatment, care andsupport of PLHA and their families. In 2012, MAGNAprogram provided care for 1,580 patients, of which197 were HIV positive pediatric patients and 169were HIV exposed children.

MAGNA conducted 17,244medical check ups including 4,392 medical checkups for pediatric patients. Psychosocial supportand advice on HIV is not a part of public healthcare,which MAGNA focuses on. In 2012, we provided 4,103individual consultations for HIV positive patients,28 support groups for 980 HIV positive children andtheir caregivers. The main purpose of those groupsis to create a place where those children can openlydiscuss about the difficulties they face because oftheir sickness and share their feelings with otherhuman being living the same situation.720 individual consultations were conducted for 60HIV positive pregnant women and 3,280 pre-natalexaminations out of which 1,249 women visited ANCfirst time. All pregnant women were automaticallycounseled and tested for HIV virus. Women who werenewly identified as HIV positive were referred to CCCwhere they received all necessary interventions.In 2012 there was up to 60 HIV pregnant womenenrolled to PMTCT program.

Every HIV positive expectant woman enrolledin PMTCT program received a regular nutritioncounseling not only during antenatal (ANC) period,but also during lactating period when quality ofnutrients are very important for her and her newbornbaby. As well as during a time of introduction ofcomplementary feeding at the 6 months of the infant.Visiting patients in an environment they are usedto and understanding their daily problems thatcan negatively affect their fight against HIV andmalnutrition is the main objective of communalmedics. 1,648 home visits for HIV patients includingtook place in 2012.Malnutrition in children was anotherchallenge that MAGNA reacted on in 2012. TheMAGNA’s Community-based Management of AcuteMalnutrition (CMAM), approach maximized impactand coverage by bringing nutrition services closerto the household and reducing opportunity coststo caregivers. MAGNA works through decentralizedservice delivery at 3 regular health facilities. MAGNAwith skilled medical team incl. nutritionist andcommunity health workers screened 14,313 pediatricpatients in three health facilities in only five monthsof the nutrition program. The 900 children wereidentified with acute malnutrition and referredand treated to nutrition programms (SFP, OTP orSC) accordingly to their nutrition status and weconducted 2.588 nutritional check ups. 123 childrenwith severe acute malnutrition with complicationswere hospitalized in stabilization center (SC) during9 months of operation in the Msambweni DistrictHospital. MAGNA provided material and technicalsupport, and also personnel that covered 24 hourscare for pediatrics patients stabilization center (SC).

The minimum SPHERE standards were respectedwhich proves the good quality of care.Somalia (Kenyan) Border –hunger strike interventionMAGNA in 2012 continued with its implementedproject to respond to a critical drought situation.While conditions have begun to improve in parts ofthe region, challenges remain for the families wholive there and the aid workers who were trying toprovide assistance. A severe drought in the Horn ofAfrica has killed tens of thousands of children andpushed millions of families to the brink of starvation.At the height of the crisis, an estimated 35 % of allchildren in the region faced emergency levels ofmalnutrition.Kenya, alongside other countries in the Horn ofAfrica, has for most of 2011 faced a severe food crisisdue to a climatic disaster that has become a recurringphenomenon in shorter cycles, negating effortsto reduce vulnerability. A combination of droughtinducedcrop failure, poor livestock conditions,rising food and non-food prices and eroded copingcapacities are some of the key factors contributingto the food crisis, which has made 3.75 millionpeople in Kenya food-insecure. The regions that wentthrough the most severe droughts are also exposedto long-term poverty and recurring conflicts thatcontinue to worsen the situation of food insecurity.An estimated 385,000 children under 5 and 90,000pregnant and lactating women are suffering fromacute malnutrition. The eastern parts of Turkana havereported 37.4 % global acute malnutrition, whichis far above the emergency threshold of 15 %. Therecurring conflict and instability in Somalia coupled with the Horn of Africa drought has caused massivecross-border influxes at the rate of 30,000 arrivalsper month in the Dadaab refugee camp alone. Thearrival figures have however drastically decreasedto approximately 100 per day because of increasedinsecurity along the Kenya/Somalia border anda halt to the registration of new asylum-seekersfrom Somalia in October 2011. Overall refugee andasylum-seekers in the country numbered 590,921 asof September 2011.Due to continuous increase of staple food, fuel pricesand drought conditions, food insecurity for the poorand very poor households in northern and easternpastoral areas deteriorated to Crisis and Emergencylevels in July 2011.The scope of the crisis has prompted the Governmentof Kenya, and other governments in the region plusthe international community, to analyze the depth ofthe food crisis, in addition to facilitating immediateassistance necessary for saving lives and addressingunderlying drivers and long-term impacts in order tofoster a constructive path to recovery.Mounting insecurity along the Kenyan-Somali borderand in and around the Dadaab refugee camps hasconstrained aid delivery and is contributing toa worsening humanitarian situation as operationshave been scaled down to critical life-saving activitiesonly.

Travel restrictions for United Nations startas well as other humanitarian staff are in placefor travel to locations near the Somali border withauthorization for only critical missions. According toGarissa Nutrition and Food Security Survey done inMay 2011 the malnutrition level in the county was ata critical level (GAM = 16.2 % and SAM = 3.2 %) andthis was unlikely to improve due to prevailing highfood insecurity coupled with high morbidity. The foodsecurity was low as provided by a low dietary diversityscore. The reported level of diarrhea in the county(17.1 %) could attributed to the lack of adequatesanitary facilities that could be a predisposing factorto illness. Micronutrient deficiencies are highlyprevalent in Kenya especially among children underfive years and women. In Kenya, infant and youngchild feeding practices are largely sub-optimal. Ratesof malnutrition usually peak during this time withconsequences that persist throughout life. Foodsand liquids other than breast milk are commonlyintroduced as early as the first month, with 65 % ofinfants already receiving other foods and liquids bytwo or three months of age (KDHS, 2008).Project mechanism has been established in order toprovide adequate care and support to malnourishedchildren and PLW (pregnant and lactating women)in targeted localities. This included implementationof the full package of High Impact NutritionInterventions (HiNi), medical assistance offered byspecially trained medical personnel, specializednutritionists as well as an education. With regard toprevention, adequate dissemination of informationand awareness raising activities at health facilitiesand in the communities were carried out. Finallywe improved quality and timeliness of reporting,including data analysis, from health facility anddistrict levels and strengthened linkages andcoordination mechanisms.MAGNA have chosen Iftin Sub-district’s hospitalin Garissa district for the establishment andimprovement of the existing services in the nutritioncentre.

Therapeutic food centre (TPC) and walk-incare in the OTP and supplementary food program (SFP) were poorly equipped with insufficient staff,making the overall care provided ineffective. In manycases, it did not reach people in need- malnourishedunderweight patients, mainly children and pregnantand lactating women. MAGNA provided full technicaland personal support for the nutrition program inIftin sub-district. The area affected by malnutritionwas wide and project activities started also in moreremove parts of the sub-district to capture as manypatients as possible. The project was operatingOTT and SFP services in 7 dispensaries and healthcenters (Bashal Islamic Community Health Initiative,Bour-algy Dispensary, Kora Kora Health Center,Young Muslim Dispensary, G.K.Prison Dispensary,Police Line Dispensary,Simaho and Medina HealthCenter). MAGNA’s project has managed to screen14,246 children under 5 years old to identify theirnutrition status. 10,902 (2.925 severe malnourishedchildren and 7,977 moderate malnourished children)malnourished pediatric patients received treatmentwith cured rate 87 % and we conducted 32.645nutritional check ups. 2,066 pregnant and lactatingwomen received treatment as well. The minimumSPHERE standards were respected which proves thegood quality of care. 5,260 children were immunizedand 3,392 received Vitamin A.Magna Children at Risk has been operating in Kenyasince 2006.

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