Activity Report Kenya 2013

Staff and volunteers: 49
Areas of intervention: Infectious diseases, HIV/AIDS, mother and child
Geographical areas of intervention: Msambweni county - Coast

Kenya belongs among the countries with low income and a food deficit; its GDP is 865 USD per capita (World Bank data, 2012). In the UNDP Human Development Index statistic, Kenya was among the countries with average human development and it ranked in the 145th place among the developing countries (total 187 countries). Kenya’s population is 40 million people. Progress towards Kenya’s attainment of the MDGs is slow and uncertain, with only education registering significant progress. Poor infrastructure, weak institutions and poor regulatory enforcement are key development challenges. Rural and urban poverty remain a challenge. Analysis of the data from the 2005-2006 Kenya Integrated Household Budget Survey (KIHBS) indicates that national absolute poverty declined from 51% in 1997 to 46.1% in 2005-2006. While this decline in poverty compares well with other Sub-Saharan African countries, it can still be considered high in comparison to neighboring countries such as Tanzania (about 36%) and Uganda (about 31%). In rural areas, overall poverty declined from 53% to 49%, while in urban areas, poverty declined from 49.2% in 1997 to 34% over the same period. Key health impact indicators suggest stagnation or decline in the health status. The rate of under-5 mortality has stagnated between 93 in 1993 and the current 92 per 1,000 live births. Maternal mortality ratio has worsened from 365 in 1994 to 414 in 2003, and maternal death is the leading cause of death in women of childbearing age (15%). In 2008-09, infant mortality and under five mortality stood at 52 and 74 deaths respectively per 1000 live births, which is an improvement from the 2003 figure of 77 and 115 deaths respectively per 1000 births. Immunization coverage also rose from 75% in 2003 to 81% in 2008. This stagnation is attributable to the high disease burden due to existing, and new conditions, and an inadequate response to manage the disease burden.

The health impact indicators also suggest wide disparities in health across the country, closely linked to underlying socio-economic, gender and geographical disparities. Low immunization coverage and cross-border social disturbances in the recent past have also seen the recurrence of measles and polio, conditions that had in the past been brought under control. According to last estimates from 2011, there are 1,6 million people with HIV/AIDS in Kenya, with new adult and child infections recorded at 104,000. Annual AIDS deaths were reportedly 62,000, which amounts to 6,3 % of the population. In that, 130 thousand are children under 14 and 800 thousand are women of childbearing age above 15 years. Women account for up to 60 % of infected adult population above 15 years of age. Statistics as well as actual data about the occurrence of HIV/AIDS and information about specific regions are not available or are inaccurate. Despite some good news, the situation remains to be alarming – the overall decrease of the occurrence of HIV/AIDS in the total population for less than 5 % of the stabilized increase of new infections, with the number of new infections remaining high at about 100,000 people.

The evaluations of the implementation of the national strategic plan regarding HIV/AIDS are a cry for the increase in medical and social services and their reliable and continual financing. According to figures from 2011, around 300 Kenyans die daily because of HIV/AIDS, 600,000 receive ARV treatment even though 500,000 are in need of it, and the number of orphans that lost their parents due to HIV/AIDS is from 990,000 to 1.4 million. The main source of infection in children is the mother to child transmission (MTCT). The transmission can occur during pregnancy, labor or during breastfeeding. During pregnancy, 5–8 % of children are infected through the placenta. During labor the risk of infection is bigger, around 10–20 %. If the mother decides to breastfeed, 10–15 % of children are infected. Statistics show that without breastfeeding and without ARV, 15–30 % infants are infected. If the mother decides to breastfeed, the percentage is around 25–45 %, depending on how widely spread the virus is. A significant problem is that a lot of infected children receive ARV treatment too late- without this treatment, 70% of HIV positive children die before they reach 1 year of age. It is therefore extremely important to identify the virus in time, so that the treatment and hence the elongation of life can be implemented.

The situation is complicated by the fact that the majority of the population (83 %) in Kenya is not aware of their HIV status. High prices of food are significant in the everyday life of the Kenyans. An estimated 5.6 million people face uncertainty about everyday food supplies due to the rise in prices of food and fuel. To overcome the price increase every day, people must decrease daily food intake or buy cheap, available food. There are many critical cases of malnutrition. As far as 25% of children suffer from acute malnutrition in some Kenyan districts. Approximately 31 % of children under the age of 5 shows insufficient growth development and about 20 % suffer from malnutrition. The level of stunted growth development and underweight children is about 10 % higher in the countryside than in urban areas. Furthermore, 3 in 4 children in the above-mentioned age are anemic, along with 50 % of women and one in 5 men. Almost half of Kenya’s children under the age of 5 and women in the reproductive age also face lack of zinc. The lack of vitamin A is prominent among children and women in general, along with specific subgroups of men. Significant problems in terms of public health are caused by a wide lack of many microelements and also by the lack of vitamin A, zinc and iron. Estimations say that the deaths of more than 23 thousand children are connected with increased predisposition to infections which is caused 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 of the population in Kenya is still desperate.

The year 2013 for MAGNA project in Msambweni District brought many challenges but also successes. The significant change started in 2012 and continued - was noticed in care of HIV patient and their relation to HIV illness. The number of defaulters dropped from 30–35 % per a month to 3–5 % and this trend continued in 2013. The trust in medical and supporting staff working in MAGNA supported CCC clinics plaid an important role in patients regular medical check ups. Program aims was to maximizing retention and enhancing the quality of care for HIV positive children and adolescents in Msambweni District Hospital. The program integrated medical treatment, patient education, emotional and social support in a comprehensive solution. It increases community involvement in the treatment, care and support of PLHA and their families.

In 2013, MAGNA program provided care for 1,465 patients, of which 167 were HIV positive pediatric patients. MAGNA conducted 4,311 medical check ups. Psychosocial support and advice on HIV was fully integrated to national strategy and fully implemented by MAGNA since 2010. In 2013, we provided 2,255 individual consultations for HIV positive patients. 896 individual consultations were conducted for 224 HIV positive pregnant women and 1.093 pre-natal examinations. All pregnant women were automatically counseled and tested for HIV virus. Women who were newly identified as HIV positive were referred to CCC where they received all necessary interventions. In 2013 there was up to 35 HIV pregnant women enrolled to PMTCT program. One of the main improvements in the program was the fact that due to stabilized program and good outcomes in our HIV/AIDS services, MAGNA have been able to prepare a organized hand over of the activities to a local partner Ministry of Health. After years of providing integrated healthcare for people living with HIV/AIDS in Msambweni, Magna was ready to hand over the program.

Over the past fours years, MAGNA's staff working closely with the Ministry of Health (MoH) in Coast area, have treated and cared for more than 2.500 people living with the disease, majority of whom were started on ART. Providing integrated HIV care has been key to this success. On average, the MSF and MoH staff at the clinic, working side by side, will see more than 100 people each day. This approach has had a huge impact on increasing the numbers of HIV-positive people seeking treatment in and has also greatly reduced the stigma and discrimination surrounding the disease. A pregnant mother with HIV, for example, can come here and receive a regular check up, antenatal care, prevention of mother-to-child-transmission care, family planning, and immunization for her children all on the same day. It’s a one stop service. Integrating care is no easy task; MAGNA worked hard to make this system work. Regular and open dialogue with the MoH was crucial. In the clinics, Magna had to provide extra staff in order to care for the increasing numbers of people coming for treatment. Frequent training and ongoing mentorship for all staff was provided. A clinics had to be renovated and extra rooms built. Yet the investment was worthwhile, as both staff and patients benefit hugely from integrated HIV/AIDS care.

MAGNA has been operating in Kenya since 2006.

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