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INTRODUCTION SITUATION ANALYSIS

Introduction

The Government of Kenya through the Ministry of Public Health and Sanitation launched the Child Survival and Development Strategy in June 2009 and is in the process of finalizing the Road Map for Maternal, Newborn and Child Health and Development in order to significantly reduce maternal and child deaths and

promote children’s growth and development. It is evident that if Kenya has to achieve MDGs 5 (reducing maternal mortality by three quarters of 1990 level) and 4 (reducing under-five mortality by two thirds of 1990 level by 2015), then extra efforts must to be made to target areas where maternal and child mortality are highest namely Nyanza, Western Provinces and parts of Rift Valley for child mortality and Northern Kenya for maternal mortality.

Situation Analysis

Kenya has an estimated population of about 38 million in 2009. The country has experienced relatively poor economic performance in the past two decades. The initial gains made after independence in 1963 was followed by a downward trend in the early 1980s with further deterioration in the late 1990’s.

The leading immediate causes of under-five mortality in Kenya are largely preventable. They include neonatal causes, malaria, diarrhoea and pneumonia. The major underlying causes of child morbidity and mortality include poor care practices, inadequate access to food, HIV and AIDS and poor access to safe water and sanitation.

Similarly, maternal mortality ratio remains high in Kenya is about 488/100,000 live births according to the 2008 Kenya Demographic and Health Survey. This means that at least 6,000 women die annually from pregnancy related complications. As with child mortality, there are major regional disparities in maternal mortality with Northern Kenya having an estimated 1,000 maternal deaths per 100,000 live births, largely due to lack of access to skilled attendant as 95% of deliveries take place at home.

Table showing mortality rates

Map of Kenya showing mortality rates

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PRIORITIZING HIGH IMPACT INTERVENTIONS

Prioritizing High Impact Interventions

Over the next two years, priority will be given to the acceleration of child survival and development through effective advocacy, mobilization of families and communities and application of a multi-sectoral approach to scale up the coverage of prioritized, simple and cost-effective high impact interventions.

High Impact Interventions

3% 5%24%

15%

16%3%

14%

20%

Neonatal causes

Neonatal causes

Diarhoal diseases

Measles

Malaria

Pneumonia

Injuries

Others

Distribution of causes of deaths under fives in Kenya, 2000

Numerous challenges exist in the effort to help accelerate child survival and development (CSD) in Kenya. These include: overall unsatisfactory sanitation habits, dismal usage of Insecticide Treated Nets (ITN), immunization levels are low and so are knowledge and action on HIV. Poor access to safe drinking

water (only 42% access), near absence of exclusive breastfeeding in the first 6 months (only 3% breast feed), the low prevalence of handwashing with soap (5%), enrollment levels and a high dropout rate of girls in achieving education for girls and how to deal with the prevailing culture of violence and abuse against children remains a challenge. The initiative focuses on the following key high impact interventions:

Exclusive breastfeeding (EBF)

Early initiation of breastfeeding is a critical intervention for child survival. In 2003, 52% of children started breastfeeding within one hour of birth. Overall, exclusive breastfeeding rates are low although there has been an increase in exclusive breastfeeding rates below 6 months from 13% in 2003 to 32% in 2008/09.

Hand washing

This initiative seeks to achieve a significant health impact in Kenya by promoting Handwashing with soap and increase its prevalence from 5% to 30% by end of 2011. Promoted effectively, Hand washing with soap can have the single greatest impact of all hygiene behaviors on two leading causes of illness and

child mortality: diarrheal disease and acute respiratory infection (ARI).

Water and Sanitation

The Kenya Household Health Expenditure and utilization Survey (2007) found that 91% of urban households have access to safe drinking water compared to 51% rural households. The survey found that a significant proportion of households in Nyanza (54%) got water from unsafe sources.

Cholera/Emergency

Cholera contributes to a case fatality of diarrhea diseases. Cholera epidemics have been experienced in the world since 1817. Kenya has had its share of this burden having suffered several waves since 1971. These outbreaks have occurred in the years 1971, 1972, 1980, 1984, 1992-93, 1997, 2005 and 2007-08. In fact since 1971, it is apparent that Kenya had been suffering two waves of cholera every decade. Since the 21st century, cholera outbreaks have occurred annually in the country, with transmission taking longer to control.

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ORAL REHYDRATION THERAPY (ORT) HIGH IMPACT INTERVENTIONS

Oral Rehydration Therapy (ORT)

In Kenya, diarrheal disease and acute respiratory infections are among the leading causes of child mortality, with about 16% attributable to diarrhea (WHO). Diarrhea and gastroenteritis are the leading causes of hospitalization among infants and accounted for 6.3% of all causes of mortality in 1999. The KDHS 2008/09 found

that 72% of children with diarrhea were treated with any oral rehydration therapy (ORT) whereas 39% received ORS. The use of ORS increased marginally from 29% in 2003.

Immunization including Vitamin A

Over the past two decades, immunization coverage has remained generally low in Kenya. According to the Kenya Demographic and Health Survey, measles coverage in 1998 and 2003 was 79.2% and 74.4% respectively, whereas the proportion of fully immunized children aged 12-23 months was 65.4% and 60.1% in 1998 and 2003 respectively. However, there has been improvement in coverage as indicated in the 2008/09 KDHS – 85% measles coverage and 77.4% fully immunized rate.

High Impact Interventions

Oral Rehydration Therapy (ORT)

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PREVENTION OF MOTHER TO CHILD COMMUNICATION APPROACHES

Prevention of Mother to Child Transmission of HIV (PMTCT)

Communication Approaches

Community engagement

The 2007 Kenya AIDS indicator survey found a national HIV prevalence of 7.1% in adult population aged 15 – 64 years. The prevalence in urban and rural areas

was 8.4% and 6.7% respectively. Females were more affected with a prevalence of 8.4% as compared to 5.4% for men. Nyanza province was the most affected with a prevalence of 14.9% followed by Nairobi and Coast provinces which had a prevalence of 8.8% and 8.1%

respectively. On the other hand North East province had the lowest prevalence at

0.81% followed by Central province with a prevalence of 3.6%. Western province had a prevalence of 5.4%. In all provinces women were more affected then men. In Nyanza province the prevalence among women was the highest at 17.2% and also highest among men at 11.6%.

Insecticide Treated Nets (ITNs)The 2008/09 KDHS found that 61% of households owned at least one net whereas 54% of

households owned at least one ITN. There has been a significant increase in ITN coverage and use

between 2003 and 2008/09. The 2003 KDHS found that only 4.6% children under-five had slept under an ITN as compared to 46% in 2008/09 whereas only 4.4% of pregnant women slept under an ITN in 2003 as compared to 48% in 2008/09.

Following are the key communication strategies to guide overall scope, direction and key approaches: • Engagement of children as change agents

• Branded and edutainment campaign with an animation character.

• Multiple and sustained individual and community engagement points

• Mixed media approaches

• Consistent, innovative and activity based behaviour change, dialogue and engagement

• Sustainability through producing and marketing branded products

• Involvement of provincial administration, local authorities, opinion and religious leaders, civil societies and others in advocacy and social mobilization • Engagement of health workers in provision of health preventive and promoting messages through information, education and communication

COMMUNICATION APPROACHES

Communication Strategies

• CommunicationwithFamilies/CareGivers Following a strategic mix of local multi communication channels, the response will attempt to bridge the gap between information, knowledge and behaviors of the individuals and communities. The affected and at risk population will be provided information and skills and will be motivated to follow desired practices. • MobilizationofCommunicators Existing and new community communicator networks such as Community Health Workers (CHWs), Women Groups, Youth groups, Churches, Mosques, Media, Traditional/Community Leaders, and General Practitioners, will be involved for communication with their patients, followers, friends, families neighbors and communities.

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•MediaSupplementation Local available and new media are engaged to supplement messages including folk, loca1 newspaper and FM radio stations.