Children with extra small head not a curse, witchcraft

Microcephaly is caused by alcohol abuse during pregnancy, malnutrition, radiation or mercury. [Courtesy]

After Dorothy Achieng gave birth to her daughter 15 years ago, she woke up and found nurses staring at her with unusual curiosity.

She had not experienced any complications during pregnancy or when giving birth to Zaida, her second-born. But Dorothy got anxious when a neurologist started examining the baby before asking: “Did you know your child developed Microcephaly?”  Confused Achieng, replied, “What is Microcephaly?”

More tests revealed that Zaida’s head was significantly smaller than expected as her brain had not fully developed.

Dr Lee Ogutha, a consultant neurosurgeon and a lecturer at Maseno University, explains that microcephaly is a rare condition in which a baby’s head is smaller than average for that age.

Dr Lee Ogutha says the size of a baby’s head is measured and compared to a Head Circumference Chat for boys and a Chat for girls.  

A baby’s head is measured every month and it’s supposed to grow at a certain rate based on the Standard Chat. But the heads of babies with Microcephaly do not follow the chat which Dr Ogutha says “should tell if the head is within the normal range, whether too large or too small.”  

The condition has no cure and in Kenya, there is no documented data on it. However, in the USA it occurs in about two to 12 per 10,000 live births.

Dr Ogutha has attended to three cases of microcephaly at Pediatric Neurosurgery Centre in Nairobi in his career as a neurosurgeon and notes that “some children who have this condition end up with birth defects and congenital effects. They might die before we get to see them in hospitals.”

Dr Ogutha explains that microcephaly is caused by congenital malformations which can be hereditary like Down syndrome- in which a baby has three copies of chromosomes instead of the usual two copies in all cells, affecting the brain.

Microcephaly can also develop via mother to child infections while the baby is in the uterus. Toxins like mercury, alcohol abuse during pregnancy, malnutrition and exposure to radiation can also cause microcephaly.

A baby’s head is measured every month and it’s supposed to grow at a certain rate based on the Standard Chat. [Courtesy]

In the case of Dorothy, medical records indicate she lacked proper vitamins and nutrients besides alcohol consumption during pregnancy and the reason Zaida suffered from the condition. 

Dr Ogutha also adds that microcephaly can also be caused by the virus that causes herpes, chickenpox, syphilis and the Zika virus - whose spread in Brazil in early 2015, also saw a peak in the number Microcephaly cases from between 3.6 million and 5.4 million in two years to 2017.

The bombing of Nagasaki and Hiroshima, Japan during World War II led to many being exposed to radiation which also saw increased number of babies born with microcephaly.

Dr Ogutha also reckons that “one can also have other kinds of destructive injuries that affect blood vessels such that fetus develop stroke even before and after they are born causing a disruption in the development of the brain.”  

Whole about 10-12 percent of these babies have normal intelligence, the majority suffer intellectual disability and learning difficulties, speech delays and seizures which are commonly accompanied with abnormal muscle function ending up with trouble walking and balancing.

For Zaida, Dorothy says “she depends on me on everything, she cannot control call of nature, she is now a teenager with normal menses but I have to take care of her.”  

Dr Ogutha explains that “what determines the level of life expectancy is the severity of the condition and the environment in which the child grows,” as those whose damage to the brain is not severe can live a long life in a supportive environment compared to those who are not.

Dr Ogutha says since there is no cure, all an expectant mother can do is have good maternal nutrition and “minimize risk by avoiding alcohol during pregnancy and situations that can cause infections to occur during pregnancy.”  

 Support for children with microcephaly include physiotherapy, speech therapy and occupation therapy-to help them adapt to activities they can do by maximizing their ability and cost depends on type and class of hospital, but those with NHIF cover and on UHC scheme can afford basic treatment in public hospitals.   

But for Zaida, her mother could not afford treatment and “for the last five years she has not received medical care save for malaria and other common illnesses,” says Dorothy.    

Another neurologist, Dr Symon Kariuki of KEMRI-Welcome Trust observes that stigma in some communities that microcephaly is caused by curses or witchcraft, sees parents hiding their children, yet the condition “is as a result of accidents that happen or due to congenital malfunctions the public and parents must understand this, it shouldn’t be feared nor parents blamed.”  

In the case of Dorothy, Zaida’s father “left us and life had to continue, he blamed me to have given birth to a curse and a disgrace to the family.”