Poor teens haunted by urinary, vaginal infections

Christine Talia, 18, is a girl with a bubbly personality and a generous liking for people.   

Her lively presence was unmistakable as we made our way to her friend's house in the sprawling Kibera slums for an interview. She opted for this location to avoid the prying ears at her home, which she shares with eight family members.  

Talia shouted greetings to people along the way. Her face lit up with each encounter as she made loose promises to catch up with them later.  

In 2022, during her final year of secondary education, Talia's outgoing nature was dampened by an unusual experience when she began having a burning sensation during urination, pain around her abdomen and intimate itching (vaginal itching).  

Alarmed and unsure of what to do, she sought the guidance of her school friends, asking about her symptoms indirectly, for fear of being shamed on the sensitive matter, she says.  

“I was told to use lemon, which I bought for Sh50. I then dabbed it against my vagina, but the itching and discomfort only got worse and I started having a foul smell," she says as she mindlessly pets a rabbit.

Talia used this “routine” for a week before abandoning it and taking up bathing in water boiled with cloves. 

None of her valiant efforts made her any better, however.  

The information technology enthusiast received a urinary tract infection (UTI) diagnosis after an unbearable agony that lasted more than three months.

"Had I told the school nurses or our matron, they would have accused me of being a lesbian because they believed only lesbians experience such issues," she says. 

“My mother, on the other hand, would think of me as reckless, so I told a close aunt, who said I was bewitched and took me to a herbalist, who gave me some herbs to boil and bathe in.” 

Seeing that the herbs were not helping, Talia unburdened herself to Gertrude Injelwe, a community health promoter (CHP) operating in the Kibera slum, who prevailed upon her to seek treatment at a health facility, where she was prescribed medication.  

AILMENT DEMYSTIFIED 

A UTI is any infection affecting the urinary system, which consists of the urethra (pipe that removes urine from the bladder and body), bladder, ureters (pipes connecting the bladder to the kidney) and the kidney.   

Bladder infections (cystitis) are the most common, explains Dr Joan Okemo, a gynaecologist and obstetrician at Aga Khan Hospital in Nairobi.  

“Most UTIs are caused by bacteria. Even though the human body is made of good bacteria, when bacteria moves from its designated site to a new area, it causes problems," she says. 

"In the case of UTI infection, there is a cross-contamination of bacteria that should be in the vagina or anus going to the urethra.” 

Dr Okemo warned against the use of lemons and the like.

"Lemons, cloves and even herbs are dangerous because they can interfere with the pH of the vagina, which is normally acidic, and make an individual more vulnerable to infections," she said. 

According to the Centers for Disease Control (CDC), symptoms of UTI include pain or burning, while urinating, frequent urination and feeling the need to urinate despite having an empty bladder, pressure and cramping in the lower abdomen. 

Complicated UTIs that affect the kidneys and ureters may present with pain in the upper back, just below the ribcage, blood in urine, chills, fever, nausea and vomiting. 

Dr Okemo says UTIs occur more commonly in women due to the female anatomy. “The urethra is very close to the vagina and to the anus, making cross-contamination highly likely,” she says.  

Poor hygiene, such as not wiping well (front to back) or failing to change sanitary pads often, and the act of sex have the potential to introduce an infection-causing bacteria to the urethra.

“Lacking access to enough water for washing or drinking, limited availability of sanitary pads and tissue for cleaning makes girls living in the slums vulnerable to infections,” the expert says.

About 75 per cent of informal settlement dwellers in Nairobi lack access to clean and safe water, which is evident for Talia.  

“This leaves them with no option but to buy water from kiosks at prices much higher than those paid by middle-and high-income households,” says a report by Kenya Institute for Public Policy Research and Analysis. 

Unreliable access to toilets, like in Talia's case, means residents retain urine for too long. Urine retention is one of the known risk factors for UTIs.  

Additionally, poor nutrition, which is a reality for slum residents, leaves the body defenceless against ailments, adds Dr Okemo. 

Talia, whose mother does odd jobs for a living, says buying pads is non-prioritised spending in the family, leaving her to rely on free pads distributed by NGOs.

REPRODUCTIVE INFECTIONS

Urinary tract infections and vaginal infections are the most common consultations found in gynecological clinics, according to multiple gynecologists we spoke to.

According to the Kenya Bureau of Statistics 2024 report, urinary tract infections are the fifth-most commonly reported disease in medical facilities nationwide.  

Between 2022 and 2023, the number of reported UTI infections was 2.5 million and 2.8 million respectively, pointing to a worrying health condition. National data on vaginal infections is unavailable. 

“Vaginal infection is primarily in the vagina and it is not sexually transmitted,” Dr Okemo says.

“The good bacteria in the vagina keeps yeast from flourishing, but once in a while, when there is a disturbance in that balance, the yeast grows, causing an infection.”

Some of the classic symptoms of vaginal infections are vaginal discharge with a bad smell, pain and itching. Vaginal infection (vaginitis ) and UTI could sometimes occur at the same time. 

Wilfred Omari, a clinician at Aids Healthcare Foundation (AFH) in Mathare slums, says elevated UTI and vaginitis cases are concerning. “We treat an average of 50 per month, mainly from the young people ages 14-24 years, but the data could be higher."

What concerns Omari most is that the teenagers have limited information on these conditions and consequently shy away from the health facility, only going there when their symptoms have become more pronounced. 

"There is fear among them that they have a sexually transmitted infection (STI) because some of the symptoms are similar to those of certain STIs, so they stay away from the hospital," he says. 

Take Mary* (not her real name), 17, for instance, a resident of Mashimoni in Kibera, whose better part of high school life has been preoccupied with symptoms of UTI and vaginitis, until recently she thought her condition incurable.

“It has been years of anguish, taking different medications that have not solved the problem. I am still trying to get better,” she says. 

Mary wrestled with the thought of speaking up but her resolve was swallowed by the terror of being an object of shame and ridicule in her family.

Like Talia, she used non-medical ways to cure her symptoms, a common solution for adolescent girls in the slums, Gertrude says.

She adds that lack of information on sexual reproductive health has left many teenagers to be doctors to their peers.

MYTHS, DRUG RESISTANCE 

“There is a widespread misunderstanding that going to the toilets or water splashing causes these infections,” Dr Okemo says.

"But bacteria that causes UTIs will not be introduced by splashing or sharing toilets. It is not one of the strong risk factors for these infections."

Gynaecologist Dr Dan Okoro agrees. “There is no medical evidence to support that you can get UTI through sharing toilets,” says Okoro, who is a sexual and reproductive health adviser with UNFPA Kenya.   

Interestingly, some health workers we spoke to are of the contrary opinion and thus advise against frequent use of shared flush toilets.

Most peer-reviewed papers are unable to make a strong connection. However, in one of the studies investigating symptomatic urinary tract infection among nursing students, it emerged that inadequate water intake and unsatisfactory toilet habits were among the strong predictors of UTI.  

Effective treatment includes a prescription of antibiotics or antifungals, depending on the nature of the condition.

A recurrent UTI or vaginal infection (occurring four times a year) requires a battery of tests to rule out any underlying conditions. 

“Treatment is affordable for uncomplicated UTIs, while a bit expensive for the complicated ones, where the infection affects the kidneys,” Dr Okemo says. 

With poor health-seeking habits in slums, many girls could be at risk of developing drug resistance, given the frequency of the occurrence of UTIs and vaginal infections.

Dr Loice Ombajo, an infectious disease expert, says: “Exposure to the wrong antibiotic for a particular infection and wrongful use of antibiotic (not finishing an entire dose) are driving forces for drug resistance. Satisfactory tests should always be done before dispensing medicine."

Estimates from WHO in 2019 suggest that drug-resistant infections were associated with 4.95 million deaths globally and the direct cause of 1.27 million of those deaths, with sub-Saharan Africa carrying the heaviest burden. 

Polycom Girls, a community-based organisation in Kibera that provides sexual reproductive health services to teenagers, is stepping in to intervene. 

“We have established an anonymous mode of communication in schools to encourage girls to talk about taboo topics,” says Caroline Odhiambo, an official from Polycom.

“We also give out sanitary pads to those in need.”

Martin Mbaya, a clinician who handles these cases from AHF, says teenagers ought to be empowered with adequate information on their reproductive health.  

Comprehensive Sexual Education (CSE) has been a bone of contention in Kenya with two factions emerging: those who support it and those who dismiss it on the grounds that it will expose and encourage immorality.  

"An education tailored to address reproductive health will empower young people to better manage health conditions by knowing where to seek medical care," says Margaret Nyambura, a health lawyer.

"The benefits of this education will be realised throughout their lives."

This reporting was supported by the International Women Media Foundation's Howard G Buffett Fund for Women Journalists