Why Children are easy prey for Aids

[Guest guest]

Why children are easy prey for Aids Story by MILDRED NGESA Publication Date: 8/22/2006

Many young patients are dying much more quickly than adults because testing kits for them are expensive and treatment is usually delayed for long owing to legal hitches

Anti-Aids campaigns: Many children are dying of Aids due to long delays in starting the Anti-Retroviral Therapy. Photo/File

Children living with Aids are suffering twice as much as adults due to lack of resources, unclear policies and socio-economic reasons.

While an adult can walk into any clinic or hospital, have an Aids test done, a CD4 count taken and be put on Anti-Retroviral Therapy (ART) in 24 hours, children go through a much longer and agonising process.

They go through a course, bogged down by lack of resources and bureaucratic bottlenecks which may take as long as six months before drugs are given.

In the process, many children are dying during the waiting period because of delays in starting the ART. The story of the late Benjelina Akoth Ogol, a nine-year-old HIV-positive child illustrates this. (see separate story).

It took a well-wisher seven years to convince Ogol's relatives to take the orphan for Aids screening.

And it took several months to convince a hospital to test the child for the virus and longer to get doctors to put the child on medication. But Ogol died before getting medicine.

She is not alone, children in the same circumstances are experiencing the same hurdles and possibly dying before medication.

Extremely difficult

" Ogol's is the plight of between 100,000 and 150,000 children diagnosed with the HIV virus in Kenya every year. We are looking at a scenario where the law requires consent for a child before any testing is done, making it extremely difficult in cases where consent is not clearly outlined, " says Dr Obimbo, a paediatrician and technical adviser for the HIV/Aids project at the Kenya Paediatric Association (KPA).

Health officials and the Government are said to have identified the problems in paediatric Aids and access to drugs and are working on it.

The Aids virus in children as opposed to that in adults records a much more rapid progression and those born with the virus hardly survive to the age of 15 unless they are on medical care.

Dr J.K. Mbuthia, a paediatrician with Acacia Medical Centre, says many children are brought to hospital when it's too late.

" The estimated 20,000 children born with the virus every year mostly die in the next three years. Many of them are far away from our reach and it is difficult for us to identify that they have been exposed to the virus before they become too sick. We have many children falling through the cracks and we lose them, " he says.

Dr Mbuthia calls for more use of the basic preventive approach to counter unnecessary casualties.

" If we continue more advocacy and education for mothers to be tested before giving birth then it will ensure adequate prevention of mother-to-child transmission and that would be a safe start. It will ensure the provision of medicare for opportunistic infections, " he says.

Maternal care

A large percentage of Aids patients are in the rural areas or slums where access to proper maternal care is scarce and unaffordable. It is therefore a challenge to counter the devastation of Aids at the paediatric level.

Poverty and the cultural stigma associated with the disease notwithstanding, the law of consent is still a major hindrance. It means that a child born with Aids may experience delayed diagnosis and treatment.

But the Aids Control Bill, which is awaiting approval, offers hope with regard to paediatric consent.

" If it is passed into law then it means that if the parents of the child are alive, they can give consent on behalf of the child. If not, then any adult taking care of the child can do the same and if that is still not possible, then any health worker can use their medical insight to take the young one for tests, " says Dr Obimbo.

The costs of paediatric Aids testing and treatment is also a major challenge. For instance, today an adult may spend an average of Sh3,000 for their ART package per month, while a child would be required to pay around Sh7,000 for tests and medication.

Even in situations where much cheaper generics are available, paediatric ART is still much more expensive for children than for adults.

Children's medication takes the syrup form, which is more expensive to manufacture and produce.

A simple CD4 count test for adults will determine the level of the virus presence and thus offer pointers to instant medical intervention.

But for children under one and a half years of age, a special DNA - PCR test is done. The PCR (polymerase chain reaction) test is specifically done to confirm the very core of HIV presence in a child, a procedure that is more tedious than in an adult because of the infants under-developed body system and under-developed disease resistance mechanism which contributes to rapid disease progression.

A PCR test for a child is charged at between Sh6,000 to Sh8,000, an amount that is beyond reach for many, says Dr Obimbo. The testing kits are also expensive and are found only in major hospitals in Kisumu, Mombasa and Nairobi.

However, the Health ministry through the National Aids/STD, TB and Leprosy Control Programme (NASCOP), has put in place various programmes for paediatric ART. Aids clinics at the district level have also been put into place in almost all districts.

Since Aids is an evolving disease, KPA acknowledges the need for the training and re-training of medical workers.

" Most health workers do not know how to handle children. KPA is working with NASCOP and other partners to boost the skills of health workers on how to bridge the gaps in paediatric ART, " says Dr Obimbo.

" There are a lot of children out there who are suffering because their parents fear the cost implications. But what most people do not know is that many district hospitals have Aids clinics where costs have been waived to serve low-income earners. The challenge is to present the cases at the hospital. This way, we will not have to lose so many of our children, " says Dr Mbuthia.

[Guest guest]

Why children are easy prey for Aids Story by MILDRED NGESA Publication Date: 8/22/2006

Many young patients are dying much more quickly than adults because testing kits for them are expensive and treatment is usually delayed for long owing to legal hitches

Anti-Aids campaigns: Many children are dying of Aids due to long delays in starting the Anti-Retroviral Therapy. Photo/File

Children living with Aids are suffering twice as much as adults due to lack of resources, unclear policies and socio-economic reasons.

While an adult can walk into any clinic or hospital, have an Aids test done, a CD4 count taken and be put on Anti-Retroviral Therapy (ART) in 24 hours, children go through a much longer and agonising process.

They go through a course, bogged down by lack of resources and bureaucratic bottlenecks which may take as long as six months before drugs are given.

In the process, many children are dying during the waiting period because of delays in starting the ART. The story of the late Benjelina Akoth Ogol, a nine-year-old HIV-positive child illustrates this. (see separate story).

It took a well-wisher seven years to convince Ogol's relatives to take the orphan for Aids screening.

And it took several months to convince a hospital to test the child for the virus and longer to get doctors to put the child on medication. But Ogol died before getting medicine.

She is not alone, children in the same circumstances are experiencing the same hurdles and possibly dying before medication.

Extremely difficult

" Ogol's is the plight of between 100,000 and 150,000 children diagnosed with the HIV virus in Kenya every year. We are looking at a scenario where the law requires consent for a child before any testing is done, making it extremely difficult in cases where consent is not clearly outlined, " says Dr Obimbo, a paediatrician and technical adviser for the HIV/Aids project at the Kenya Paediatric Association (KPA).

Health officials and the Government are said to have identified the problems in paediatric Aids and access to drugs and are working on it.

The Aids virus in children as opposed to that in adults records a much more rapid progression and those born with the virus hardly survive to the age of 15 unless they are on medical care.

Dr J.K. Mbuthia, a paediatrician with Acacia Medical Centre, says many children are brought to hospital when it's too late.

" The estimated 20,000 children born with the virus every year mostly die in the next three years. Many of them are far away from our reach and it is difficult for us to identify that they have been exposed to the virus before they become too sick. We have many children falling through the cracks and we lose them, " he says.

Dr Mbuthia calls for more use of the basic preventive approach to counter unnecessary casualties.

" If we continue more advocacy and education for mothers to be tested before giving birth then it will ensure adequate prevention of mother-to-child transmission and that would be a safe start. It will ensure the provision of medicare for opportunistic infections, " he says.

Maternal care

A large percentage of Aids patients are in the rural areas or slums where access to proper maternal care is scarce and unaffordable. It is therefore a challenge to counter the devastation of Aids at the paediatric level.

Poverty and the cultural stigma associated with the disease notwithstanding, the law of consent is still a major hindrance. It means that a child born with Aids may experience delayed diagnosis and treatment.

But the Aids Control Bill, which is awaiting approval, offers hope with regard to paediatric consent.

" If it is passed into law then it means that if the parents of the child are alive, they can give consent on behalf of the child. If not, then any adult taking care of the child can do the same and if that is still not possible, then any health worker can use their medical insight to take the young one for tests, " says Dr Obimbo.

The costs of paediatric Aids testing and treatment is also a major challenge. For instance, today an adult may spend an average of Sh3,000 for their ART package per month, while a child would be required to pay around Sh7,000 for tests and medication.

Even in situations where much cheaper generics are available, paediatric ART is still much more expensive for children than for adults.

Children's medication takes the syrup form, which is more expensive to manufacture and produce.

A simple CD4 count test for adults will determine the level of the virus presence and thus offer pointers to instant medical intervention.

But for children under one and a half years of age, a special DNA - PCR test is done. The PCR (polymerase chain reaction) test is specifically done to confirm the very core of HIV presence in a child, a procedure that is more tedious than in an adult because of the infants under-developed body system and under-developed disease resistance mechanism which contributes to rapid disease progression.

A PCR test for a child is charged at between Sh6,000 to Sh8,000, an amount that is beyond reach for many, says Dr Obimbo. The testing kits are also expensive and are found only in major hospitals in Kisumu, Mombasa and Nairobi.

However, the Health ministry through the National Aids/STD, TB and Leprosy Control Programme (NASCOP), has put in place various programmes for paediatric ART. Aids clinics at the district level have also been put into place in almost all districts.

Since Aids is an evolving disease, KPA acknowledges the need for the training and re-training of medical workers.

" Most health workers do not know how to handle children. KPA is working with NASCOP and other partners to boost the skills of health workers on how to bridge the gaps in paediatric ART, " says Dr Obimbo.

" There are a lot of children out there who are suffering because their parents fear the cost implications. But what most people do not know is that many district hospitals have Aids clinics where costs have been waived to serve low-income earners. The challenge is to present the cases at the hospital. This way, we will not have to lose so many of our children, " says Dr Mbuthia.