Introduction: Kenya adopted the World Health Organization’s recommendation of community case management of malaria (CCMM) in 2012. Trained community health volunteers (CHVs) provide CCMM but information on quality of services is limited. This study aimed to establish determinants of quality of service of CCMM conducted by CHVs. Methodology: A cross-sectional survey was conducted in November 2016 in Bungoma County, Kenya. Data were collected through observing CHVs perform routine CCMM and through interviews of CHVs using structured questionnaires. A ≥ 75% score was considered as quality provision. Descriptive statistics were performed to describe basic characteristics of the study, followed by Chi-Square test and binary logistic regression to examine the differences and associations between the categorical variables. Results: A total of 147 CHVs participated; 62% of CHVs offered quality services. There was a direct association between quality of services and stock-outs of artemether-lumefantrine (AL), stock-outs of malaria rapid diagnostic tests (RDT) and support supervision. CHVs who were supervised during the year preceding the assessment were four times more likely to perform better than those not supervised (uOR 4.2, 95% CI: 1.38-12.85). CHVs with reliable supplies of AL and RDT kits performed three times better than those who experienced stock outs (uOR = 3.2, 95% CI: 1.03-10.03 and 3.3, 95% CI: 1.63-6.59 respectively). Biosafety and documentation were the most poorly performed. Conclusions: The majority of CHVs offered quality CCMM services despite safety gaps. Safety, continuous supplies of RDT, AL and supervision are essential for quality performance by CHV in delivering CCMM.
Childhood mortality is still a public health issue in Sub-Saharan Africa, with Kenya being among the countries that experience the highest rate of children dying before reaching the age of five. Under-5 child mortality (U5CM) is heavily influenced by demographic, environmental, and socio-economic factors. The study aimed to examine the risk factors of under-5 child mortality in Kenya. The data were based on birth histories from the Kenya Demographic and Health Surveys (KDHS) conducted in 2014. The relative contribution of factors such as the mother's education, mother's occupation, household wealth, place of residence, region, and sex of the child to the variability in the under-five child mortality was assessed using Kaplan-Meier and Cox hazard methods. The outcome variable for the study was the child's survival before the age of 5 and age at death. All children born in the period between 2009 and 2014 (n=83,591) were included in the study. Within the observation period, a total of 6,123 child deaths were recorded. The under-5 mortality rate in Kenya was strongly associated with the mother's education, region, place of residence, preceding birth interval, birth order, the total number of children ever born, mother's occupation, and type of toilet facility. The results indicated that a child born in Nyanza is twice more likely to die than that born in the Central region of Kenya. Male children had a higher risk of dying before the age of five than their female counterparts. The risk of experiencing U5CM increased among children born in rural areas compared to those born in urban areas. The study findings provide evidence in support of prioritizing interventions aiming at improving maternal and child healthcare. The findings also suggest that programs aimed at empowering women and boosting health knowledge among mothers should be scaled up. Furthermore, implementing socio-economic development interventions that reduce regional disparities is a recommendation that the central government should consider. Finally, national and local governments should commit resources to guarantee that modern contraceptives are available and used to increase child spacing.
Despite substantial progress in sanitation and hygiene in Kenya, its semi-arid regions still experience poor environmental conditions. Kitui County, a semi-arid region, is characterized by water supply shortages, poor sanitation and poor hygiene coverage. This study covers water, sanitation and hygiene coverage and practices in two subcounties of Kitui County. A cross-sectional survey using mixed methods of data collection was adopted. Seven hundred and fifty-seven households were included and household heads were interviewed. Quantitative data were analyzed using descriptive statistics. Five focused group discussions and key informant interviews were conducted and data analyzed thematically. These revealed that a majority of people obtain their water from rivers (39.9%), with 57.4% walking more than 2 km to water sources. Only 11.9% of all water sources were available throughout the year. A total of 47.4% of people use 13.3 liters/capita/day with an average cost of Ksh. 35 per 20 liter jerry can, which was reported as costly. A total of 43.6% of people felt that the water they collected was not enough to meet their requirements. Filtering was the most common form of water purification, with a majority of people perceiving clear water as safe for drinking. Latrine coverage stood at 56.4% and open defecation at 8.5%. Access to safe and adequate water supply, hygiene and sanitation services to the community continues to be poor and hence WASH interventions need to be scaled up for meeting recommended national standards.
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