Story by: Caroline Katana,

Lack of sanitation and hygiene interventions focus by Kilifi Ministry of Health ,promotes post morbidity and mortality due to diarrhea. Diarrhea is a leading killer of children ,accounting for approximately of 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. Everyday 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 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 from 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 health care 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 , covers an area of 12,370.8 km2 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, Kilifi north and Rabai, achieving 100 percent open defecation –free and target 90 percent to all villages by 2022 so as to combat deaths caused by diarrhea especially amongst children below 5 years ,however Kilifi county still recognize an increase that children remain at risk of death after discharge from health facilities ,diarrhea being highlighted as a risk factor for post –discharge mortality. Since then at least three sub-counties ,Kilifi north ,Rabai and Kilifi south has achieved open defecation free ,targeting ODF to all the sub-counties by end of 2024 or early 2025 .

Kilifi ministry of health through water and toilet hygiene head of department Abdullah Munga, confirmed the gap between the sanitation interventions and the post morbidity and mortality following diarrhea is 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 paderaite units but after discharge they re -contaminate bacteria ,we have to invest more to save lives of children ,” said Mr. Munga.

Josephine Bahati Kazungu a mother of 4 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 with dehydration. “After being 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,” said Mrs. Kazungu

Community health promoter from Sokoni ward in Kilifi County, Khadija Said admitted poor sanitation and hygiene to be the major cause of high cases of diarrhea among children below 5 years in Sokoni 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,” said Mrs Said .

At the same time she added that sanitation situation is personal. “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 ,” said Mrs Said .

Culture and traditions some communities still believe that women should not use a toilet because they can not mix their stool with that of their father –in- laws. Some families associate diarrhea with a curse or witchcraft hence seeking treatment from traditional healers. Open defecation made it easier for those who sought to bewitch others to access their intended victim’s farces, anyone could easily access a family’s open defecation site and use the farces there to cast a spell of of misfortune on a certain family .

Causes of Diarrhea is a disease caused by a wide range of pathogens ,including viruses ,protozoa and bacteria, there are several most 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, sanitation and hand washing is the leading risk factor in Kilifi county.

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.

Interventions by Kilifi county MOH 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 ,installation of water treatment plant at Mtondia Kilifi county Executive Committee Member health and sanitation Peter Mwarogo said post mortality is 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 ,”Said the Cec . He confirmed areas like Ganze and Bamba often hit by drought ,the area has 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 ,” Said the Cec .

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

At the same time ,the Cec urged communities to shun away from culture and traditions that destroy them healthily and instead to change their behavior from negative to 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 ,”Said Mr. Mwarogo.

According to the Kilifi County Integrated SMART survey of 2023 , the focus was on children aged 6-59 months, assessing disease incidence , the survey delved into symptoms presented, whether caregivers sought healthcare for their ill child, and if so, where. The surveys outcomes revealed that 53.6% of children had experienced illness, with a substantial 86.4% of them having sought medical attention.

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

The leading incidence of illnesses was ARI/Cough at 28.7% followed by fever chills/malaria at 10.9% watery diarrhea (three watery stools) stands at 9.3% of which 83.9% and 80.6% of these cases received therapeutic zinc and ORS respectively as reported.

This story was made possible with the support of the UZIMA-DS project, funded by the National Institutes of health (NIH).