Lack of Sanitation Proper Hygiene Interventions Promote Post-Morbidity and Mortality due to Diarrhea in Kilifi County

By Caroline Katana

Email, thecoastnewspaper@gmail.com

Diarrhea is a leading killer of children that accounts to approximately 9 percent of all deaths among children under age 5 worldwide since 2021.

This translates to over 1,200 young children dying each day or about 444,000 children a year despite the availability of a simple treatment solution.

Every day, 2,000 African children die from diarrhea – deaths that are entirely preventable.

Nine out of ten cases of diarrhea can be prevented by safe water and sanitation as proven cost-effective interventions.

Unfortunately, the burden of diarrhea remains high and inadequately characterized owing to the complex interplay that the environment, food, water and sanitation have with poverty and deprivation.

Despite this, today only four in ten Africans have access to a basic toilet due to poor cultures and traditions against toilet use.

There is an increasing recognition that children remain at elevated risk of death following discharge from health facilities in resource poor settings.

Worldwide, 780 million individuals lack access to improved drinking water and 2.5 million lack improved sanitation.

Diarrhea, due to infection, is widespread throughout developing countries, in low-income countries, children under 3-years-old experience on average three episodes of diarrhea every year.

As a result, diarrhea is a major cause of malnutrition and malnourished children are more likely to fall victims of diarrhea.

Kenya is not exceptional of diarrhea burden. A population based surveillance study from Kenya showed differences in prevalence of diarrhea between rural and urban residents, where rural residents were identified as more at risk.

Household income and wealth index are determinants for diarrhea in children under five, children between 6- 24 months were identified as the most susceptible to contract diarrhea.

In Kenya healthcare, spending from the national budget remains low despite the commitments made to increase health sector funding by 16 percent.

Kilifi is one of the six counties in the Coast region of Kenya that covers an area of 12,370.8 square kilometre and has a population of 1,453,787 people (KNBS, 2019) of which 202,076 (13.9%) are children under five years old.

A large proportion of children (87.6%) who reported to be ill sought treatment from health facilities with the least seeking treatment from traditional healers at 0.4%.

In 2019, Kilifi county was leading by achieving community-led total sanitation with two sub-counties of Kilifi North and Rabai achieving 100 percent open defecation free (ODF).

Its target is 90 percent of all villages by 2022 to combat deaths caused by diarrhea, especially amongst children below 5 years. However, the county still recognises an increase that children remain at risk of death after discharge from health facilities and diarrhea being highlighted as a risk factor for post-discharge mortality.

Since then, at least three sub-counties of Kilifi North, Rabai and Kilifi South have achieved ODF while targeting to achieve the same of four other subcounties by end of 2024 or early 2025.

Kilifi ministry of health (MOH) through water and toilet hygiene head of department, Abdullah Munga confirmed the gap between the sanitation interventions and the post morbidity and mortality from diarrhea as a result of loss of focus on sanitation and hygiene interventions by Kilifi MOH and other stakeholders.

“We are not doing well in Kilifi in matters of sanitation and hygiene, this is an issue of concern that requires multi-stakeholder approach in filling the intervention gap, we have witnessed children with diarrhea admitted in our paedriatic units but after discharge they  re-contaminate bacteria, we have to invest more to save lives of children,” he said.

From 2023/2024 period, Kilifi County department of health recorded a total  of 104,618 cases of children with diarrhea in health facilities.

“These numbers are very high and we need to put up measures to bring it down, diarrhea is still a bigger problem here in kilifi, we don’t have a clear data  but I believe some children re-contaminated bacteria and virus and die.”

He confirmed the county was highly burdened by open defecation saying the top 10 diseases recorded in health centres were as a result of poor sanitation and hygiene.

“According to 2019 census statistics Kilifi county was ranked among the top 15 counties in Kenya practicing open defecation, among the top 10 diseases due to poor sanitation and hygiene we have diarrhea, skin, eye disease among other sanitation diseases.”

The county has recorded an achievement on toilet usage with at least 85 percent of its population using toilets instead of nearby bushes as it were.

“This is a good gesture and big milestone for our people in maintaining hygiene, they have improved within a short time but we want to work on the remaining 15 percent by end this year to ensure ODF, building toilets aim  to prevent spread of faeces that contaminate water in dams, also this will  encourage the community to wash hands.”

A clinician at Kiwandani dispensary Daniel Rangu said he recorde 30 to 80 cases of diarrhea per month.

“Diarrhea cases vary, depending on weather, in a month 30 cases of diarrhea can be  recorded, another month 80, we normally record 1 to 2 cases per day.”

Josephine Bahati Kazungu, a mother of four children at Kiwandani, narrates how she spent four days in pediatric unit in Kilifi Hospital with her 12 months third-born baby after getting malnourished due to    diarrhea and dehydration.

“After diagnosed with  diarrhea with dehydration at Kiwandani Dispensary, I was referred to Kilifi hospital where  my son got four days admission, his chances of surviving were slim but I thank God, he was introduced to oral rehydration solution ORS, a mixture of clean water, salt and sugar, it is absorbed in the small intestine and replaces the water and electrolytes lost in faeces, he also was given nutrients foods because he was malnourished so as to break the vicious circle of malnutrition and diarrhea.”

Community health promoter from Sokoni ward of Kilifi, Khadija Said admitted that poor sanitation and hygiene was a major cause of high cases of diarrhea among children below five years in the ward.

“The reality is that there is poor sanitation and lack of access to readily accessible water, even when water is available there are contamination risks majorly due to open defecation and poor waste management,” she said adding that sanitation was actually at personal level.

“CHPs have committed themselves to sensitize and create awareness to the community on effort to ensure 100 percent proper sanitation and hygiene so as to curb diarrhea among children.”

Culture and traditions of some communities still believe that women should not use a toilet because they cannot mix their stool with that of their father-in-laws.

Such beliefs have led some families to associate diarrhea with a curse or witchcraft hence seeking treatment from traditional healers instead of medical personnel.

ODF has made it easier for those who sought to bewitch others to access their intended victim’s faeces, thus, anyone could easily access a family’s open defecation site and use the faeces there to cast a spell of misfortune on a certain targeted family.

*Causes* *of* *diarrhea* 

Diarrhea is a disease caused by a wide range of pathogens, including viruses, protozoa and bacteria.

There are several life-threatening viral and bacterial pathogens affecting individuals among them is rotavirus which is the leading cause of acute diarrhea and is responsible for about 40 percent of all hospital admissions.

Unsafe water, poor sanitation and poor handwashing techniques are the leading risk factors in the county.

Therefore, eradicating open defecation is vital in achieving basic health care because it reduces the number of patients affected by poor hygiene.

An estimated 1,400 children under the age of five die each year because of diarrhea directly linked to lack of access to safe water, sanitation and hygiene. 

For its interventions mrasures, Kilifi MOH is increasing access to safe and affordable drinking water, improved sanitation facilities and hygiene practices, strengthening capacity of community health promoters, creating awareness on hand washing and proper use of toilets apart from installing a water treatment plant at Mtondia.

County Executive Committee Member health and sanitation (CECM) Peter Mwarogo said post mortality was highly contributed by poor sanitation and hygiene in communities.

“Environmental factors, stool disposal practices in the household, dirt floor and thatch roof materials of household unit are risk factors for diarrhea disease, many a times mothers are sensitized about sanitation and hygiene while in hospitals but unfortunately after discharge still their kids get re-infections.”

He said that areas such as Ganze and Bamba were often hit by drought and long suffered from food shortages and poverty leading to severe malnutrition in children.

“The areas has faced various health-related issues including a shortage of health  facilities and healthcare workers, limited access to safe and clean water and high maternal mortality rate.”

Approximately 18 cases of diarrhea were recorded in Magarini sub-county during the heavy rains this year.

The CECM urged communities to shun from cultures and traditions that destroyed their physical health and instead change them of life to the positive.

“Communities should embrace the sanitation and hygiene education given to them by our community health promoters, Kilifi county has over 4 thousand trained CHPs who are creating awareness on matters sanitation and hygiene.”

According to the Kilifi County Integrated SMART survey of 2023 children aged 6-59 months presented symptoms of different diseases because of lack of proper care from medical personnel in the county.

The survey’s outcomes reveal that 53.6% of children had experienced illness, with a substantial 86.4% of them having sought medical attention in health facilities.

Among the caregivers, the majority turned to public clinics (64.5%) as their primary choice for seeking such healthcare services followed by private clinics (23.1%).

The leading incidents of illnesses was ARI/cough at 28.7% followed by fever chills/malaria at 10.9% and watery diarrhea (three watery stools) stood at 9.3% of which 83.9% and 80.6% of those cases received therapeutic zinc and ORS respectively.