maryannewaweru

A Kenyan Journalist Writing About Health

Archive for the category “Women”

Jacklyne Nekesa: “I Lost my Uterus to a Rare Form of Cancer”

By Maryanne Waweru-Wanyama

Five years ago, Jacklyne Nekesa Nyongesa had her uterus removed, in a surgical procedure known as a hysterectomy. She was aged 35 then and even though she did not wish to have her uterus removed, it was her only option if she needed to stay alive.

“Ever since I was a little girl, I always desired to have my own child, but nature did not seem to favour me in that way. I have now accepted the fact I will never give birth to my own child,” she says.

Jacklyne’s journey to having her uterus removed began in 1997 when, for a period of time, she experienced heavy bleeding accompanied by intense pain to the extent that she would pass out. With time, the bleeding became constant and would see her bleed every single day of the year. And it was not light bleeding, for she would bleed in huge clots.

“Pads would not help as the blood would sip right through them and onto my clothes. I always had to carry a change of two or three clothes in my handbag. I was studying at that time and it became difficult for me to move around as I had to constantly keep dashing into public toilets to change my soiled clothing. Eventually, I stopped going to college and preferred to stay indoors,” she recalls.

Selina Cimmone

Photo: Jacklyne Nekesa during the interview.

As the bleeding continued, it would be accompanied by feelings of nausea, vomiting and extreme fatigue. Jacklyne then decided to visit Kenyatta National Hospital where the doctors ran a series of tests on her, including a pregnancy test.

“The tests showed that my pregnancy hormones (hCG) were very high. This puzzled me because I knew for a fact I was not pregnant as I was not sexually active. An ultrasound later on showed that I had abnormal growths in my uterus. These growths were mimicking a pregnancy, hence the symptoms of a firsttrimester pregnancy,” she says.

The doctors further took tissue samples from Jacklyne’s uterus, which established the presence of cancerous cells along her uterine wall.

Jacklyne was diagnosed with an unusual type of cancer called choriocarcinoma. She had to undergo two surgeries in a span of six months to remove the abnormal growths, as well as undergo chemotherapy to destroy the tumour cells. She underwent a total of 15 cycles of chemotherapy.

However, the pain and bleeding never stopped, despite the two forms of treatment.

“As the years went by and the bleeding and pain got worse, the doctors recommended having my uterus removed, but I resisted this. I believed I would heal, meet a nice man, get married and have babies,” she says.

For the next decade, Jacklyne experienced heavy bleeding accompanied by intense pain everyday. Due to the loss of blood, she became anaemic and lost count of the number of times she underwent blood transfusions. The disease affected not only her physical and emotional health, but her social life too.

“I could not date. How could I be intimate with a man yet I bled every single day of my life?” she remembers. Finally, in 2009, Jacklyne gave in and heeded the doctor’s call to have her uterus removed.

“My cancer had started spreading to other parts of the body. A hysterectomy was the only solution if I wanted to stay alive. My dream of birthing my own babies had to come to an end,” she sadly remembers.

After the hysterectomy, the bleeding and pain stopped and for the first time in 12 years, she did not have to wear a pad or carry an extra set of clothes in her handbag. It has been five years since Jacklyne had her uterus removed. The 40-yearold is still single, but hopes to find love someday.

“Most men want a woman who can bear them children. I am yet to meet a man who doesn’t want that. Maybe I will find him someday. For now, I am considering adopting a child,” she says.

Today, Jacklyne volunteers at the Texas Cancer Centre in Hurlingham, Nairobi, where she interacts with cancer patients and survivors.

Choriocarcinoma, the kind of cancer that Jacklyne had is a rare form of cancer. In majority of the cases, choriocarcinoma develops from Gestational Trophoblastic Disease (GTD), a group of diseases that see abnormal cells grow inside the uterus after conception.

The most common type of GTD is a hydatidiform mole, which is a tumour that forms inside the uterus at the beginning of a pregnancy. It results from an abnormal production of the tissue that is supposed to develop into the placenta, and is also referred to as a molar pregnancy.

However, in a few cases, choriocarcinoma can come about as a result of non-trophoblastic disease, where it is not pregnancy-related. Such is the case of Jacklyne, who developed this form of malignant tumour yet she was not pregnant.

According to Dr Amin Medhat, a gynaecologist and oncologist in Nairobi, this kind of cancer can originate from ovaries in women, or the testes in men. The choriocarcinomas, which result from genetic damage to a germ cell, make human chorionic gonadotropin (hCG) which is a hormone found only in pregnancy.

Dr Catherine Nyongesa, an oncologist, says that patients who present with choriocarcinoma give a positive pregnancy test results.

“This type of cancer is the only one that can cause a man to have a positive pregnancy test result. This is because it originates from some primitive cells in the testes. Therefore, if a man feels some swellings in his testicles, it is recommended that he sees a doctor immediately,” she says.

It is also these abnormal cells that may have caused Jacklyne’s tests to indicate a high hCG level (pregnancy hormones), even though she was not pregnant.

The symptoms of choriocarcinoma depend on the origin of the tumour. In the uterus, the most common symptom is bleeding, while in the ovaries, it is characterised by abdominal pain. In the testes, the choriocarcinomas present as small painless lumps.

According to Dr Medhat, most cases of choriocarcinoma can be treated if the correct diagnosis is made and treatment sought early.

“Treatment for choriocarcinoma includes chemotherapy, though in persistent cases surgery is necessary. All choriocarcinoma patients must be closely monitored following treatment,” he says.

In Kenya, cancer is the third leading cause of death, with a reported 40,000 new cases each year, according to Dr Nyongesa.

“Prostrate and oesophagus cancer is the most common among men, while in women, breast and cervical cancer lead the pack,” she says.

Cancer diagnosis, treatment and management still remains a problem in Kenya. In November 27-29, the Kenya Society of Haematology and Oncology will hold a conference that is expected to discuss issues surrounding cancer research, prevention, treatment, rehabilitation and palliation in Kenya.

With cancer treatment costs being out of reach for most Kenyans, it is hoped that the government and other stakeholders will come up with innovative strategies that can work towards enabling and ensuring the cancer cases in Kenya are reduced through prevention, early diagnosis and treatment in local health facilities.

Article courtesy: The Star

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Fistula: When Childbirth is a Cause for Misery

By Maryanne Waweru-Wanyama

Lovina Okwara is a bubbly 17-year-old whose broad smile, infectious laughter and carefree attitude is evident of a young woman enjoying her life. However, this has not always been Lovina’s attitude. For the last four years, her life has been one of misery.

Lovina traces it all back to four years ago when she gave birth to her daughter. An occasion that was supposed to bring her untold joy and happiness turned out to be the beginning of her nightmare. She recalls the day.

“My mother helped me birth my baby in our small house. Maternity services were not free back then so going to hospital was not an option as I had no money,” Lovina says, adding that the baby’s father, also a young man, had no financial means either.

Lovina comes from Teso district, Western Kenya. She comes from a poor background and so do many of her neighbours. Many of the women deliver their babies at home with no skilled care — among the reasons being personal preference, ignorance and poverty. While some women and children die during childbirth, Lovina and her daughter are among the lucky who survived.

But it was not an easy survival.

“I laboured for about 48 hours and when my baby finally came, I was exhausted, physically damaged and in pain. My private parts had been ripped apart during the delivery,” she remembers.

A few hours later, Lovina noticed she was unable to control her flow of urine and faeces.

“When I sat, I felt wetness overcome me and when I looked down, I noticed I was urinating on myself. I also noticed that my underwear had stool. Worried, I asked my mother about it.”

Lovina’s mother reassured her that the leaking urine and faeces were nothing to worry about, that many other mothers experienced it too.

This situation would see Lovina, who dropped out of school in class seven, eat very little food and take few sips of liquids to avoid quickly filling up her bladder and bowels.

“I would starve myself yet I was breastfeeding. I also stopped laughing as this would make my urine gush out. Even though I am grateful for my daughter, it has been a harrowing experience for me ever since she was born,” she says.

When Lovina, a causal labourer in Nairobi, tried to seek treatment for her condition, she learnt it would cost her about Sh30,000, money she could not raise. So it therefore came as a pleasant surprise when in July this year, she came across information about a free fistula medical camp at Kenyatta National Hospital.

Lovina wasted no time in going to the hospital for screening and a few days later, underwent a successful fistula repair surgery. Today, she is a happy teenager who has since regained her cheer and laughter which had been taken away by the fistula she suffered for four years.

Lovina Okwara

Photo: Lovina Okwara

Lovina’s fistula is likely to have been caused by the prolonged labour she went through. According to Dr Stephen Mutiso, a gynaecologist and fistula repair surgeon at Kenyatta National Hospital, obstetric fistula is a childbirth injury that develops due to prolonged and neglected labour which becomes obstructed.

“Obstructed labour causes destruction of vaginal tissue which leads to the development of a hole (fistula) between the bladder and birth canal. This causes urine to leak continuously through this hole. When the same damage occurs between the rectum and the birth canal, faeces leak continuously from the rectum to the birth canal,” he says.

Prolonged labour is that which goes on for more than 24 hours and according to the World Health Organization, obstructed labour accounts for up to six per cent of all maternal deaths. Dr Mutiso says that majority of the patients who present with fistula often have laboured for three to five days at home usually under the assistance of relatives or traditional birth attendants. In most of these cases, nine out of ten babies are born dead. Many of the women are from remote areas where the overall infrastructure is poor and they are unable to reach hospitals in good time.

In Mwingi district, Kitui County in Eastern province for example, women have to walk long distances in rough terrain to the nearest health centre. And when they get there, lack of personnel as well as lack of equipment and supplies is yet another challenge. A case example is Nyaani dispensary in Nuu location, where there is only one health worker, a community nurse who attends to all patients seeking services there. Nyaani dispensary serves a population of about 7,000 people.

Without a theatre or other basic equipment necessary for handling birth complications, the nurse has to call for an ambulance from Mwingi District Hospital which is 79km away. By the time the ambulance arrives and gets the pregnant woman to hospital, about four hours have elapsed. And this is when an ambulance is available. Many times it is not.

“A pregnant woman experiencing a birth complication and who is referred to the district hospital often has to use public transport. Public vehicles are hard to come by because of the poor state of the roads. Sourcing for transport and eventually getting to the hospital can even take a day,” says Damaris Wanjiru, the nurse in-charge at Nyaani dispensary.

Interestingly, while Damaris sees an average of 12 pregnant women a month attending antenatal clinics, she only delivers about three babies a month, with the rest delivering at home. Lack of transport is one of the major reasons the women cite for failing to make it to the dispensary when labour checks in.

Eastern province is one of the regions that bears the highest number of fistula cases. Other areas include Nyanza, Coast and Northern Kenya regions, as well as West Pokot. It is important to note that fistula can affect any woman regardless of her age, marital status, education level or income status. For as long as she experiences prolonged and obstructed labour and does not have access to emergency and quality obstetric intervention, then she can develop fistula.

In Kenya, there are an estimated 300,000 women living with fistula, with an occurrence of about 1,000 new fistulas each year, according to Dr Mutiso.

The consequences of fistula on the woman are dire. Stella Mburu, a nurse at Mbagathi District Hospital and who has been trained in fistula care, says that in most of the cases, the woman is emotionally pained following the loss of her baby. In addition, she has to deal with the continuous leaking of urine or faeces which make her smell foul. Most women from poor areas cannot afford fistula repair surgery and therefore use pieces of old cloth or mattresses to contain the leaking urine or faeces.

“They face rejection by their families and communities and because of the stigma, they soon stop going to public places such as the church or the market. They also stop attending social gatherings like weddings or chama. They also find it hard to find employment or engage in business. Some women experience domestic violence while some are disowned by their men who leave them to marry other women. Some women suffer depression as a result,” she says.

The good news is that fistula is treatable. Small fistulas can heal if a urinary bladder catheter is inserted for about four weeks immediately the fistula occurs. Surgery is the other option. However, the costs of surgery remain far beyond the reach of many women affected by fistula. In public hospitals, fistula repair surgery costs between Sh20,000 and Sh40,000 which is a subsidised fee. In private hospitals the price is much higher.

For women such as Lovina who cannot even afford the subsidised cost at government hospitals, they are lucky to benefit from organisations that sponsor their treatment through free fistula medical camps. Her surgery was made possible by the Freedom from Fistula Foundation, the Flying Doctors Society of Africa and Kenyatta National Hospital.

Fistula can be prevented by delaying the age of pregnancy and ensuring that all women have access to quality maternal care. The free maternity services in public health facilities are aimed at encouraging more women to deliver in hospitals under the supervision of skilled birth attendants to reduce negative maternal outcomes such as fistula.

Article courtesy: The Star

Former Female Prisoner Helping Society Accept Ex-Convicts

By Maryanne Waweru-Wanyama

For more than seven years, Elizabeth Ndunge engaged in a lucrative business at Gikomba market in Nairobi, where she traded in second-hand clothes. As the business grew, she partnered with two friends and they would buy clothes in bales and then sell them in Juba – South Sudan, where they had established a new market. Each week, the ladies would take turns to travel to Juba, sell the clothes then return after three or four days when the stock was sold out.

Elizabeth Ndunge

Photo: Elizabeth Ndunge during  the interview

“Business was very good, and we were all happy with the huge profits we were making,” remembers the 42 year-old mother of two.

“We would buy about five bales, and then hire one of our regular taxi drivers to take us to the town center from where one of us would board a bus to Juba,” she remembers.

This arrangement went on smoothly for three years, until one day, an unexpected event altered the course of Ndunge’s life forever.

“It was a morning February 2008, and it happened to be my turn to travel to Juba. After purchasing the bales at Gikomba, I waited for my regular taxi driver to take me to the town center. Unfortunately, he delayed, and fearing I would miss my bus, I decided to take the first taxi that came my way.”

And that was to be the decision that would cost her dearly.

“I negotiated the fare with the driver, and after reaching an agreement, I boarded the taxi. The drive was smooth, but just as we were about to get into the town center at the Muthurwa market roundabout, I heard the taxi driver murmur some words before suddenly changing routes. When I asked him why, yet we were almost at our destination, he said he was avoiding traffic. However, I noticed there were policemen ahead of us, and I thought he could have been avoiding them perhaps because he didn’t have a driving licence,” Ndunge recalls.

But she became worried when the car began heading further away from the town center. The taxi driver kept going on, ignoring her pleas to drop her off at the next bus stop. She sensed danger when they got onto Mombasa road.

“Each time I asked him where we were going, he ignored me. Frightened, I even wet my pants, believing I had been kidnapped,” she remembers.

Shortly thereafter, Ndunge suddenly heard loud bangs coming from behind. Instinctively, she ducked down to the floor of the car, realising that the sounds were gunshots.

“I then heard the taxi driver open his door and jump out, leaving the car on its own motion. I felt the car enter a ditch and come to a halt.”

Ndunge recalls struggling to get out of the car, and when she finally did so, she raised her hands in the air screaming out for help. She was grateful when she saw policemen rushing towards her, glad that they would rescue her from her kidnapper. But she was in for a rude shock when the same policemen immediately pounced on her with slaps, kicks and blows.

“As they rained punches on me, asking me to name my accomplice (the taxi driver), it was only then that I realised that the car had been stolen! The policemen stripped me naked by the roadside and tortured me for about three hours, asking me to reveal other members of the car theft syndicate. I was saved from death by the crowd of onlookers who begged for the policemen to spare my life,” she remembers.

At the Langata police station, Ndunge was booked, and there began her court case where she stood trial for the capital offence of armed robbery. The prolonged court case would see her stay in remand for three years. Eventually, she was found not guilty of the robbery with violence charges. However, the judge ordered her to serve 12 months in jail for the offense of being found in a stolen vehicle.

“The judge ruled that it was wrong for me to have boarded a ‘taxi’ that bore no yellow-line, or which was not branded a taxi company’s name. She explained that anybody found in a car that has been reported stolen must answer to charges of theft of the vehicle. She said my sentence would serve as a warning to me and others who board unbranded taxis.”

Having already served slightly over three years in remand, Ndunge decided to make the best of her remaining time behind bars. During the course of her year-long jail term, she began composing gospel songs which she would later record.

While incarcerated, she began noticing that many prisoners, once released, would after a short while return to prison.

“We would spend the eve of her release singing, dancing and praying together, wishing our sister a good life outside the prison walls. But less than a month later, we would see the same woman return. It happened to so many times, and it became an issue that deeply troubled me. One day I gathered courage to inquire about the disturbing trend.”

All the returnees Ndunge talked to all said the same thing.

“They said that once freed, they faced so much stigma and rejection by society that they longed to return to prison. Rejected by their families, friends, neighbours and former colleagues, they found it hard to settle down and make a decent living. Distraught, they would deliberately commit a crime so that they would return to prison –the only home they had come to know. In prison, they were guaranteed of acceptance, friends, food, shelter and clothing.”

As she listened to their experiences, Ndunge hoped that her family would not reject her. She could not fathom the idea of returning to prison no matter the challenges out there.

Finally, her release day arrived in October 2012, and after leaving the prison gates, she vowed she would not return there. She travelled to her rural home in Kangundo, Machakos County, unsure of the reception she’d get.

“Thankfully, my family welcomed me back. Sadly though, my husband had already remarried. I chose to accept and move on with my two children, who had been left under the care of my mother. Shortly thereafter, I returned to my former business in Gikomba, where I was welcomed back by my former colleagues. Relieved, and knowing that acceptance of ex-convicts into society was a possibility, I decided to use the profits of my business to help women ex-convicts so that they too could be accepted back into society.”

Ndunge began offering help to ex-convicts facing problems of rejection by their families after their release by mediating between both parties. As her work progressed, Ndunge decided to make her venture more formal, and in 2013, she registered the organization Kenya Ex-Prisoners Fighting Acceptance Back into Society (Kefabis).

So far, Ndunge has been able to help 29 female ex-convicts be accepted back by their families, after initially being rejected. She sometimes requests the assistance of local chiefs, respected community leaders as well as religious leaders to help in the mediation process. Her initiative has seen her travel across the country, with some of her travel expenses being taken care of by the Missionaries of Africa –a Catholic based society whom she became acquainted with while in prison.

Today, Kefabis has 2,600 members, many of whom have established support groups as a way for helping and motivating each other to live by the law.

“In Kangundo, members have formed a group where they engage in commercial farming activities. In Malinidi, the women engage in craft work while in Kisumu, they engage in evangelical ministry. The Kefabis Kakamega chapter recently received training from a painting company, where they were taught how to paint professionally. The members often get contracts to do painting jobs, and are earning money from this. In Nairobi, members design and tailor clothes, jewellery and other accessories such as handbags. Most of these women use the skills they learnt while in prison,” she says.

Her work has however not been without challenges. Many are the times she has been chased by family members of the ex-prisoner she is trying to mediate for.

“Both of us are hounded out, as the families want nothing to do with ex-prisoners. Many are the times we have been thrown out violently,” she says.

“It is also disheartening when some families completely reject their family member. Two women have so far been completely rejected by their kin,” she says.

But Ndunge soldiers on, because as an ex-convict, she understands the stigma associated with former prisoners.

“I know what it is like to be stigmatised by society. Today, not all my friends have accepted me as some fear me thinking that I am a dangerous criminal. But that will not stop me from doing my work of helping female ex-prisoners rebuild their lives again,” she concludes.

*Ndunge is reachable on 0708898542

Article courtesy: The Star

Warning Sins in Pregnancy: When to Call Your Doctor

During pregnancy, many women have lots of questions and queries. Some of them we ask our moms, our aunts, our friends, our colleagues, and some of us go to Facebook to seek answers :) . But, when does it become obvious that you need to call your doctor or midwife, or visit the health center immediately?

Dr. Stephen Mutiso, a consultant obstetrician/gynaecologist at KNH is our guest writer today and he lets us in on the warning signs –when a pregnant woman should seek a medic’s opinion as soon as possible.

*Antenatal care entails monthly visits to the clinic till 28 weeks gestation, then visits every two weekstill 36 weeks, and thereafter weekly visits till delivery –for those progressing well. However, sometimes there is variation from this schedule, and this depends on the needs of the expectant mother.

However there are certain situations when it becomes necessary to get in touch with your gynaecologist on an urgent basis before the next visit. This is especially when certain complications develop.

Complications during pregnancy and childbirth are common. Infact, approximately two out of every five pregnant women experience some complication during pregnancy, childbirth and postpartum period. 15 percent of pregnant women develop life-threatening complications. Most complications cannot be predicted and can happen at any point during the antenatal period, during delivery or post-delivery. Therefore, all pregnant women should be prepared to respond appropriately when complications arise by contacting their care givers immediately.

There are certain symptoms which if present denote that they could be serious complications hence need to act immediately. These symptoms are referred as danger signs. Knowledge of danger signs of pregnancy emergencies and appreciation of the need for rapid and appropriate response when they occur is important to avert fatal outcomes. At times, getting medical help early  makes the difference between survival and death.

The danger signs in pregnancy are: vaginal bleeding, severe headache, severe vomiting, swelling of hands and face, difficulty in breathing, fits, fever, reduction or absent fetal movements, gush of fluid, intense abdominal pain and contractions before 37 weeks. Danger signs indicate a woman needs immediate medical care.

Bleeding is a very serious complication. It causes most of the maternal and foetal deaths in Kenya. Any bleeding in pregnancy –irrespective of the amount is abnormal. When bleeding is present during pregnancy it may indicate that the placenta position is on the lower aspect of the womb (placenta praevia). Bleeding may also occur when there is premature separation of the placenta. This premature separation cuts off delivery of oxygen and other nutrients to the baby, and this could lead to the baby’s death. Other causes of bleeding in pregnancy include: rupture of the uterus and bleeding from the baby (though this is rare). Heavy bleeding after delivery may arise from different causes such as relaxation of the uterus (atony), injuries in the birth canal, incomplete expulsion of placenta and sometimes bleeding disorders.

Severe headache, swelling of hands and face, blurred vision, fits and difficulty in breathing indicate high blood pressure and need urgent attention. This complication is referred to as severe preeclampsia, and when fits are present it is called eclampsia. This disease is also deadly and delivery is the way out regardless of whether the baby is mature or not. Seekng immediate care from your gynaecologist is important.

Hotness of the body with or without vomiting may indicate presence of serious infection or malaria. Prompt treatment does save life.

When waters break it is important to call your doctor immediately, because there is a possibility that the baby’s cord can come out and get compressed by the baby’s head, thereby stopping blood supply to the baby. This can cause death of the baby. It is also very easy for infection in the uterus to set in once the waters break. This infection is life threatening. Urgent care is therefore crucial.

Pregnant mothers should be keen on foetal movements (kicks) throughout their pregnancy. Any decrease in baby’s movement may indicate that all may not be well with the baby, and so it is important for the woman to report this observation to her gynaecologist as soon as possible.

Intense abdominal pains require urgent evaluation by your doctor. Causes of severe abdominal pain include ectopic pregnancy; rupture of uterus, premature separation, infection of the kidney. At times, abdominal pain may be due to surgical diseases such as appendicitis, intestinal obstruction etc.

Contractions which occur before 37 weeks indicate premature labour. Babies born at this time could develop breathing difficulties which sometimes could prove fatal. Its advisable for expectant women to seek assistance when they start getting regular uterine contractions especially if there are more frequently than 10 minutes apart.

In conclusion, knowledge of danger signs is important because it improves complication recognition and ensures timely decision to seek care hence handling complications in good time and consequently saving lives and avoiding serious disabilities.*


Dr. Stephen Mutiso is based at the KNH Doctor’s Plaza, Suite 26/27. He provides a  wide range of  gynaecological services including: antenatal care, delivery (normal and caesarean),  infertility  treatment, fibroids, fistula surgery, screening for reproductive tract cancers and various  gynaecological operations.

Tel: 0722 678 002 or 0788 306 674

Website: drmutiso.com Email: mutisoh@yahoo.com

What Are Pregnant Women Dying From?

What are pregnant women dying from? Here are the answers.

WHO pregnant_moms

What Foods Should a Pregnant Woman Eat? Should Pregnant Women Eat Liver?

What foods should a pregnant woman eat to ensure she maintains a healthy pregnancy and delivers a healthy baby? There is also lots of talk that pregnant women should not eat liver. How true is that? Dr. Stephen Mutiso, a consultant obstetrician / gynaecologist gives us answers to this.

What Foods Should You Eat While Pregnant?

Pregnant women should eat healthy foods in order to provide adequate nutrition to the growing baby. A pregnant woman must strive to eat a balanced diet, as this is crucial for the healthy development of the baby.

A diet is balanced if it contains the following: starch, proteins, vitamins and minerals. Thankfully, many of our locally available foods are rich in these nutrients, and they are affordable.

Foods rich in starch include ugali, rice, chapati and potatoes. Common sources of proteins include beans, peas, fish, milk, eggs and meat. There are many fruits and vegetables available locally which are a good source of vitamins and nutrients and include spinach and sukuma wiki.

It is also important to note that the demand for iron in pregnancy is very high and cannot be met purely through foods. That is why iron supplementation is recommended during pregnancy.

A high intake of fiber and water is recommended during pregnancy, as it helps to reduce constipation because pregnancy slows down bowel movement.

What about Liver During Pregnancy? Should you or Should you not Eat?

It is not advisable to eat foods rich in vitamin A –such as liver or if eaten, they should be eaten in moderation. This also applies to supplements that contain high doses of vitamin A. This is because high doses of this vitamin have been associated with significant birth defects, hence caution to avoid prenatal vitamins containing this vitamin. This caution is especially important for women planning to get pregnant, and during the first trimester of pregnancy when the organs are forming.

Pregnant women are also advised to avoid raw and undercooked meat which may increase risk of acquiring toxoplasmosis which may affect the baby.

Alcohol must be avoided at all times.

Should I be Eating for Two When Pregnant?

From a nutritional point of view, a pregnant woman eats for two, hence the need for her to eat nutritious food. However, this does not mean eating twice as much in pregnancy. She should focus on ensuring she eats quality food, not quantity food. Eating too much is bad both for the mother and baby and could lead to problems.

How Much Weight Should I Gain During Pregnancy?

Weight gain during pregnancy is vital in preparation for breastfeeding. The recommended weight gain for non-obese women by the end of pregnancy is 10-12kg.This translates to about 0.5kg per week. If one is obese, the recommended weight gain is about 8kg.Weight loss during pregnancy is not recommended, so one should not be on a weight-loss diet.

Most of the weight gain occurs after 20 weeks of pregnancy when nausea and vomiting has reduced or even ceased.

Gaining too much weight increases the risk of gestational diabetes, backache, high blood pressure and a likely caesarean section due to a big baby. Too little weight gain can lead to low birth weight and premature birth.


Dr. Stephen Mutiso is based in Nairobi, and he provides a wide range of gynaecological services including: antenatal care, delivery (normal and caesarean), infertility treatment, fibroids, fistula issues, and screening for reproductive tract cancers, and gynaecological operations.

He is based at KNH Doctor’s Plaza, Suite 26/27

Tel: 0722 678 002 or 0788 306 674

Email: mutisoh@yahoo.com Website www.drmutiso.com

Post originally published in Mummy Tales – A blog by a Kenyan mom.

 

Malaria in Kenya: The Facts

Today is World Malaria Day. Even though Kenya has made great strides over the last 10 years in the fight against the disease, alot more still needs to be done, as malaria is the leading cause of morbidity and mortality in Kenya.

Here is a glance of Malaria situation in Kenya:

  •  25 million out of a population of 34 million Kenyans are at risk of malaria.
  • It accounts for 30-50% of all outpatient attendance and 20% of all admissions to health facilities.
  • An estimated 170 million working days are lost to the disease each year (MOH 2001).
  • Malaria is also estimated to cause 20% of all deaths in children under five (MOH 2006).
  • The most vulnerable group to malaria infections are pregnant women and children under 5 years of age.
  •  Malaria is preventable and curable. (Source: KEMRI).

The government has a 10-year Kenyan National Malaria Strategy (KNMS) 2009-2017. The goal of the National Malaria Strategy is to reduce morbidity and mortality associated with malaria by 30% by 2009 and to maintain it to 2017.

Here are more elaborations on Kenya’s malaria situation. 

MalariainKenyaWEB

Malaria mappingmalaria

Malaria mothersatrisk

Malaria DiagnosingMalaria

Malaria Knowledgegap

Malaria Treatingthefever

source of data graphics and information: InternewsKenya

 

My Husband’s Support Kept Me Going When I Had Breast Cancer -Violet Mulama

Three years ago, Violet Mulama, 53, began observing that her left breast was gradually hardening.  Even though the mother of five, a primary school teacher in Kitale was not in any pain, it gave her sleepless nights because it was something she had never seen or felt before. Not one to take any chances, she decided to see a doctor about it.

The doctor she saw referred her to Eldoret for further tests; a mammogram, an ultrasound and a biopsy. All results showed that while there was a mass overlapping her entire breast, it was not cancerous. Relieved that the lump was not life-threatening, Violet went back home, thankful that she would live to see another day.

However, as days went by, the mass continued hardening and she decided to apply some herbal remedies on the breast in a bid to soften it.  She also decided to undergo therapy sessions with a Ceragem Thermal Massage machine, which is a massager that places heat and pressure to specific parts of the body and is said to among others; help relieve pain, increase blood circulation, loosen muscles and take away stress.

But Violet still did not feel any better and if anything, the lump in her breast only became harder. Worse, she had now developed chest pains, was coughing a lot, was having recurrent sore throats, shortness of breath and was experiencing lots of heavy night sweats.

She went back to hospital and this time, blood tests showed she had typhoid and was given antibiotics. Unfortunately, Violet continued feeling pain and the drugs did nothing to offer her the relief she needed. It was then that she decided to consult a specialist doctor in Eldoret town where she was referred for more tests; a breast ultrasound, a chest x-ray and a biopsy.

The results were not good. Violet had cancer, which was fast spreading. In just six months, the lump had moved from being non-cancerous, to cancerous. She was saddened by this news, believing that her end had come.

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The doctor then referred her to specialist doctor in Nairobi for further consultation. At the Aga Khan University Hospital in Nairobi, Violet and her husband received more bad news – that her cancer was at an advanced stage and she therefore needed immediate surgery to prevent it from spreading further.

After a difficult time fundraising for the required money, Violent underwent a successful mastectomy, which is a surgery done to remove a breast or part of a breast and is done to treat breast cancer. Violet’s affected breast was removed.

Following the surgery, there was no time to rest as she immediately began chemotherapy, a form of cancer treatment that involves the use of chemicals that work towards disabling or destroying cancer cells. She was to undergo eight sessions in total. But the side effects of the chemotherapy sessions were an agonizing and unpleasant experience for Violet.

“I would get severe headaches, I would vomit everything I ate, I would experience bad nausea, loss of breath, I was coughing and my body was generally weak. After my first chemotherapy session, I collapsed and had to be admitted in hospital for six days,” she remembers.

The second time she went for chemotherapy, her body went through the same rigors and once again, she collapsed and had to be admitted for another six days. All these events were taking their toll on her – physically, emotionally and mentally.

“I was devastated. I had never felt such pain and weakness in my life. I knew I was dying. My body was in so much distress that I felt I could not handle it anymore,” she remembers.

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The only thing that kept Violet going was the support from her husband.

“Having observed my defeatist attitude, my husband one day sat me down and told me that we had five children who needed me around. His firm words of reprimand are what jolted me into reality, and I knew that I had to soldier on,” she remembers.

Violet’s husband once never left her side, and even had to incur businesses losses back home in Kitale as he stayed in Nairobi for months, putting up with relatives just so that he could be by his wife’s side.

With renewed strength, Violet managed to go through the remaining chemotherapy sessions, albeit with lots of difficulty.

Sis weeks later, she began radiotherapy sessions. Radiation therapy is a form of cancer treatment that uses high levels of radiation to destroy cancer cells, or stop them from growing and dividing.

Violet successfully completed her radiotherapy sessions in September 2012, and is today living a healthy life.

The Facts on Breast Cancer

Breast cancer develops in the breast tissue, primarily in the milk ducts. The first sign of breast cancer often is the feeling of a lump in the breast or the underarm, or an abnormal mammogram test result. A mammogram is an x-ray done on the breast and is used to detect and evaluate any changes in the breast.

According to Dr. Michelle Lang’o of the pharmaceutical company Novartis Pharma, and who has worked as a Medical Officer at Nairobi Hospice and is today heavily involved in breast cancer treatment and management says the exact causes of breast cancer are unknown, though there are certain risk factors.

“Having one first-degree blood relative with breast cancer such as a mother, sister or daughter doubles a woman’s risk of getting it too. Having two first-degree relatives increases a woman’s risk by about three-fold,” she says.

Dr. Lang’o adds that a woman with cancer in one breast has an increased risk of developing a new cancer in the other breast or in another part of the same breast.

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According to the World Health Organization (WHO), breast cancer is the leading cancer in women worldwide, comprising 16% of all female cancers. Even though previously thought to be a disease of the developing world, statistics offer different insights into this.

The 2004 WHO Global of Disease Burden report indicated that 69% of breast cancer deaths occurred in the developing world. WHO says that certain factors could be attributable to this growing trend, such as increase in life expectancy, increased urbanization and the adoption of western lifestyles by those in the developing countries.

Dr. Lang’o says it is hard to put an exact figure of the number of breast cancer in Kenya because there lacks a national cancer registry.

While breast cancer is best treatable when detected early, many breast cancer cases in the developing world are unfortunately diagnosed when it’s too late – when the cancer is already at an advanced stage. This leads to a high death rate from the disease.

 

images: dreamstime.com 

Kenya on Awareness Campaign to Increase Uptake of Iron and Folic Acid in Pregnant Women

When Scholastica Kasyoka conceived her first child six years ago, she was elated at the thought of becoming a new mother. To ensure that all would be well with her pregnancy, she immediately started her antenatal clinics at a health facility near her home in Kayole, Nairobi.

During her initial ANC visits, she was given iron and folic acid tablets and was told to take one tablet each day. These tablets, she was told, would help her have a healthy pregnancy and healthy baby. And indeed, Scholastica took one tablet daily -as instructed. But just for a while, for a few days later, she stopped.

“I would feel very sick every time I swallowed them. I would feel nauseated, weak, and would many times vomit. Hard as I tried to keep up with the tablets, I just could not. So I stashed them away and carried on with the pregnancy,” she remembers.

Nine months later, Scholastica gave birth to a baby girl. But something was wrong. The nurses told her that her newborn had a problem.

“They said my daughter’s spinal cord was not well formed,” she recalls of the disheartening news that cut short her celebrations as a new mum.

Scholastica Kasyoka. Her daughter was born with spina bifida --a neural tube defect.

Scholastica Kasyoka. Her daughter was born with spina bifida –a neural tube defect.

Scholastica was later to leant that her daughter had spina bifida. She had never heard of spina bifida; she had no idea what it was.

“The nurses told me that my baby was born with a deformed spine because I had stopped taking the iron and folic acid tablets I had been given,” she remembers.

Spina bifida is a neural tube defect characterized by the incomplete development of the brain, spinal cord, or the protective covering around the brain and spinal cord.

Anne Mulwa, a clinician at Bethany Kids Hospital –hosted by the AIC Kijabe Hospital in Central Kenya, says that in some cases of children with spina bifida, part of the contents of the spinal canal protrude through the spinal column. Spina bifida may lead to disability.

“Spina bifida may cause difficulties with bladder control, and can lead to paralysis at the point where the bifida is highest. Depending on the severity of the deformity, people with spina bifida may be paralyzed or may have challenged mobility,” she says.

Bethany Kids Hospital is one of the largest referral hospitals in Kenya for children with disabilities and who need surgical intervention. The highest numbers of referrals are those of neural tube defects. From its inception in 2004 to the year 2012, Bethany Kids conducted a total of 14,333 surgical procedures. Operations on children with neural tube defects accounted for more than half (51%) of the total surgeries. Scholastica’s daughter Grace, is among these statistics.

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Though the exact cause of spina bifida is not known, research suggests that lack of enough folic acid in the pregnant woman’s diet, more so during the first trimester when the spinal cord is being formed as a key factor in causing spina bifida and other neural tube defects. Folic acid is particularly essential before the woman gets pregnant –and within 28 days after conception.

Esther Kariuki, a nutritionist with the Micronutrient Initiative says that women, especially those in the childbearing age should make it a habit to eat foods rich in iron and folic acid, and where necessary, boost this with recommended supplements. Some of the foods that contain high amounts of these essential nutrients, Ms. Kariuki says, include; liver, meat, green leafy vegetables and fruits rich in citric acid.

“Neural tube defects happen in the first few weeks of pregnancy; usually before a woman even knows she is pregnant. It doesn’t help matters that many pregnancies are unplanned, so by the time she realizes she’s pregnant, it could be too late to prevent these birth defects.” she says.

Women who have had prior pregnancies that resulted in babies with spina bifida or other neural tube defects are also at a high risk of having a subsequent similar pregnancy. Ms. Mulwa adds that such women are advised to take folic acid even when they are not pregnant.

It is for this reason that Scholastica was put on folic acid supplements after she delivered her daughter, even though she was not sure she wanted to have a baby again –not with the problems she was facing with her daughter -a child who would need lifelong care because of her disability.

Various fruits and vegetables are rich in iron and folic acid.

Various fruits and vegetables are rich in iron and folic acid.

The World Health Organization (WHO) recommends daily iron and folic acid supplementation for pregnant women. The recommended daily dose is 60mg of iron, and 0.4 mg of folic acid. Doing so reduces the risk of having a pregnancy affected with spina bifida or other neural tube defects, reduces the risk of having babies with low birth weight and iron defects. The supplements also reduce the risk of maternal anaemia.

Kenya’s Ministry of Health has been implementing the WHO recommendation of daily supplements for pregnant women through its antenatal care strategies. However, the current uptake and adherence rates of iron and  folic acid supplements among pregnant women has been low, according to Ms. Evelyn Kikechi, a nutritionist at the Department of Nutrition. This could be due to a combination of many factors.

One of them is pregnant women’s failure to follow the instructions given to them about taking the tablets.

“When the women are given the supplements during their ANC, many of them stop taking them once they start experiencing side effects. The side effects include nausea, vomiting, a general feeling of weakness as well as a taste of ‘metal’ in the mouth”.

Ms. Kikechi aptly describes some of the side effects that Scholastica experienced, which made her stop taking the supplements. Many women, Kikechi says, do not understand the importance of these supplements. It also doesn’t help that women delay their first ANC visit, thereby missing out on the opportunity to be given the supplements in their first trimester.

A mother and her child at Bethany Kids Hospital. The child has spina bifida.

A mother and her child at Bethany Kids Hospital.

Some religions don’t allow visits to hospitals or taking of ‘Western’ medicine, thus women don’t visit ANC clinics –missing out on opportunities for the needed supplements. Pregnant women are also reluctant to vist ANC because they fear they will get tested for HIV. Others are not able to attend ANC clinics because the health facilities are far off, and they may not have money for transport. Getting to the health facility is therefore not a priority –over tilling the land and preparing meals for their families.

According to the 2008-09 KDHS, less than half (47%) of pregnant women make four or more ANC visits and only 15% access antenatal care while in the first trimester of their pregnancy. The report adds that about half (52%) receive care before the 6th month of pregnancy. The median number of months of pregnancy at first visit is above the first trimester –at 5.6 months.

Some cultural practices also stand in the way of women accessing iron and folic acid supplements. Some communities prescribe certain herbs and specific soils and stones to the pregnant women, claiming these are sufficient enough to enable them have healthy babies. But this is not always the case, where infact, eating the soils and stones could lead to even bigger health problems for the woman.

Another reason for the low uptake of iron and folic acid supplements by pregnant women is some health provider’s limited understanding on the reason for giving their clients the supplements.

Kenyatta National Hospital. The government is sensitizing all health workers on iron and folic acid supplements for pregnant women.

Kenyatta National Hospital. The government is sensitizing all health workers on iron and folic acid supplements for pregnant women.

“Because some health providers in the ANC clinics do not have a clear understanding of the importance of these supplements, they fail to give the pregnant women sufficient information on the same. They do not stress on the need for these women to take these tablets, so the women do not take it seriously either,” Ms. Kikechi says.

According to her, all staff at public health hospitals are currently being sensitized on the need to inform women on the importance of iron and folic acid supplements, and give them to every pregnant woman who visits an antenatal clinic. The government, in collaboration with other partners and stakeholders is also engaged in various awareness campaigns, including the use of mass media to pass on messages of the importance of iron and folic acid supplements.

But the government too has its contributory role in the low uptake of these iron and folic acid supplements among pregnant women.  A Kenya Service Provision Assessment (KSPA) survey done in 2010 showed that not all government facilities were stocked with these supplements. Only 2 out of every 5 health facilities had iron tablets, while 74% had folic acid tablets.

In addition, for facilities that stocked the supplements, there were frequent stock-outs, caused by among others: communication breakdown between facilities and depots, low prioritization of IFA supplements by government, differences in forecasting by different MOH units, and inadequate budget allocation.

Even further, the current country policy on iron and folic acid supplementation requires that all pregnant women be given these supplements whether they have been screened for anaemia or not. However, current practice at the facility level is that health workers insist on screening pregnant women for anaemia before prescribing the tablets. This is despite statistics from the 2010 Kenya Service Provision Assessment (KSPA) showing that just about 36% of ANC facilities have the capacity to test for anaemia –thereby denying supplements to the ‘eligible’ target group.

A happy mother with her healthy child.

A happy mother with her healthy child.

To reduce the health burden of the country, stringent efforts to educate the public, especially women, on the essentials of good maternal and child health is of utmost importance. If Kenya is to achieve MDGs 4 and 5, then it needs to seriously pull up its socks. Creating awareness on the importance of iron and folic acid supplements to childbearing women and health workers, as well as policy makers will go a long way in reducing the number of children born with birth defects.

How Can I Prepare for a Healthy Pregnancy?

Are you planning on becoming pregnant? Do you know what measures you should be taking to ensure that you have a healthy pregnancy and a healthy baby?  Our guest writer today tells us more on this.

By Dr. Stephen Mutiso, Consultant Obstetrician/Gynaecologist

A healthy pregnancy culminating into birth of a healthy baby is the ultimate desire of any mother. The outcome of any pregnancy is determined long before conception. To optimize pregnancy outcomes, it is important to have good health prior to conceiving.

Achieving good health before pregnancy includes adopting a healthy lifestyle. A healthy eating habit ensures you have adequate nutrients such as folic acid –which are important for baby’s good growth.

Diet rich in fruits and green vegetables provide high levels of micronutrients, hence should be encouraged to be taken by women contemplating getting pregnant. Weight reduction for those who are obese is important as obesity is associated with bad pregnancy outcomes. Ceasation of smoking and alcohol and other substance abuse is critical as these substances are harmful to the growing baby.

In addition to lifestyle changes, it is important to have a health check up by your gynaecologist before getting pregnant. This health checkup usually 3 months before conception, and is called preconception care. The goal of preconception care is to provide the woman with the best chance of a having a healthy pregnancy and a healthy baby. Preconception care involves review current and past medical and pregnancy history, physical assessment and laboratory testing to screen and detect any new and pre-existing diseases. If you have any chronic disease, it is important to inform your doctor. Any new or preexisting diseases must be treated or controlled well before pregnancy.

Education and counseling are important services offered during preconception care. Key topics usually covered include diet, HIV and other STDs, smoking and alcohol cessation. Folic acid supplementation is also provided during preconception care.

Chronic medical diseases which may affect pregnancy include: diabetes, hypertension, asthma, heart diseases, obesity, hypothyroidism, sickle cell anemia, HIV, Hepatitis, Venous thrombosis, kidney disease and epilepsy. Chronic medical diseases should be put under control before becoming pregnant. In some cases, a change in treatment may be needed because some medications are harmful to the baby.

Preconception care therefore is not a luxury but a very key intervention to improve pregnancy outcome. It’s very necessary for every woman regardless of age and number of previous births. If you’re planning to get pregnant its important you adopt a healthy lifestyle as well as schedule an appointment you’re your gynaecologist.

Dr Stephen Mutiso is based in Nairobi, and he provides a wide range of gynecological services, including; antenatal services, delivery, Vaginal Birth after Caesarean (VBAC), Obstetric Fistula, Infertility issues and Fibroids among others. He has admission rights in various private hospitals.

He is based at Kenyatta National Hospital Doctors plaza, Suite 26/27

Telephone: 0722 678 002 or 0788 306 674

Email: mutisoh@yahoo.com   —    Website: www.drmutiso.com

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