Kenya: Hygiene
Kenya: Integrated approach
Kenya: Nutrition
Kenya: ORS
Kenya: Water and sanitation
Community capacity building on hygiene and prevention of waterborne diseases
To realize adequate community awareness and sensitization in Kenya, the Rural Integrated Community Organization (RICO), the Ministry of Health, and specialized partners developed Information, Education and Communication (IEC) strategies. The IEC materials contained messages against negative cultural beliefs about the transmission of waterborne diseases and unhygienic practices.
The materials targeted community members and were behavior-change oriented, not just limited to awareness-raising. The residents of the Bukalama and Muyala villages learned the importance of good hygiene practices, proper latrine use, the dangers of acute diarrhea, and the importance of oral rehydration salts and how ORS can be accessed.
Contributed by RICO
Identifying gaps and providing education
In 2009, PATH launched a pilot program in Kenya’s Western Province aimed at building awareness of new diarrheal disease control interventions. Workshops with parents and providers helped PATH, health officials, and local physicians evaluate current practices and knowledge gaps. The needs identified through these workshops informed follow-up training for providers and community members on diarrheal disease control interventions.
As Elijah Mbiti from the Ministry of Public Health and Sanitation said upon closing the inaugural gathering, "The work on diarrhea does not end here. The work goes on."
On March 31, 2010, the Government of Kenya stepped out as a regional leader in the renewed fight against diarrhea—unveiling an updated national diarrheal disease control policy. The policy, which highlights traditional and new interventions like ORS, breastfeeding, zinc, hygiene, and forthcoming interventions including rotavirus vaccines, shows Kenya’s commitment to addressing diarrheal disease through a comprehensive approach.
Contributed by PATH
Vitamin A supplementation in Kenya
Palkamau calls out to his neighbours in the Kayaba area of Nairobi, Kenya’s Mukuru slum. With a megaphone in hand, he roams through the streets and alleys. He’s lived in the area since 1978 and, in 1986, joined the Kayaba Community Health Workers project as a volunteer. He is now the project’s Chairperson.
It’s been a busy week for Palkamau and his fellow volunteers. For five days they’ve been active in their community, encouraging caregivers to bring their children to the temporary health post for the week-long campaign for measles vaccination and vitamin A supplementation campaign.
Thanks to its powerful ability to boost the immune system, vitamin A is a critical micronutrient for the survival and physical health of children exposed to disease. Supplementation in populations who are at risk of vitamin A deficiency can reduce childhood mortality by an average of 23 percent. Vitamin A can help the body fight deadly infections such as measles and has been proven to not only reduce the duration of diarrhea episodes but also to reduce diarrhea severity and complications. Vitamin A supplementation is critical if Kenya is to reach its Millennium Development Goals, including reducing child deaths.
Mercy has come to the health post with her son Stephen, who is just six months old. “I am looking for the vitamin A,” she says. Stephen is not yet old enough for the measles vaccination but will receive his first dose of vitamin A. Mercy is told that Stephen should get doses every six months until he is five to protect him from disease.
The vitamin A supplements are donated by the Micronutrient Initiative, an Ottawa-based organization supported by the Canadian International Development Agency (CIDA). The Micronutrient Initiative supplies more than 75 percent of the world’s need for vitamin A, working with governments and agencies such as UNICEF in a concerted effort to achieve universal coverage of vitamin A supplementation in children aged six to 59 months. Bottles of vitamin A supplements bearing the Canadian flag, are found in countless health posts and hospitals around the world.
Palkamau continues his efforts to get parents and children into the health post. “I know most of the people around here so I know who has brought their children to the post and who has not,” he explains. “Many of the parents here are working so we must keep at it throughout the week so their children can be protected.” Palkamau is just one of the millions of everyday heroes around the world working to help the children in their communities survive and thrive, with a little long-distance help from Canada.
Contributed by the Micronutrient Initiative
Revitalizing ORT corners and reprioritizing diarrheal disease in Kenya
In 2009, PATH reinvigorated efforts to bring back oral rehydration therapy, or ORT, corners to defeat diarrheal disease. An ORT “corner” is a small area set aside from a crowded waiting room in a clinic or hospital, where mothers can immediately access oral rehydration solution (ORS) and clean water to begin to rehydrate children suffering from severe diarrhea. In this small room furnished simply with benches, plastic containers, spoons, and cups, mothers replenish their children’s lost fluids sip by sip; health workers educate them about hygiene and sanitation, prevention, and treatment of diarrhea at home; and they learn about proper nutrition, including zinc treatment, for infants and young children.
In the 1980s, ORT corners in health facilities were instrumental in global health efforts to reduce the number of child deaths in Kenya and other parts of Africa and Asia. In the two decades that followed, however, international aid shifted to other threats like HIV/AIDS and malaria. Many believed the diarrheal disease burden was under control. Unfortunately, with this shift in focus diarrhea death rates that were on the decline began to stagnate, and diarrhea remains a leading killer of children, particularly in sub-Saharan Africa and Asia. In fact, in Africa diarrhea is the number one cause of child death.
PATH partnered with Kenya’s Ministry of Public Health and Sanitation and the Department of Child and Adolescent Health to bring the ORT corners back to health facilities and raise community awareness about diarrheal disease and simple prevention and treatment solutions. Access to ORT corners in local clinics reduces the need to refer mothers and their children to higher level facilities that are often miles and hours away. It also prevents the senseless deaths of children who die simply because they are not able to see a doctor in time. The partners have seen a real impact in a very short amount of time. Since the Kenya project’s inception:
- Over 44,000 mothers received information about diarrhea management from community health workers, women’s health programs, health providers, village health meetings, and ORT corners.
- 430 nurses and clinical officers, 480 community health workers, and 55 pediatricians received training in clinical management of diarrhea.
- 20,000 ORS packets and 2,500 blister packs of zinc were distributed.
- Nearly 40 ORT corners were established, with an additional 20 planned by April 1, 2011.
- The Government of Kenya launched a new diarrheal disease control policy that highlights traditional and new interventions like ORS, breastfeeding, zinc, hygiene, and forthcoming interventions including rotavirus vaccines.
Contributed by PATH
Provision of safe drinking water
After conducting a needs assessment, the Rural Integrated Community Organization (RICO) identified two villages in Kenya (Muyala and Bukalama) that were in dire need of safe drinking water. Each community selected a site for a new borehole that would provide access to clean drinking water. Communities provided resources such as bricks, sand, and labor for construction. RICO hired contractors to drill boreholes and tested water quality. Water Committees were formed and trained to maintain, repair, and clean the boreholes.
These initiatives led to a reduction of diarrheal diseases by approximately 50 percent in the two villages, leading to improved health.
Contributed by RICO
Improved health, door-to-door
Safe Water and AIDS Project (SWAP) is an NGO operating in Western Kenya with the aim to reduce diarrheal diseases and to improve general health and income of HIV support groups and other community self-help groups. SWAP visits the groups and introduces them to a variety of safe water treatment and health products.
The groups are engaged as vendors of these products and sell door to door, during home-based care and community meetings, and at community kiosks and pharmacies. SWAP offers training on safe water and business skills and links the groups to microfinance services. The field officers routinely visited the groups to offer business counseling, restock them with new supplies, and provide microfinance services.
As of 2009, more than 700 groups are vending and 4,000 vendors registered with microfinance services, with over 2,500 loans disbursed. The growth of the project allowed SWAP to decentralize its activities and open two provincial offices and nine satellite offices throughout the districts in Western Kenya. SWAP activities have demonstrated a tremendous impact on individuals, self help groups, and the entire community:
- Reduced stigma and discrimination because HIV support group members become useful members of society.
- Improved income of group members.
- Increased access to microfinance services.
- Improved health of HIV self-help group members and their families.
- Increased access to water treatment and other health products in the communities.
- Improved health of the community at large due to affordable access to treated water. (A study is - currently in progress to measure the health impact.)
- No stigma attached to water programs, so easy access to homes and entry point for HIV programs.
Contributed by Safe Water and AIDS Project (SWAP)
been distributing oral rehydration solution through commercial outlets in Burundi under the brand Orasel since 2004 as part of a USAID-funded project to reduce childhood morbidity and mortality.
construct latrines in their communities. A friendly competition between villages led to rapid construction across a region where sufficient sanitation is nearly non-existent. As a result, the Salapoumbé Private Catholic Hospital in southeastern Cameroon reported that cases of childhood diarrhea admitted to the hospital dropped significantly in the course of a few months after the latrines were introduced. Building on this success, funds were extended to the hospital to create an additional water source, thereby providing clean water to its patients, as well as general residents.
In collaboration with Management Sciences for Health, A2Z, and USAID, and building on earlier work by Johns Hopkins University School of Public Health in Tanzania, USAID/BASICS developed a tool to assess country readiness for zinc introduction. The tool was first used in Madagascar, and adapted for Indonesia, DR Congo, and Senegal. It has also been shared with Uganda, Rwanda, Afghanistan, and Malawi. The tool covers case assessment, classification, and treatment; extension of diarrhea case management to community health workers; communication approaches and tools; logistics issues, including registration of zinc, as well as supply of both zinc and low osmolarity ORS; and data for monitoring and evaluation.
The GAVI Alliance, the public health community, and vaccine manufacturers made an unprecedented commitment to understand how these vaccines would work in developing-world conditions. Initiated in 2005, clinical trials conducted by PATH, the US CDC, WHO, and manufacturers evaluated the safety and efficacy of Rotarix® (GlaxoSmithKline) and RotaTeq® (Merck Sharp & Dohme Corp.) Rotarix® was evaluated in South Africa and Malawi, while RotaTeq® was tested in Ghana, Kenya, and Mali—as well as Bangladesh and Vietnam. In total, more than 12,000 infants were enrolled and most were followed into their second year of life. All populations studied represented low-income, high-mortality settings in which diarrheal disease is a major cause of child deaths.
