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Success Stories

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Quality of Life of Twin Babies Improved

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     During a mentoring visit at Mbabane Government Hospital (MGH) in January 2018, newly admitted twins were reviewed with two pediatricians. They were admitted at the MGH Children’s Ward at 3-weeks of age with severe acute malnutrition, with their admission weight at the time approximately half their birth weight. They were extremely irritable and emaciated with loose skin and protruding ribs and vertebrae.  At the time, they were exclusively breastfeeding. However, their mother, also emaciated, was barely able to produce any breastmilk. The twins were the only surviving children of their mother following her eighth pregnancy. All her other children had died prior to 24 months of age due to complications associated with malnutrition. Their mother was HIV positive and had defaulted from treatment for over 2 years. None of the parents were working, and the family lived in abject poverty, dependent on neighbors and relatives for food donations and sustenance.

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     It became evident during the ward round that ensuring the survival of these children was of utmost priority. As a team, a comprehensive management plan for these children and their family was developed. HIV testing was done immediately to determine their eligibility for ART. The ward dietitian was contacted, and the twins were immediately commenced on nutritional rehabilitative feeds. Their parents were counselled comprehensively on coping with grief. Both parents were also prepared for ART re-initiation and commenced on treatment. Their mother consented to using hormonal contraception.

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     Within 24 hours, the initial testing for HIV came back as negative for both twins. They were closely monitored, and within two weeks of admission, began showing signs of improvement with consistent weight gain. They became less irritable and were more interested in their surroundings. Both twins are currently temporarily placed at an orphanage to allow their parents to find jobs and sustain themselves. Their parents visit them often. Their follow-up HIV test at six weeks of age was also negative for both twins. They are both thriving at 8-weeks of age, with weights of 5.8kg and 6.2kg respectively. Owing to collaboration between teams from Baylor Clinic and MGH as a result of the EGPAF Pediatric TB/HIV support program, the odds of survival and quality of life of these children was significantly improved.

     This story describes a 12 year old male child, WHO HIV clinical stage I. He was initiated on antiretroviral medication in 2008. In January 2018, a nurse scheduled him for review during a site mentoring visit, because she was concerned that he was failing his ART treatment. Initiation of antiretroviral therapy should result in increased CD4 cells. However, despite being on ART treatment for over a decade with persistent viral suppression and normal weight-for-age, his CD4 count started declining in June 2017 and was still declining at the time of the visit. He had had full disclosure of his HIV status, attended camp and Teen Club and felt motivated to take his treatment. He knew the names of all his medications and took them at the same times daily. He denied history of pill-counting or treatment fatigue. 

 

     His grandmother was his treatment supporter and was dedicated to his care. There was no food insecurity, and his caregiver adequately catered for his basic needs. His younger sister, also on ART supervised by the same caregiver, was virally suppressed. When asked to demonstrate how he took his ART, he crushed them prior to consuming them, because he felt anxious about taking whole tablets. He had been doing so since switching to the larger ART tablet. 

 

     It was determined that the cause of the elevated viral load was likely due to reduced effectiveness of the medicine as a result of crushing his tablets (decreased bioavailability). He was counseled regarding this. During subsequent visits, he was switched to the smaller ART tablets, and trained on how to swallow tablets using candy. He is now confident regarding taking his treatment. His grandmother reports that he can now confidently swallow the large ART tablet. He is currently being closely monitored and has improved. 

Issue with Proper Consumption of Medication Resolved

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Suicide Averted through UReport Platform

     This situation involved one of the teens sending in messages on U-report, an SMS based platform where members can ask health related questions. One morning, the message that our officers saw was “I don’t have a problem with my ARVs, but I’m thinking of ending my life." Because the platform doesn’t give us the person’s number (the system hides it), in such cases we have to request the member to send us their number in order to call them. This particular member’s number couldn't be reached when we called them, but the social worker noticed that the demographic details were very similar to those of a patient we had. In resgistering for U-report, the member had used their own name instead of a nick name as required for anonymity. The social worker was able to figure out the member's identity and called her to ask her to come in. After counselling involving meeting with the doctor and social worker, she said that she indeed had been contemplating suicide. With the support received from Baylor Swaziland, she changed her mind and decided to continue her life.

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