Landscape analysis of the Kenyan policy on the treatment and prevention of diarrheal disease among under-5 children.

OBJECTIVE: Diarrhoea remains a leading cause of morbidity and death among under-5 children in Kenya, despite multipronged policy and programme initiatives to increase access to treatment. This study interrogates the comprehensiveness and adequacy of Kenya's policies, frameworks and action plans for diarrheal management and prevention. The study seeks to identify policy and practice gaps that need to be filled to strengthen diarrhoea treatment and prevention among under-5 children in Kenya. DESIGN: Our study is a landscape analysis, which seeks to identify the gaps in the current Kenya diarrheal policy, frameworks and action plans. The critical questions included their comprehensiveness, the availability of elaborate treatment, management and prevention solutions, together with updatedness, building on evidence from extant literature on key pathways to infection relating to man-animal environmental interaction, which are critical in enteric infection prevention initiatives. DATA SOURCES: We conducted an internet search of databases of Government of Kenya's Ministry of Health; relevant websites/publications of international organisations and groups (Centre for Disease Control and Prevention, UNICEF and WHO) and published and grey literature (Google searches, Google Scholar and PubMed). ELIGIBILITY CRITERIA: Included are publicly available key national diarrheal policy frameworks, plans, strategies, laws, institutional frameworks and operational guidelines that inform pertinent questions on the adequacy of policy and practice and preventive policy updates and actions. Further, peer-reviewed and grey literature on diarrheal morbidity and mortality and diarrheal prevention and management are included. The analysis excluded any information that was not referenced on the internet nor obtained from the internet. DATA EXTRACTION AND SYNTHESIS: The review team extracted the key provisions of the policy guidelines guided by a checklist and questions around the adequacy of existing national policies in addressing the determinants, prevention and treatment interventions of enteric infections and diarrhoea among under-5 children in the country. The checklist covered Kenyan background and diarrhoea situation analysis, policy objectives, policy strategies and policy implementation. RESULTS: The analysis identified a corpus of strategies for the management of diarrhoea at multiple levels: health facilities, communities and households. The policies highlighted advocacy, health communication and social mobilisation, as well as logistics management and prevention strategies. However, the triangulation of evidence from the policy provisions and extant literature identified critical policy gaps in diarrhoea prevention and management in Kenya, particularly the lack of focus on zoonotic pathways to enteric infection, environment-pathogen linkages and operationalisation of the roles of social determinants of health and related services. The policy documents had limited focus on rapid diagnosis, vaccine development and deployment, together with weak funding commitment towards implementation and unclear pathways to funding responsibilities. CONCLUSION: Policies are central to guiding programmatic actions towards effective enteric and diarrhoea prevention and management measures in Kenya. This study shows the need for policy updates to reflect pathways to enteric infections not covered in the current policy guidelines. Further, there is a need to strengthen the treatment and management of infection through rapid diagnosis, vaccine development and deployment, and strong funding commitment towards implementation together with clear funding responsibilities. Together, these will be vital in strengthening the current policy provisions and addressing other pathways to the prevention of enteric infections relating to zoonotic, environment-pathogen linkages and social determinants of health in Kenya and other low-income and middle-income countries. TRIAL REGISTRATION NUMBER: NCT05322655.

Protocol for the PATHOME study: a cohort study on urban societal development and the ecology of enteric disease transmission among infants, domestic animals and the environment.

INTRODUCTION: Global morbidity from enteric infections and diarrhoea remains high in children in low-income and middle-income countries, despite significant investment over recent decades in health systems and water and sanitation infrastructure. Other types of societal development may be required to reduce disease burden. Ecological research on the influence of household and neighbourhood societal development on pathogen transmission dynamics between humans, animals and the environment could identify more effective strategies for preventing enteric infections. METHODS AND ANALYSIS: The 'enteric pathome'-that is, the communities of viral, bacterial and parasitic pathogens transmitted from human and animal faeces through the environment is taxonomically complex in high burden settings. This integrated cohort-exposure assessment study leverages natural socioeconomic spectrums of development to study how pathome complexity is influenced by household and neighbourhood infrastructure and hygiene conditions. We are enrolling under 12-month-old children in low-income and middle-income neighbourhoods of two Kenyan cities (Nairobi and Kisumu) into a 'short-cohort' study involving repeat testing of child faeces for enteric pathogens. A mid-study exposure assessment documenting infrastructural, behavioural, spatial, climate, environmental and zoonotic factors characterises pathogen exposure pathways in household and neighbourhood settings. These data will be used to inform and validate statistical and agent-based models (ABM) that identify individual or combined intervention strategies for reducing multipathogen transmission between humans, animals and environment in urban Kenya. ETHICS AND DISSEMINATION: The protocols for human subjects' research were approved by Institutional Review Boards at the University of Iowa (ID-202004606) and AMREF Health Africa (ID-ESRC P887/2020), and a national permit was obtained from the Kenya National Commission for Science Technology and Innovation (ID# P/21/8441). The study was registered on Clinicaltrials.gov (Identifier: NCT05322655) and is in pre-results stage. Protocols for research on animals were approved by the University of Iowa Animal Care and Use Committee (ID 0042302).

Open Defecation Practices in Lodwar, Kenya: A Mixed-Methods Research.

BACKGROUND: As of the year 2014, about 2.5 billion people globally lacked access to improved sanitation. The situation is even worse in the sub-Saharan African countries including Kenya. The practice of open defecation (OD) peaks beyond 72% of the population in Turkana County, Kenya, despite various interventions to end it. METHODS: This article reports on both qualitative and quantitative aspects of a cross-sectional study. A partially mixed sequential dominant (quantitative) status was used to understand various socioeconomic factors associated with OD practice in Lodwar's human settlements, Turkana County. Simple random sampling technique was chosen to select participants for this study with the sample drawn from various administrative units of Lodwar. Standardized questionnaires, focus group discussions, and key informant interviews were used to collect data. RESULTS: The quantitative findings revealed that culture was the leading factor as to why people practiced OD with a frequency of 44%. The findings further revealed that poverty was the major influencing factor for latrine ownership among the households (frequency 27%). Pearson χ2 tests revealed that there was a significant association between latrine presence and education level of the household head (χ2 = 107.317; P < .05), latrine sharing (χ2 = 403; P < .05), and occupation of the household head (χ2 = 74.51; P < .05). The quantitative findings showed that culture was by far the most common factor that contributed to the OD practice with a theme intensity of 31.1%. Further analyses identified 5 major cultural aspects that were associated with OD practice. This included sexual immorality, OD as a common habit, nomadic pastoralism, bride's dignity and mixing of feces. Open defecation as a common habit among the respondents was the most cited factor that contributed to its rampant practice (theme intensity 31.3%) followed closely by nomadic pastoralism kind of life among the residents that limit latrine construction (theme intensity 28.1%). CONCLUSIONS: In addition to cultural aspects, high poverty levels influence latrine adoption and consequently OD practices. Future sanitation interventions addressing OD should assess and factor in these cultural aspects in such communities to come up with appropriate eradication measures which have otherwise been difficult to solve through poverty eradication and sanitation campaigns that have been in existence.