Kenya

Report of activities in the year 2011

Number of international workers: 3; Local workers: 70
Focus of intervention: malnutrition, HIV/AIDS, emergencies

MAGNA comprehensive HIV/AIDS program in Kenya include education and awareness activities so people understand how to prevent the spread of the virus; condom distribution; HIV testing along with pre and post-test counseling and psychosocial support to patient including a adherence counseling and support groups; treatment and prevention of opportunistic infections; prevention of mother-to-child transmission; and provision of anti-retroviral treatment for patients in advanced clinical stages of the disease.
MAGNA implemented its project in Msambweni District Hospital in 2011 that was later expanded to another two health facilities Lunga Lunga and Vitsangalaweni in the district. Comprehensive care for 1,790 HIV patients and 545 acute malnourished patients in nutrition services are delivered by the team of MAGNA skilled and trained medical staff. In cooperation with personnel from health facilities are daily working on improvement of all services provided to patients suffering from acute malnutrition, HIV positive patients, including HIV pregnant women enrolled to PMTCT programme.

HIV tests are offered in our pre-natal consultation centres at Msambewni, Lunga Lunga and Vitsangalaweni, as well at labour time to identify women who are infected. Once a diagnosis has been made appropriate care can be offered to women including ARV drugs, pre-natal care and advice on breast-feeding.

After birth we provide early infant diagnosis (EID) to identify a HIV status of newborns early and preventative ARV drugs to these babies, then monitor them for infection. If, despite everything, these babies are infected we offer them treatment.

Kenya, as one of the Sub-Saharan African countries with an overall HIV prevalence of 7.8% in 2008 (WHO AIDS Epidemic update, 2009) and with 168 000 new infections per year is in a high need of help to fight against AIDS. Prevention should be one of the ways to decrease still high number of new infected people (34 000 pediatric infections). PMTCT programs play a very important role in reduction of new HIV infections.

The country is dealing with so many issues related to poverty, infant mortality (54,7 death/ 1,000 live birth in 2009), low life expectancy (57,86 years), and also overall HIV prevalence (7,8% in 2008). Kenya has to face every day HIV issues and work on improving HIV care, treatment and prevention for people living with HIV/AIDS.

Kenya has introduced PMTCT services first time in 2000 on a pilot basis. The increase of the health facilities, where every HIV positive pregnant woman could access PMTCT program was significant for last ten years. However, the number of involved women in the program was not increasing as fast. Only 42% pregnant women were counseled and tested in 2006. The main issue is to deliver comprehensive PMTCT program, where a woman gets complex and effective care. Kenya currently has more then 5000 health facilities, but only 14% of them are able to provide comprehensive PMTCT program. (MOT, 2009).

From our past five years of experience of working in Kenya, we learn about the weakest links in the system regarding providing HIV and PMTCT services. Based on the information from the research in Coast Province that was done by Magna we decided to implement comprehensive HIV program in Msambweni District Hospital.

Msambweni District is located in the south coast region and is known as poor and rural area of Coast Province with very bad accessibility from Mombasa due to constant problems with a ferry system.

MAGNA’s comprehensive HIV and PMTCT model is very specific with its complexity, where a pregnant woman is identified as HIV positive and together with her child they receive continuously medical, nutrition and social care until 18 months of the age of a child. The fact that 96% of children born to HIV positive mothers are negative in the end of the program shows a great result of our PMTCT model and a comprehensive approach, which is improving life for people, especially women living with HIV and their new born children.

MAGNA HIV and PMTCT program fills many gaps in the existing system. During implementation and realization of the project the main aim is to be focused on three groups of clients. The first group is a pregnant woman - to identify HIV positive pregnant women and to offer complex antenatal care (ANC) during the pregnancy, labour and delivery, including treatment, counseling, nutrition and psych-social support. Another group are newborns - medical care is oriented on early infant diagnosis (EID), nutrition support and social care. The third group is HIV positive patients (incl. children) - offering comprehensive care, including treatment for opportunistic infections for HIV positive pediatrics.

Kenya is dealing also with a problem of malnutrition in children and even in general population. Nutrition status of children in past few years slightly improved, however at the national level, 35% of children under five are stunted (low height-for- age), while 7% of children are wasted (low weight-for-height) and 16% are under- weight (low weight-for-age). (KDHS, 2008-2009).

The year 2011 for MAGNA project in Msambweni District brought many challenges but also successes. One of the main improvement was the fact that due to high needs of our services, MAGNA instead of one health facility in Msambweni District Hospital extended project activities to another two health facilities – Lunga Lunga Dispensary and Vitsangalaweni Dispensary. The high number of people in need of our services made us to stretch our programs and to bring our support to the remove areas of the district.

MAGNA project improved the working system with daily counseling services in CCC (Comprehensive Care Clinic) for HIV patients in all three facilities and done affective changes in Pediatric Ward, where set up inpatients stabilization center for malnourished children.

The significant change 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 5-8%. The trust in medical and supporting staff working in CCC clinics plaid an important role in patients regular medical check ups. MAGNA with its approach and the way of working build comprehensive system of provided care, including regular laboratory testing, HIV counseling, community home base care and psychosocial care.

Antenatal interventions during pregnancy were included in project activities. MAGNA staff in cooperation with the partnering health facilities provided care for every pregnant woman that visited ANC clinic. For last nine months since the project started there was 2,177 ANC visits, out of which 763 women visited ANC first time. Pregnant women were automatically counseled and tested for HIV virus.

MAGNA’s programs oriented on HIV services in the district covered in the year 2011 1,798 HIV positive patients including 158 HIV positive pediatric patients and 135 HIV exposed children in the three health facilities. HIV counseling and psychosocial support is detachable part of HIV comprehensive care that Magna program is focused on. During realization of the program was done 993 individual HIV counseling for HIV positive pediatrics, 536 individual counseling for HIV exposed children, respectively their parents and caretakers, 1,406 HIV counseling for HIV positive adult patients and 2,174 PMTCT individual counseling for pregnant women attending ANC.

Malnutrition in children was another challenge that MAGNA reacted on. With skilled nutritionist and community health workers screened almost 6,500 (6,447) children to identify their nutritional status. In three nutrition programs (OTP, SFP and TFC) in three health facilities were enrolled 486 children that were in need of nutrition interventions. 59 children with severe acute malnutrition with complications were hospitalized in TFC in the district hospital for treatment of complications due to malnutrition in 9 months of duration of the activity.

MAGNA during whole year of constant work and effort to improve the project activities made a significant change in peoples lives in the district of Msambweni. Especially, in HIV patients lives, when every patient has an access to a quality medical care with full services that require a person who is identified as HIV positive.

KENYA/SOMALIA BORDER

In Garissa District MAGNA started its mission in August 2011.
Project prevents further deterioration of nutritional status through improved access to high impact nutrition interventions children under five and pregnant and lactating women and to contribute to the reduction of morbidity and mortality linked to acute malnutrition among vulnerable groups. The critical situation as a reaction on long drought in the region and war crisis in Somalia was the main reason for MAGNA to focus its project on malnutrition in children under 5 years in the district.
The number of underweight children, women and even children with acute malnutrition was increasing since beginning of 2011. The project is focused on screening as prevention measures of malnutrition, early intervention for underweight children and treatment of acute malnutrition in children under 5 years. There were 5,207 children under 5 treated for acute malnutrition at 8 out patients therapeutic centers and 8 supplementary feeding centers along one stabilization center in 5 months in 2011.

MAGNA provides full technical and personal support and established working SC where are daily treated children with severe acute malnutrition with complication. The area affected by malnutrition is wide and project activities started also in more remove parts of district to capture as many patients as possible.

Sub district hospital in Iftin was chosen for establishing and improving existing services in nutrition center. Stabilization center (SC) and outpatient care in outpatient therapeutic program (OTP) and in supplementary feeding program (SFP) were underequipped, understaffed and delivered care was not effective, in many cases did not reach even beneficiaries – underweight and malnourished patients, especially children. Stabilization center (SC) was before implementation did not operate at all. The project in OTP and SFP is operating in 8 dispensaries and health centers.

Kenya, alongside other countries in the Horn of Africa, has for most of 2011 faced a severe food crisis due to a climatic disaster that has become a recurring phenomenon in shorter cycles, negating efforts to reduce vulnerability. A combination of drought-induced crop failure, poor livestock conditions, rising food and non-food prices and eroded coping capacities are some of the key factors contributing to the food crisis, which has made 3.75 million people in Kenya food-insecure.

In addition, those areas that experienced the worst effects of drought also face entrenched poverty, limited investment, and intermittent conflict that have further compounded the food security situation. About 1.4 million people – predominantly in the northern and northeastern pastoral areas – were classified in the emergency phase following the long rains assessment in August 2011.

An estimated 385,000 children under 5 and 90,000 pregnant and lactating women are suffering from acute malnutrition. The eastern parts of Turkana have reported 37.4% global acute malnutrition, which is far above the emergency threshold of 15%. These are the highest malnutrition rates recorded in the last decade. The increase in refugee flows numbering 154,450 into Dadaab and 8,132 into Kakuma. Since January 2011 has been accompanied by growing insecurity in and around the refugee camps in northeastern and northwestern Kenya.

The recurring conflict and instability in Somalia coupled with the Horn of Africa drought has caused massive cross-border influxes at the rate of 30,000 arrivals per month in the Dadaab refugee camp alone. The arrival figures have however drastically decreased to approximately 100 per day because of increased insecurity along the Kenya/Somalia border and a halt to the registration of new asylum-seekers from Somalia in October 2011. Overall refugee and asylum-seekers in the country numbered 590,921 as of September 2011.

The 2011 long rains were highly depressed and poorly distributed over most parts of the country. Due to continuous increase of staple food, fuel prices and drought conditions, food insecurity for the poor and very poor households in northern and eastern pastoral areas deteriorated to Crisis and Emergency levels in July 2011.

MAGNA after detailed research of areas in Garissa District implemented in 2011 the project that reacts on the humanitarian crisis in the Horn of Africa. Garissa District that is neighboring Somalia is the one of the places where thousands of Somalis people sick a refuge.

MAGNA provide full technical and personal support and established working SC in Iftin sub District hospital Garissa, where are daily treated children with severe acute malnutrition with complication. The area affected by malnutrition is wide and project activities started also in more remove parts of district to capture as many patients as possible. The project in OTP and SFP is operating in 8 dispensaries and health centers (Bashal Islamic Community Health Initiative, Bour-algy Dispensary, Iftin Hospital Kora Kora Health Center, Young Muslim Dispensary, G.K.Prison Dispensary, Police Line Dispensary and Medina Health Center).

In all health facilities was introduced and implemented system of registration, referrals, records keeping with filing arrangement for medical files, which is helping nutritionists and medical staff to follow patients and provide adequate care. Screenings of all patients visiting health facilities and also living in surrounded communities become a standard way of working for community health workers.

With the setting and system that was implemented in the beginning of the project in August 2011 we have managed to register and provide nutritional services to almost 4,300 underweight or malnourished pediatric patients. For last five months of duration of the programs was enrolled 1,387 pediatrics with severe acute malnutrition without complication in OTP, 3,820 children with mild acute malnutrition in SFP.

Horn of Africa is still dealing with the humanitarian crisis and people are still in need of humanitarian intervention. MAGNA with its humanitarian project is continuing with planned activities in the partnering facilities to stabilize current catastrophic situation and to build sustainable system that can benefit to all people in the area.

Magna Children at Risk operates in Kenya since 2006.