Summer Update: Deworming 29,000

Led by Moses Kiti and the Rotary Club of Kilifi, the latest round of deworming took place on July 12, 2012.  The launch of the program started at Masemo Primary School at 9 a.m. with various stakeholders in attendance, including the Kenyan Ministries of Health and Education, and will continue to 82 other primary schools across the Ganze and Vitengeni provinces in the Kilifi District.  On the following day (July 13), there was a follow-up session for any child who missed the initial drug administration.  It is expected that 29,000 students received a deworming tablet in last week’s campaign.  

A giant thanks to all of those who have supported this work, including our partners, volunteers, and donors.  We are excited to continue this important work, now in our fifth year, and help so many children have healthier and happier lives free of disease!  

Rita’s Story: Life Lessons Made in Kenya & US

I was fortunate enough to attend Loreto High School, a highly ranked Kenyan Catholic school for girls. At the school, we were all young women from different economic, religious and ethnic backgrounds. Of course they were girls who were more clever and more talented than me; girls considered more beautiful than me, but for some unknown reason we all still got along.

As a young woman in high school, it was all about luck (or lack of it), you were either lucky to be born pretty, lucky to be smart, or lucky to be a leader… you could never venture out into something else, it was either you were or you weren’t; not in-between.

High school for me was a challenge; to find out what my “luck” was. I realized that I was unlucky; unlucky that I didn’t live in the capital city Nairobi, (Apparently, alot of things in Kenya happen in the capital city and that’s where the ‘cool’ kids lived. I always tell people that I live in Mombasa and only mention Kilifi when they ask me for more detail). I was unlucky that I didn’t really know what I wanted to do after school, unlucky that people saw leadership in me when leadership was considered uncool.

It was always a hustle travelling to school. I would have to leave home three days before and travel by bus to Nairobi. Lucky for me, my siblings and I could rest at my aunts house and then catch a matatu (commuter omnibus) to Limuru the next day or day after.

To be honest, I finished high school ‘confused’. To my grandma I was going to be an Engineer. To my parents, I was all set for International Affairs and to my peers I was going to be a lawyer. Deep down, I was still trying to figure out how I could incorporate music somewhere in my future career. This was something I couldn’t share with anyone.

Why you may ask? I remember at one time reciting a poem back in elementary school, and one of my uncles trying to discourage me saying “Do you want to become Ojwang’?” A Kenyan TV actor, he considered a ‘mere’ comedian.

Later on, I was on my way to the beach with my neighbors when I received a phone-call from the Kenyan National Committee: “We feel that you are a perfect candidate for our program and would love you to consider our offer. Would you be interested in pursuing music in your studies?“. I will never forget the weight of those words.

According to them, I was a qualified candidate for their program by virtue of my interest in the arts. I would be headed to Swaziland on scholarship for the United World college (UWC) program. I was convinced this was the first sign that I had chosen a true path.

Studying at a UWC definitely broadened my way of thinking. Over 200 nationalities under one roof opened up my mind to unlimited possibilities. Two years of interacting with various people intrigued me and elicited an epiphany; I wanted to keep interacting with people to get their different views and music was the perfect avenue to do this.

All I had to do, was figure out how I was going to make that happen and encourage my family, friends and community support me. At this point, the woman in me had a vision; a dream albeit with a lingering hindrance.

In UWC Swaziland, a biology Professor Jim Proctor from Lewis & Clarke made a presentation about the university. It aroused my curiosity. During an interview with the professor, he said to me: “You give out this ‘mover’ vibe, like you want to take on so much. It is such people who make great Pio’s –LC pioneers.”

I really didn’t feel solid enough to travel abroad again and was anchored onto getting a referral to a university back home in Kenya. As I weighed my options, I spoke to a kind hearted lady (Timmy’s mum) residing in Swaziland who said, “it’s a sad thing to live in Swaziland as a woman, you know. Here, women are comfortably stepped on, looked down upon and made to feel inferior to men in a world that is craving equality in every essence. You are a young, beautiful, educated, African female. Just decide what you want and the world will cave into your demands.”

Timmy’s mum made me choose to take my step, a journey to the US and a discovery of my passion.

Most of my friends usually envy me when I go abroad and always ask me about my school with such genuine admiration. From my point of view, I always see it as a hindrance. I lost a lot of friends along the way simply because our ways of thinking were very different. I also no longer relate to people who go or went to college in Kenya and this fills me with sadness. I do however always talk to my few remaining friends about their experiences as I share my own and have come to realise that even if I had gone to college in Kenya, my experience would not be relative to all Kenyan students. We are all so diverse and that’s what makes Kenya very special to me. Our diversity ecompasses people of all walks of life, religion, creed and race.

I am now a Musicology and International Affairs double major. Thriving for excellence in everything I get involved in and getting constant inspiration and support from everyone around me.

The Challenges & Opportunities We Face with Introducing Cell Phones to Kilifi

In March, Isaac Holeman of Medic Moble visited Kilifi and gave us an assessment of the health system in the District.  Here are some of his notes that paint a picture of the opportunities and challenges facing us with our mHealth work.
The health system in Kilifi District revolves around a district hospital co-located with the KEMRI-Wellcome Trust. Approximately 40 health facilities report to the District Hospital and 30-50 Community Health Workers (“CHWs”) report to each health facility.  Most of the health facilities lack the proper staff and, in many cases, have no IT infrastructure to support their work.  Hospital and community staff use phones but mobile Internet is unreliable. Computer use is not the norm.  Modems may show no bars of network even when a phone displays 1-2 bars.

Some dispensaries have only one nurse; other clinics have four to five nurses and a clinical officer.  Prior to the introduction of cell phones, a staff member could spend the majority of his/her day delivering weekly reports to the District Hospital, closing the health facility if he/she was the only person on staff.

At the national level, Kenya’s strategy for harmonizing CHW programs describes Community Health Units, which includes two Community Health Extension Workers (“CHEWs” are volunteer coordinators).   CHEWs are based at each health facility and about 50 volunteer CHWs can serve approximately 5,000 people. Ten Kilifi facilities are roughly in-line with this national CHW strategy, having at least one CHEW, and 22 more (a mix of Ministry of Health and private) have a data clerk focused on reporting.

In terms of people, 1,500-2,000 volunteer CHWs have a 2-3 week orientation to provide mainly prevention and health promotion services.  Forty CHWs per health facility is typical; the national strategy calls for 50 CHWs but the proposed pilot facility has 36.  CHWs typically visit their health facilities about once per month to deliver Community Based Information System reports.

Due to constraints imposed by the paper based system, the health service is designed for virtually all communication to occur between CHWs in the community and CHEWs at the facility. No district staff are designated to directly support CHWs, which means that putting communication technologies in the hands of CHWs and district staff without also involving CHEWs at health facilities would either be useless or would require substantial restructuring of staff responsibilities to support CHWs.

Picking up Steam – What We’re Doing with Cell Phones

Our mHealth pilot is picking up steam.  Phase 1 of our project began last July (2010), where we deployed cell phones to approximately 20 health facilities throughout the Kilifi District (about half of total) to improve the reporting of disease surveillance.  Our Phase 2 has officially kicked off this past July (2011) and will go much further in improving health outcomes and providing greater access to Kilifi’s residents.Specifically, we are working closely with Medic Mobile to get the Past 2 project off the ground.  Medic Mobile is serving as our technical partner and is providing their expertise in software development, CHW training and deployment, long-term remote support, and evaluation of the interventions.  They will work in close collaboration with our Kilifi leaders, Jonathan Mativo and Benjamin Tsofa, to ensure that we are meeting our objectives and timeline for the project.Our work is centered on a number of use cases that focus on improving the communication between community health workers (CHWs) and the District Hospital, including:

  • CHWs can be notified of health facility meeting times
  • CHWs can be notified of vaccination days to mobilize communities
  • Health facilities can provide feedback to CHW questions
  • CHEWs (Community Health Extension Workers; our volunteers) can request follow-up sessions for HIV/TB/Antenatal cases
  • CHWs can request emergency services of the District Hospital
  • CHWs can provide referrals for malnutrition, malaria, pneumonia cases

Simultaneously, we plan to equip the District Hospital with a basic electronic health record system that can identify and monitor the health of patients that are cared for by the District Hospital and CHWs in the community.

Jonathan Mativo is leading the work on the ground and is a former President of Kilifi Rotary and new Project Manager for Medic Mobile.  He will be able to give us regular reports on the progress of our pilot and future work.  We’re excited for the full roll-out of this phase and will be sure to keep the information flowing.

56,313 Healthier Kids: More Work to Do (Part 3)

In my last post of a three-part discussion on our de-worming program, I believe it critical to emphasize that, even with our tremendous results, more work is needed to fight these devastating diseases (helminthes and schistosomiasis).  With incidence rates below 1 percent for 50,000 pupils in Kilifi today, it would be easy to move on.  Some might argue, why not leave this behind and focus on Kilifi’s other serious problems now that this is solved?

Yet, the news from our in-depth report was not all positive and should give us pause.  A questionnaire administered to 496 pupils in classes 5 to 7 showed mix results on our educational progress.

The Good:  100 percent of children could (1) identify why worms and schistosome infections were harmful, (2) explain at least one way to avoid infection, and (3) provide at least one way to improve the health of their infected classmates.

The Not-so-Good:  Only 40 percent of the same children knew how one got infected with schistosomiasis.  Less than 20 percent knew the degree of how many other students were sick with parasites.  And, dismally, only 7.8 percent of the respondents knew all the ways of improving health for children infected with the diseases.

The answer to the question above is clear.  If we left our work now, the infection rates would most certainly return to pre-2008 levels in a matter of years.  More education is needed to eradicate these devastating diseases.  It is not just enough to supply a child with a pill once a year.  Education leads to better health and so it falls to us and others in the community to ensure that every child understands how to live healthier and avoid situations that put them in greater jeopardy of getting sick from water-borne diseases.

Kilifi Kids has funding to continue the program for the next three years and we have been strong advocates to other organizations and local government to get more involved in this fight.  We believe that this work has huge pay-offs for the community and will push forward.  We will also explore other avenues to combat the causes of infection (notably sanitation) and are always looking for help in this cause.  So, send an email, pick up the phone, and join us to make the next study produce just as impressive results as this last one.

56,313 Healthier Kids: Testing & Evaluation (Part 2)

If you’re like me and not a public health expert, you may not understand how much work goes into accurately measuring and analyzing the success of a de-worming campaign like ours.  I thought it would be interesting to highlight some of the procedures undertaken in our recent study.  Below are sections pulled from the report based on laboratory analysis and surveying.

We carried out an evaluation of the project by conducting questionnaires to school headteachers and pupils and examined stool and urine from 250 children from 10 schools who had participated in the deworming programme.

Urine filtration
Children were asked to urinate into a wide-mouthed plastic container. After stirring, urine was drawn into a plastic syringe, the volume measured, and the urine passed through a filter holder containing a Nucleopore TM filter of2.5mm diameter and 12μm pore size. Subsequently, the syringe was half-filled with air and this was passed through the filter to ensure the passage of all urine. The membrane was then removed with forceps and scanned at low magnification(x4) with a microscope.

Visual Examination
Macrohaematuria was used to measure heavy infection/high morbidity. Presence of blood in urine is a good indicator of pathological conditions in the bladder. This can also assess the potential of anaemia in the children in endemic area. Any child with urine-which was red (or pink) in colour was regarded as positive.

Interview and questionnaires
A simple standard questionnaire was administered to a sample of 500 respondents in 10 primary schools. The study population was drawn from the 58 Primary schools with an enrollment of 56,313 pupils in Ganze and Vitengeni Divisions in Kilifi district. We used both purposive and random sampling to identify the study area, schools and the respondents. The criteria for selection of the 10 schools and 500 respondents were done through the zoning of schools to ensure equitable representation. We also considered acceptability and accessibility. Ballot papers were prepared for random sampling of the schools while school registers were used to identify respondents from which sampling was done. A qualitative questionnaire was administered to all respondents including teachers by the Public health officers from the Ministry of Public Health and Sanitation.

It thus gives us confidence that we’re measuring our performance accurately and in turn truly helping the community in our work.  If you have any feedback on ways we could improve or enhance our evaluation process for future work, we would love to hear from you! You can leave your comments on this post, or find us on Twitter at @kilifikids.

56,313 Healthier Kids: Big Results! (Part 1)

I am happy to report exciting news. Since 2008, Kilifi Kids and its partners, notably the Rotary Club of Kilifi and Kilifi District Hospital, have planned, raised funds, and deployed medication to a target population of 30,000 school-age students per year in the Kilifi District to fight the deadly parasitic diseases of helminthes and schistosomiasis. Throughout our trials, we knew we were helping the community but it wasn’t until we received the results of a recent in-depth study that we could fully appreciate the impact of our work on the community.

Drumroll please. After four years of work, we learned that more than 50,000 children were de-wormed. Subsequently, we dropped parasitic infections from 32% (last measured in 2003) to nearly nothing today. Wow!

Below, I have included excerpts from that report that give the details:

The burden of disease caused by soil transmitted helminthes (STH) and schistosome infections are enormous. More than 200 million people are affected world wide, of whom more than 300 million suffer from associated severe morbidity; 155,000 deaths reported annually (WHO-2001). These infections account for more than 40% of the global burden of all tropical diseases excluding malaria. Schistosomiasis and STH infections are diseases of poverty.

Vitengeni and Ganze divisions are the poorest divisions in Kilifi District according to an official Government reports. In 1998 to 2003, a survey conducted by African Medical Research Foundation (AMREF) in Kilifi District showed that schistosomiasis and helminthes account for more the 40% of infection among school going children…Mass drug administration (MDA) of praziquantel and albendazole were administered [to the Vitengeni and Ganze] as follows: paraziquantel once yearly and albendazole twice yearly. This exercise was conducted by the personnel from the Ministry of Public Health and Sanitation with the help from the trained teachers and personnel from the health facilities in the Division. MDA was started in May 2008 and continued up to 2010 at the time we conducted this evaluation. A total of 56,313 pupils were dewormed reached during the 3–year program.

In September/October 2010, we carried out an evaluation of the project by conducting questionnaires to school headteachers and pupils and examined stool and urine from 250 children from 10 schools who had participated in the deworming programme. The study’s main objective was to assess the impact of deworming among school-going children, establish the prevalence of worms after a 3-year Mass Drug Administration, and assess knowledge, attitude, and perception of school-going children on the worms.

250 specimens of both stool and urine were taken from the 10 sampled schools making a total of 500 specimens per school. Only 3.6% of the stool samples were positive for Entamoeba Coli while 0.8 % of the children had Entamoeba histolytica. However, Trichuris trichiura was observed in 0.4% of the pupils stool. All the positives were referred and treated in health facilities No infections with Schistosoma mansoni and S. haematobium were observed except that 1.6% of the urines had yeast cells. This was attributed to the mass drug administration of praziquantel and albendanzole that has been on-going for the last 3 years.

Thank you to all involved parties to make these accomplishments a reality. It is incredible to see the progress that has been made in Kilifi in the past five years and our team is eager to expand our work to help even more in need both in Kilifi and throughout Kenya.

Great year ahead for us in 2011

Kilifi Kids has a remarkable 2010 and 2011 will be even bigger.

In 2010, we kicked off our mHealth pilot by connecting rural clinics with mobile phones in late spring.  After a successful fundraising drive, we sent a 4-person team to Kenya in July to meet the Ministry of Health and build our solution.  In November, we attended the mHealth Summit in Washington and expanded our network of experts in public health and technology.  Today, we await good news from the Rotary Foundation on a $60,000 grant for a massive expansion of our pilot to help 25,000.  All of this is on top of de-worming 28,000 children each year and providing 40 students a high school education.  

Kilifi Kids could really use your help today to do even greater good in 2011!  As we grow, we need specialists to develop our solutions and build awareness.  Specifically, we encourage you to visit our site where we are actively recruiting our next generation of leaders: 

http://www.kilifikids.org/open-positions/

Be a part of our magic!

Kilifi Kids at the mHealth Seminar

This has been a big year for us.  We’ve started our mHealth pilot project by connecting rural clinics with mobile phones.  We’ve travelled to Kenya and made tremendous progress on bringing healthcare to malnourished children when they most need it.  We’ve dewormed 30,000 children.  We’ve supported kids in high school. 

This coming year will be even bigger, and we’re planning that now at the NIH mHealth Summit in Washington, DC, Nov 7-10, 2010.  We’ll be meeting with current partners and future partners.  Please look out for Marc Olsen and Erik Michielsen there!

See Our Fantastic Supporters

We’re so lucky to have so much wonderful support.  From Kenya to the UK to the US, from Washington to Florida, we had 137 named donors.  Thank you all so much for your generous, fantastic support.  

[See the honor roll of Kilifi Kids investors.]