In-depth: Another Kenya - The humanitarian cost of under-development

KENYA: Nomadic communities struggle to access PMTCT

Most Samburu women deliver their babies at home
SAMBURU, 7 September 2010 (IRIN) - Nomadic Kenyan women who test positive for HIV but live in remote areas far from the nearest health facility are missing out on the opportunity to prevent their children from becoming infected with the virus.

Mary Lesojile* discovered her HIV status when, pregnant with her fifth child, she visited a mobile clinic in the village of Lemisigiyo in Samburu District.

"The nurse used to come to our village with a camel... I never go to the hospital because it is far away," Lesojile told IRIN/PlusNews. "They tested me and told me I have HIV, but they told me my child would not get it if I gave birth in the hospital."

However, Lesojile lived a two-day trek from the nearest hospital and when the time came, she delivered her baby at home with the help of a traditional birth attendant.

"I had no option," she said. Her child later tested positive for HIV, and died of an opportunistic illness.

Access to healthcare

According to Janet Leng'ojine, a nurse with the Nomadic Communities Trust, a community-based health services organization which runs the mobile camel clinics, the main reason so few women in Samburu make use of prevention of mother-to-child transmission (PMTCT) services is because they cannot reach health facilities in time.

"We attend to many expectant women at our mobile clinics, but we don't offer maternity services; when you follow up, you realize they all delivered at home," she said.

Poor health-service provision also means that children infected with HIV at birth rarely receive treatment because their mothers do not access post-natal care and get little information on how to safely feed their children.

"While it is important to prevent HIV transmission to children, being born with it shouldn't mean death. But here, when a child is born positive, in many cases [it does] mean the death of the child," Leng'ojine said. "Many mothers who are HIV-positive lose their children without even knowing [the cause].

''Here, when a child is born positive, in many cases [it does] mean the death of the child''
"The major problems faced by women in nomadic communities in accessing PMTCT services are lack of adequate health facilities, their nomadic lifestyle, cultural encouragement of home births and lack of awareness on the existence of such services," said Shanni Wreford-Smith, coordinator of the Nomadic Communities Trust.

"The government must do more to stop these HIV-related deaths by bringing services closer to these people," Leng'ojine added.

Government statistics show that just 44 percent of Kenyan women give birth in health facilities, although antenatal attendance and PMTCT uptake is on the rise in most parts of the country. Just less than half of all children born with HIV receive antiretroviral treatment.

Ill-equipped hospitals

In 2009, the government released guidelines requiring health professionals to provide a three-drug regimen - Zidovudine, Nevirapine and Lamivudine - to mothers and their babies, but Dofa Abdi, Samburu District HIV/AIDS and sexually transmitted infections coordinator, said only the district hospital had a supply of the drugs.

"It takes days for some women to get here [Samburu District Hospital]. Moreover, the personnel here have not even been trained in some of these guidelines," he said. "While we as a government encourage mothers to deliver at facilities, the facilities are not there in the first place.

"Using mobile services to bring health services to where [the pastoralists] are might help, but the government hasn't started doing this," he added.

Family planning for PMTCT 

Today, Lesojile receives contraceptives from the mobile clinic; she does not want to risk having another HIV-positive child. "Even my husband does not know [that I take the pill]," she said. "I just don't want to give birth again because I will infect the child."

Wreford-Smith said providing family planning services was one way of reducing cases of mother-to-child transmission in remote areas where pregnant women cannot access health facilities.

"We have been doing that, but we can only reach a few people – many are infecting their children without knowing it."

Read more
 Better prevention needed for HIV-exposed babies
 Low breastfeeding rates threaten PMTCT efforts
 Support groups boosting PMTCT uptake
She added that family planning services not only helped in reducing new HIV infections in children but also in reducing poverty. "When you talk to the women, they want the services even if the husbands might be reluctant," she said.

Family planning is one of the main prongs of Kenya's national PMTCT strategy, but according to the 2007 Kenya AIDS Indicator Survey, about 58 percent of HIV-infected women in Kenya were not using any form of contraception. The survey also found that 48 percent of HIV-infected women surveyed did not want another child.

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* Not her real name