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Experts: Not all TB infections come with a cough

Beryl Atieno, a middle-aged TB survivor who hails from Rarieda in Siaya County, had no idea that she had contracted the infectious disease when she started ailing in March 2017.

Atieno was not coughing and therefore had no reason to suspect she had tuberculosis even though she had other signs and symptoms like high fever, loss of appetite, loss of weight among others for one week.

To her surprise, she was diagnosed with TB when she went for screening at the local Madiany Hospital and immediately put on treatment for 6 months under close surveillance until she was cured completely.

“As a TB survivor at first I thought it was normal ailment and I had no reason to imagine that I had contracted it. However after my diagnosis I followed my prescriptions to the letter until now that I am well,” Atieno says.

Just like Atieno, there are a number of people who suffer in silence because of ignorance about tuberculosis, an airborne infectious disease.

There are two types of clinical manifestation of tuberculosis, the most common one being the pulmonary TB which affects the lungs and the second type being extra pulmonary TB which affects all the body organs apart from hair and nails.

TB still remains in the top 10 causes of death worldwide according to World Health Organization.

In Siaya County, Western Kenya, the high TB burden has been attributed to poor health seeking habits among residents who are prone to contracting the infectious disease.

According to the county Tuberculosis and Leprosy Coordinator, Mrs. Mary Wambura, the County records about 2,000 to 2,500 TB patients yearly, placing it among top ten most heavily burdened by the disease in Kenya.

She says that Siaya is also ranked position three in the number of TB patients who have developed Multi-Drug Resistant (MDR) TB. She adds that since 2012 the county has recorded 82 of such patients.

“This high incidence of TB related disease is unacceptable and the society need to have a positive behaviour change in curbing the spread of the airborne disease,” the coordinator advised.

Wambura mentioned that it is very costly to treat MDR TB and revealed that the Kenya spends up to Ksh 2.1 million treating one MDR TB patient “Patients who have contracted TB should adhere to normal TB treatment to avoid escalating to other stage which become expensive and difficult to treat,”

she advises. In the fight to end TB, the coordinator announced that the county health facilities are currently administering one anti -TB drug called Isoniazid to children under five years who stay with TB patients as a measure to prevent them from contracting the disease.

However, she regrets that some parents and guardians still fail to bring their young ones to get the drug hence putting them at high risk of infection.

“Once infected, children get subjected to traditional medicine and other nonmedical means and in the long run they end up dying without being treated for TB,” she regretted.

The health department has also innovated a TB active case finding stamp that helps in identifying and screening TB patients who visit health facilities in the county.

According to the Centre for Health Solutions Technical Adviser on TB in Siaya, Mr. Duncan Barkebo, the TB stamp contain four questions that will be used to screen all patients who seek medical attention in the health facilities.

Barkebo mentioned that the TB active case finding stamps have been distributed to all health facilities within the county so that all the patients get to be screened for the disease.

He regretted that Siaya County has been losing 10 per cent of TB patients every year due to late diagnosis and by the time they start treatment, their immune system is usually very low to respond to the treatment being administered to them.

“This stamp innovation is one of its kind in Kenya and this will ensure no patient is left out in TB screening since the stamp contains four crucial question that will guide clinicians in identifying patients who have contracted the disease early enough for treatment,” Barkebo added.

In 2017 the county recorded 1,700 patients with TB, unfortunately 170 people out of the number died due to late diagnosis.

This, Mr. Barkebo says is unacceptable since it is way beyond the National TB program’s acceptable percentage of less than 5 percent mortality on TB.

TB coordinator Wambura further revealed that the county has 155 TB centres spread across the six subcounties where individuals diagnosed with TB can get treatment.

 

Ms Rose Kaberia, a survivor of MDR TB strain, addresses MESHA journalists during a past media training on infectious diseases

There are effective machines to detect TB by use of sputum and they can be found at Siaya County Referral Hospital, Madiany, Bondo, Matibabu in Ukwala, Ambira and Yala sub county hospitals.

Wambura mentions, “With the machines in place in major health facilities within the six sub counties, locals can seek services closer to them unlike in the past where they had to travel long distances.”

Many people still think that patients who have TB are automatically infected with HIV/AIDS, a notion Mrs. Wambura is discarding saying its false and further advised residents to seek TB testing early as a preventive measure to avoid developing MDR TB.

“The stigma on TB is still high since most patients fear going for testing thinking that they are going to be associated with HIV/AIDS and other customary which are faults, “she mentioned.

Kenya is among countries with the highest TB burden in the world with a prevalence rate of 291 cases per 100, 000 people.

This has greatly been contributed by the high poverty levels in the country estimated at 45.2 per cent through poor nutrition, overcrowding, alcohol and substance abuse and poor access to health care services.

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Why we need HIV vaccines like yesterday

More than 20 years ago, just after I had completed my secondary education, I was diagnosed with HIV. At that time, I thought I now had full self responsibility to my life. I had dreams, just like any other young person. This was the worst news I heard at that moment.

My life came to a standstill for awhile. Everything around me was now dictated by my diagnosis. My education, my career and family dreams were shattered and my parents and siblings were affected even more than myself. Ever since then, life has never been normal, It is not normal, It will never be normal for me even if a cure is found.

I have been to hell and back because of HIV on all fronts. Most notable and physical was my onset of treatment. Twice, I have reacted very badly to medication to the point of almost losing my life. At one point, I thought death would be more relieving than the pain and discomfort I was feeling. I am alive today mainly for having had access to competent, quick medical attention and strong family support at that time. In my more than 20 years work in the HIV field, I do not know of any HIV positive individual who has had it easy both socially and medically. I know some that have even died due to drug reactions, stigma and late diagnosis and lack of access to care and support. We musk a lot; because that is what society wants to see or wants us to portray.

 

Why am I saying all this?

I want to repeat, it is not normal. I do not wish this to happen to our children who have dreams and a full life ahead of them. I would not wish HIV infection to happen even to my worst enemy. It is for these reasons I am joining the prevention advocates. I will do whatever it takes within my ability to speak out and support prevention efforts to stop any single HIV infection where I can. I will support the HIV vaccines initiative because if it succeeds, it will be one of the biggest breakthroughs in the fight against HIV.

It is no longer about me People spoke for us; I am alive today because of the many voices that stood up for us – people living positively with HIV (PLWHIV). My immediate family takes the biggest credit. They read anything and everything they could come across that would enable them to help me and understand me.

But it still has never been normal and it will never be for me. As an existential fact, we are alone. Many a times I am alone, pain, drugs swallowing, loss of appetite….I am alone.

This can, and could have been prevented. I am going to spend the remaining part of my life, advocating for all forms of prevention…. but education and vaccines are going to take centre stage of my advocacy work. For we all know, PREVENTION IS BETTER THAN CURE.

The face of HIV today is young people. As a mother, and as a person who got infected at that tender age, the news about new HIV infections among young people churns my stomach.

I look forward to seeing how advocates are going to be engaged in the HIV vaccine initiatives and I am more than happy and willing to take on this assignment very seriously to let communities know and understand the importance of HIV vaccine and prevention.

Inviolata Mwali Mmbwavi is the National Coordinator International Community of Women Living with HIV Kenya Chapter (ICW-K)

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New device to encourage taking of PrEP drugs

A new device is being developed to encourage individuals at risk of contracting HIV to take their daily dosage of Pre-exposure prophylaxis (PrEP).

Wise Pill was developed as an HIV prevention technique to help take control and take charge of new infections. The device is currently being tested.

To increase the uptake of PrEP among the youth, who are the largest consumers of technology, this invention has been incorporated with IT to help them take their drugs daily.

According to Wise Pill adherence study coordinator, Kamolo Kevin, the program is aimed at getting more young ladies to use the gadget but since it is still on study, they are currently testing its efficacy among 175 girls within Kisumu county.

“This is a generation that studies done previously have shown have had difficulties to adhere to the uptake of PrEP,” Kamollo said.

The device is under study by Kenya Medical Research Institute’s Centre for Microbiology Research (KEMRI-CMR) and helps young adult women carry their prep wherever they go. The device has two compartments that carry 15 tablets each and a participant is supposed to take a tablet each day at a specific time of their choice.

Kamolo said participants using the device were trained before one was handed over to them to ensure they do not interfere with the kit.

“We train them how to open inside.

And when she (participant) gets to open it, it sends a signal to our server,” he said.

To certify whether the participant indeed took their tablets, they give a report each time they go back to the facility which is then counter checked by the servers at KEMRI.

“We also conduct tests to confirm the amount of drug in the participant’s blood. This will help confirm whether participant was taking the drug,” Kamollo explained.

To ensure that the participant never misses to take the daily dosage, she can be prompted by an SMS from the server at the specific time she is supposed to take the drug.

“During registration, members request for the kind of sms to be sent to them as a prompt,” Kamollo said.

With the device easy to conceal as a power bank, Kamollo said they hoped  that the results of the study will help the community on HIV prevention and generally the uptake of drugs.

But in a separate interview, Dr. Elizabeth Irungu, KEMRI, stressed that PrEP was not meant for everybody.

“It is for people who are at risk of acquiring HIV and they just need to be identified or identify themselves and visit a facility to take the pill daily. If the risk is gone, stop. If the risk is back, start,” Dr. Irungu said.

She added, “We need to be sure that you’re HIV negative and not positive. HIV positive individuals should take ARVs not PrEP.”

Other than United States of America, the study on the wise pill gadget is taking place in Kisumu and Thika in Kenya.

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Premature babies: Letting them thrive

The voices of preemies mothers came out with a plea to the medical world to let them thrive in reference to various ways in which measures can be taken to enhance the survival rates of the preemies.

To help our readers understand more about the tribulations of preemie mothers in Africa, we sought to hear the story of a real experience from Ms Glena Nyamwaya.

And this is her story; It all started in April 2016 when I had gone to visit my grandmother together with my family. As soon as we got to the compound and alit from the car, I felt a cold sensation going down my leg. I lifted my maxi skirt up to reveal my worst fear. My water had broken prematurely, in a remote village of Kisii, a 45 minute drive away from Kisii town. Unfortunately I was the only driver in tow, so I had to bravely get back on the driver’s seat and get myself to hospital, all the while tears rolling down my face.

To cut the long story short, I got to the hospital and since they could not deal with my case, I was evacuated and driven through the night to Aga Khan Hospital, Nairobi, nearly 400km away arriving at 3 am. My obstetrician received me and tried the best he could to keep the pregnancy as I was only 26 weeks pregnant.

But two days later, I went into labour and delivered a 780grams baby boy. As fate would have it, Junior passed on 7 days after staying in the NICU due to complications and infections he had suffered. I refused to let this situation bring me down and conceived again in June that year. This time round the doctor established that a small cyst on my cervix had triggered the premature labour and carried out a MacDonald stitch procedure to secure the pregnancy for a longer term.

But the scenario would play out yet again as on my 27th week, two days before my doctor’s appointment, I was awoken at 4 a.m. by a gash of amniotic fluid. I was scared and sneaked out to go to the hospital fearing for the worst, without letting anyone in the house know.

I drove to hospital and admitted myself having called my doctor who agreed to meet me there. I was monitored and put on bed rest and on the evening of the following day, the doctor made the call to remove the MacDonald stitch and trigger labour as most of the amniotic fluid had leaked and the baby was at risk of contracting infections.

On the same night at about 1am, my angel Samantha Malaika came into this world weighing 1.1kg. Although my fears and wounds from the previous experience were still fresh, the glow in her little eyes gave me optimism. She would later lose weight to weigh 850gms before she started the upward trend.

I got a scare one day after her doctor prescribed sodium injections to counter her deficiency. She reacted to the sodium badly and even had to be resuscitated at some point when her tiny body gave in. Fortunately the medical team managed to get her lungs back to work and she was put on oxygen for three days. Other than that,

Samantha had minimal complications and was discharged after 45 days in hospital. The greatest challenge however was raising money to cater for the two hefty medical bills in one year. To date, her progress is impressive and her milestones just slightly delayed.

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Farmers in Eastern Kenya to earn USD40m from exports of green grams

The locals here call it ndegu. Globally it is simply green grams. This crop, especially in Kenya, has had its own share of setbacks.

For a very long time, farmers have been complaining of the rapid reduction in green grams yields. But now, farmers in Eastern Kenya’s Kitui County, will soon be smiling all the way to the bank, due to a timely intervention by the Kenya Red Cross Society.

Most parts of Kitui County are favorable for growing green grams which thrive best at an altitude of 0 -1600m above sea level well adapted to sandy loam and clay soils at pH range of 5.5 -7.5. They are drought tolerant with rain fall requirement range between 350 – 700mm per annum. Heavy rain fall results to increased vegetative growth with reduced pod setting and development.

Indigenous green grams have small seeds with the plants maturing at different times. Most of the time they mature late. Consumers complain that such varieties have a lot of stony seeds, which makes a green gram meal difficult to eat.

In an effort to make farming of ndegu more profitable, the Kenya Red Cross Society (KRCS) has embarked on an ambitious intervention that will see the county export all its produce to international markets. All this will be realized through a partnership with the county government that is expected to fetch a whooping Sh4 billion (USD40m) for local farmers a season.

The strategy of this intervention is seen as a major boost to plans by the country government to increase agricultural productivity through promotion of uptake of planting green grams, a drought tolerant crop.

Last month, the humanitarian agency donated the first consignment of 200 tons of certified green gram seeds which appropriate for Kitui County, an area with erratic rainfall and poor market access worth Sh50 million (USD5m) for distribution to 200,000 households with the county.

Speaking at Mutomo market in Kitui South Constituency during a ceremony to distribute the seeds, Secretary General Dr Abass Gulet said the agency had set aside Sh500 million (USD5m) to buy the produce from local farmers to shield them from exploitation by middle men.

Dr Gulet who was accompanied by Kitui Governor, Charity Ngilu said the demand for Kenyan green grams in Asian countries including India, China, Japan, Saudi Arabia, and Pakistan among others was inexhaustible and that farmers should strive to produce more of the crop.

“We’ll walk with Kitui people in this journey of actualizing the Ndegu revolution and we are willing to give more financial support in providing linkages with better paying international markets,” said Dr Gulet who believes the initiative is real and achievable because the county is endowed with plenty of arable land with very good soils and terrain.

In the partnership, the Kenya Red Cross and the county government have pooled 400 tons of seeds worth Sh108 million (USD108,000) for distribution to farmers in the county.

Mrs Ngilu said the targeted households will each get 2kg of free seeds as part of the startup investment. This will be an addition to what the farmers will buy depending on their farm sizes. “If each kilo of seeds yields a bare minimum of 100 kilo produce, this will give our county 40,000 tons of green grams,” Mrs Ngilu said adding that if the harvest was sold at a conservative price of Sh100 (USD10) per kilo it will earn the county an estimated Sh4 billion (USD40m) in one season.

The Governor urged the county assembly to enact strict legislation to protect farmers from brokers who exploit them with poor prices saying her administration had secured good overseas market for the anticipated harvest.

Mrs Ngilu said her government mooted the Ndegu revolution because the county has the best soils for growing the crop which does not require a lot of rainfall. She believes the initiative will eradicate perennial hunger in the county as well as improve livelihoods of residents and reduce poverty. “Never before in the history of our county have we seen so many Red Cross trucks, not bringing relief food but seeds for planting. Today, we declare the days of government relief food over,” she said.

The Governor urged other partners and donors to support the revolution by giving farmers more seeds, farm equipment, technologies on water harvesting and training of farmers on post harvest management.

She said whereas the seeds would have cost a farmer Sh500 (USD5), the county government will subsidize the cost by paying Sh250 (USD2.5) for each farmer while KRCS will top up the balance of the other Sh250 (USD2.5).

Besides the seed support, the county government will assist farmers to access agricultural extension services and technical advice from agricultural experts.

The partnership will further see KRC rehabilitate 20 boreholes, water pipeline and water points as part of the emergency interventions to enable communities in Kitui to access water as they wait for recharge of surface water sources in the short rains.

Green grams are said to have health benefits which are they fight breast cancer, weight control, diabetic friendly, protein source, controls blood pressure and they are also a source of protein.

In Kenya, seeds can be obtained from Kenya Seed Company, Dry Land Seed Ltd, Kenya Agricultural Research and Livestock Organization (KALRO) Katumani and KALRO Kitale.

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Push-Pull technology halts fall army worm rampage

The fall armyworm is a moth that causes devastating damage to almost 100 plant species, including sorghum, rice, wheat and sugarcane, thereby threatening food and nutritional security, trade, household incomes and overall economies. The fall armyworm spreads very fast – in its adult stage it can move over 100 kilometres in a single night. The pest is also capable of laying hundreds of eggs, with the emerging larvae burrowing into crops, destroying and eventually killing the plants.

Until 2016, the fall armyworm was constrained to its native region of origin, the Western Hemisphere (from the United States of America to Argentina). However, in January 2016, the pest was reported in Nigeria and it has since spread at an alarming rate across Africa; its presence has been confirmed in more than 28 African countries, while a further nine either strongly suspect, or are awaiting confirmation of invasion.

Already, in less than 2 years, the impact of the fall armyworm is being felt across Africa. Estimates from 12 African countries indicate that the pest is causing annual maize losses of between 8 and 21 million tonnes, leading to monetary losses of up to US$ 6.1 billion, while affecting over 300 million people in Africa, who, directly or indirectly, depend on the crop for food and well-being. The pest’s impact is likely to be even higher when its damage on other crops is quantified.

This new menace piles onto a range of existing challenges afflicting Africa. For instance, many regions of the continent are already experiencing the impacts of climate-change, including drier and hotter weather, stressed out soils, various invasive pests such as Tuta absoluta, and increased outbreaks of existing pests such as stemborers and the parasitic Striga weed.

“Efforts to control the fall armyworm through conventional methods, such as use of insecticides is complicated by the fact that the adult stage of the pest is most active at night. The pest also has a diverse range of alternative host plants that enables its populations to persist and spread. Moreover, fall armyworm has been shown to develop resistance to somewhile the performance of such chemicals is also hindered by limited knowledge and purchasing power of farmers, resulting into use of low quality, and often harmful products,” notes icipe scientist, Dr Charles Midega.

A recent study has established that a climate-adapted version of Push-Pull, an already widely used technology developed by icipe and partners is effective in controlling the fall armyworm, providing a suitable, accessible, environmentally friendly and cost-effective strategy for management of the pest.

Push-Pull, an innovative companion cropping technology developed over the past 20 years by icipe in close collaboration with national partners in eastern Africa and Rothamsted Research, United Kingdom, is modelled along the African smallholder farming system of multiple cropping. Originally developed for the control of stemborers, the key pests of cereal crops across most of Africa, and the parasitic Striga weeds, Push-Pull involves intercropping cereal crops with insect repellent legumes in the Desmodium genus, and planting an attractive forage plant such as Napier grass as a border around this intercrop. The intercrop emits a blend of compounds that repel (‘push’) away stemborer moths, while the border plants emit semiochemicals that are attractive (‘pull’) to the pests. Push-Pull has recently been adapted to drier areas through the incorporation of drought tolerant companion plants: Greenleaf Desmodium as an intercrop and Brachiaria cv Mulato as a border crop. In addition, Push-Pull also controls maize ear rots and mycotoxins, while improving soil health and providing high quality fodder, since the companion crops are superior forages. Therefore, the technology facilitates crop-livestock integration thus expanding farmers’ income streams.

“Over the past several months we received information from Push-Pull farmers that their fields were free of fall armyworm infestation while neighbouring monocrop plots were being ravaged by the pest. Therefore, we evaluated the climate-adapted version of the technology as a potential management tool for fall armyworm in Kenya, Uganda and Tanzania,” explains Prof. Zeyaur Khan, Push-Pull leader at icipe.

The study revealed fall armyworm infestation to be more than 80% lower in plots where the climate-adapted Push-Pull is being used, with associated increases in grain yields, in comparison to monocrop plots. The findings were supported by farmers’ perceptions through their own observations regarding significantly reduced presence of fall armyworm in Push-Pull plots.

“The ability to manage such a devastating pest clearly demonstrates Push-Pull’s utility as a platform technology in addressing the multitude of challenges that affect cereal-livestock farming systems in Africa. icipe intends to continue disseminating the technology as widely as possible across Africa, while advancing studies to understand the scientific basis of its effectiveness against the fall army worm,” says icipe Director General, Dr Segenet Kelemu.