Tag Archives: immunization

Kenya: plan to halve infant diarrhoea prevalence

Kenya has set its sights on halving the prevalence of infant diarrhoeal disease – which kills dozens of children daily – within five years, using new treatments and by boosting preventive measures.

Every Kenyan child under five has an average of three episodes of diarrhoea annually, according to the 2008 Demographic and Health Survey.

Hon Beth Mugo, EGH, MP

“With 86 children dying every day, diarrhoea is the third leading cause of death among under-fives in Kenya. It is unacceptable, but we can stop this!” said Beth Mugo, Minister for Public Health and Sanitation, at the 31 March 2010 launch in Nairobi of national policy guidelines [1].

The new guidelines, she said, complemented the government’s Child Survival and Development Strategy with a package of interventions based on using a new type of oral rehydration salts (ORS) containing lower concentrations of glucose and salt; zinc supplements to reduce the frequency of episodes; selective use of antibiotics; and encouraging prevention through breastfeeding.

“With exclusive breast feeding, vitamin A supplementation, strengthened routine childhood immunization, proper hygiene and access to improved water supplies, we can curb the number of deaths,”said David Okello, country representative of the World Health Organization (WHO).

“We are also looking forward to solutions such as PATH’s rotavirus vaccines. With 730,000 doses distributed this year, we could really make a difference for all the children of Kenya,” said Annah Wamae, head of the Department of Child Health at the ministry.

Kenya's new diarrhoeal disease control guidelines

According to the WHO, vaccination is the only preventive method for diarrhoeal disease cases caused by rotavirus, the most severe form of diarrhoea. In Kenya rotavirus causes 7,500 deaths each year.

At the launch, Sanjiv Kumar, the UN Children’s Fund Kenya (UNICEF) chief of health, announced a financial support package worth US$850,000 by the end of 2010. Aimed at control and management of diarrhoeal disease in Kenya, Kumar added that the focus of the funding was to scale up oral rehydration therapy to cover the whole country; train health staff in new enhanced diarrhoeal guidelines; and to support communication to promote appropriate household behaviours.

Calling for more resources from partners to implement child health programmes, Mugo said resources allocation would be increased to include training of health personnel on control and management of diarrhoeal diseases, strengthening of health systems and programmes aimed at empowering communities to control diarrhoeal diseases.

“The rate of exposure to diarrhoea and waterborne diseases in this country is extremely high because of the high fluoride content in groundwater and the poor wastewater treatment,” James Gesami, Assistant Minister for Public Health and Sanitation, told IRIN.

“In 2010, no single town in Kenya has a sustainable water supply,” he added. “We can’t do much about quantity, but when it comes to quality, the Ministry of Health is working together with USAID and other partners to set up a strategy that will include the protection of springs ready by 2015.”

Training parents

The new guidelines include training parents in home-based care to under-fives to help them recognize the symptoms of dehydration.

This follows the health ministry’s recognition that about 30 percent of children with diarrhoeal diseases are not getting any oral rehydration salts or fluids. Home therapy will include information about recommended fluid intake to prevent dehydration at the onset of diarrhoea as well as feeding, including breastfeeding, during and after diarrhoea.

“Together with our partners, we can save thousands of lives. A coordinated approach involving already proven prevention and treatment methods is the way to do it,” said Olivia Yambi from UNICEF.

[1] Wamae, A. … [et al.] (2010). Policy guidelines on control and management of diarrhoeal diseases in children below five years in Kenya. Division of Child and Adolescent Health, Ministry of Public Health and Sanitation. Download PDF file [407 KB]

Source: IRIN, 01 Apr 2010.

See also the press release by PATH “New policy unveiled to combat diarrhoeal disease, a leading killer of Kenyan children”, 31 Mar 2010

Sanitation vs. vaccination in cholera control

IVI scientist Dr. Anna Lena Lopez with local children during oral cholera vaccine trial in Kolkata, India, Aug 2006. Photo: IVI

IVI scientist Dr. Anna Lena Lopez with local children during oral cholera vaccine trial in Kolkata, India, Aug 2006. Photo: IVI

Only weeks away from the launch in India of an oral cholera vaccine significantly cheaper than available vaccines, community workers and health officials are still sceptical of whether a vaccine is the best way to control cholera, according to the International Vaccine Institute (IVI).

IVI’s director John Clemens told IRIN some water and sanitation programme managers argue that the focus in cholera control should be on safe water access rather than vaccine development.

[…] Introducing a cheaper vaccine in endemic countries “does not mean diminishing the importance of safe water access”, said IVI’s Clemens. “It is a false dichotomy to pit sanitation against vaccination. Improved water and sanitation is the ultimate, but still far-off, goal for impoverished [endemic] countries. Meanwhile we need to think about inexpensive ways to augment efforts [to control cholera].”

Clemens told IRIN that despite a decade of education about the importance of sanitation and safe drinking water, cholera infections have not declined. “Rather, in recent years there have been unprecedented outbreaks of unprecedented duration [in places] where [cholera] had not been [as serious] a problem in recent years.”

[…] People living in countries hardest hit by cholera can ill afford the only internationally licensed vaccine sold as Dukarol, Clemens told IRIN. […] Dukarol can cost up to US$30 per dose and requires at least two doses with boosters. IVI’s new vaccine, Shanchol, is expected to cost about $1 per dose and calls for two doses.

Other more affordable oral vaccines are not licensed internationally.

IVI’s oral vaccine is in the final phase of a clinical trial in India where 70,000 patients have been tracked since 2006. The manufacturer is expecting to produce five million doses in the first year of immunisations. IVI’s director said the vaccine has not been tested on infants under one year old. IVI, based in Seoul, South Korea, started cholera research in 1999 with almost $40 million from The Bill & Melinda Gates Foundation. The institute received an additional $20 million in 2006 to introduce a cholera vaccine in endemic countries. As the cholera vaccine is licensed only in India, IVI will seek WHO’s approval in late 2009.

See IVI’s page on its cholera vaccine programme.

Source: IRIN, 14 May 2009