Patient with special needs as noted on 7th November 2014 home visit.

On Friday 7^th November 2014 we conducted 7 home visits and of the seven home visits, two of the patients visited attracted more of our attention.

Phenias

Seven year old child enrolled in our facility as from 25^th February 2014. At time of enrolment the child had features of TB. Was evaluated and after relevant tests were done, the child was put on anti-TBs and HAART initiated the same month but at different dates.

Improvement was noted initially but later the weight remained constant. Then we noted that his mother had stopped to attend the clinic with the child for two months but could only report to collect drugs alone. This prompted our need to pay a home visit on 7/11/2014 and here are our findings.

• The child was left alone in the house and was not able to walk by himself (directed into the house by the uncle)
• The mother went to look for food through working as a day labourer in a neighbouring home.
• The mother is a single parent with two children.
• After evaluating the child we realised that he had severe acute malnutrition with complications of oedema + + +, with such features of muscle wasting, skin changes, stiff joints, cough and hair changes visible.
• The last cd4 count was 622 as on 17/09/2014 with initial cd4 as 214 as at 15^th march 2014. FHG/RFT/LFT all within normal range as at 19^th June 2014 still waiting for viral load results.
• The hygiene practices in this home still under question as we learnt there were no latrine in their home but they rather share the latrine with the uncle.

Measures taken.

• Advised for urgent hospital admission for the management of severe acute malnutrition (were not ready to accompany us that day)
• We supported him with food integration package and advised them to report in hospital on Monday for possible admission and further treatment.

ii) Silveria Nchurubi

Fifty five years old patient enrolled in our facility on 25^th October 2011. Has been doing well since then with most recent cd4 being at 514 (9^th July 2014)

Other test FHG/UREA/CTEATININE /GOT/GPT within normal range; still awaiting viral load results.

What prompted our visit.

On Thursday 6^th November 2014 this patient explains of headache, chills alternating with hotness of body and joint pains. Relevant test was done (under support of Dream project) and salmonella surface antigen test for typhoid turned  positive.

This being a communicable disease and associated with poor hygienic practices, then we decided to find out the reason of such an infection even with support of BCP (basic care package).

Findings

• A single woman who has never been married.
• Lives together with grand child.
• Poor housing with a single room house used as bed room and kitchen, poor ventilation and lightning.
• Availability of pit latrine locally constructed but not roofed. We found out that the latrine was almost full and with no roof. At times there was flooding with the leakage from the pit latrine spreading to the maize farm (can this be what led to typhoid infection since this is the weeding season?).
• Since people could see what you are doing in the latrine at day time, then she told us that they doesn’t visit the toilet at day time (then where do they defecate at day time?? Could it be in the shamba??)

Measures taken

• Advised on appropriate use of BCP
• Simple hygienic measures like hand washing, boiling of drinking water and others advised.
• Advised on digging another pit latrine and ensuring roofing is done but she insisted not able due to her poor economic status. The current pit latrine was constructed by church members and well wishers.

Martin, RCO, in charge of CCC Cottolengo Mission Hospital

Dream Project Member