Risk reduction of diarrhea and respiratory infections following a community health education program - a facility-based case-control study in rural parts of Kenya

Karinja, Miriam N.; Schlienger, Raymond G.; Pillai, Goonaseelan; Esterhuizen, Tonya; Onyango, Evance; Gitau, Anthony; Ogutu, Bernhards

doi:10.1186/s12889-020-08728-z

Cited by 11 publications

(9 citation statements)

References 31 publications

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“…Antibacterial and malaria‐related treatments and general screening tests also generate high total costs, but benefit many and are effective in reducing the death rates of malaria and diarrheal diseases that are still responsible for 6% and 8% of child deaths, respectively, in Tanzania (WHO, 2016). However, raising awareness and prevention behavior (e.g., hygiene practice, usage and maintenance of long‐lasting insecticidal nets) and providing better infrastructure (e.g., water and sanitation) could also prevent people from suffering from these diseases and, thus, could also substantially reduce the costs for health insurance schemes (Deressa et al., 2014; Karinja et al., 2020; Yaya et al., 2018).…”

Section: Resultsmentioning

confidence: 99%

Toward mandatory health insurance in low‐income countries? An analysis of claims data in Tanzania

et al. 2022

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Many low‐income countries are in the process of scaling up health insurance with the goal of achieving universal coverage. However, little is known about the usage and financial sustainability of mandatory health insurance. This study analyzes 26 million claims submitted to the Tanzanian National Health Insurance Fund (NHIF), which covers two million public servants for whom public insurance is mandatory, to understand insurance usage patterns, cost drivers, and financial sustainability. We find that in 2016, half of policyholders used a health service within a single year, with an average annual cost of 33 US$ per policyholder. About 10% of the population was responsible for 80% of the health costs, and women, middle‐age and middle‐income groups had the highest costs. Out of 7390 health centers, only five health centers are responsible for 30% of total costs. Estimating the expected health expenditures for the entire population based on the NHIF cost structure, we find that for a sustainable national scale‐up, policy makers will have to decide between reducing the health benefit package or increasing revenues. We also show that the cost structure of a mandatory insurance scheme in a low‐income country differs substantially from high‐income settings. Replication studies for other countries are warranted.

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Section: Resultsmentioning

confidence: 99%

Toward mandatory health insurance in low‐income countries? An analysis of claims data in Tanzania

et al. 2022

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“…Champions are identified as ‘innovators’ (ie, individuals who are the first to develop and try out new ideas) and ‘early adopters’ (ie, opinion leaders who enjoy leadership roles and embrace change opportunities) who over time through their influence and their existing relationships and communication with members of the community66 67 can encourage adoption of new ideas, both passively and actively. Innovators and early adopters in a community include teachers,68 69 leaders,10 21 37 38 66 68–71 healthcare workers52 68 69 72 73 and community committees 20 58 74 75. This mechanism is triggered primarily by contexts of strong social relations, and our analysis resulted in availability, change and longevity outcomes.…”

Section: Diffusionmentioning

confidence: 99%

“…Diffusion can occur through communication among peers, which leads to shared understanding, therefore reinforcing the adoption of new behaviour at an individual or community level 38 58 68 79. Examples of diffusion influencing behaviour change include reduction of open defecation,10 37 39 57 60 65 66 69 80 water purification,79 disposal of rubbish and care of animals57 and sanitation and hygiene behaviours such as handwashing and safe disposal of faecal material,41 65 71 75 which may lead to improved health outcomes such as a reduction in diarrhoea rates, waterborne diseases and respiratory infections 37 41 52 72 75. Behaviour change is enabled by diffusion in communities with high levels of social cohesion and connectedness by enabling communication among peers, to build and share knowledge, that is, through community and marketing events or radio shows,37 39 58 65 72 76 and as highly regarded leaders influence the spread of new behaviour and create new social norms through their endorsement 11 19 65 66 69.…”

Section: Diffusionmentioning

confidence: 99%

“…Examples of diffusion influencing behaviour change include reduction of open defecation,10 37 39 57 60 65 66 69 80 water purification,79 disposal of rubbish and care of animals57 and sanitation and hygiene behaviours such as handwashing and safe disposal of faecal material,41 65 71 75 which may lead to improved health outcomes such as a reduction in diarrhoea rates, waterborne diseases and respiratory infections 37 41 52 72 75. Behaviour change is enabled by diffusion in communities with high levels of social cohesion and connectedness by enabling communication among peers, to build and share knowledge, that is, through community and marketing events or radio shows,37 39 58 65 72 76 and as highly regarded leaders influence the spread of new behaviour and create new social norms through their endorsement 11 19 65 66 69. Higher levels of social cohesion in small rural and remote communities can also help sustain long-term behaviour change (eg, reduction in open defecation), especially where people stick together to create a supportive environment for long-lasting change.…”

Section: Diffusionmentioning

confidence: 99%

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How community participation in water and sanitation interventions impacts human health, WASH infrastructure and service longevity in low-income and middle-income countries: a realist review

et al. 2021

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ObjectiveTo understand how, and under what circumstances community participation in water and sanitation interventions impacts the availability of safe water and sanitation, a change in health status or behaviour and the longevity of water, sanitation and hygiene (WASH) resources and services.DesignRealist review.Data sourcesPubMed, Web of Science and Scopus databases were used to identify papers from low-income and middle-income countries from 2010 to 2020.Eligibility criteria for selecting studiesCriteria were developed for papers to be included. The contribution of each paper was assessed based on its relevance and rigour (eg, can it contribute to context, mechanism or outcome, and is the method used to generate that information credible).AnalysisInductive and deductive coding was used to generate context–mechanism–outcome configurations.Results73 studies conducted in 29 countries were included. We identified five mechanisms that explained the availability, change and longevity outcomes: (1) accountability (policies and procedures to hold communities responsible for their actions and outcomes of an intervention), (2) diffusion (spread of an idea or behaviour by innovators over time through communication among members of a community), (3) market (the interplay between demand and supply of a WASH service or resource), (4) ownership (a sense of possession and control of the WASH service or resource) and (5) shame (a feeling of disgust in one’s behaviour or actions). Contextual elements identified included community leadership and communication, technical skills and knowledge, resource access and dependency, committee activity such as the rules and management plans, location and the level of community participation.ConclusionsThe findings highlight five key mechanisms impacted by 19 contextual factors that explain the outcomes of community water and sanitation interventions. Policymakers, programme implementers and institutions should consider community dynamics, location, resources, committee activity and practices and nature of community participation, before introducing community water and sanitation interventions.

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“…Early outbreak and sporadic case reports indicate that E. albertii is transmitted through contaminated water and food such as salads, chicken, and packed lunches [ 9 , 11 , 12 , 14 , 28 ]. Due to poor hygiene and sanitary conditions that prevail in several countries, such infectious gastroenteritis will remain an important cause of morbidity and mortality [ 29 , 30 ]. Therefore, we need to expand our knowledge on infectious gastroenteritis causative agents to better control and prevent such infections.…”

Section: Introductionmentioning

confidence: 99%

Microbiology and Epidemiology of Escherichia albertii—An Emerging Elusive Foodborne Pathogen

et al. 2022

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Escherichia albertii, a close relative of E. coli, is an emerging zoonotic foodborne pathogen associated with watery diarrhea mainly in children and immunocompromised individuals. E. albertii was initially classified as eae-positive Hafnia alvei, however, as more genetic and biochemical information became available it was reassigned to its current novel taxonomy. Its infections are common under conditions of poor hygiene with confirmed transmission via contaminated water and food, mainly poultry-based products. This pathogen has been isolated from various domestic and wild animals, with most isolates being derived from birds, implying that birds among other wild animals might act as its reservoir. Due to the absence of standardized isolation and identification protocols, E. albertii can be misidentified as other Enterobacteriaceae. Exploiting phenotypes such as its inability to ferment rhamnose and xylose and PCR assays targeting E. albertii-specific genes such as the cytolethal distending toxin and the DNA-binding transcriptional activator of cysteine biosynthesis encoding genes can be used to accurately identify this pathogen. Several gaps exist in our knowledge of E. albertii and need to be bridged. A deeper understanding of E. albertii epidemiology and physiology is required to allow the development of effective measures to control its transmission and infections. Overall, current data suggest that E. albertii might play a more significant role in global infectious diarrhea cases than previously assumed and is often overlooked or misidentified. Therefore, simple, and efficient diagnostic tools that cover E. albertii biodiversity are required for effective isolation and identification of this elusive agent of diarrhea.

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Risk reduction of diarrhea and respiratory infections following a community health education program - a facility-based case-control study in rural parts of Kenya

Cited by 11 publications

References 31 publications

Toward mandatory health insurance in low‐income countries? An analysis of claims data in Tanzania

Toward mandatory health insurance in low‐income countries? An analysis of claims data in Tanzania

How community participation in water and sanitation interventions impacts human health, WASH infrastructure and service longevity in low-income and middle-income countries: a realist review

Microbiology and Epidemiology of Escherichia albertii—An Emerging Elusive Foodborne Pathogen

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