Kenya — Catherine Nyiva's first pregnancy was difficult. She didn't know what to expect.
"I was very scared," she says. "At the clinic, we did not have time to talk to nurses one on one, to express our fears, to ask questions."
Eventually, Catherine delivered a healthy baby girl. But it took a long time to rid herself of the anxiety that attended pregnancy and childbirth.
Catherine's daughter, Stacey, is now 10 years old - an attentive, curious girl. Catherine is pregnant with her second child.
Catherine and her daughter, Stacey, at their home near Kisumu, Kenya. This time, she seeks out care at the Vihiga County Referral Hospital: one of 61 health facilities in Kenya that train health care workers on integrating HIV, tuberculosis (TB) and malaria services into care for mothers-to-be and newborns.
The training is provided through a partnership among local health authorities, the Global Fund and the Liverpool School of Tropical Medicine, with funding support from Takeda Pharmaceutical Company Limited's Global Corporate Social Responsibility Program.
In Kenya, HIV, TB and malaria impact millions of people every year. According to the World Health Organization, there were an estimated 5 million malaria cases in Kenya in 2022 - many of these among pregnant women and children under 5. TB is the fourth-leading cause of death among communicable, maternal and neonatal diseases, and Kenya is one of the top high-burden countries for HIV.
Pregnancy is one of the few, guaranteed moments when many women and families seek out health care - a critical opportunity to test for, treat and prevent disease.
"For most of the clients who come to our facility, nurses and midwives are the first health care workers they get in contact with," says Amina Baraka, a nurse and administrator at Vihiga County Referral Hospital.
In addition to administering physical and regular antenatal checkups, Amina and her colleagues test expectant mothers - and often, family members who join them at the clinic - for HIV. They provide antiretroviral medications to women who test positive to prevent mother-to-child transmission.
Nurses screen mothers for TB and malaria and offer advice and tools to prevent these diseases - which can be especially dangerous for pregnant women and babies. They take detailed histories to identify risk factors for illness and harm, including intimate partner violence.
Amina, nurse and administrator at Vihiga County Referral Hospital. She was trained on integrated care through the Liverpool School of Tropical Medicine program; today, she helps coordinate the training for the nurses and midwives she oversees. The training builds trust and confidence among patients and providers.
"This time around was very different," says Catherine. "The nurses were so open, so supportive - I could talk to them about any challenge, anything and everything."
When nurse Evalyn Omusonga started on the labor ward seven years ago, it was often understaffed. "You would find yourself alone, with 10 or 12 deliveries," she says.
As part of the integrated care training, Evalyn began working with early-career nurses - offering advice, fostering talent, and teaching them how to build relationships with and serve mothers like Catherine.
Today, Evalyn oversees 14 labor ward nurses, each trained on the same program.
Evalyn has been a nurse for decades, with nearly 10 years on Vihiga County Referral Hospital's labor ward and two years at the antenatal clinic. She believes the training makes a difference: "[We] serve the patients better." Evalyn also facilitates regular group antenatal clinics, which bring together health care providers and 10 or 12 pregnant women to discuss what to do and expect before, during and after childbirth - the importance of eating well, sleeping under mosquito nets and getting plenty of rest.
Women are also encouraged to talk to each other - to share their fears, hopes and experiences around childbirth and motherhood.
"It makes you feel very good because you know you are not alone," says Catherine. "It makes you gain the courage to continue pushing on - it makes us feel free."
In just three years, the integrated care program administered by the Liverpool School of Tropical Medicine has trained more than 1,200 health workers across Kenya, Tanzania and Nigeria - reaching more than 1.3 million pregnant women and families.
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In Vihiga County alone, Evalyn and her colleagues have increased testing rates for HIV by more than a third, and screenings for malaria and TB have increased by more than 164% and 117%, respectively, since the program's inception in 2021.
Incorporating HIV, TB and malaria services into antenatal and postnatal care is an effective and cost-efficient way to reach more people - often, those most vulnerable to infectious disease - with potentially lifesaving care.
It also builds up a health workforce and community that can support each mother's physical, emotional and psychological needs.
"We treat you as an individual, welcome you, give you a seat, address you by your name, give you the privacy that you deserve," says Amina. "The training has been so beneficial, to the health care worker and to the women and to the population at large."
This story was first published by The Star.
Photos by Brian Otieno. Many thanks to the Liverpool School of Tropical Medicine and Takeda Pharmaceutical Company Limited's Global Corporate Social Responsibility Program.
