Safe Water and AIDS Project

Kisumu, Kenya

Safe Water and AIDS Project

Kisumu, Kenya

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Nyothach E.,Kenya Medical Research Institute | Odhiambo F.O.,Kenya Medical Research Institute | Eleveld A.,Safe Water and AIDS Project | Vulule J.,Kenya Medical Research Institute | And 3 more authors.
PLoS ONE | Year: 2013

Background: Keeping girls in school offers them protection against early marriage, teen pregnancy, and sexual harms, and enhances social and economic equity. Studies report menstruation exacerbates school-drop out and poor attendance, although evidence is sparse. This study qualitatively examines the menstrual experiences of young adolescent schoolgirls. Methods and Findings: The study was conducted in Siaya County in rural western Kenya. A sample of 120 girls aged 14-16 years took part in 11 focus group discussions, which were analysed thematically. The data gathered were supplemented by information from six FGDs with parents and community members. Emergent themes were: lack of preparation for menarche; maturation and sexual vulnerability; menstruation as an illness; secrecy, fear and shame of leaking; coping with inadequate alternatives; paying for pads with sex; and problems with menstrual hygiene. Girls were unprepared and demonstrated poor reproductive knowledge, but devised practical methods to cope with menstrual difficulties, often alone. Parental and school support of menstrual needs is limited, and information sparse or inaccurate. Girls' physical changes prompt boys and adults to target and brand girls as ripe for sexual activity including coercion and marriage. Girls admitted 'others' rather than themselves were absent from school during menstruation, due to physical symptoms or inadequate sanitary protection. They described difficulties engaging in class, due to fear of smelling and leakage, and subsequent teasing. Sanitary pads were valued but resource and time constraints result in prolonged use causing chafing. Improvised alternatives, including rags and grass, were prone to leak, caused soreness, and were perceived as harmful. Girls reported 'other girls' but not themselves participated in transactional sex to buy pads, and received pads from boyfriends. Conclusions: In the absence of parental and school support, girls cope, sometimes alone, with menarche in practical and sometimes hazardous ways. Emotional and physical support mechanisms need to be included within a package of measures to enable adolescent girls to reach their potential.


Bennett S.D.,Centers for Disease Control and Prevention | Otieno R.,Safe Water and AIDS Project | Ayers T.L.,Centers for Disease Control and Prevention | Odhiambo A.,Safe Water and AIDS Project | And 2 more authors.
PLoS ONE | Year: 2015

Many health care facilities (HCF) in developing countries lack access to reliable hand washing stations and safe drinking water. To address this problem, we installed portable, low-cost hand washing stations (HWS) and drinking water stations (DWS), and trained healthcare workers (HCW) on hand hygiene, safe drinking water, and patient education techniques at 200 rural HCFs lacking a reliable water supply in western Kenya. We performed a survey at baseline and a follow-up evaluation at 15 months to assess the impact of the intervention at a random sample of 40 HCFs and 391 households nearest to these HCFs. From baseline to follow-up, there was a statistically significant increase in the percentage of dispensaries with access to HWSs with soap (42% vs. 77%, p<0.01) and access to safe drinking water (6% vs. 55%, p<0.01). Female heads of household in the HCF catchment area exhibited statistically significant increases from baseline to follow-up in the ability to state target times for hand washing (10% vs. 35%, p<0.01), perform all four hand washing steps correctly (32% vs. 43%, p = 0.01), and report treatment of stored drinking water using any method (73% vs. 92%, p<0.01); the percentage of households with detectable free residual chlorine in stored drinking water did not change (6%, vs. 8%, p = 0.14). The installation of low-cost, low-maintenance, locally-available, portable hand washing and drinking water stations in rural HCFs without access to 24-hour piped water helped assure that health workers had a place to wash their hands and provide safe drinking water. This HCF intervention may have also contributed to the improvement of hand hygiene and reported safe drinking water behaviors among households nearest to HCFs. © 2015, Public Library of Science. All rights reserved. This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.


Foote E.M.,University of Washington | Gieraltowski L.,Centers for Disease Control and Prevention | Ayers T.,Centers for Disease Control and Prevention | Sadumah I.,Safe Water and AIDS Project | And 6 more authors.
American Journal of Tropical Medicine and Hygiene | Year: 2013

Household air pollution is a risk factor for pneumonia, the leading cause of death among children < 5 years of age. From 2008 to 2010, a Kenyan organization sold ∼2,500 ceramic cookstoves (upesi jiko) that produce less visible household smoke than 3-stone firepits. During a year-long observational study, we made 25 biweekly visits to 200 homes to determine stove use and observe signs of acute respiratory infection in children < 3 years of age. Reported stove use included 3-stone firepit only (81.8%), upesi jiko only (15.7%), and both (2.3%). Lower, but not statistically significant, percentages of children in upesi jiko-using households than 3-stone firepit-using households had observed cough (1.3%versus 2.9%, rate ratio [RR] 0.48, 95% confidence interval [CI]: 0.22-1.03), pneumonia (0.9%versus 1.7%, RR 0.60, 95% CI: 0.24-1.48), and severe pneumonia (0.3% versus 0.6%, RR 0.66, 95% CI: 0.17-2.62). Upesi jiko use did not result in significantly lower pneumonia rates. Further research on the health impact of improved cookstoves is warranted. Copyright © 2013 by The American Society of Tropical Medicine and Hygiene.


Schilling K.,Centers for Disease Control and Prevention | Person B.,National Center for Emerging and Zoonotic Infectious Diseases | Faith S.H.,Safe Water and AIDS Project | Otieno R.,Safe Water and AIDS Project | Quick R.,Centers for Disease Control and Prevention
American Journal of Public Health | Year: 2013

Poverty is a critical social determinant of health. A particular approach toward mitigating inequitable access to health services in Kenya has been through a community-based distribution program implemented by the Safe Water and AIDS Project (SWAP) that has achieved modest uptake of public health interventions. To explore reasons for modest uptake, we asked program participants about child health problems, daily tasks, household expenditures, and services needed by their communities. Respondents identified child health problems consistent with health data and reported daily tasks, expenses, and needed services that were more related to basic needs of life other than health. These findings highlight the challenges of implementing potentially self-sustaining preventive interventions at scale in poor populations in the developing world.


Foote E.M.,University of Washington | Sullivan K.M.,Emory University | Ruth L.J.,Centers for Disease Control and Prevention | Oremo J.,Safe Water and AIDS Project | And 3 more authors.
American Journal of Tropical Medicine and Hygiene | Year: 2013

Although anemia in preschool children is most often attributed to iron deficiency, other nutritional, infectious, and genetic contributors are rarely concurrently measured. In a population-based, cross-sectional survey of 858 children 6 - 35 months of age in western Kenya, we measured hemoglobin, malaria, inflammation, sickle cell, a- thalassemia, iron deficiency, vitamin A deficiency, anthropometry, and socio-demographic characteristics. Anemia (Hb < 11 g/dL) and severe anemia (Hb < 7 g/dL) prevalence ratios (PRs) for each exposure were determined using multivariable modeling. Anemia (71.8%) and severe anemia (8.4%) were common. Characteristics most strongly associated with anemia were malaria (PR: 1.7; 95% confidence interval [CI] = 1.5-1.9), iron deficiency (1.3; 1.2-1.4), and homozygous a-thalassemia (1.3; 1.1-1.4). Characteristics associated with severe anemia were malaria (10.2; 3.5-29.3), inflammation (6.7; 2.3-19.4), and stunting (1.6; 1.0 -2.4). Overall 16.8% of anemia cases were associated with malaria, 8.3% with iron deficiency, and 6.1% with inflammation. Interventions should address malaria, iron deficiency, and non-malarial infections to decrease the burden of anemia in this population. Copyright © 2013 by The American Society of Tropical Medicine and Hygiene.


Suchdev P.S.,Centers for Disease Control and Prevention | Suchdev P.S.,Emory University | Shah A.,Emory University | Jefferds M.E.D.,Centers for Disease Control and Prevention | And 5 more authors.
Maternal and Child Nutrition | Year: 2013

To evaluate the sustainability of market-based community distribution of micronutrient powders (Sprinkles®, Hexagon Nutrition, Mumbai, India.) among pre-school children in Kenya, we conducted in August 2010 a follow-up survey, 18 months after study-related marketing and household monitoring ended. We surveyed 849 children aged 6-35 months randomly selected from 60 study villages. Nutritional biomarkers were measured by fingerstick; demographic characteristics, Sprinkles purchases and use were assessed through household questionnaires. We compared Sprinkles use, marketing efforts and biomarker levels with the data from surveys conducted in March 2007, March 2008 and March 2009. We used logistic regression to evaluate associations between marketing activities and Sprinkles use in the 2010 survey. At the 2010 follow-up, 21.9% of children used Sprinkles in the previous 7 days, compared with 64.9% in 2008 (P<0.001). Average intake was 3.2 sachetsweek-1 in 2008, 1.6 sachetsweek-1 in 2009 and 1.1 sachetsweek-1 in 2010 (P<0.001). Factors associated with recent Sprinkles use in 2010 included young age [6-23 months vs. 24-35 months, adjusted odds ratio (aOR)=1.5, P=0.02], lowest 2 quintiles of socio-economic status (aOR=1.7, P=0.004), household attendance at trainings or launches (aOR=2.8, P<0.001) and ever receiving promotional items including free Sprinkles, calendars, cups and t-shirts (aOR=1.7, P=0.04). In 2010, there was increased prevalence of anaemia and malaria (P<0.001), but not iron deficiency (P=0.44), compared with that in 2008. Sprinkles use in 2010 was associated with decreased iron deficiency (P=0.03). Sprinkles coverage reduced after stopping household monitoring and reducing marketing activities. Continued promotion and monitoring of Sprinkles usage may be important components to sustain the programme. © 2012 Blackwell Publishing Ltd.


Date K.,Epidemic Intelligence Service | Date K.,Centers for Disease Control and Prevention | Person B.,Office of Infectious Diseases | Nygren B.,Centers for Disease Control and Prevention | And 4 more authors.
Journal of Infectious Diseases | Year: 2013

Background. In response to recurrent cholera outbreaks in Nyanza Province, Kenya, a local nongovernmental organization assisted the Ministry of Health by providing cholera education activities to some cholera-affected communities. We evaluated the impact on cholera prevention knowledge and practices.Methods. In November-December 2008, we conducted a cross-sectional household survey and tested stored water for chlorine in 6 cholera-affected enumeration areas (intervention-EAs) where response activities had occurred between March-September 2008, and 6 comparison-EAs with no known reports of cholera outbreaks or response activities.Results. We enrolled 358 individuals from intervention-EAs and 365 from comparison-EAs. Overall, >80% knew cholera symptoms and over 60% knew that water treatment prevented diarrhea; <20% had chlorine residual in stored water. More intervention-EA respondents than comparison-EA respondents recalled a cholera outbreak in their community (52% vs 19%, P <. 0001), and of those, 51% versus 39%, respectively, had attended a cholera response event. Detectable chlorine residuals in stored water were found in a higher percentage of intervention-EA and comparison-EA event attendees (21% and 25%, respectively) than nonattendees (17% and 8%, respectively). Conclusions. There was a gap between knowledge and practice of water treatment as a cholera preventive measure. Cholera event attendance may have modestly motivated increased household water treatment. © 2013 Published by Oxford University Press.


PubMed | Centers for Disease Control and Prevention, University of Liverpool and Safe Water and AIDS Project
Type: Journal Article | Journal: PloS one | Year: 2016

Household air pollution (HAP) from biomass fuel burning is linked to poor health outcomes. Improved biomass cookstoves (ICS) have the potential to improve HAP.A pre-/post- intervention study assessed the impact of six ICS on indoor air quality and acceptability of ICS to local users in rural Western Kenya.We measured mean personal and kitchen level concentrations of particulate matter <2.5m in diameter (PM2.5, g/m3) and carbon monoxide (CO, ppm) during the 48-hour period of each ICS use in 45 households. We compared these levels to those observed with traditional 3-stone fire (TSF) use. We assessed ICS acceptability through interviews and focus groups. We evaluated association of stove type, fuel use, and factors related to cooking practices with mean kitchen PM2.5 and CO using multivariable regression.Stove type, exclusive ICS use (vs. concurrent TSF use), and the amount of fuel used were independently associated with kitchen PM2.5 and CO levels. Reductions (95%CI) in mean PM2.5 compared to TSF, ranged by ICS from 11.9% (-2.8-24.5) to 42.3% (32.3-50.8). Reductions in kitchen CO compared to TSF, ranged by ICS from -5.8% (-21.9-8.2) to 34.5% (23.2-44.1). Mean kitchen PM2.5 ranged from 319g/m3 to 518g/m3 by ICS. Women thought ICS were easy to use, more efficient, produced less smoke, and cooked faster, compared to TSF. Women also reported limitations for each ICS.We documented reductions in HAP from ICS compared to TSF. The PM2.5 levels with ICS use were still considerably higher than WHO indoor air quality guidelines. Achieving maximal potential of ICS requires adherence to more exclusive use and addressing user reported ICS limitations.


PubMed | Centers for Disease Control and Prevention, U.S. Center for Disease Control and Prevention, Safe Water and AIDS Project and Kenya Medical Research Institute
Type: | Journal: Journal of sexually transmitted diseases | Year: 2015

We evaluated the integration of rapid syphilis tests (RSTs) and penicillin treatment kits into routine antenatal clinic (ANC) services in two rural districts in Nyanza Province, Kenya. In February 2011, nurses from 25 clinics were trained in using RSTs and documenting test results and treatment. During March 2011-February 2012, free RSTs and treatment kits were provided to clinics for use during ANC visits. We analyzed ANC registry data from eight clinics during the 12-month periods before and during RST program implementation and compared syphilis testing, diagnosis, and treatment during the two periods. Syphilis testing at first ANC visit increased from 18% (279 of 1,586 attendees) before the intervention to 70% (1,123 of 1,614 attendees) during the intervention (P < 0.001); 35 women (3%) tested positive during the intervention period compared with 1 (<1%) before (P < 0.001). Syphilis treatment was not recorded according to training recommendations; seven clinics identified 28 RST-positive women and recorded 34 treatment kits as used. Individual-level data from three high-volume clinics supported that the intervention did not negatively affect HIV test uptake. Integrating RSTs into rural ANC services increased syphilis testing and detection. Record keeping on treatment of syphilis in RST-positive women remains challenging.


PubMed | Tufts University, Centers for Disease Control and Prevention, Georgia State University and Safe Water and AIDS Project
Type: | Journal: Water research | Year: 2016

Household water treatment with chlorine can improve microbiological quality and reduce diarrhea. Chlorination is typically assessed using free chlorine residual (FCR), with a lower acceptable limit of 0.2mg/L, however, accurate measurement of FCR is challenging with turbid water. To compare potential measures of adherence to treatment and water quality, we chlorinated recently-collected water in rural Kenyan households and measured total chlorine residual (TCR), FCR, oxidation reduction potential (ORP), and E.coli concentration over 72h in clay and plastic containers. Results showed that 1) ORP served as a useful proxy for chlorination in plastic containers up to 24h; 2) most stored water samples disinfected by chlorination remained significantly less contaminated than source water for up to 72h, even in the absence of FCR; 3) TCR may be a useful proxy indicator of microbiologic water quality because it confirms previous chlorination and is associated with a lower risk of E.coli contamination compared to untreated source water; and 4) chlorination is more effective in plastic than clay containers presumably because of lower chlorine demand in plastic.

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