The Test

HIV is still a major problem in the country and has had an impact on the individual, the family, community and the nation as a whole. The government is trying to ensure that the problem is contained but we have to take the fight individually. One of the ways is by knowing your HIV status.

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Testing

Testing can be done at any hospital or clinic as voluntary testing or as health provider initiated testing and in your home through the newly introduced home based testing done by trained health workers at the comfort of your home.

HIV testing is done by rapid methods and you get your results as you wait. The test is done using only a drop of blood and it takes 15 minutes to run. The heath worker has been trained to give counseling before the test is done (pre-test counseling) and after the test (post-test counseling).

Testing is advocated for all individuals, whether single or married. Many Kenyans have used marriage as an excuse to avoid HIV testing. At this time, it is vital for all to know their status in order to come together in the fight against HIV. This has especially been emphasized by the ever increasing numbers of discordant couples. This is a case whereby one person is found to be negative and their partner is positive. This has been the subject of debate and is still under study. Even in these cases, the measures to ensure that one’s partner is not infected can be instituted.

Pre-test counseling

The pre-test counseling is done to asses your HIV risk and various questions are asked about your past history that would have made you at risk for HIV infection and your knowledge on HIV. The post test counseling depends on the results.

Post-test counseling

If one is found to be HIV negative, advice is given on how to live so that you remain negative. The prevention strategies include

  • Abstinence from sex,
  • Being faithful to one sexual partner and
  • Using condoms when having sex.

Voluntary medical male circumcision (VMMC) has gained popularity in the recent past. VMMC comes as a package including HIV testing and counseling, behavioral change communication, reduction of risky behaviour, condom promotion and distribution and male circumcision performed under local anaesthesia.

Studies done in Kenya and other African countries have shown the preventive effects of male circumcision and hence the drive to encourage male circumcision in the country especially in the communities that do not practice male circumcision.

If one is found to be positive for HIV when tested advice is given on positive living, how you can prevent spreading the infection to other people and how you can prevent getting infected by another strain of HIV. One is referred to a care and treatment facility where various tests are done and if needed antiretroviral drugs given.

Referral

Referral is also given to various support groups where one interacts with others who are HIV positive and they can share experiences. All the testing and treatment services are free in all public health facilities and at subsidized rates in some private health facilities.

Another very important issue in the fight against HIV is the prevention of Mother to Child transmission (PMTCT) in and after pregnancy. All pregnant women should have their status confirmed in order to ensure that the child is not at risk or that risk is reduced. The measures of PMTCT have greatly reduced the numbers of children born to HIV mothers who turn out infected. Recently the government launched a new strategy towards elimination of mother to child transmission (EMTCT) by 2015. This strategy not only focuses on preventing transmission of HIV to the child but also keeping the mother alive.

It is important to know your HIV status. If negative, reduce risky behavior and try to prevent getting infected. If positive, reduce risky behavior and prevent transmission of the infection to others. Through this individual measures we are able to achieve an important goal in the spread of this disease and reduction in the new cases of HIV infection.

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Acute Otitis Media

You may find it interesting to know that the ear is made up of 3 parts:

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  • The outer ear includes the ear lobe (pinna) and ear canal which helps collect and direct sound into the inner part of the ear.
  • The middle ear is separated from the outer ear by an ear drum .The middle ear is an air filled space with three small bones that help convert sound waves into mechanical vibration that the inner ear can interpret. The air pressure in the middle is maintained by a tube called the Eustachian tube that opens in the throat. The Eustachian tube is what creates a lot of problems especially in children when it gets blocked.
  • The inner ear is what helps the brain to interpret sound outside. The inner ear also helps us with maintaining balance.

The middle ear is what regularly gets infected and the infection is called Acute Otitis Media. It is a very common infection amongst children and most common reason take parents to the Doctor.

CAUSES

Acute Otitis Media is caused both by viruses and bacteria. Usually the root cause of the infection arises from a blocked Eustachian tube. One this tube blocks there is a buildup of fluid in the middle ear which gets infected also making the ear drum get infected. The result is ear pain.

The tube can get blocked due to allergies, colds and flus that affect the throat, irritants like cigarette smoke and overgrown adenoids. If your child has overgrown adenoids then they are likely to get middle ear infections though the mechanism is not fully understood.

SYMPTOMS

Infants who are unable to communicate will often be irritable, cry a lot ,have a fever, keep touching their ear or even vomit.

There may be some yellowish fluid that will come from the ear. This suggests the ear drum has ruptured.

TREATMENT

  • If your child is less than 6 months old and has a fever you need to take them to the hospital.
  • If your child is older and the symptoms are mild, try using pain killers like paracetamol and ibuprofen.
  • If the symptoms do no improve within 24 hours then you can take them to the hospital. If your child looks unwell, do not take chances, take them to hospital.

PREVENTION

Acute Otitis Media per se is not contagious. However colds and flus that may trigger it, are contagious and need to be prevented through:

  • Proper hand washing using soap and water after blowing your nose, sneezing or coughing.
  • Frequent washing of toys that are shared.
  • Breastfeed for as long as possible as breast feeding leads a child to have less infections like AOM
  • Avoid smoking around children as the smoke can irritate the Eustachian tube which can trigger AOM
  • Ensure your child is vaccinated against the pneumococcal vaccine. This vaccine is Free in Kenya and helps prevent AOM that is caused by the same bacteria that causes pneumonia.
  • Do not use antibiotics unless prescribed by a Doctor.
  • When sick with the flu it is best to stay away from places of work and school thus avoiding its spread. Avoid close contact with people who are sick.
  • Cover your nose and mouth when coughing or sneezing. Preferably use tissue or a handkerchief. Make sure the tissue is well disposed and the handkerchief washed using hot water or disinfectant.
  • Ensure your immune system is strong by eating well, sleeping adequately, manage stress and exercise regularly.

If a child gets frequent middle ear infections and they have symptoms of enlarged adenoids then they need to consult an ENT surgeon. Depending on the severity of the effects of the enlarged adenoids, the surgeon may consider removing them. The result is that the middle ear infections will reduce.

Asthma & Nutrition

Asthma is a long term disease where the air passages in the lungs get blocked as they tighten and get filled with mucus. Though there is no cure for this disease, there are ways to prevent the disease from making your life a living hell. It all starts with you and your environment and how you manage it.Image

 INFLUENCES

There are various factors that may influence asthmatic attacks for patients. They entail:

  • Sensitivity to food additives mostly sulphites,
  • History of bottle feeding,
  • Family history of eczema or asthma,
  • Diet high in processed foods, soft drinks, sweets, dairy products, saturated fats and overeating
  • Sensitivity to tobacco smoke and alcohol
  • Sensitivity to salicylates found in apples, cauliflower, some shampoos, aspirin etc.

DIETARY RECOMMENDATION

Carbohydrates:

DO: Consumption of nutrient rich whole grains should be increased, in addition, vegetables and fruits consumption should be increased particularly those rich in vitamin C and other antioxidants. To reduce inflammation, the intake of oily fish which have high supply of omega 3 fatty acids should be increased.

DON’T: Processed carbohydrates, sweets and confectionery as they are likely to contain food additives and preservatives so they should be avoided.

Protein:

DO: Increase intake of protein from skinless chicken and turkey, fish and from vegetables. Increased intake of live yoghurt which is a source of probiotics helps in balancing gut flora.

DON’T: Proteins attached to saturated fats found in dairy products and red meat should be avoided.

Fibre:

DO: Take plenty of dietary fibre from lentils, pulses, beans, fruits and vegetables.

Fats:

DON’T: Saturated fats and hydrogenated fats should also be avoided as they influence inflammation. They include dairy products, red meat and margarines.

 

Fluids:

DO: 1.5litres-2 litres of water should be taken daily. The drinks should be taken away from meals and sipped slowly so as not to stress the kidneys. Variety of drinks can be taken including diluted fruit juices, herbal teas as well as organic vegetable juices.

DON’T: All soft drinks should be avoided as they may contain additives. Also alcohol consumption should be reduced and if wine is a trigger, it should be avoided altogether.

 

Nutrient Rich Foods for Asthmatics

Vitamin A: Liver, butter, eggs, cheese, sweet potato, dried apricots, carrots, buckwheat, and dark green vegetables.

Vitamin C: Citrus fruits, sprouted seeds, kiwi fruit, tomatoes, black currants, and peppers.

Vitamin B6: Tuna, avocados, carrots, bananas, lentils brown rice, shrimp, and salmon.

Vitamin E: Wheat germ oil, fish, nuts and seeds, eggs, green vegetables and avocados,

Magnesium: green leafy vegetables, fish, nuts and seeds, lentils, dried fruits.

Selenium: whole grain, organic meat, onions, fish, muscle meat, fruit, garlic and nuts

Zinc: Oysters, liver, eggs, brewer’s yeast, whole grains, mushrooms, pumpkin seeds.

Quercetin: Red and yellow onions, apples

Lycopene: Richest food source: tomatoes

Anti-oxidant complex: Red, orange and yellow fruit and vegetables, red berries, blueberries, blackberries, reds grapes, dark green leafy vegetables, avocados

Essential fatty acids: mackerel, tuna, salmon, trout

Lactobacillus acidophilus: live yoghurt

LIFESTYLE RECOMMENDATIONS

  1. Stress should be avoided at all cost. Time management is critical as it allows time to relax. Yoga classes, breathing techniques and counselling can help reduce stress.
  2. Exercises are very important for managing asthma. Controlled aerobics especially swimming has been proved to be beneficial for asthma patients. Breathing exercises such as balloon blowing, learning to play a wind instrument or sing is beneficial for asthmatics.
  3. Environmental toxins should also be avoided as they act as a trigger for immune responses associated in asthma. Airborne particulates can also act as allergens, including dander feathers and dust mites. Hypoallergenic bedding, vacuum cleaners, dust filters could be useful in reducing these possible allergens.
  4. To minimize the risk of an attack, foods should be small and frequent, decreasing any bronchi-constriction.

Asthma

Asthma is a disease of the airways where the lining of the airways swell due to the muscles around the airway becoming tight and mucus increases in the airway. This disease affects nearly 300 million people in the world. In Kenya it is estimated that about 6 million Kenyans may have asthma in varying degrees of severity.

 CAUSES

The main cause of asthma in not fully understood. However asthma is known to run in families. The environment around us plays even a bigger role in asthma development with people leaving in urban areas being more prone to asthma.

 OCCURRENCE

People who are prone to getting asthma are more sensitive to triggers in the environment than normal people. These triggers include:

  • Infections: This is the number one trigger of asthma in children. These infections are usually the upper respiratory tract infections like the common cold and the flu.
  • Allergies: Allergies are caused by chemicals in the environment called allergens. An allergy is an overreaction of the body’s immune system that leads to chemicals released in the body that cause allergy symptoms. These chemicals can also trigger an asthma attack. Common allergy causing chemicals (allergens) include dust mites, pollen from flowers, animal dander (saliva or hair), cockroach droppings, dust and food additives like food colouring or preservatives.
  • Irritants: These chemicals do not cause allergy but irritate the airway triggering an asthma attack. These irritants include cigarette smoke, smoke from firewood, diesel fumes, perfumes and paint fumes.
  • Sudden weather changes can also trigger asthma as the sudden weather change can release triggers like dust or pollen or even cold air.
  • Exercise can induce asthma. As one exercises, the amount of air going in and out of the lungs dries and cools the airways. This drying effect seems to trigger asthma in those prone to getting it.
  • Medications such as Aspirin and some types of pain killers could cause asthma.
  • Emotional extremes of joy or sadness can trigger asthma.

SYMPTOMS

You will know you have asthma if you:

  • Have a family history of allergies/asthma and tend to get breathless,
  • Have a wheezing sound when breathing and/or coughing a lot especially at night

These symptoms are as a result of the buildup of mucus and the tightening of the airways. It is important to get screened.

TREATMENT

Here are instructions of how to properly use the inhaled medications in both adults and children:Image

source :Global Initiative for Asthma

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Source:premier care paeds

 Asthma has no cure but it can be easily managed. The key to proper control of asthma is the prevention of asthma, identifying when an asthma attack is coming and the use of medication as prescribed by the Doctor.

The medications given have two functions. They relax the tightened airway muscles and reduce the mucus. The result is the reduction of the symptoms. The medications are usually inhaled to have a faster effect and avoid side effects with less of the medication reaching the blood. The inhaled medications can be taken for immediate relief and for long term prevention of attacks.

NB: When using a steroid inhaler remember to rinse out the mouth with water.

WHEN TO SEE A DOCTOR

An asthma attack can get progressively worse and the person is unable to get enough air into the lung. This is a dangerous situation. Watch out for these danger signs in a person having an asthmatic attack:

  • Not improving on the inhaled medication
  • Gasping for air
  • Difficulty talking
  • Continuous coughing
  • Reducing level consciousness or very restless

When you notice these attacks on a person, rush them to hospital immediately.