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Reversing the trends
NATIONAL HEALTH SECTOR
Republic of Kenya
Strategic Plan of Kenya
Community Strategy Implementation Guidelines Key Health Messages for Level 1 of the Package for Health A Manual for Community Health Extension Workers and Community Health Workers Ministry of Health
Key Level 1 Health Messages THIS PUBLICATION is one of a series that the Ministry of Health will produce to
support the achievement of the goals of the second National Health Sector Strategic
Plan, 2005–2010 (NHSSP II). Aiming to reverse the declining trends in key health
sector indicators, NHSSP II has five broad policy objectives. These are:
Increase equitable access to health services.
Improve the quality and responsiveness of services in the sector.
Improve the efficiency and effectiveness of service delivery.
Enhance the regulatory capacity of MOH.
Foster partnerships in improving health and delivering services.
Improve the financing of the health sector.
Any part of this document may be freely reviewed, quoted, reproduced or translatedin full or in part, provided the source is acknowledged. It may not be sold or used inconjunction with commercial purposes or for profit.
Key Health Messages for Level 1 of the Kenya Essential Package for Health – A
Manual for Community Health Extension Workers and Community Health Workers
Published by: Ministry of Health Sector Planning and Monitoring DepartmentAfya HousePO Box 3469 - City SquareNairobi 00200, KenyaEmail: [email protected] Taking KEPH to the Community Abbreviations and Definitions 4. COHORT 3: Late Childhood:
(6 To 12 Years)
4.1.1 Education and Socialization 1. Introduction and Background
1.1 Why This Manual 1.2 The Importance of Good 4.1.3 Personal Hygiene 4.2 Summary of Key Messages for 1.3 The Six Life Cycle Cohorts 2. COHORT 1: Pregnancy, Delivery
5. COHORT 4: Adolescence and
Youth (13–24 Years)
2.1.1 Care during Pregnancy 5.1.1 Reproductive Health 2.1.2 Use of Family Planning 5.1.2 Drug and Substance Abuse 2.1.3 Basic Human Rights 5.1.3 Nutrition for the Youth 2.1.4 Disabilities and Impairments 10 5.1.4 Mental Health 2.2 Summary of Key Messages for 5.2 Summary of Key Messages for 3. COHORT 2: Early Childhood
6. COHORT 5: Adults 25–59 Years
(2 Weeks–5 Years)
6.1.1 STIs AND HIV/AIDS 3.1.1 Early Childhood Development 14 6.1.2 Routine Health Care 3.1.2 The Basics of Breastfeeding 6.1.3 Tuberculosis 3.1.3 Nutrition and Growth 6.2 Summary of Key Messages for 3.1.4 Immunization 3.1.6 Respiratory Infections 7. COHORT 6: Elderly Persons (Over
3.1.8 Injury Prevention 3.1.9 TB and Other Urgent Problems 31 7.2 Summary of Key Messages for 3.1.10 Schooling Begins at Home 3.2 Summary of Key Messages for Household Dialogue Cards Immunization Chart Assessing a Sick Child Key Level 1 Health Messages Abbreviations and Condition in which the blood lacks sufficient red threatment (for malaria) corpuscles (known as "thin Insecticide treated (bed) Acquired immune deficiency Kenya Demographic and Kenya Essential Package for Adolescent Reproductive Health and Development Maternal and child health Ministry of Health Antiretroviral therapy National Coordinating Tuberculosis vaccine Agency for Population and Community health worker Community health extension All the persons of a specific Second National Health Sector Strategic Plan 2005– Colostrum The thick yellowish milk the mother produces in the first Oral rehydration salts few days after giving birth Person with disability Community-owned resource Person living with HIV and Directly observed treatment, Prevention of mother-to- short course (for TB) child transmission (of HIV) Diphtheria, pertussis and Reproductive health Sexually transmitted Female genital mutilation Sexually transmitted disease Haemorrhage Heavy loss of blood Human immuno-deficiency Voluntary counselling and Integrated management ofchildhood illness infant mortality rate Taking KEPH to the Community
Taking the Kenya Essential community resource persons who are Package for Health to the involved in mobilizing communities to Community: A Strategy for the improve their health. The CHWs can Delivery of LEVEL ONE SERVICES is the use the messages in their everyday the health sector's blueprint for interaction with household members.
promoting improved community, The CHEWs can rely on the manual as household and personal health they train, coach and support the practices, including health seeking CHWs in their work.
behaviour. The aim of the Community The intention of these key Strategy can be realized if health messages is to help people attain the workers, especially those working at behaviours and attitudes necessary to community level, and the community keep household members healthy. It is have the knowledge about the therefore my hope and that of the conditions of public health importance Ministry that as the dissemination of and the right skills for dealing with the messages contained herein these conditions. The availability of reinforces appropriate health seeking appropriate information for decision behaviours, the use of the manual will making at community, household and eventually enable communities, individual level is key to the households and individuals to live implementation of the Community healthy lifestyles.
This manual has been developed to provide that information. The manualpresents a set of essential healthinformation messages for level 1 KEPH Dr. T. Gakuruh
services. It is intended as reference Head, Department of Sector Planning material for community health workers (CHWs), community health extension Ministry of Health workers (CHEWs) and any other Key Level 1 Health Messages Many individuals and Services for providing valuable inputs institutions at the to the community implementation different levels of the health care system have participated The Ministry particularly in the process of developing this acknowledges our development manual. The Ministry of Health is partners, especially the World Health grateful to all of them for their Organization (WHO), the Department concerted effort to improve the for International Development (DFID) health of the communities of Kenya.
and the Swedish International Appreciation also goes the Development Cooperation Agency Departments of Preventive and (Sida) for the technical and financial Promotive Health Services and of assistance provided during the Curative and Rehabilitative Health manual development process.
Taking KEPH to the Community 1. Introduction and Background Communities are at the heart of delivery. Level 1 refers to the specific the Ministry of Health's second approach to community level health National Health Sector Strategic care services described in the Plan (NHSSP II – 2005–2010). The Community Strategy. The overall goal of community is so important to the the Community Strategy is to enhance success of NHSSP II that a specific community access to health care in strategy was developed for the order to improve individual productivity implementation and roll out of the plan and thus reduce poverty, hunger, and at the community level: Taking the child and maternal deaths, as well as Kenya Essential Package for Health to improve education performance.
the Community: A Strategy for the The community-based approach set Delivery of LEVEL ONE SERVICES. out in the Community Strategy is the The Kenya Essential Package for mechanism by which households and Health defines six levels of service communities strengthen their role inhealth and health-related development.
The strategy intends to do this by Levels of service delivery under KEPH
improving community members'knowledge of health care as well as the skills they need to participate in planning and managing local health Household-based caregivers, usually family members, are the first line of health care at level 1. For as long as Primary hospitals there have been families, they have always provided some essential Health centres, maternities, elements of care for people of all ages.
Not all family members, however, havesufficient knowledge and experience to provide care for all health conditions, or to prevent some of those conditions from occurring. The intention of theCommunity Strategy is therefore to support household-based caregivers through a host of community-owned Key Level 1 Health Messages resource persons (CORPs) who are messages is to help attain the experienced in many aspects of health behaviours and attitudes necessary to care. The resource persons closest to keep household members healthy. The the family are community health CHWs can use the messages in their workers (CHWs), who will each support everyday interaction with household about 20 households. The CHW is in turn members. For their part, the CHEWs can supported by a trained community rely on the manual as they train, coach health extension worker – a CHEW. The and support the CHWs in their work. The CHEW is based at a health facility but intention is not just to provide assigned to a specific sub-location to information, however. The manual also work with all the CHWs and other aims to serve as a tool for continuous resource people so as to ensure respectful dialogue that involves acceptable standards of care at level 1.
listening to people, and sharing All these people require specific, information in interesting and accurate information in order to meaningful ways. Ultimately the purpose is to help the primary caregiversto appreciate the relevance of themessages to their lives, as they freely 1.1 Why This Manual
share, exchange and absorb ideas,knowledge and opinions.
The purpose of this manual is to provide The manual thus aims at enhancing a handy reference for promoting the transfer of knowledge and skills on improved household health practices.
health matters from resource persons to The manual is intended for use by the family members with the idea of helping primary caregivers at the household people make informed choices, decisions level such as parents, grandparents and and actions for health. In other words, older children, plus the community the health messages serve as a health workers (CHWs) and the preventive measure because they can community health extension workers reinforce positive behaviour and (CHEWs) who support them. It can also influence attitudes. Armed with be used by any other community essential accurate information, resource people who are part of the households can seek early diagnosis of overall effort to improve the health of health problems and manage their the community. These may be health health situation appropriately. This will workers, teachers, government help the households to decrease their extension workers, and religious and health risks, stay productive and lower community leaders, among others.
health care costs.
Members of youth and women's groupsand non-government organizations,employers and business people, 1.2 The Importance of
members of trade unions, and social workers can all use this manual as areference material to support their Effective communication requires a message, the sender of the message, the The manual provides a set of receiver of the message, and feedback essential health information as "key from the receiver to the sender and messages" arranged by the age groups or back again. Communication is thus a cohorts defined in KEPH. The aim of the Taking KEPH to the Community Effective communication is a two-way process
two-way process that begins when one They are encouraged to discuss it person sends a message to another. To and to ask questions to clarify their work properly, communication must be understanding of what needs to be grounded in understanding, respect, and done, when and why.
honesty between the sender and thereceiver.
These factors should make it clear Communication has many purposes.
why community health workers are so It can inform people about an idea or important to the success of the event, persuade them to a point of view, Community Strategy – CHWs are by or even move them to take action. All definition respected members of the these purposes are important to the community whom people can turn to presentation of the messages in this and rely on for good advice. CHWs thus manual. CHWs have to inform mothers,
often have to communicate one-on-one for example, about the importance of a to individual family or household full course of immunizations for their members. In such interactions it is children. Then they have to persuade
necessary to portray an open, the mothers that their babies will sympathetic manner through both actually stay healthier if they have their spoken words and body language.
jabs on time. Building on this awareness, Comments should be respectful and they then reinforce the message so that questions answered in a way that the mothers will take action by actually
encourages the person to explore the taking their babies to clinic for the issue. The person should always be given an opportunity to respond.
People's reactions to new There are many different ways of information are influenced by how, communicating, but whether you are where and from whom they receive it.
working person-to-person within a These factors make a difference in community, advocating with political whether people act on the information.
leaders, or presenting ideas to People are more likely to trust community groups and meetings, the information and act on it if: basic principles are the same: They hear it repeatedly from many 1. Know who needs the information different sources.
and find out about their living The person delivering it is well conditions, language, customs and known and trusted.
level of knowledge. This helps to They understand how it can help identify the messages that are more their families.
relevant, more easily understood, It is communicated in a familiar and more likely to be accepted and Key Level 1 Health Messages 2. Use simple language that people 1.3 The Six Life Cycle
understand. Do not overload themessages with too many actions or technical details. Keep to theverified information in the manual.
The Kenya Essential Package for Health If the messages are adapted, their (KEPH) addresses the health accuracy should be verified.
requirements of six distinct cohorts (or 3. Make sure the audience understands stages) of the human life cycle: the information and knows how to Pregnancy, delivery and the newborn put it into practice. When you are child (up to 2 weeks of age) sharing the messages with parents Early childhood (2 weeks to 5 years) and other caregivers in the Late childhood (6 to 12 years) community, ask open-ended Adolescence (13 to 24 years) questions to encourage discussion.
Adulthood (25 to 59 years) This will help you to determine Elderly (60 years and over) whether the message is both clearlyunderstood and feasible. Utilize Emphasis in the early years of NHSSP their feedback to adjust the II is on the first two cohorts. The aim is messages and visual aids.
to phase in more specific attention to 4. Find ways to make the messages the others later during the strategy.
interesting and meaningful to each The following chapters detail the household and community such as by specific messages for each cohort to be illustrating them with local shared with communities and households examples and stories.
by the community health workers.
5. Repeat the information to reinforce Annex A contains Household Dialogue Cards that can be used by communityhealth workers to gather informationduring household visits. The answers tothe questions on the cards will helpguide the CHW on the type of healthmessages household members needmost.
Taking KEPH to the Community 2. COHORT 1: Pregnancy, Delivery and Newborn This first life cycle cohort during pregnancy and delivery, concerns pregnant women and pregnancy-related hypertension, and the unborn child (the antenatal other medical causes such as malaria phase); the mother and child during delivery (perinatal); and the first two All pregnant women need to have weeks after delivery (postnatal).
access to skilled care throughout The threats that affect the pregnant pregnancy, delivery and the postpartum mother and the newborn child include period. However, the 2003 KDHS showed maternal infections, anaemia, malaria, that only 42% of births in Kenya were complicated and unsupervised attended by a health professional, a deliveries, nutritional deficiencies, figure that varied regionally and by hypertension, and postpartum economic status.
haemorrhage. In response to thesethreats, KEPH at the community level Care during Pregnancy
calls for the use of insecticide treatedbed nets (ITNs), essential antenatal Too many people assume that pregnancy (tetanus vaccine and malarial is just another phase in a woman's life, prophylaxis) and postnatal care, family one that she will get over soon enough planning and child spacing information without too much extra attention or and methods, the use of skilled birth planning. But thousands of Kenyan attendants, and general health women experience complications during pregnancy, many of which are life-threatening for the women and theirbabies or leave them with severe 2.1 Key Messages
disabilities. For every woman who dies, approximately 30 more develop serious, aternal and neonatal death rates disabling problems. The dangers of in Kenya are unacceptably high.
childbearing can be greatly reduced if a According to the 2003 Kenya woman is healthy and well nourished Demographic and Health Survey (KDHS),the current level of maternal mortality 1 CBS/MOH/NCPD and IRD/Macro, 2004, Kenya is estimated to be 414 per 100,000 live Demographic and Health Survey 2003. Columbia births. Most of the deaths occur because Maryland: Central Bureau of Statistics, NationalCouncil for Population and Development (NCPD), of complications from abortion, bleeding Ministry of Health/Macro Inc.
Key Level 1 Health Messages before and during pregnancy, if she has going wrong. These complications a health check up by a trained health cannot always be predicted. Many worker at least four times during every dangers can be avoided if the woman pregnancy, and if the birth is assisted by goes to a health centre or to a skilled a skilled birth attendant such as a birth attendant when she first suspects doctor, nurse or clinical officer.
she is pregnant. The Ministry of Healthwants every pregnant woman to have at KEY MESSAGE 1:
least four check ups throughout each It is important for all pregnant pregnancy. The woman should also be women and their households to checked 12 hours and 6 weeks after have a birth plan and to organize delivery. A skilled birth attendant (such resources for getting skilled as a doctor, clinical officer or nurse) will assistance at delivery.
help ensure a safer pregnancy andhealthy baby by: Although it is usually impossible for Checking the progress of the a woman to know ahead of time what pregnancy so that if problems arise sort of a delivery she will have, it is timely action can be taken.
helpful to think about some of the Checking for high blood pressure, options her household might face when which can be dangerous to both she goes into labour. The household can mother and child.
make some decisions in advance about Checking for anaemia and providing what to do and how to care for her iron/folate supplements regularly.
when this happens. Making a plan helps Checking any infections during people consider what factors will make pregnancy, especially urinary tract this birth safe for mother and child, and infections and sexually transmitted an enriching and positive experience for infections (some of which can be the entire family. It can also help a passed to the baby), and treating household think about other possible them with antibiotics.
problems and how to handle them. It is Giving the pregnant woman two particularly crucial for the man of the injections to protect her and her family to be involved in the planning so newborn baby against tetanus that he is aware of the importance of Checking that the foetus is growing skilled birth attendance and knows what to do when the time comes.
Giving antimalaria tablets (IPT), if Regular clinical care, good nutrition and attention to possible non-pregnancy Preparing the woman for the related illness are important to the experience of childbirth and giving health of the mother and the baby.
advice on breastfeeding and caringfor herself and her newborn.
Providing voluntary and confidential KEY MESSAGE 2:
HIV testing and counselling, and if A pregnant woman needs to be HIV positive, providing treatment to checked at a clinic or health prevent transmission of HIV to the facility by a clinical officer, nurse baby. All women have the right to or doctor at least four times voluntary and confidential HIV during every pregnancy.
testing and counselling.
Every pregnancy deserves attention, All families need to know about as there is always a risk of something special risk factors and be able to Taking KEPH to the Community recognize the warning signs of possible After delivery, the skilled attendant problems such as bleeding or abdominal pain during pregnancy.
Check on the woman's health in the12 hours after birth and 6 weeks KEY MESSAGE 3:
Every household should have plans Advise the mother on how to and funds for quickly getting the prevent or postpone another birth.
woman, at any hour, to where she Counsel the mother on how to avoid can be delivered by a skilled birth sexually transmitted infections such attendant. If possible, the woman should temporarily stay at a place Explain how to reduce the risk of that is closer to a health facility exposing the infant to infections.
or hospital so that she is within reach of medical help.
KEY MESSAGE 4:
A pregnant woman needs the best Having a skilled birth attendant foods available to the family: milk, assist at the delivery in a health facility fruits, vegetables, meat, fish, eggs, and check on the mother in the 12 hours grains and beans. All these foods after delivery reduces the likelihood of are safe to eat during pregnancy.
either the mother or the baby becomingill or dying.
Many communities have traditional During delivery, the skilled approaches to the types of foods pregnant women are allowed to eat.
When labour has gone on for too Many of these approaches are simply long (over 12 hours) and an wrong. Women will feel stronger and be intervention is necessary.
healthier during pregnancy – and their How to reduce the risk of infection babies will be healthier – if they eat (clean hands, clean instruments, a foods that are rich in iron, vitamin A and clean delivery area).
folic acid. These foods include meat, What to do if the baby is in the fish, eggs, green leafy vegetables, and wrong position.
orange or yellow fruits and vegetables.
What to do if the mother is losing Health workers can provide pregnant too much blood.
women with iron tablets to prevent or When to cut the umbilical cord and treat anaemia.
how to care for it.
What to do if the baby does notbegin breathing right away.
KEY MESSAGE 5:
How to dry the baby and keep her or Pregnant women are particularly him warm after delivery.
susceptible to malaria, which can How to guide the baby to breastfeed cause serious problems for them immediately after delivery.
and their unborn baby.
How to deliver the afterbirth safelyand care for the mother after the Malaria is especially dangerous for baby is born.
pregnant women. It causes severe How to put recommended eye anaemia, miscarriages, stillbirths, low medicine in the baby's eyes to birth weight and maternal death.
Pregnant women should sleep under Key Level 1 Health Messages insecticide treated bed nets and if That treatment with specified possible try to avoid going out of the medicines during pregnancy can house at night for calls of nature.
greatly reduce the risk of passingthe infection to the infant.
KEY MESSAGE 6:
That special care during pregnancy Every pregnant woman should and delivery can reduce the risks of receive confidential counselling passing the infection to the infant.
and testing for HIV so that The different options for feeding her appropriate action can be taken if infant and the related risks. Health necessary to avoid passing the workers can assist in identifying a infection to the baby.
feeding method that can maximizethe infant's chance of growing up HIV counselling and testing can help healthy and free of HIV.
in early detection of HIV infection and That babies born to HIV-positive in enabling those who are infected to women who have not received get the support services they need, medication have about one chance manage other infectious diseases they in three of being born with HIV and might have, and learn about living with more than two-thirds of the infants HIV/AIDS and how to avoid infecting infected with HIV may die before others. Counselling and testing can also they are five years old.
help those not infected to remainuninfected through safer sex.
Use of Family Planning
If the result of an HIV test is negative, this means the person tested An analysis of recent fertility trends is not infected or it is too early to based on the results of the 2003 KDHS detect the virus. The HIV blood test may shows that fertility rates, which had not detect infection up to six months declined as contraceptive prevalence after infection. The test should be increased since the 1970s, actually repeated after six months.
stalled between 1998 and 2003.2 This Households and communities should means that more women are having demand and support confidential HIV/ more children than previously.
AIDS counselling, testing andinformation to help protect adults and KEY MESSAGE 7:
children from the disease. An HIV/AIDS Pregnancy before the age of 18 test can help couples decide whether to and after age 35 or within two have children. If one partner is infected, years of a previous delivery he or she could infect the other while increases the health risks for the attempting to conceive.
mother and her baby. The health Empowering women and promoting risks of pregnancy and childbirth safer sex, condom use, and better increase after four pregnancies.
detection and treatment of sexuallytransmitted infections can reduce HIVinfection in women. If a womandiscovers that she is HIV positive, she 2 NCAPD and MEASURE Evaluation, 2006, A Closer needs emotional support and counselling Look at KDHS 2003: Further Analysis of theContraceptive Prevalence and Fertility Stalls – to help her make decisions and plan for Summaries of Selected NCAPD Working Papers her future. A pregnant woman needs to 2005. Nairobi: National Coordinating Agency for Population and Development.
Taking KEPH to the Community Too many births, too close together, and births to adolescent girls endanger Too early, too
women's lives and the lives of their close, too many,
children. Delaying a first pregnancy until close together.
a girl is at least 18 years of age will help ensure a safer pregnancy and delivery, and will reduce the risk of her baby being born underweight.
health, nutrition- A girl is not physically ready to health problems.
begin childbearing just because she has started having menstrual periods. Her body will not be completely developed pregnant again. Men need to be aware until she is about 18 years of age.
of the importance of a two-year space Childbirth is more likely to be difficult between births and the need to limit the and dangerous for an adolescent than number of pregnancies to help protect for an adult. Babies born to very young their family's health. If a woman mothers are much more likely to die in becomes pregnant before she is fully the first year of life. The younger the recovered from a previous pregnancy, mother, the greater the risk to her and there is a higher chance that her new her baby. Because their bodies are not baby will be born too early and weigh fully developed, young women are also too little. Babies born underweight are more likely to develop fistulae during less likely to grow well and more likely to become ill. They are also four times Young women need special help to more likely to die in the first year of life delay pregnancy. All women and their than babies of normal weight.
families should be given information A woman's body can easily become about the risks of early pregnancy and exhausted by repeated pregnancies, how to avoid them. For example, the childbirth, breastfeeding and caring for risk of death for a young child increases small children. After four pregnancies, by nearly 50% if the mother has another especially if there has been less than baby before the child is two years old.
two years between births, she faces an In other words, one of the greatest increased risk of serious health problems threats to the health and growth of a such as anaemia ("thin blood") and child under the age of two is the birth of haemorrhage (heavy loss of blood). A a new sibling. Breastfeeding for the baby is at greater risk of dying if the older child stops too soon, and the mother has had four or more mother has less time to prepare the special foods a young child needs. She Family planning is one of the most may not be able to give the older child powerful ways of improving the health the necessary care and attention, of women and children. Health clinics especially when the child is ill. As a should offer advice to help people result, children born less than two years choose a family planning method that is apart usually do not develop as well, acceptable, safe, convenient, effective physically or mentally, as children born and affordable. Exclusive breastfeeding two years apart or more.
can delay the return of the mother's A woman's body needs two years to fertility for approximately six months recover fully from pregnancy and after childbirth. Exclusive breastfeeding childbirth. The risk to the mother's provides a woman with 98% protection Key Level 1 Health Messages from pregnancy, but only if her baby is A pregnant woman who is physically under the age of six months, her abused may be unable to have any more menstrual periods have not returned, children. Members of her family should and the baby is breastfed on demand be aware of these dangers and she and exclusively.
should be protected from her abuser.
Both the Children Act of 2001 and KEY MESSAGE 8:
the Sexual Offences Act of 2006 make Family planning is the responsibility specific provisions against various types of both men and women. Every of abuse. Community members should couple should decide on and use a know that the law is on the side of those family planning method to delay who are abused.
pregnancy, space births and limit the number of children they have.
KEY MESSAGE 10:
Every woman has the right to Men as well as women must take health care, especially during responsibility for preventing unplanned pregnancy and childbirth. Health pregnancies. They should have access to care providers should be available information and advice from a health and should treat women with worker so that they are aware of the various methods of family planning thatare available. Information can also be All women have the right to the obtained from a doctor, nurse, teacher, services of a skilled birth attendant such family planning clinic, and youth or as a doctor, nurse or midwife, and to women's organizations. Accurate emergency obstetric care if needed.
information and counselling will help Quality health care enables women to people to understand the various make informed decisions about their methods and to disregard the many health by offering information and myths that are circulated about the use counselling. It should be easy for women of contraceptives.
who need maternal care to reach thehealth facility, and cost should not Basic Human Rights
prevent women from using theseservices. Health care providers should Human rights are women's rights too.
have the skills needed to provide quality Women have the right to be safe in their care. They should be trained to treat all homes and communities. They are women with respect, to be sensitive to entitled to effective, respectful health cultural norms and practices, and to care services.
respect women's right to confidentialityand privacy.
KEY MESSAGE 9:
Physical abuse of women and children is a serious public health problem and is unacceptable.
Abuse during pregnancy is Approximately one out of ten people in dangerous both to the woman and every population is a person with a to the unborn baby.
disability (PWD). In other words, 10% ofKenyans are people with disability. The If a pregnant woman is abused, she mandate of the Ministry of Health is to and the foetus can be seriously harmed.
Taking KEPH to the Community provide preventive, promotive, curative Some causes of disability and and rehabilitative health services to all Kenyans for their social, cultural and economic development. Health care is a Drugs consumed by the mother basic human right and PWDs enjoy equal rights as the able bodied people (The Diseases like malaria, syphilis and Disability Act 2003, Laws of Kenya).
Disability does not discriminate Delayed births – babies born to against gender, and women with women over age 40 are more likely disabilities are also among the expec- to have disabilities tant mothers of this country, with theirspecial needs largely taken for granted KEY MESSAGE 13:
to their detriment. PWDs, especially All newborn babies need to be women, are known to be the most protected from infections that vulnerable to rape or sexual abuse with may interfere with their growth its attendant problems of pregnancy, and development.
transmission of STIs, HIV, etc.
Health care providers should: KEY MESSAGE 11:
Check for any congenital All pregnant women should be abnormality and if present seek screened for disabilities and medical attention.
impairments and advised on the Ensure the infant is immunized best and suitable methods of against tuberculosis at birth (BCG).
delivery for them.
Ensure the infant is given an eyemedicine at birth (tetracycline eye Some newborns are found to have physical disabilities at birth; they mayhave cleft palates, be blind, or have Mothers should be advised to: paralysed legs or arms. Other disabilities Begin breastfeeding at birth, within or impairments are not evident immedi- the first one hour of delivery.
ately after birth, e.g., deaf and mute.
Breastfeed the infant exclusively forsix months. That is, the baby is notgiven any food except breast milk KEY MESSAGE 12:
for the first six months.
All newborns should be screened Not give the baby any fluid, even for disabilities and impairments in water, before the age of six months.
order to plan for any corrective Refer any child with oral thrush.
measures to address the problem.
Seek immediate medical attentionfor breast problems such as breast All newborns need to be screened engorgement/breast abscess and for impairments using appropriate cracked nipples.
methods and tools. The earlier this Ensure the child gets all the happens after birth the better it is for vaccines according to the schedule taking appropriate corrective measures.
on the child welfare card.
This is yet another reason why all Take the child to the nearest facility pregnant women need to deliver at for vitamin A from 6 months to 5 health facilities attended to by skilled years after every 6 months.
Key Level 1 Health Messages Keep the baby's umbilical cord clean weighing less than 2 kilograms at and dry after delivery and avoid any local applications to the umbilical The woman has had a previous cord. (Do not apply soot, ash, saliva, difficult or Caesarean birth.
Vaseline, soil, etc.) The woman has had a previous Avoid dipping the baby in water until miscarriage or stillbirth.
the cord falls off. Bathe the infant 8. Recognize the following warning/ with a soft cloth wrung out in warm danger signs during pregnancy and Keep the infant warm: wrap the Anaemia, paleness inside the baby snugly but not tightly.
eyelids, or being tired or easily Keep the baby close to the body out of breath.
Swelling of legs, arms or face.
The foetus moves very little ornot at all.
2.2 Summary of Key
Spotting or bleeding from the Messages for Cohort 1
vagina during pregnancy orprofuse or persistent bleeding 1. Recognize the warning signs during after delivery.
pregnancy and childbirth and have Severe headaches or abdominal plans and resources for getting immediate skilled help.
Severe or persistent vomiting.
2. Remind community members that physical abuse of women for any The water breaks before due reason is dangerous and time for delivery.
3. Encourage pregnant women to Prolonged labour.
attend at least four ANC visits 9. Encourage mothers to get before delivery.
immunized against tetanus.
4. Encourage all pregnant mothers to 10. Immunize all newborn children sleep under ITNs to prevent malaria.
against the preventable diseases.
5. Help a pregnant woman prepare a 11. Ensure all births are notified and birth plan, that is, what to do when the time comes.
12. Remember that the child health card 6. Encourage all pregnant women to is an important document that must deliver with the assistance of skilled be kept safely to monitor growth medical personnel.
and immunization and other services 7. Recognize the following risk factors to the child.
13. Wash hands before feeding or breastfeeding, after cleaning the An interval of less than twoyears since the previous birth.
baby's faeces or using the toilet.
14. Breastfeed your baby exclusively for A girl is under 18 or a woman isover 35 years of age with first 15. Follow instructions given at the health facility FOR EACH SERVICE.
The woman has already had fouror more deliveries.
16. Encourage fathers to be involved in the reproductive health of the The woman has had a previouspremature birth or baby Taking KEPH to the Community 3. COHORT 2: Early Childhood (2 weeks–5 Years) During this phase, the treatment of diseases environment of the child poses of childhood, vitamin constant and serious health A distribution).
threats: Malaria, diarrhoeal disease, have a major role upper respiratory infections and TB, workers have a major worm infestations, and malnutrition all contribute to the well-documented high child mortality and morbidity figures.
healthy by sharing sharing important Kenya's national average infant important information mortality rate (IMR) is 115/1,000 live with parents.
births. This is an improvement over earlier years, but is unacceptably high.
Moreover, the average conceals wide 3.1 Key Messages
differences across the country. The 2003KDHS, for example, found a very high The first eight years of childhood are IMR in Nyanza Province, at 206/1,000 critically important, and most live births, compared with only 54/1,000 particularly the first three years. They live births in Central Province.
are the foundation of future health, Integrated management of childhood growth and development. During this illness (IMCI) provides a comprehensive period, children learn more and faster package with proven effectiveness for than at any other time. Babies and this cohort. It includes community-level young children develop more rapidly and IMCI (promotion of treated bed nets, learn more quickly when they receive exclusive breastfeeding up to six love and affection, attention, months, appropriate nutrition advice) encouragement, and mental stimulation, and a service-related or clinical IMCI as well as nutritious meals and good (immunization, child weighing clinics, health care. All children have the rightto legal registration at birth, healthcare, good nutrition, education, and All children have the right to protection from harm, abuse and birth registration, health care, discrimination. It is the duty of parents good nutrition, education, and and governments to ensure that these protection from harm, abuse and rights are respected, protected and Key Level 1 Health Messages A child who has completed Children's minds develop rapidly immunizations on time and has been when they are talked to, touched and given proper nutrition has an increased cuddled, and when they see familiar chance of survival and is more apt to faces, hear familiar voices and handle interact, play and learn. A healthy child different objects. Babies learn quickly is usually happy and pleasant to be when they feel loved and secure from around. At a very practical level, birth and when they frequently play and keeping a child healthy will reduce the interact with family members. Children family's expenditure on health care, the who feel secure usually do better in child's absence from school due to school and cope more easily with the illness and the income lost to care for a difficulties of life. Caregivers can help children learn and grow by giving themnew and interesting things to look at, listen to, hold and play with. Crying is the way very young childrencommunicate their needs. Respondingpromptly to the cry by holding and Babies learn rapidly from the moment of talking soothingly to the child will help birth. Holding, cuddling and talking to establish a sense of trust and security.
the child stimulate growth and promote Babies and small children should not emotional development. Being kept be left alone for long periods of time.
close to the mother and breastfed on This delays their physical and mental demand provides the infant with a sense development. The most important way of security. The baby needs to suckle for children develop and learn is through both nutrition and comfort.
interaction with others. The more often Skin-to-skin contact and breastfeed- parents and caregivers talk to and ing within one hour after birth help respond to the child, the quicker the babies achieve better growth and devel- child learns. Parents or caregivers should opment and establish a close bond with talk, read or sing to infants and young their mother. Touch, hearing, smell, sight children. Even if children are not yet and taste are learning tools the child uses able to understand the words, these to explore the surrounding world.
early "conversations" develop theirlanguage and learning capacities.
Conversations don't have to be "baby KEY MESSAGE 1:
talk" – caregivers can simply describe Care and affection during the what they are doing or the way things earliest years help a child to appear in a conversational way. It is the tone of voice and the attention that willengage the baby's interest. Teaching Exclusive breastfeeding on demand children first in their mother tongue for the first six months, timely helps them develop their ability to thinkand express themselves. Children learn introduction of safe and nutritious language quickly and easily through complementary foods after the age of songs, family stories, rhymes and games.
six months, and continued breastfeeding Boys and girls have the same for two years or beyond all have inter- physical, mental, emotional and social related benefits. They provide the child needs. Both have the same capacity for with good nutrition, protect the child's learning. Both have the same need for health and build bonds of affection.
affection, attention and approval.
Taking KEPH to the Community All children need to be encouraged affection and stimulation and ensure the and praised when they learn to do and child receives a good quality education, say new things. When the child is not good nutrition and health care. The growing well, physically or mentally, father can help ensure that the parents need to seek the advice of a environment is safe and free of health worker.
violence. Fathers can also perform household tasks, Boys and girls have anaemic, malnourished or particularly when the the same physical, frequently sick may mother is pregnant or mental, emotional become fearful and upset breastfeeding. It has been more easily than healthy and social needs, said that one of the children and will lack the the same nutritional father's most important drive to play, explore and requirements, the contributions to his child's interact with others. These same capacity for welfare is to treat the children need special learning, and the child's mother with attention and encourage- respect and caring.
ment to eat.
affection, attention Parents and caregivers Children's emotions need to know the major and approval.
are real and powerful and milestones that show the should not be taken lightly.
child is developing Children may become frustrated if they normally. They also need to know when are unable to do something or have to seek help and how to provide a caring something they want, for example, or and loving environment for a child with they may be frightened of strangers or a physical or mental disability. While all the dark. Children whose reactions are children grow and develop in similar laughed at, punished or ignored may patterns, they all also develop at their grow up shy and unable to express own pace. By observing their young emotions normally. If caregivers are children to see how they respond to patient and sympathetic when a child touch, sound and sight, parents can expresses strong emotions, the child is identify signs of possible developmental more likely to grow up happy, secure problems or disabilities. If a child is and well balanced.
developing slowly, parents and caregivers Physical punishment or displays of can help by spending extra time with the violence can harm the child's child, playing and talking with the child, development. Children who are punished and massaging the child's body.
in anger are more likely to become If the child does not respond to violent themselves. Clear explanations stimulation and attention, parents and about what to do, firm rules about what caregivers need to seek help. Taking not to do and praise for good behaviour early action is very important in helping are more effective ways of encouraging children with disabilities reach their full children to become full and productive potential. Parents and caregivers need members of the family and community.
to encourage the greatest possible Both parents, as well as other family development of the child's abilities.
members, need to be involved in caring A girl or boy with a disability needs for the children. The father's role in extra love and protection. Like all day-to-day care is often underestimated children, such a child needs to be but is critically important. The father registered at birth or soon afterwards, can help meet the child's needs for love, to be breastfed, immunized and given Key Level 1 Health Messages nutritious food, and to be protected Support the baby's head when you from abuse and violence. Children with hold the baby upright.
disabilities should be encouraged to play Massage and cuddle the baby often.
and interact with other children.
Always handle the baby gently, even Children who are unhappy, having when you are tired or upset.
emotional difficulties or experiencing Breastfeed frequently, at least every problems that are too big for them to cope with may behave abnormally.
Talk, read and sing to the baby as Examples include suddenly becoming often as possible.
unfriendly, sad, lazy, unhelpful or Visit the health worker with the naughty; crying often; becoming violent baby six weeks after birth.
with other children; sitting alone insteadof playing with friends; or suddenly Warning signs to watch for:
having no interest in usual activities or Poor suckling at the breast or school work and losing appetite and refusing to suckle.
sleep. The problems that bring on such Little movement of arms and legs.
behaviour may be internal – that is, they Little or no reaction to loud sounds are related to the child's own feelings or bright lights.
and perceptions. Or they can indicate Crying for long periods for no something more serious, such as secret apparent reason.
abuse by a family member or friend.
Vomiting and diarrhoea, which can Parents and caregivers must be alert to lead to dehydration.
abnormal behaviour and try to find outwhat causes it.
By the age of 6 months
The following guide gives parents an Babies should be able to: idea of how children develop. There are Raise their head and chest when differences in the growth and lying on their stomach.
development of all children. Slow Reach for dangling objects.
progress may be normal for that Grasp and shake objects.
particular child, or may be due to Roll both ways.
inadequate nutrition, poor health, a lack Sit with support.
of stimulation or a more serious Explore objects with hands and problem. Parents may wish to discuss the child's progress with a trained Begin to imitate sounds and facial health worker or a teacher.
Respond to their own name and to By the age of 1 month
Babies should be able to:w Turn their head towards a hand that Advice for parents and caregivers:
is stroking their cheek or mouth.
Lay the baby on a clean, flat, safe Bring both hands towards their surface so she or he can move freely and reach for objects.
Turn towards familiar voices and Prop or hold the baby in a position so she or he can see what ishappening nearby.
Advice for parents and caregivers:
Continue to breastfeed on demand Make skin-to-skin contact and day and night, and start adding breastfeed within one hour of birth.
other foods (two meals a day at 6–8 Taking KEPH to the Community months, 3–4 meals a day at 8–12 Talk, read or sing to the baby as often as possible.
Warning signs to watch for:
the child is fully Stiffness or difficulty moving limbs.
Constant moving of the head (this receives all recommended doses of might indicate an ear infection, which could lead to deafness if nottreated).
Warning signs to watch for:
Little or no response to sounds, The child does not make sounds in familiar faces or the breast.
response to others.
Refusing the breast or other foods.
The child does not look at objectsthat move.
By the age of 12 months
The child is listless and does not Babies should be able to: respond to the caregiver.
Sit without support.
The child has no appetite or refuses Crawl on hands and knees and pull up to stand.
Take steps holding onto support.
The Basics of
Try to imitate words and sounds and respond to simple requests.
Enjoy playing and clapping.
Breast milk is the best food a young Repeat sounds and gestures for child can have. Animal's milk, infant formula, powdered milk, teas, sugar Pick up small items with thumb and drinks, water and cereal foods are all inferior to breast milk. Breast milk is Start holding objects such as a spoon easy for the baby to digest. It also and cup and attempt self-feeding.
promotes the best growth anddevelopment and protects against Advice for parents and caregivers:
illness. This protection lasts for as long Point to objects and name them, as the child is breastfed. Even in hot, talk and play with the child dry climates, breast milk meets a young baby's need for fluids. Water or other Use mealtimes to encourage drinks are not needed during the first six interaction with all family members.
months. Giving a baby any food or drink If the child is developing slowly or other than breast milk increases the risk has a physical disability, focus on of diarrhoea and other illnesses.
the child's abilities and give extrastimulation and interaction.
Do not leave a child in one position KEY MESSAGE 2:
for many hours.
Breast milk ALONE is the only Make the area as safe as possible to food and drink an infant needs prevent accidents.
for the first six months. No other Continue to breastfeed and ensure food or drink, not even water, is that the child has enough food and a needed during this period.
variety of family foods.
Key Level 1 Health Messages Having the baby start to breastfeed reducing the intake of breast milk.
soon after birth stimulates the The mother should not give other production of the mother's breast milk.
fluids and should breastfeed only.
It also helps the mother's uterus tocontract, which reduces the risk of Many new mothers need heavy bleeding or infection. The baby encouragement and help to begin should be allowed to breastfeed as often breastfeeding. How the mother holds as he or she wants. Colostrum, the thick her baby and how the baby takes the yellowish milk the mother produces in breast in the mouth are very important.
the first few days after birth, is the Holding the baby in a good position makes it easier for the baby to take the newborn babies. It breast well into the mouth and suckle.
is very nutritious Signs that the baby is in a good position the baby's "first and helps protect for breastfeeding are: The baby's whole body is turned towards the mother.
diarrhoea and other The baby is close to the mother.
The baby is relaxed and happy.
substitutes that are Holding the baby in a poor suckling position can cause such difficulties as: Sore and cracked nipples.
Not enough milk.
Refusal to feed.
one baby for a year Signs that the baby is feeding well: kilograms (about 80 The baby's mouth is wide open.
The baby's chin is touching the formula. Using breast milk substitutes, mother's breast.
such as infant formula or animal's milk, More of the dark skin around the can be a threat to infants' health. This mother's nipple can be seen above is particularly the case if parents cannot the baby's mouth than below it.
afford sufficient substitutes, which are The baby takes long, deep sucks.
quite expensive, or do not always have The mother does not feel any pain in clean water with which to mix them.
If regular weighing shows that a breastfed baby under six months is not Almost every mother can produce enough milk when: The child may need more frequent She breastfeeds exclusively.
breastfeeding. At least 12 feeds The baby is in a good position and during a 24-hour period may be has the breast well in the mouth.
necessary. The baby should suckle The baby feeds as often and for as for at least 15 minutes.
long as he or she wants, including The child may need help to take during the night.
more of the breast into the mouth.
The child may be ill and should be From birth, the baby should taken to a trained health worker.
breastfeed on demand. Newborns who Water or other fluids may be sleep more than three hours after Taking KEPH to the Community breastfeeding may be gently awakened important source of and offered the breast. Crying is not a energy, protein and sign that the baby needs other foods or other nutrients.
drinks. It normally means that the baby needs to be held and cuddled more.
not give the child Some babies need to suckle the breast breastfeed her child for comfort. More suckling will produce for as long as she and more breast milk. Mothers who fear that the child wish.
they do not have enough breast milk often give their babies other food or frequently as they drink in the first few months of life. This begin to crawl, walk, causes the baby to suckle less often, so play, pick things off the floor, and drink less breast milk is produced. The mother and eat foods other than breast milk. A will produce more milk if she does not sick child needs plenty of breast milk.
give the child other food or drink and Breast milk is a nutritious, easily breastfeeds often.
digestible food when a child loses Bottles should not be given to appetite for other foods. Breastfeeding breastfed babies because the sucking can comfort a child who is upset.
action for these is very different from The general guidelines for suckling at the breast. Using bottles complementary feeding are: even for breast milk could cause the From 6 to 12 months: Breastfeed mother to produce less breast milk and frequently and give other foods the baby to reduce or stop three to five times a day.
breastfeeding. Breastfeeding can From 12 to 24 months: Breastfeed provide an opportunity for a mother to frequently and give family foods five rest. Fathers and other family members times a day.
can help by encouraging the mother to From 24 months onward: Continue rest quietly while she breastfeeds the breastfeeding if both mother and baby. They can also make sure the child wish and give family foods five mother has enough food and help with times a day.
Any infant older than six months of There is a risk that a woman age needs other foods and drinks. From infected with HIV can pass the virus on the age of six months to one year, to her infant through breastfeeding.
breastfeeding should be offered before Women who are infected should be other foods, to be sure the infant takes advised by a health worker on how to plenty of breast milk every day. The reduce the risk of infecting the child.
child's diet should include peeled,cooked and mashed vegetables, grains, KEY MESSAGE 3:
legumes like peas and beans, and fruit, Bottle-feeding can lead to the some oil, as well as minced fish, eggs, illness and death of the baby. If a chicken or meat, along with dairy woman cannot breastfeed her products to provide vitamins and infant, the baby should be fed minerals. In the second year, breast milk or a breast milk breastfeeding should be offered after substitute from an ordinary clean meals and at other times. Breastfeeding should continue until the child is twoyears or older because breast milk is an Key Level 1 Health Messages Unclean bottles and teats can cause diarrhoea and ear infections. Diarrhoea KEY MESSAGE 4:
is deadly for babies. The best food for a Weigh your child regularly from baby who cannot be breastfed is milk birth to the age of two years. If a expressed from the mother's breast or child has not gained weight for from another healthy mother. The breast about two months then something milk should be given from a clean, open cup. Even newborn babies can be fedwith an open cup, which can be easilycleaned. Breast milk can be stored for Regular weight gain is the most up to eight hours at room temperature important sign that a child is growing without going bad. Keep it in a clean, and developing well. The child should be covered container.
weighed during every contact with a If breast milk is not available, a health care provider. A child who does nutritionally adequate breast milk not gain weight for two months may substitute should be fed to the baby by need larger servings or more nutritious cup. Infants who are fed breast milk food, may be sick, or may need more substitutes are at greater risk of death attention and care. Parents and health and disease than breastfed infants.
workers need to act quickly to discover Feeding the baby breast milk the cause of the problem.
substitutes can cause poor growth or Each young child should have a illness if too much or too little water is growth chart, a line that shows how well added or if the water is not clean. It is the child is growing. If the line goes up, important to boil and then cool the the child is doing well. A line that stays water and carefully follow the directions flat or goes down indicates cause for for mixing breast milk substitutes.
concern. If a child is not gaining weightregularly or growing well, there are Nutrition and Growth
some important questions to ask:w Is the child eating often enough? Achild needs to eat three to five More than half of all child deaths are times a day. A child with disabilities associated with malnutrition, which may require extra help and time for weakens the body's resistance to illness.
Poor diet, frequent illness, and Is the child receiving enough food? If inadequate or inattentive care of young the child finishes his or her food and children can lead to malnutrition. If a wants more, the child needs to be woman is malnourished during offered more.
pregnancy, or if her child is Do the child's meals have too little malnourished during the first two years "growth" or "energy" food? Foods of life, the child's physical and mental that help the child grow are milk, growth and development may be meat, fish, eggs, beans, nuts, grains slowed. This cannot be made up when and pulses. A small amount of the child is older — it will affect the vegetable oil will add energy. Some child permanently. Children have the oils available on the market are right to a caring, protective vitamin enriched.
environment and to nutritious food and Is the child refusing to eat? If the basic health care to protect them from child does not seem to like the taste illness and promote growth and of a particular food, other foods Taking KEPH to the Community should be offered. New foods should drawn from ponds, streams, springs, be introduced gradually.
wells or tanks should be boiled or Is the child sick? A sick child needs treated with chlorine to kill any encouragement to eat small, germs, then kept in a clean covered frequent meals. After an illness, the child needs an extra meal every day Does the child play in an area where for a week. Young children need chickens, goats or other livestock extra breast milk for at least a week are kept? Are faeces put in a latrine after an illness. A child who is or toilet or buried? A child who frequently ill should be checked by a comes into contact with faeces trained health worker.
(human or animal) may frequently Is the child getting enough foods get worms and other sicknesses. A with vitamin A to prevent illness? child with worms needs deworming Breast milk is rich in vitamin A.
medicine from a health worker.
Other foods with vitamin A are liver,eggs, dairy products, red palm oil,yellow and orange fruits and KEY MESSAGE 5:
vegetables, and many green leafy From the age of six months to two vegetables. If these foods are not years, children need to be fed five available in adequate amounts, a times a day, in addition to child needs a vitamin A capsule twice a year.
Thereafter the child can be fed Is the child being given breast milk family foods five times daily with substitutes by bottle? If the child is or without breastfeeding.
younger than six months, exclusivebreastfeeding is best. From 6 to 24 A child's stomach is smaller than an months breast milk continues to be adult's, so a child cannot eat as much at the best milk as it is an important one meal. But children's energy and source of many nutrients. If other body-building needs are great. So it is milk is given, it should be fed from a important that children eat frequently clean, open cup, rather than from a to provide for all their needs. Foods such as mashed vegetables or eggs, or a Are food and water kept clean? If little finely chopped meat or fish should not, the child will often be ill. Food be added to the child's food as often as storage areas like cupboards should possible. A small amount of oil may be be kept clean. The food should be covered to keep out insects and dirt.
If meals are served in a common Foods like fruits that are eaten raw dish, younger children may not get should be washed with soapy water enough to eat. Young children should and dried before they are eaten.
have their own plate or bowl of food to Food to be cooked should also be ensure they can eat what they need and washed well in clean water. Cooked so the parent or caregiver can see how food should be eaten without delay.
much they have eaten. Young children Leftover food should be thoroughly may need encouragement to eat – but reheated. Water should come from a they should not be forced – and may safe source and be kept clean. Clean need help in handling food or utensils. A water may be obtained from a child with a disability may need extra protected spring or well. Water help eating and drinking.
Key Level 1 Health Messages Even mild anaemia in infants and more than a few days, the child needs young children can impair intellectual to be taken to a health worker. The child development. Anaemia in children under is not fully recovered from an illness two years of age may cause problems until he or she weighs about as much as with coordination and balance, and the when the illness began.
child may appear withdrawn andhesitant. This can limit the child's ability to interact and may hinderintellectual development. Iron All children have the right to supplements for pregnant women immunization. Even so, despite the protect both women and their babies.
availability of vaccines and the efforts Malaria and hookworm can cause or of the Ministry of Health, the 2003 KDHS worsen anaemia. Malaria can be found that 27% of Kenyan infants reach prevented by sleeping under a mosquito their first birthday without being fully net that has been treated with a immunized against measles. All parents recommended insecticide. Children must be made aware of the importance living in areas where worms are highly of knowing why, when, where and how endemic should be treated two to three many times the child should be times a year with a recommended immunized. Parents also need to know deworming medication. Good hygiene that it is safe to immunize the child practices help prevent worms.
even if the child has an illness or adisability or is suffering from EY MESSAGE 6:
During an illness, children need to continue to eat and drink KEY MESSAGE 7:
regularly. After an illness, children Immunization is urgent. Every need at least one extra meal every child needs a series of day for at least a week.
immunizations during the first year of life. A child who is not immunized is more likely to suffer When children are sick, their illness, become permanently appetite decreases and their body uses disabled, or become the food they eat less effectively. If this undernourished and die.
happens several times a year, the child'sgrowth will slow or stop. It is essentialto encourage a sick child to eat and Why is immunization so important? drink. This can be difficult, as children Because immunization provides who are ill may have no appetite. It is protection against many dangerous important to keep offering foods the diseases – some of which are even more child likes, a little at a time and as dangerous for children. Besides measles, often as possible. Extra breastfeeding is immunizable diseases include diphtheria, whooping cough (pertussis), It is also essential to encourage a polio, tetanus and others. These sick child to drink as often as possible.
diseases can kill. Children who survive Dehydration is a serious problem for these diseases are weakened and may children with diarrhoea. Drinking plenty not grow well or may be permanently of liquids will help prevent dehydration.
disabled. They may die later from If illness and poor appetite persist for malnutrition and other illnesses. All Taking KEPH to the Community children have the right to be protected of malnutrition, poor mental from these diseases.
development, and hearing and visual Breast milk is the baby's "first impairments. The signs that a child has immunization". It helps to protect measles are a fever and rash that have against diarrhoea, ear and chest lasted for three days or infections, and other health problems.
more, together with a The protection is greatest when breast cough, a runny nose or milk alone is given for the first six red eyes. Measles can months and breastfeeding continues well cause death.
into the second year and beyond. No other drinks or foods can provide this everywhere, need to be immunized against Vitamin A also helps children fight polio. The signs of infections and prevents blindness. In polio are a floppy limb areas of vitamin A deficiency, children or the inability to aged six months and older should be move. For every 200 children who are given vitamin A capsules or liquid when infected, one will be disabled for life.
they are immunized. Vitamin A is also an Pregnant women need to be important part of measles treatment.
immunized to protect themselves and Immunizations should begin early – their infants from tetanus, a major killer in fact, some are given at birth. Half of of newborn infants. Tetanus bacteria or all deaths from whooping cough, a third spores grow in dirty cuts. In certain of all cases of polio and a quarter of all situations mothers give birth in deaths from measles occur in children unhygienic conditions. If a pregnant under one year old. It is essential that woman is not immunized against tetanus infants complete the FULL number of and tetanus bacteria or spores enter her immunizations — otherwise the vaccines body, her life will also be at risk. These may not work. The chart in Annex B germs can also grow if the umbilical summarizes the type and timing of cord is cut with an unclean knife or if immunization the child should receive anything unclean touches the end of the during the first year of life. The cord. Any tool used to cut the cord immunizations are most effective if they should first be cleaned and then boiled are given at the ages specified, or as or heated over a flame and allowed to close to those ages as possible.
cool. For the first week after birth, the A child is immunized by vaccines, baby's umbilical cord must be kept which are injected or given by mouth.
The vaccines build up the child's It is safe for a pregnant woman to defences against disease. But be immunized against tetanus. She immunization only works if given should be immunized according to this BEFORE the disease strikes. If for any reason a child has not had the full series A First dose: As soon as she knows she
of immunizations in the first year of is pregnant.
life, it is extremely important to have A Second dose: One month after the
the child fully immunized as soon as first dose, and no later than two possible or during special National weeks before her due date.
A Third dose: Six to 12 months after
All children need to be immunized the second dose, or during the next against measles, which is a major cause Key Level 1 Health Messages A Fourth dose: One year after the
hygiene practices or a lack of clean third dose, or during a subsequent drinking water, or when infants are not breastfed. Infants who are fed only A Fifth dose: One year after the
breast milk seldom get diarrhoea.
fourth dose, or during a subsequentpregnancy.
KEY MESSAGE 8:
At six weeks of age, the baby needs Diarrhoea kills children by the first dose of DPT (diphtheria, draining water from the body. As pertussis and tetanus vaccine) to extend soon as diarrhoea starts, give the protection against tetanus.
extra fluids as well as regular One of the main reasons why foods and fluids to the child. A parents do not bring a child for child's life is in danger if there are immunization is that the child has a several watery stools within an fever, a cough, a cold, diarrhoea or hour or if there is blood in the some other illness on the day the child faeces. Seek immediate help from is to be immunized. However, it is safe a trained health worker.
to immunize a child who has a minorillness. It is safe to immunize all A child who passes three or more children including those who are watery stools a day has diarrhoea. The disabled or malnourished. After an more numerous the watery stools, the injection, the child may cry or develop a more dangerous the diarrhoea. A child fever, a minor rash or a small sore. This with diarrhoea should be given drinks as is normal. Breastfeed frequently or give often as possible until the diarrhoea the child plenty of liquids and foods. On stops. Drinking lots of liquids helps to the other hand, any child who develops replace the fluids lost during diarrhoea.
a high fever after being vaccinated Recommended drinks for a child with should be taken to the health provider.
Breast milk (mothers should breastfeed more often than usual) Diarrhoeal diseases among children under five account for over 4.7% of all Fresh fruit juices outpatient cases in Kenya. Dehydration Weak tea with a little sugar caused by severe diarrhoea is a major cause of morbidity and mortality. Clean boiled or filtered water from a Children are more likely than adults to die from diarrhoea because they become Oral rehydration salts (ORS) mixed dehydrated more quickly. About 1 in with the proper amount of clean every 200 children who contract diarrhoea will die from it. The annualincidence of diarrhoea is 3.5 to 4.6 Diarrhoea usually cures itself in a episodes per child per year, making it few days. The real danger is the loss of one the of top child killers.
liquid and nutrients from the child's Diarrhoea is caused by germs that body, which can cause dehydration and are swallowed, especially germs from malnutrition. A child with diarrhoea faeces. This happens most often when should never be given any tablets, there is unsafe disposal of faeces, poor antibiotics or other medicines unless Taking KEPH to the Community these have been prescribed by a trained There are four major ways to limit health worker. The best treatment for the spread of diarrhoea: diarrhoea is to drink lots of liquids and Dispose of all faeces in a latrine or oral rehydration salts (ORS) properly toilet or bury them.
mixed with water.
Wash hands with soap or ash and If ORS packets are not available, water after contact with faeces.
dehydration can be treated by giving the Use treated or boiled water for child a drink made with four level teaspoons of sugar and half a level Thoroughly wash and dry then peel teaspoon of salt dissolved in one litre of all foods eaten raw and be sure all clean boiled and cooled water. Be very cooked foods are thoroughly done.
careful to mix the correct amounts, astoo much sugar can make the diarrhoea A child with diarrhoea loses weight worse and too much salt can be and can quickly become malnourished. It extremely harmful to the child. If the is a mistake to think that a child who mixture is made a little has diarrhoea should too diluted no harm not be given much can be done and there A child is not fully food. The opposite is is very little loss of recovered from diarrhoea true. A child with until he or she is at least diarrhoea needs all the Breastfed children the same weight as when food and fluid he or she should breastfeed as the illness began.
can take in addition to often as possible, and the extra fluids. Food other children should can help stop the drink plenty of liquids every time a diarrhoea and help the child recover watery stool is passed. Drinks should be more quickly. If the child is around six given from a clean cup. If the child months of age or older, parents and vomits, wait for 10 minutes and then caregivers should encourage the child to begin again to give the drink to the child eat as often as possible, offering small slowly, small sips at a time.
amounts of soft, mashed foods or foods The child should be given the extra the child likes. These foods should liquids until the diarrhoea has stopped.
contain a small amount of salt. Soft If the diarrhoea lasts longer than one foods are easier to eat and contain more week, caregivers should seek help from fluid than hard foods. Recommended a trained health worker.
foods for a child with diarrhoea are Parents should immediately seek well-mashed mixes of cereals and beans, help from a trained health worker if the minced fish or well-cooked meat, rich soups made with meat, beans or Passes several watery stools in one chicken, yoghurt, and fruits. One or two teaspoons of oil can be added to cereal Passes blood in the faeces and vegetables. Foods should be freshly Vomits frequently prepared and given to the child five or six times a day.
Is not able to drink/breastfeed After the diarrhoea stops, extra feeding is vital for a full recovery. At this time, the child needs to eat an Looks weak or is lethargic extra meal a day, or breastfeed more Has had diarrhoea for more than one every day, for at least two weeks. This Key Level 1 Health Messages will help the child Hands should always be washed with replace the energy and soap and water or ash and water after nourishment lost due to defecating, after cleaning the baby's the diarrhoea. A child is bottom, and immediately before feeding not fully recovered from children, handling food or eating. Young diarrhoea until he or she children frequently put their hands in is at least the same their mouths, so it is important to keep weight as when the the household area clean and to wash illness began.
children's hands often with water and Vitamin A capsules soap or ash, especially before giving and foods that contain vitamin A help a child Other hygiene measures can help to recover from diarrhoea.
prevent diarrhoea: Foods that contain Food should be prepared and vitamin A include breast thoroughly cooked just before eating.
milk, liver, fish, dairy Food left standing can collect germs products, orange or yellow fruits and that can cause diarrhoea.
vegetables like carrots, pumpkin, After two hours cooked foods are mangos and pawpaws, and green leafy not safe unless they are kept very hot or very cold.
Measles frequently causes severe All refuse should be buried, burned diarrhoea. Immunizing children against or safely disposed of to stop flies measles prevents this cause of diarrhoea.
from spreading disease.
Children and adults can swallow germs that cause diarrhoea if faeces touch the household's drinking water,food, hands, utensils or food preparation Coughs and colds may be danger signs of surfaces. Flies that settle on faeces and more serious illnesses such as then on food also transmit the germs pneumonia or tuberculosis.
that cause diarrhoea. Covering food anddrinking water protects them from flies.
All faeces, even those of infants and KEY MESSAGE 10:
young children, carry germs and are A child with a cough or cold should be kept warm and If children defecate without using encouraged to eat and drink as the latrine or toilet, their faeces should much as possible. If the child is be cleaned up immediately and put breathing rapidly or has fever take down the toilet or buried. Keeping the child immediately to a health latrines and toilets clean prevents the facility for treatment.
spread of germs.
Babies and very young children lose KEY MESSAGE 9:
their body heat easily. When they have a Wash your hands thoroughly with cough or cold they should be kept soap and water or ash and water covered and warm. Children with after contact with faeces, and coughs, colds, runny noses or sore before touching food or feeding throats who are breathing normally can be treated at home and will recoverwithout medicines. They need to be Taking KEPH to the Community kept warm, but not overheated, and be The child is breathing much more given plenty to eat and drink.
quickly than usual: for a child 2 to Medication should be used only if 12 months old — 50 breaths a minute prescribed by a health worker.
or more; for a child 12 months to 5 A child with a fever should be years old — 40 breaths a minute or sponged or bathed with cool but not cold water. In areas where malaria is The child is breathing with difficulty common, the fever could be dangerous.
or gasping for air.
The child should be checked by a health The lower part of the chest sucks in worker immediately.
when the child breathes in, or it The nose of a child with a cough or looks as though the stomach is cold should be cleared often, especially moving up and down.
before the child eats or goes to sleep. A The child has had a cough for more moist atmosphere can make breathing than two weeks.
easier, and it will help if the child The child is unable to breastfeed or breathes water vapour from a bowl of hot but not boiling water.
The child vomits frequently.
A breastfed child who has a cough or cold may have difficulty feeding. But breastfeeding helps to fight the illnessand is important for the child's growth, Malaria is the number one killer of so the mother should continue to children under five years in Kenya.
breastfeed often. If a child cannot Seeking early and proper treatment for suckle, the breast milk can be expelled malaria is critical if malaria related into a clean cup and the child can then mortality is to be reduced. Delaying be fed from the cup. Children who are treatment or using the wrong treatment not breastfed should be encouraged to can lead to serious complications and eat or drink small amounts frequently.
death. Most adults and caregivers of When the illness is over, the child should young children do not realize how be given an extra meal every day for at dangerous malaria is to children. They least a week. The child is not fully lack knowledge about appropriate recovered until he or she is at least the treatment of malaria, and don't same weight as before the illness.
appreciate the importance of early and Coughs and colds spread easily.
People with coughs and colds shouldavoid coughing, sneezing or spitting near KEY MESSAGE 11:
children. If a health worker provides Malaria is transmitted through antibiotics to treat a bacterial infection, mosquito bites. Sleeping under a like pneumonia or strep throat, that mosquito net treated with a comes with the cough or cold it is recommended insecticide prevents important to follow the instructions malaria. All children should sleep carefully. Give the child all the medicine under a treated mosquito net.
prescribed for as long as the instructionssay, even if the child seems better.
The child should be taken All members of the community immediately to a health clinic or a should be protected against mosquito trained health worker if any of the bites, particularly young children and following are present: pregnant women, and especially Key Level 1 Health Messages between sunset and sunrise when treatment is not completed, the malaria mosquitoes are most active.
could become more severe and difficult Mosquito nets, curtains or mats that to cure. Children with a fever should be are dipped in a recommended kept cool for as long as the fever insecticide kill mosquitoes that land on them. Special, permanently treated Sponging or bathing with cool (not mats should be used, or nets, curtains or cold) water.
mats that are regularly dipped in Covering the child with only a few insecticide. Usually, the nets need to be clothes or one blanket.
retreated when the rains begin, at leastevery six months, and after every third Malaria burns up energy, and the wash. Trained health workers can advise child loses a lot of body fluid through on safe insecticides and re-treatment sweating. The child should be offered food and drink frequently to help Babies and other small children prevent malnutrition and dehydration.
should always sleep under a treated Frequent breastfeeding prevents mosquito net. If the nets are expensive, dehydration and helps the child fight the family should buy at least one big infections, including malaria. Children net, which the small children can sleep with malaria should be breastfed as under. Breastfed babies should sleep often as possible.
with their mothers under a net. Treatedmosquito nets should be used KEY MESSAGE 13:
throughout the year, even during times Families and communities can when there are fewer mosquitoes.
prevent malaria by removing standing pools of water and cutting grass and bushes around KEY MESSAGE 12:
their dwellings to stop mosquitoes A child with a fever should be from breeding.
examined immediately by a trained health worker and receive an appropriate antimalaria treatment Mosquitoes breed wherever there is as soon as possible.
still water — for example in ponds,swamps, puddles, pits, drains, opencontainers, old tyres, hoof and tyre Malaria should be suspected if tracks, and the moisture on long grass anyone in the family has a fever, or if and bushes. They can also breed along the young children refuse to eat or have edges of streams and in water containers, vomiting, drowsiness or fits. A child with tanks and rice fields. The number of a fever believed to be caused by malaria mosquitoes can be reduced by: needs to be given immediate antimalaria Filling in or draining places where treatment as recommended by a health water collects.
worker. If children with a malarial fever Covering water containers or tanks.
are not treated within a day, they may Clearing bushes around houses.
die. A health worker can advise on whattype of treatment is best and how long Malaria affects the whole it should continue.
community. Everyone can work together A child with malaria needs to take to reduce the breeding places for the full course of treatment, even if the mosquitoes and to organize regular fever disappears rapidly. If the treatment of mosquito nets with Taking KEPH to the Community insecticide. Communities should ask all Electrical shock from touching health workers and political leaders in broken electrical appliances or their regions to help them prevent and wires, or poking sticks or knives into control malaria.
Anything that may be dangerous for active young children should be stored The most common childhood injuries are safely away, out of their reach. Children falls, burns, drowning and road should never be expected to work longhours or to do work that is hazardous or accidents. Children between 18 months interferes with schooling. Children must and four years old are at high risk of be protected from heavy labour, serious injury and death. Most of these dangerous tools and exposure to injuries happen in or near the home.
Almost all can be prevented. Many Burns and scalds are among the most would be less serious if parents knew common causes of serious injury among what to do when an injury happens.
young children. Children need to beprevented from touching cooking stoves, KEY MESSAGE 14:
boiling water, hot food and hot irons.
Many serious injuries can be Burns often cause serious injury and prevented if parents and permanent scarring, and some are fatal.
caregivers watch young children The great majority of these are carefully and keep their preventable. Burns can be prevented by: environment safe. Poisons, Keeping young children away from medicines, bleach, acid and liquid fires, matches and cigarettes.
fuels such as paraffin (kerosene) Keeping stoves and cookers on a should never be stored in drinking flat, raised surface out of the reach bottles. All such liquids and of children. If an open cooking fire poisons should be kept in clearly is used, it should be made on a marked containers out of raised mound of clay, not directly on children's sight and reach.
Turning the handles of cooking potsaway from the reach of children.
The main causes of injuries in the Keeping petrol, paraffin, lamps, matches, candles, cigarette lighters, Burns from fires, stoves, ovens, hot irons and electric cords out of cooking pots, hot foods, boiling the reach of young children.
water, steam, hot fats, paraffinlamps, irons and electrical Falls are a common cause of bruises, broken bones and serious head injuries.
Cuts from broken glass, knives, Serious falls can be prevented by: scissors or axes.
Discouraging children from climbing Falls from cots, windows, tables and onto unsafe places.
Keeping the home clean.
Choking on small objects such ascoins, buttons or nuts.
Broken glass can cause serious cuts, Poisoning from paraffin (kerosene), loss of blood and infected wounds. Glass insecticides, rat poison, bleach bottles should be kept out of the reach (e.g., Jik) and detergents.
of young children, and the house andplay area should be kept free of broken Key Level 1 Health Messages glass. Young children should be taught and wheezing like in asthma. Fumes not to touch broken glass; older children from charcoal can kill. Keep the house should be taught to dispose of any well ventilated when cooking over a fire broken glass safely.
Knives, razors and Poisoning is a serious danger to Stop, look and
scissors should be small children. Bleach (e.g., Jik), insect and rat poison, paraffin (kerosene), and crossing a road
household detergents can kill or perma- w Stop at the side nently injure a child. Many poisons do of the road.
children should be not need to be swallowed to be danger- w Look both ways.
trained to handle ous. They can kill, cause brain damage, w Listen for cars them safely. Sharp blind or permanently injure if they: or other vehicles Are inhaled.
machinery and rusty Get onto the child's skin or into the tins can cause badly w Hold the hand of infected wounds.
Get onto the child's clothes.
w Walk, don't run, If poisons are put in soft drink or across the road.
kept clear of these beer bottles, jars or cups, children may objects. Household drink them by mistake. All medicines, refuse, including chemicals and poisons should be stored broken bottles and old tins, should be in their original containers, tightly disposed of safely.
sealed. Detergents, bleaches, chemicals Very young children should not be and medicines should never be left given groundnuts (peanuts), hard where children can reach them. They sweets, or food with small bones or should be tightly sealed and labelled.
seeds. Young children should always be They should also be locked in a cupboard supervised during meals. Cut or tear or trunk or put on a high shelf where children's food, especially meat, into children cannot see or reach them.
small pieces. Coughing, gagging and Medicines meant for adults can kill small high-pitched, noisy breathing or the children. Medicine should only be given inability to make any sound at all to a child if it was prescribed for that indicate breathing difficulty and possible child and never be given to a child if it choking. Choking is a life-threatening was prescribed for an adult or some emergency. Caregivers should suspect a other child. Overuse or misuse of child is choking when he or she suddenly antibiotics can cause deafness in small has trouble breathing, even if no one children. Medication should only be used has seen the child put something into as prescribed by the health worker.
the mouth. Do not think you will be able Aspirin is a common cause of poisoning.
to hear the choking from another room – It should be kept out of the reach and often the child is unable to make a sight of children.
A small child who falls into even just Children should be protected from inches of water can drown. Wells, tubs smoke, fumes and other inhalations.
and buckets of water should be covered.
Some inhalations affect children's Children should be taught to swim when health. Inhalation of indoor smoke may they are young as they will then be less lead to chest problems in young likely to drown. Children should be children, e.g., difficulty in breathing taught never to swim alone.
Taking KEPH to the Community Road safety should be taught very TB and Other Urgent
early in life. Nearly half of Kenya's many road accident victims are pedestrians.
Young children do not think before they Babies and small children can get very run onto the road. Families need to sick very quickly – sick enough to die if watch them carefully. Children should they are not treated promptly.
not play near the road, particularly if Caregivers need to be alert to danger they are playing with balls.
signs that mean the child is very ill and Older children should be encouraged needs immediate treatment.
to look after younger children and to seta good example. Bicycle accidents are afrequent cause of injury and death KEY MESSAGE 15:
among older children. Families can All caregivers should be aware of prevent bicycle accidents if they make and watch for specific signs of sure that children with bicycles are serious problems in a baby aged trained in road safety. If possible, zero to 2 months. The signs are children should wear helmets or related to bacterial infection, protective headgear when biking.
diarrhoea and breastfeeding Children are at high risk of serious difficulties. These problems can injury if they travel in the front seat of be fatal. The baby should be taken a car or unsupervised on the back of a immediately to the nearest health pickup truck or lorry. Always ensure that children use seat belts when travellingin a vehicle and that babies are strappedinto special baby carriers. (If a person Major danger signs include: can afford a car, they can afford a baby A A bacterial infection Community members should be Umbilical discharge sensitized on the need for extra care Yellowness of the eyes when children are on or near a road, for example near a school. They should be informed that children lack grown-up spatial perception and cannot accurately judge the distance or speed of an A Breastfeeding problems - incorrect approaching vehicle. An adult driver or cyclist should never assume a child will
"get out of the way in time". Schools
Tuberculosis (TB) is a disease caused near roads that children must cross should by bacteria called Mycobacterium organize "crossing guards" – adults who tuberculosis. The bacteria usually attack are empowered to stop traffic so that the the lungs, but TB bacteria can attack children can cross safely.
any part of the body such as the kidney,spine and brain. If not treated properly,TB disease can be fatal. TB is spread Young children should be taught through the air from one person to their full names, the names of another. Bacteria are released into the their parents, where they live, air when a person with active TB coughs and the telephone numbers if or sneezes. People nearby may breathe any of caregivers or relatives.
in these bacteria and become infected.
Key Level 1 Health Messages example, it's important to stimulate KEY MESSAGE 16:
your baby's sense of touch to improve A child who has a cough lasting emotional and physical growth. Babies for two weeks or more should be and small children respond to facial taken for a TB test immediately.
expressions, hugs, and positive Early diagnosis and prompt treat- interaction. Parents need to recognize ment is the only way to beat TB.
the importance of this early education.
Reading aloud and activities that develop speech and language can all People with active TB disease are benefit a child by encouraging mental most likely to spread it to people they and physical development. Reading to spend time with every day. This includes your child also fosters speech and family members, friends and co-workers.
language development. In fact, any Babies, young children and people loving, responsive, affectionate infected with HIV have very weak interactions will help your child develop immune systems. This makes them prone normally. (For more about early child- to TB infection. Children born to hood development, see Section 3.1.1.) mothers with a chronic cough should bescreened for tuberculosis. If the motherhas TB, the baby should be protectedfrom TB by getting Isoniazid 5 mg/kg 3.2 Summary of Key
body weight for three months. If a child Messages for Cohort 2
has a chronic cough, the family shouldbe screened for TB too.
1. Immunize all children during the Refer to Annex C for guidelines on first year of life to protect against assessing a sick child, including major danger signs.
2. Give all children Vitamin A 3.1.10 Schooling Begins at
3. Monitor the child's growth monthly from birth to age two and thereafterwhen a child has a health problem.
The human brain reaches 90% of its 4. Recognize warning signs showing adult size during the first five years of that the child's growth and life. Children may fall behind in both development are faltering.
academic and social skills if during these 5. Give the child a proper mix of foods years they are not exposed to the right in 3–5 meals a day.
kinds of stimulation. Unfortunately, this 6. Provide stimulation and affection to gap only gets wider as children grow ensure social, physical and 7. Provide exclusive breastfeeding to KEY MESSAGE 17:
the infant for the first six months.
Young children need much more 8. Introduce weaning foods to infants than just food to develop. They from the age of six months, but need lots of intellectual, emotional continue breastfeeding through the and physical stimulation.
child's second year and beyond.
9. Keep the child health card safe. It is an important document that has all There are many ways to encourage the information about child your child's early development. For immunization and growth.
Taking KEPH to the Community 10. Remember that diarrhoea kills
worker and receive an appropriate children by draining water from the anti-malaria treatment as soon as body, thus dehydrating the child. As soon as diarrhoea starts, give the 16. Watch young children when they are child extra fluids as well as regular playing and keep their environment safe to avoid accidents.
11. Give the child an extra meal a day 17. Do not use drinking bottles to store
for at least two weeks while poisons, medicines, bleach, acid and recovering from diarrhoea.
liquid fuels such as paraffin. All such 12. To prevent diarrhoea, wash hands liquids and materials should be kept thoroughly with soap or ash and in clearly marked containers out of water after contact with faeces and children's sight and reach.
before touching food or feeding 18. Involve fathers in the care of their 13. Keep a child with cough or cold warm and continue normal feedingand drinking.
14. All children should sleep under a treated mosquito net to preventmosquito bites.
15. Have a child with a fever examined immediately by a trained health Key Level 1 Health Messages 4. COHORT 3: Late Childhood: The challenges that affect the early years, the brain's ability to change health of children aged 6–12 and grow is dramatic. It is important for years are becoming similar to parents to nurture their children‘s those of adults. However, these children curiosity from day one to foster normal are also still susceptible to malaria infection; they suffer from various worminfestations and they have a relativelyhigh risk of traumas and injuries (for KEY MESSAGE 1:
example, through child labour).
During the early and formative years of a child's development it is important to nurture and 4.1 Key Messages
encourage proper growth and development. Children learn how to behave by imitating the The KEPH focus for this age-group is behaviour of those closest to mainly on school health programmes, like de-worming, health education andthe promotion of physical activity(sports and various social activities). But In school as in life, consistent all parents and caregivers should know support from parents is crucial to that the child's education begins at sustaining a confidence and sense of home, and continues at home even after achievement. Parents play a distinct the child starts school.
role in their child's education. Anunderstanding of this role can help you help your child step up to the challenges Socialization of Young
of learning. By watching and imitatingothers, young children learn how to interact socially. They learn what kindsof behaviour are and are not High quality education in the early years acceptable. The examples set by adults makes a huge difference. Children who and older children are the most receive better early education are more powerful influences in shaping a child's likely to succeed in both school and in behaviour and personality. Children life. Early education creates connections learn by copying what others do, not in the brain that are important for what others tell them to do. If adults growth and socialization. During these shout and behave violently, children will Taking KEPH to the Community learn this type of behaviour. If adults child is protected from danger, treat others with kindness, respect and struggling to do something new and patience, children will follow their difficult is a positive step in the child's development. All children need a variety Children like to imitate. This should of simple materials to play with that are be encouraged as it develops the child's suitable for their stage of development.
imagination. It also helps the child Water, sand, cardboard cartons, wooden understand and accept the ways other building blocks, and pots and lids are people behave.
just as good as toys bought from a shop.
Children are constantly changing and developing new abilities. Caregivers KEY MESSAGE 2:
should pay attention to these changes Encouraging children to play and and follow the child's lead to help her or explore helps them learn and him develop more quickly.
develop socially, emotionally, Getting into the habit of active physically and intellectually.
physical activity early in life can preventmany problems later. Physical activity Children play because it is fun, but helps build and maintain healthy bones, play is also key to their learning and muscles and joints and can prevent or development. Playing builds children's delay the development of high blood knowledge and experience and helps pressure – which can even affect develop their curiosity and confidence.
children and adolescents. Such activity Children learn by trying things, need not be strenuous to be beneficial.
comparing results, asking questions and Moderate amounts of daily physical meeting challenges. Play develops the activity are recommended for people of skills of language, thinking, planning, all ages. This amount can be obtained in organizing and decision making.
longer sessions of moderately intense Stimulation and play are especially activities, such as brisk walking for 30 important if the child has a disability.
minutes, or in shorter sessions of more Parents can encourage emotional intense activities, such as jogging.
development by playing games with Playing ball, running races, even walking their children. Girls and boys need the to school and home again are all good same opportunities for play and for exercise for kids.
interaction with all family members.
Play and interaction with the father help KEY MESSAGE 3:
strengthen the bond between the father Girls who are educated are more and the child. Family members and likely to delay sexual activity. If other caregivers can help children learn they are healthy and have a good by giving them simple tasks with clear diet during their childhood and instructions, providing objects to play teenage years, they will have fewer with, and suggesting new activities – but problems in pregnancy and without dominating the child's play.
childbirth when the time comes.
Watch the child closely and follow her orhis ideas.
Caregivers need to be patient when Being able to read and write helps a very young child insists on trying to do women protect their own and their something unaided. Children learn from family's health. Girls who have at least trying until they succeed. As long as the seven years of schooling are less likely Key Level 1 Health Messages sometimes travel to other sites in the Be patient when a young child body and cause problems there as well.
insists on trying to do something Worms contribute to health problems in unaided. Children learn from both adults and children. A large number trying until they succeed.
of tapeworms or round worms in theintestines may lead to intestinalobstructions, while hookworms may to become pregnant during adolescence cause anaemia. Pinworms may cause and are more likely to marry later than irritation and frequent itching of the those with little or no education. A nutritious diet during childhood andadolescence reduces problems inpregnancy and childbirth. A nutritious KEY MESSAGE 4:
diet includes beans and other pulses, All children should be de-wormed grains, green leafy vegetables, and red/ at least twice a year yellow/orange vegetables and fruits.
Whenever possible, milk or other dairy The common types of worms are: products, eggs, fish, chicken and meat round worms (ascaris), hookworms should be included.
(ankylostoma), tapeworms (Taenia) and Female genital mutilation (FGM) or pinworms (also called threadworms, female circumcision can be the cause of oxyurae). All the worms except sometimes major health problems. In tapeworms can be treated with traditional rites the girl or woman mebendazole tablets. Tapeworms are experiences severe pain, shock and treated with niclosamide tablets.
sometimes severe bleeding. There is risk To prevent intestinal worms advise of infection, blood poisoning, tetanus and gangrene. Other problems can be Wear shoes or slippers (pata-pata).
lifelong. These may include urine Wash their hands after defecating, retention and associated urinary tract before handling food and before infections, obstruction of menstrual flow and related reproductive tract Use latrines, which should be infections, infertility, prolonged and located well away from sources of obstructed labour, and psychological pain. FGM may result in painful Cook meat well, especially pork and intercourse for both the man and the woman because it interferes with thenormal elasticity of the vagina and thelubricating system. The opening is thus too small and both parties experiencepain. The woman may also be injured.
Personal hygiene refers to the steps you The Children Act of 2001 forbids the take to keep your body clean and procedure on girls under age 18.
healthy. Good hygiene keeps andpromotes the health of people and the community. This means washing yourhands especially before eating anythingand after coming in contact with Worms are extremely common. There unclean items. Your body should be kept are different types of worms, most of clean by taking a bath at least once a which live in the intestines but can day if possible. Maintaining good Taking KEPH to the Community personal hygiene helps fight infection by 4.2 Summary of Key
removing substances that allow bacteriato grow from the surface of your skin.
Messages for Cohort 3
1. Ensure all children attend primary KEY MESSAGE 5:
Parents should support and 2. Ensure children receive an adequate encourage their children to balanced diet, three meals a day.
maintain good hygiene practices.
3. Respond to child's need for care by playing and talking with them, and Practices that children should providing a stimulating environment to promote mental and Washing hands frequently especially before eating and after visiting the 4. Seek health care as soon as an illness appears or is suspected.
Taking a bath at least once a day: 5. Insist that children sleep under ITNs Bathing/showering removes dirt, to prevent malaria.
dead skin cells and body odour.
6. Treat all drinking water at the point Brushing teeth after every meal: Regular brushing of the teeth keeps 7. Wash hands after visiting toilets and your mouth and gums healthy, so before eating in school and at home.
you can keep your breath odour- 8. Introduce sexuality education at focal points (home, church and Eating healthy foods.
Getting enough sleep.
9. Follow the instructions given at the health facility for each service.
Key Level 1 Health Messages 5. COHORT 4: Adolescence and Youth (13–24 Years) During adolescence, new threats professionals that messages targeted at to healthy development pose this specific age group need to be themselves. These are in different and adapted to their culture particular related to behaviour changes, and lifestyle.
like sexuality (STIs, HIV/AIDS and risk ofearly pregnancy), drug and substance abuse (alcohol and tobacco), andgeneral professional development According to Kenya's Adolescent Reproductive Health and DevelopmentPolicy (ARHDP, 2003), adolescents (youngpeople aged 10–19 years) constitute 5.1 Key Messages
25.9% of Kenya's population. They oftenlack the means to begin taking KEPH emphasizes services that are responsibility for their own reproductive specifically targeted for this age group: health because they do not fully like the provision of reproductive health understand or appreciate the changes in information and counselling and their bodies and may need reassurance contraceptives if necessary, voluntary and support.
counselling and testing (VCT) centres for Information and education on sexual testing HIV prevalence, promotion of and reproductive health is important for anti-tobacco and drinking habits, and adolescents. They need accurate and the establishment of youth-friendly appropriate information to help them services within existing health facilities.
understand their sexuality and the The need for such centres comes from reproductive process as they grow to the growing realization among health help them make sound decisions.
Too Young for Sex?
Prevention is the most The ARHDP also reports that adolescence effective strategy against the is associated with many adverse health spread of HIV/AIDS. Every outcomes that include pregnancy, person in every community abortion, sexually transmitted diseases unit should know how to avoid including HIV/AIDS. All of these can have getting and spreading the a devastating effect on the health and lives of the young.
Taking KEPH to the Community economic responsibilities. Millions of KEY MESSAGE 1:
adolescents are sexually active. These Early childbearing, unsafe adolescents are likely to have sex abortion and STDs threaten without using modern contraceptives or adolescents' health and future protection against STDs and pregnancy.
fertility. Delay sex, delay Sexuality Education
Sexuality education programmes can be
effective in teaching young people
Adolescents are more likely to important decision making and experience pregnancy related communication skills, which will help complications than are older women. A them resist peer pressure to have sex key reason for this is that young and make responsible decisions about women's bodies may not be mature initiating sex. Sex education does not enough to handle the stress of increase sexual activity. In fact, sex pregnancy and childbirth. Women below education can delay the start of sexual age 20 are especially likely to suffer activity and lead to protective from pre-eclampsia and eclampsia, behaviour once sexual activity begins.
obstructed labour, and iron deficiencyanaemia. Young women are also atgreater risk of developing fistulae as a KEY MESSAGE 2:
result of prolonged labour occasioned by Sexually active adolescents should their smaller pelvic size.
choose a method that they can STD and reproductive tract infection use successfully and that protects rates are particularly high among young them from both pregnancy and people. STDs not only cause illness that can interfere with a young person'seducation or employment, but also cancause infertility. The safest way to prevent pregnancy Unsafe abortion contributes and disease is to avoid sexual significantly to maternal morbidity and intercourse. Many adolescents lack the mortality among adolescents in Kenya.
skills necessary for abstinence or The majority seeking care for unsafe successful method use or lack the abortion complications are below 25 discipline to use a method consistently.
years (ARHDP, 2003).
They may need special counselling about Pregnant adolescents may be denied how to avoid pregnancy and STDs. For important opportunities. Compared with those who are sexually active, male and a woman who delays childbearing until female condoms, used correctly and her twenties, a woman who has her first consistently, provide the best protection child before age 17 is likely to receive against STDs while also preventing less education, be out of work, have a lower paying job and be separated from To help ensure contraceptive use her partner. Young, unmarried women among sexually active adolescents, have sometimes been forced to turn to contraceptive information, counselling prostitution to support themselves and and services must be readily and easily their children.
For young men, early fatherhood can disrupt educational plans and increase Abstinence has no side effects.
Key Level 1 Health Messages available. Youth-friendly services are a membranes (eyes, vagina, etc.). There priority of KEPH, so that more and more are basically three ways HIV is adolescents are expected to have access transmitted: through unprotected sexual to such services.
intercourse (vaginal, anal or oral) withan infected person; through contact with blood or other body fluids; and According to the ARHDP, adolescents are from an infected mother to a child in very vulnerable to HIV/AIDS infection.
the womb, during labour and birth, or About 20% of all reported new AIDS patients are young people aged 15-24 In Kenya the most common mode of years. Young women aged 15-19 years transmission is unprotected sexual are more than twice as likely to be intercourse. Other common ways of infected as males in the same age spreading HIV are by using unsterilized needles and syringes (most often thoseused for injecting drugs), razor blades,knives or other instruments for KEY MESSAGE 3:
injecting, cutting or piercing the body, AIDS is an incurable but and through transfusions of infected preventable disease. HIV, the blood. All blood for transfusions should virus that causes AIDS, is spread be screened for HIV.
through unprotected sex; It is NOT possible to get HIV/AIDS transfusions of unscreened blood; just by touching those who are infected.
from an infected woman to her Hugging, shaking hands, coughing and child during pregnancy, birth and sneezing will not spread the disease. HIV breastfeeding; and contact with cannot be transmitted through latrines contaminated body fluids such as or toilet seats, telephones, plates, with the re-use of contaminated glasses, eating utensils, or swimming needles and syringes.
pools. It is not spread by mosquitoes,flies or other insects.
AIDS is caused by the human School-aged children should be immunodeficiency virus (HIV), which provided with age-appropriate damages the body's defence system.
information on HIV/AIDS and life skills People infected with HIV usually live for before they become sexually active.
years without any signs of the disease.
Education at this stage has been shown They may look and feel healthy, but to delay sexual activity and to teach they can still pass on the virus to others.
AIDS is the late stage of HIV infection.
For those living with or affected by People who have AIDS grow weaker HIV/AIDS, care and compassion are because their bodies lose the ability to needed. Measures should be taken to fight off illnesses. In adults, AIDS remove the social, cultural and political develops 7 to 10 years after infection, barriers that block access to HIV/AIDS on average. AIDS is not curable, but new medicines can help people with AIDS livehealthier for longer periods.
Voluntary Counselling and Testing
HIV is contained in blood, semen, HIV counselling and testing can help in vaginal fluid and other body fluids, and the early detection of HIV infection and is most likely to be infectious if it in enabling those who are infected to contacts sores, cuts or mucous get the support services they need, Taking KEPH to the Community manage other infectious diseases they might have, and learn about living with mature women.
HIV/AIDS and how to avoid infecting others. Counselling and testing can also help those who are not infected to targeted by older remain uninfected through education about safer sex.
with little or no sexual experience KEY MESSAGE 4:
Everyone who is sexually active less likely to be should contact a health worker or go to a voluntary counselling and testing (VCT) centre to receive Girls have the right to refuse confidential counselling and unwanted and unprotected sex. Parents testing for HIV.
and teachers should discuss this issuewith girls and boys to make them aware If the result of an HIV/AIDS test is of girls' rights, to teach boys to respect negative, this means the person tested girls as equals, and to help girls avoid or is not infected or it is too early to defend themselves against unwanted detect the virus. The HIV blood test may sexual advances.
not detect the virus during the first sixmonths after infection. The test should KEY MESSAGE 5:
be repeated six months after any Parents and teachers can help possible exposure to HIV. Since an young people protect themselves infected person can transmit the virus at from HIV/AIDS by talking with any time, it is important to always use a them about how to avoid getting condom during sex or to avoid and spreading the disease, including the correct and Families and communities should consistent use of male or female demand and support confidential HIV/ AIDS counselling, testing andinformation to help protect adults andchildren from the disease. It is possible Young people need to be informed to stop HIV from spreading to the next that there is no vaccination and no cure generation if young people know the for HIV/AIDS. They need to understand facts about HIV transmission, if they that prevention is the only protection abstain from sex, and if they have against the disease. Young people also access to condoms if they don't abstain.
need to be empowered to refuse sex.
HIV rates are much higher among Condoms can save lives by preventing teenage girls than teenage boys.
the sexual transmission of HIV. Everyone Teenage girls are more susceptible to has the right to voluntary and HIV infection because: confidential counselling and testing for Young girls may not understand the HIV/AIDS and the right to be protected risk or may be unable to protect from discrimination of any kind related themselves from sexual advances.
to their HIV/AIDS status.
Their vaginal membranes are thinner HIV can be spread by unsterilized and more susceptible to infection needles or syringes, such as those used Key Level 1 Health Messages for injecting drugs. Used razor blades, hospital. Women who are raped should knives, or tools that cut or pierce the also seek post-exposure prophylaxis as skin also carry some risk of spreading soon as possible after the assault.
HIV. Nothing should be used to pierce a person's skin unless Other Sexually Transmitted
Sexually transmitted infections (STIs) Injections should be are infections that are spread through sexual contact, either through the exchange of body fluids (semen, vaginal and other STIs.
fluid or blood) or by contact with the child or adult being skin of the genital area (particularly if there are lesions such as blisters, or fully sterilized needle and syringe abrasions or cuts, often caused by the should be used. Sharing needles and STI itself).
syringes with anyone, including familymembers, may transmit HIV or otherlife-threatening diseases. No one should KEY MESSAGE 6:
share needles or syringes. Parents should Young people who have a sexually ask the health worker to use a new or transmitted infection (STI) are at sterilized needle for every person.
greater risk of getting HIV and of Any kind of cut using an unsterilized spreading HIV to others. People object such as a razor or knife can with STIs should seek prompt transmit HIV. The cutting instrument treatment and avoid sexual must be fully sterilized for each person, intercourse or practice safer sex.
including family members, or rinsed withbleach and/or boiling water. Any instru- STIs often cause serious physical ment that is used to cut a newborn's suffering and damage. Some can be umbilical cord must be sterilized.
passed to the baby during pregnancy or Particular care should be taken when birth. Any STI, such as gonorrhoea or handling the placenta and any blood syphilis, can increase the risk of from the delivery. Protective (latex) catching or transmitting HIV. Persons gloves should be used if available. Great suffering from an STI have a 5 to 10 care should be taken to avoid splashing times higher risk of becoming infected blood in the eyes during delivery.
with HIV if they have unprotected sexual Equipment for dental treatment, intercourse with an HIV-infected person.
tattooing, facial marking, ear piercing Women often have few or no and acupuncture is not safe unless the symptoms of sexually transmitted equipment is sterilized for each person.
The person performing the procedureshould take care to avoid any contactwith blood during the procedure.
KEY MESSAGE 7:
Health workers or family members Parents can help young people who are accidentally exposed to HIV protect themselves from risky contaminated body fluids should behaviours by having regular immediately seek post-exposure communication with them on such prophylaxis (treatment with anti- retroviral medication) at the district Taking KEPH to the Community Young people need to understand develop a dependency, moving on to the possible consequences of risky more dangerous drugs and causing behaviours of all types. Parents, significant harm to themselves and guardians or the person in the possibly others.
community in charge of rites of passagecan warn young people about the risksof HIV/AIDS, other STIs and unplanned KEY MESSAGE 8:
pregnancy. Traditional cultures can make Parents should talk with their it awkward for parents to discuss sexual children early and often about the issues with their children. One way to dangers of drug and substance begin the discussion with school-aged abuse. Never assume that "my children is to ask them what they have child" would never do drugs.
heard. If any of their information iswrong, take the opportunity to provide Parents can help keep their children them with the correct information.
from drug abuse by being good role Talking with and listening to young models, ensuring open communication people is very important.
with their children, and starting early to Parents who are uncomfortable with educate their children about the dangers such discussions should ask a teacher, a of using drugs. But, they should also relative or someone who is good at recognize that for some young people discussing sensitive issues for advice on peer pressure can very quickly undo how to talk to the child about this.
years of parental teaching. Parents need Community health workers should share to know the risk factors, signs of drug information on sexuality and HIV/AIDS use and where to get help.
regularly with parents. This will helpclarify issues received from various Who Is At Risk?
Teenagers at risk of developing seriousalcohol and drug problems include Drug and Substance
With a familyhistory of A drug is any chemical that produces a therapeutic or non-therapeutic effect in the body. Most foods are not drugs.
Alcohol is a drug not a food. Some drugs used to treat illness can also be abused if they are not used for the specific purpose of treatment. Teenagers may they don't fit in become involved in drug abuse during or are out of the adolescence when they feel immune to talk to the child the problems others face. This feeling is about this issue.
bolstered by peer pressure from others in the group, i.e., the need to be identified with the group.
Youth who use alcohol and tobacco tobacco, prescribed medications (such at a young age are prone to using other as diazepam), inhalants (glue), drugs later. Some teenagers will marijuana (bhang), cocaine and heroin.
experiment and stop; others will Key Level 1 Health Messages Signs That a Young Person May Be
youth do not get proper and nutritious foods, then chances of developing these Uncharacteristic withdrawal from diseases in later years increase.
family activities All young people should eat a The appearance of new and undesirable friends Problems in school Uncharacteristic moodiness – from pressure can very being extremely dejected to extremely elated or energetic years of parental Spells of being abnormally hungry (even for a growing teenager) The disappearance of money or sellable objects from the house giving foods (carbohydrates and oils). Inthis way they will consume the Consequences of Drug Abuse
appropriate mix of proteins, starches, The consequences can be both vitamins and minerals. Besides immediate and long term. They include: contributing to growth and a good Chronic addiction energy level, a balanced diet protects the body from illnesses.
Accidents due to poor judgment KEY MESSAGE 9:
Criminal or socially undesirable All youth require sufficient behaviour to raise money to pay for nutritionally balanced foods for their growth and development, Unplanned and unsafe sex both mental and physical. Since Possible permanent brain damage the youth are in a critical developmental phase, the amount Substance Abuse Treatment
of food available to them should Early recognition of problems is one key be increased.
to overcoming them. If there is anysuspicion that there is a problem,parents must find the most appropriate way to help their child. Parents areencouraged to consult with a mental Mental health can be described as the health professional when making balance between the individual, their decisions about substance abuse social group and the larger environment.
treatment for children or adolescents.
When the three components are inharmony the individual has a sense of Nutrition for the Youth
wellbeing, and of being able to handleenvironmental issues and social Young people are growing and changing concerns. The changes occurring in our rapidly. Healthy eating is essential for societies have both positive and proper growth and development. Proper negative aspects. Some of these changes nutrition also reduces the risks of heart have led to role reversals, e.g., women disease, some cancers and stroke. If the become sole breadwinners after their Taking KEPH to the Community spouses migrate to urban areas looking illness is not considered a real medical for jobs. These changes may lead to condition, but is viewed as a weakness insecurity in some people, causing of character or as a punishment for nervousness, uneasiness, restlessness, immoral behaviour. Young people are tension, and sleeplessness. All these expected to "grow out of it". Even when symptoms are signs of anxiety.
people with mental disorders are Kenyan youth are often under recognized as having a medical tremendous pressure – to succeed in condition, the treatment they receive is school so as to pass make-or-break often less than humane. People with national examinations, to find a job and mental illness are also thought to be earn a living in an economy that is not violent and they often invoke fear generating sufficient employment despite the fact that they are far more opportunities, to find some balance likely to be the victims of violence between traditional and modern rather than the perpetrators.
lifestyles, to keep up with "trendy"friends and schoolmates, to resist the Signs of Mental Illness
lure of risky behaviours. The pressures Irritability with slightest or are sometimes enough to cause sometimes no provocation depression, anxiety, and behaviour and Neglect of health and personal eating problems. Suicides among Kenyan youth are distressingly common.
Bouts of hyperactivity Lack of appetite or eating too much KEY MESSAGE 10:
Any person having difficulties in Withdrawal from normal activities performing simple chores at home A feeling of hopelessness and and in work places as well as relating to people should be taken Feeling tired and generally without to a health worker for Inability to find pleasure Sleeping too much or not enough Comments about feeling useless and People presenting with symptoms of committing suicide anxiety need to be reassured andencouraged to continue with their life as best as possible.
Enlist the aid of a trusted teacher, People with mental disorders are relative, church/mosque elder or some of the most neglected people in other to try to talk to the young the world. In many communities, mental person who appears to be sufferingfrom a mental or emotional illness.
Someone outside the family is likely Kenyan youth are often under to have more success in getting a tremendous pressure – pressure that is sometimes enough to cause w Encourage the young person to talk to a health worker.
depression, anxiety, and w Be prepared to be involved in the behaviour and eating problems.
Suicides among Kenyan youth are w Do not disregard any threats or comments about suicide.
Key Level 1 Health Messages 5.2 Summary of Key
8. Avoid the use of alcohol, cigarettes Messages for Cohort 4
9. Involve both parents in the care of their adolescents and in 1. Seek health care as soon as an reproductive health of the family.
illness appears or is suspected.
10. Encourage parents to discuss 2. Sleep under ITNs to prevent malaria.
sexuality issues with their 3. Treat water at point of use.
4. Remember that abstinence is the 11. Prevent unwanted pregnancy safest way to prevent STDs and HIV through family planning.
12. Encourage (or take) any person 5. Delay sexual engagement as long as depicting major attitude or lifestyle changes to see a health worker for 6. Use protection during sex if one review and advice.
must have sex.
7. Follow all the instructions given at the health facility for each service.
Taking KEPH to the Community 6. COHORT 5: Adults The health of adults is threatened know what is expected of them, but for both by well-known infections others there are no roadmaps through like malaria, TB, STIs and HIV/ all these changes. Staying healthy when AIDS, and by non-communicable diseases both you and your environment are like heart diseases, cancer and diabetes.
constantly changing is a big challenge.
Trauma, accidents and stress also plagueadults. It is for this age-group that KEPH STIs and HIV/AIDS
emphasizes the necessity of adopting ahealthy lifestyle: stop smoking, do Members of this age cohort are the ones exercises or sports, eat a balanced diet most likely to be sexually active – regularly, avoid stress, avoid unsafe whether in permanent or temporary sexual encounters.
relationships. They are therefore atrelatively greater risk of contractingsexually transmitted infections including 6.1 Key Messages
HIV. Because the majority of people ofthis age are also parents and This age cohort represents the widest breadwinners and thus in highly span in years of the human life cycle. At responsible roles, it is important for the lower end members are usually full them to avoid infection for the sake of of energy, getting married or looking, their own health and the welfare of and settling into a job or profession. As those who depend on them.
the years go by there are many changes– the newlyweds become parents, jobs KEY MESSAGE 1:
change, relationships change, bodies People who have a sexually age. Many people continue to live a transmitted infection (STI) are at relatively traditional life, where they greater risk of getting HIV and of spreading HIV to others. People Most people in this cohort are with STIs should seek prompt parents and breadwinners, so it treatment and avoid sexual is important for them to avoid intercourse or practice safer sex.
infection for the sake of theirown health and the welfare of People who suspect that they have those who depend on them.
an STI should seek prompt treatment Key Level 1 Health Messages from a health worker in order to bediagnosed and get treatment. They The ABCs of Safer Sex
should avoid sexual intercourse or practise safer sex (non-penetrative sex B – Be faithful to a single or sex using a condom). If found to have partner whose only partner an STI, they should tell their partner. If both partners are not treated for an STI, C – Condomize! Use a condom they will continue infecting each other with the STI. Most STIs are curable.
D – Don't take chances! A man infected with an STI may have pain or discomfort while urinating;discharge from his penis; or sores, one of them will have HIV/AIDS and pass blisters, bumps and rashes on the it on. However, anyone can have HIV/ genitals or inside of the mouth. A AIDS — it is not restricted to those who woman infected with an STI may have have many sex partners. And an infected discharge from the vagina that has a person may look completely healthy. A strange colour or bad smell, pain or blood test is the most accurate way to itching around the genital area, and pain tell if someone is infected with HIV.
or unexpected bleeding from the vagina A person can become infected during or after intercourse. More severe through even one occasion of infections can cause fever, pain in the unprotected penetrative sex (sex abdomen and infertility. However, many without a condom). Unless partners have STIs in women produce no symptoms at sex only with each other and are sure all — and some STIs in men also may not that they are both uninfected, they have any noticeable symptoms.
should practise safer sex or use a new Also, not every problem in the latex condom for every act of vaginal genital area is an STI. There are some and anal intercourse. Condoms should infections, such as candidiasis (yeast) never be re-used.
and urinary tract infections, that are Condoms with lubrication already on not spread by sexual intercourse but them are less likely to tear during cause great discomfort in the genital handling or use. If the condom is not lubricated enough, a "water-based"lubricant, such as silicone or glycerine,should be added. If such lubricants are KEY MESSAGE 2:
not available, saliva can be used.
The risk of getting HIV through Lubricants made from oil or petroleum sex can be reduced if people don't (e.g., vaseline) should never be used have sex, if they reduce the because they can damage the condom. A number of sex partners and if safe alternative to the male condom is they use a condom. Correct and the female condom. The female condom consistent use of condoms can is a soft, loose-fitting polyurethane save lives by preventing the spread sheath that lines the vagina. It has a soft ring at each end. The ring at theclosed end is used to put the device Mutual fidelity between two inside the vagina and to hold it in place uninfected partners protects them both during sex. The other ring stays outside from HIV/AIDS. The more sex partners the vagina and partly covers the labia.
people have, the greater the risk that Before sex begins, the woman inserts Taking KEPH to the Community in certain age groups. Among the When health problems are diseases that can be detected through detected early before advancing check ups are hypertension, diabetes into serious conditions, then and cancers (cervix, breast, prostate, remedial actions can be taken rectum, lung, etc.).
through lifestyle changes,treatment or surgical KEY MESSAGE 3:
All adults over 25 years should undergo regular check ups for the female condom with her fingers.
ailments that may present in later Unlike the male condom, the female years especially due to lifestyle condom can be used with any lubricant changes. Check ups should be — whether water-based, oil-based or carried out at least once a year.
petroleum-based — because it is madefrom polyurethane.
Precautions against Common
Drinking alcohol or taking drugs interferes with judgment. Even those In addition to regular medical check ups, who understand the risks involved and adults need to remember guard against the importance of safer sex may become the routine ailments that are common in careless after drinking or using drugs.
Kenya. They should sleep under ITNs toprevent malaria and use only boiled or Routine Health Care
treated water for drinking.
Adults can do many things to take responsibility for their own good health.
Physical activity is one of the most Having regular medical check ups, taking important things you can do to maintain care to prevent malaria and water-borne your physical and mental health and diseases, getting enough physical quality of life as you get older. Walking, exercise, eating right, and avoiding or stretching and keeping your muscles in limiting stress are among the important good condition will help you to maintain steps to take.
your independence. Inactivity makesyour body age faster. To stay Regular Check Ups
independent you need to be able to Health check ups assist in detecting bend, lift, carry things and move around health conditions that might develop easily. Inactivity leads to declines in into chronic health problems later in bone strength, muscle strength, heart life. The earlier we start going for these and lung fitness, and flexibility.
check ups, the better for our health aswe grow older. When health problemsare detected early before advancing into KEY MESSAGE 4:
serious conditions, then remedial To maintain your health and actions can be taken through lifestyle independence as you grow older changes, treatment or surgical you need to keep yourself active.
Physical activity ensures that your During check ups different tests are body organs function effectively carried out depending on the age of the due to the stimulus in your person, since some diseases are common Key Level 1 Health Messages Being active reduces the risk of: Tuberculosis is a disease that usually Falls and injuries attacks the lungs (80%), but can affect Heart disease, high blood pressure, almost any part of the body except the hair and the nails.
Adult-onset diabetes KEY MESSAGE 5:
Tuberculosis is a curable disease if it is diagnosed and treated early, regardless of the HIV In rural areas getting exercise is not likely to be a problem – farming, tending The difference between HIV and TB livestock, walking to the market and is that one of them – TB – can be other activities help keep a person fit. If you do not do these things, make a If you have been coughing for two conscious effort to stay active by weeks or more, go for a TB test spending at least 30 minutes a day doing physical activity that makes you sweat.
Curing TB is a personal choice even Some specific points to remember are: for a person with HIV.
Start slowly and build up.
Early diagnosis and prompt treat- Do gentle reaching, bending and ment is the only way to beat TB.
HIV does not mean TB and TB does Lift weights, do resistance activities.
not mean HIV.
Do the activities you are doing now, Find out what you have. If it is TB, it can be cured. Act fast.
Take the stairs instead of the lift.
Once hope replaces fear, TB can be Walk instead of drive for short KEY MESSAGE 6:
If you have been coughing for two More than a third of Kenyans are weeks or more, go for a TB test infected with the organism that causes immediately. Early diagnosis and TB (Mycobacterium tuberculosis). Most prompt treatment is the only way of these people will never develop TB disease because their immune (defence)systems are strong enough to prevent TB is spread through air by a sick the bacteria from multiplying and person through coughing, sneezing, causing disease. If the immune system is singing or even speaking to a healthy weakened, for example by HIV infection, person who then inhales the TB the infection can eventually lead to bacteria. TB usually enters the body disease. Since an estimated 7% of through the lungs. TB in the lungs or Kenyans are currently infected with HIV, throat can be very infectious. This a large number of Kenyans are likely to means that the bacteria can be easily be infected with both HIV and TB. These passed on to other people. TB in other individuals have a considerably higher parts of the body, such as the kidney or risk of developing TB disease.
spine, is usually not infectious. TB Taking KEPH to the Community patients with bacteria in their sputum 6.2 Summary of Key
(smear positive TB) are the sources ofinfection. Therefore all patients Messages for Cohort 5
presenting with cough for two weeks ormore should have three sputum samples 1. Remember that all people are at risk collected for examination.
of HIV/AIDS; use condoms to reduce HIV-positive people can easily be screened for TB. If they are infected 2. If you suspect that you might be they can be given prophylactic infected with HIV, contact a health treatment to prevent development of worker or a VCT centre to receive the disease or curative drugs if they confidential counselling and testing.
already have the disease. TB patients 3. Reduce the risk of getting HIV can be offered an HIV test.
through sex by not having sex at all TB is curable even in people living or by being faithful to one partner.
with HIV, as long as the diagnosis is 4. Parents and teachers, help young made early and treatment is prescribed people protect themselves from and taken properly (right regimen, right HIV/AIDS by talking with them about dosage and right duration of treatment).
how to avoid getting and spreading The treatment is free at all government the disease.
facilities and in some designated health 5. Discuss sexuality and HIV/AIDS with facilities, e.g., mission hospitals, where children early enough.
TB services are offered. Duration of TB 6. Get information on lifestyle related treatment ranges from 6 to 8 months.
For better adherence to TB 7. Check regularly for non-communi- treatment, it is recommended that cable illnesses like diabetes, every TB patient should have a hypertension, cholesterolaemia, etc.
treatment supporter. TB patients can get 8. Seek health care as soon as illness their drugs daily from the nearby health appears or is suspected.
facility or from the community 9. Sleep under ITNs to prevent malaria.
(community-based directly observed 10. Treat drinking water at the point of treatment, short course – DOTS).
Key Level 1 Health Messages 7. COHORT 6: Elderly Persons Elderly people suffer from various chronic diseases, like KEY MESSAGE 2:
hypertension (high blood Try to be physically active every pressure), disabilities (eyes, ears), degenerative diseases (problems withwalking, backaches, etc.) and mentaldisorders. For this age group KEPH calls If at all possible moderate physical for regular medical screenings, activity should be part of an older promotion of healthy lifestyles adult's daily routine to help prevent (exercises, sports, social activities) and conditions such as obesity, hypertension, access to drugs for degenerative diabetes and coronary artery disease.
Most adults need to participate in up to30 minutes of moderate to vigorousphysical activity on most days to 7.1 Key Messages
prevent unhealthy weight gain.
Persons aged 65 and older are at high KEY MESSAGE 3:
risk for complications that require Increase daily intake of fruits and hospitalization. Elderly persons are less vegetables, whole grains, and able to fight new infections because reduced-fat milk and milk their immune systems become weaker with age. They may suffer visual orbalance problems that lead to falls. And Fruits are important sources of fibre they may be less likely to eat a good and at least eight additional nutrients, balanced diet. All these factors combine including vitamin C, folate and to threaten the health of older people.
potassium (which may help control bloodpressure). Many vegetables provide only KEY MESSAGE 1:
small amounts of sugars and/or starch, Seek regular medical check ups and some are high in starch, and all provide information on old age conditions.
fibre. Vegetables are important sources Follow the instructions given at of many nutrients, including potassium, the health facility to the end and folate, and vitamins A and E. Most fruits seek health care as soon as an and vegetables are also relatively low in illness appears or is suspected.
calories – which is important to think Taking KEPH to the Community about since many people gain undesirable sodium; it is important to also take care amounts of weight as they get older.
to reduce other sources of sodium.
Older adults who increase their fruit Another dietary measure to lower and vegetable consumption to meet blood pressure is to consume a diet rich recommended nutrient levels will also in potassium. A potassium-rich diet be reducing their risk of such chronic blunts the effects of salt on blood diseases as stroke. Moreover, increased pressure, may reduce the risk of consumption of fruits and vegetables is developing kidney stones, and possibly generally regarded as an important decreases bone loss with age. Bananas approach to achieving and sustaining and oranges are important sources of weight loss.
Women over age 50 need to be sure they get enough calcium in their diet toprotect their bones.
7.2 Summary of Key
Blood pressure generally increases as people get older. Reducing blood Messages for Cohort 6
pressure, ideally to the normal range,reduces the chance of developing a 1. Seek health care as soon as illness stroke, heart disease, heart failure and appears or is suspected.
2. Use ITNs when sleeping to prevent The relationship between salt (sodium chloride) intake and blood 3. Use only boiled or treated water for pressure is direct and progressive. This means that the higher a person's salt 4. Follow instructions given at the intake, the higher is their blood health facility for any service.
pressure. Thus, reducing salt intake as 5. Take regular exercise to the extent much as possible is one way to lower blood pressure. It is important to note 6. Go for regular medical check ups.
here that the big culprit in salt is the Key Level 1 Health Messages Household Dialogue Cards Questions and Answers for
or the baby in time to address them Use at Household Level
and thus save lives.
3. Check if the woman requires special during Home Visits by CHWs
counselling and care for her ownhealth and that of the child.
1. PREGNANCY AND CHILDBIRTH
2. EARLY CHILDHOOD (2 WEEKS
Q 1: What can you do to ensure
TO 5 YEARS)
that [name of pregnant woman]
delivers her baby safely?
Q 3: What do you do to ensure
that your baby receives adequate
1. Prepare a birth plan.
2. Identify the most appropriate facility or qualified person.
1. Breastfeed the baby exclusively and 3. Ensure that she can reach the on demand for six months.
facility at the time of need.
2. Introduce other foods at six months.
4. Prepare materials needed for safe 3. Feed the child at least four times a delivery and newborn care (specific 4. Mix the food types.
5. Recognize danger signs and take action to receive timely assistance.
Q 4: What do you do to protect
your child from diseases or
Q 2: Why should a pregnant
woman be checked at a clinic at
least four times during a
1. Ensure they complete immunization by nine months.
2. Immunization protects against 1. Ensure that all warning signs are several dangerous diseases.
identified and action taken.
3. The child sleeps under a treated 2. Recognize danger signs that may mosquito net.
threaten the life of the mother and/ 4. Watch young children carefully and keep their environment safe.
Taking KEPH to the Community 5. Ensure things such as fires, cooking 3. Be open and non-judgemental in stoves, lamps, matches, liquids and discussing sexuality issues.
medicines are kept away from thechild.
5. ADULTHOOD (25—59 YEARS)
6. Wash hands thoroughly with soap and water or ash and water after Q 8: What are the benefits of
contact with faeces, and before planning your family?
touching food or feeding children.
Q 5: How do you take care of a
1. Helps one have children one can child sick with fever and/or cough?
2. Helps the mother to recover from a previous birth.
1. Seek the help of a health worker as 3. Gives each child enough space for a soon as illness is suspected.
attention and care.
2. Comply with the advice or treat- 4. Gives mother space for self- ment given by the health worker.
3. Continue regular feeding of the 5. Allows a woman to have a baby at the right time.
4. Keep the child warm and encourage it to eat and drink as much as Q 9: What do you do to protect
yourself from STIs and HIV
3. LATE CHILDHOOD (6—12
Q 6: How do you take care of a
2. Delay having sex.
child sick with diarrhoea?
3. Be faithful to regular partner.
4. Use condoms to prevent STIs, HIV and unwanted pregnancy.
1. Give the child plenty of fluid.
2. Seek help from a health worker.
6. ELDERLY (60+ YEARS)
3. Encourage the child to eat and drink as much as possible.
Q 10: How can you ensure early
detection of health problems?
4. ADOLESCENCE (13—24 YEARS)
Q 7: What do you do to ensure
1. Go for regular check ups that your adolescent child has the
right information about sex?
1. Be available to listen and answer
their questions accurately.
2. Look for relevant opportunities to discuss sexuality issues with thechild.
Key Level 1 Health Messages Immunization Chart There are four main vaccines that every child needs before they reach one year ofage. These vaccines are given according to the schedule in the chart below.
Type of immunization
Age of child
w Immediately after birth w Or, at first contact with –Injection into left child after birth Polio (against poliomyelitis)–Oralw Birth polio w Birth polio at birth w Birth or at first contact with child before 6 weeks w 1st polio – at 6 weeks w 1st or at first contact with child after 6 weeks w 2nd polio – at 10 weeks w 2nd or at second contact with child after 10 weeks w 3rd polio – at 14 weeks w 3rd or at third contact with child after 14 weeks DPT* (against 3 diseases*)–Injection into upper w 1st – at 6 wks w 1st – Or at first contact with child after 6 weeks w 2nd – at 10 wks w 2nd – Or at 2nd contact with child after 10 weeks w 3rd – at 14 wks w 3rd – Or at 3rd contact with child after 14 weeks w Or at first contact with child after 9 months into left upper arm *DPT = diphtheria, pertussis (whooping cough), tetanus Taking KEPH to the Community Assessing a Sick Child Check the child's immunizationstatus 1.) Take the child's history from the Assess other problems the mother: age, reason for the visit, mother has mentioned 2.) Ask about the three main symptoms: Cough or difficulty in breathing Strange sounds (stridor) Fever (malaria, measles) – 50 breaths or more per minute in a child 2 months up to 12 A Cough or difficult breathing may
indicate pneumonia or other very
– 40 breaths or more per minute in a child 12 months to 5 years 3.) Check child for general danger signs: A If one or more of the above signs is
Child not able to drink or present, refer urgently to the
nearest health facility.
Child vomits everything Child has had convulsions Child not alert, not responding, Assessing Specific Conditions
uninterested (lethargic orunconscious) Not alert or not responding, A If any one of the danger signs is
uninterested (lethargic or present refer urgently to the
nearest health facility. If no danger Not able to drink nor breastfeed signs are present, advise caregiver on home care and on when it is Slow return of a skin pinch necessary to take the child to healthfacility immediately.
A Pinch the skin of the abdomen: If
the skin goes back very slowly 4.) Ask additional questions to help (longer than 2 seconds), this is classify the illness: DIARRHOEA WITH DEHYDRATION. It is Check the child for malnutrition an emergency.
Key Level 1 Health Messages A If one or more of the above signs is
Generalized rash and any of the present, refer urgently to the
following: Cough, runny nose, red nearest health facility and advise eyes — SUSPECTED MEASLES caregiver to give the child sips ofORS on the way to the facility.
A Drugs to give - 1st dose of
paracetamol. Refer urgently to the
nearest health facility.
Irritable or restless Thirsty, drinks eagerly, A If yes for both, this is DIARRHOEA
Rubs or pulls ear frequently WITH DEHYDRATION. Refer to the Liquid coming from the ear nearest health facility. Advisecaregiver to give ORS and to A If one of the above signs is
present, refer urgently to nearest
If no to both of the above signs: Give extra fluids Continue breastfeeding Visible wasting or Advise to return immediately Oedema of both feet A If diarrhoea has lasted for 14 days
A Refer urgently to the nearest
or more, refer to the nearest
A If the child has blood in the stool
A Severe palmar pallor - Refer
this is DYSENTERY. It is an
urgently to the nearest health
emergency. Refer to the nearest health facility. Advise caregiver togive ORS on the way.
Sick Young Infant Age O–2 Months
Baby was born at home and has not Fever / Malaria
visited a health facility Temperature of 37.5oC or higher Has fever or feels cold Is unable to suck or is sucking poorly Felt hot in the last three days Any general danger sign or stiff neck Has malformations Cough with fast breathing or Yellowness of the skin difficult breathing Bulging fontanel (the soft spot on the top of the head) A If yes to any of the above signs,
Pus draining from the eye or this is a very severe febrile disease
or malaria or pneumonia. Refer
Difficult or fast breathing urgently to nearest health facility.
Dehydration (skin pinch goes back Temperature of 37.5oC or above Felt hot in the last three days A If one of the above signs is
present, refer urgently to nearest
If yes to the above, plus: Taking KEPH to the Community Key Level 1 Health Messages Taking KEPH to the Community Key Level 1 Health Messages Taking KEPH to the Community
Reversing the trends
NATIONAL HEALTH SECTOR
Republic of Kenya
Strategic Plan of Kenya
Community Strategy Implementation Guidelines Key Health Messages for Level 1 of the Package for Health Extension Workers and Community Health Workers Ministry of Health
Key Health Messages for Level 1 of the Kenya Essential
Package for Health – A Manual for Community Health
Extension Workers and Community Health Workers
Communities represent the first level of health care of theKenya Essential Package for Health defined in Kenya'ssecond National Health Sector Strategic Plan. Serviceprovision at level 1 is organized in three tiers starting withhousehold-based caregivers, adult members of thehousehold who provide the essential elements of care forhealth in all dimensions and across life-cycle cohorts. Thesehousehold-based caregivers are supported by volunteercommunity-owned resource persons - community healthworkers and community health extension workers - who arein turn supported and managed by a range of communitystructures to be established or strengthened through theimplementation of the Community Strategy. This manualintends to provide the basic information the CHWs andCHEWs need in their efforts to assist communities in theirquest for better health.
Ministry of Health
Sector Planning and Monitoring Department
PO Box 3460 - City Square
Nairobi 00200, Kenya
Email: [email protected]
Becoming Critical Consumers: Research and the Media Elizabeth Blackmore, M.A. and Wendi Rockert, M.Ed. Over the past year, newspaper and magazine columns have headlined the "effectiveness" of the newest generation of weight loss fads – the low carbohydrate diet. A recent study, however, showed that both low fat diets and low carbohydrate diets produced comparable rates of weight loss in the longer term. In May, a Toronto research team reported that strict dieting, dangerous weight control practices and eating disorders are occurring at alarming rates amongst grade school children. We are presented with information about food, weight and eating disorders in the media every day, and often make important decisions about our own lives based on what is communicated. At times the information reported in one study is in conflict with information from another study. How do we determine the validity of what we read and hear? Develop a critical stance We rely on the media to inform us of current trends and to transmit the latest research results, despite the fact that we are not formally trained to evaluate the information that appears in newspapers, magazines, on the radio, TV or internet. This is especially true in the case of articles that cite research evidence to support their position. Because most of us are not scientists or statisticians, we often believe what is written in print without questioning some basic assumptions about the research. As consumers of information, we need to adopt a critical stance when we read about research findings. Although the interpretation of complex statistical analyses is well beyond the scope of this article, there are some basic questions/issues to consider which can help you to decide how much emphasis to place on the results that are being reported. This will make you a more informed consumer and ultimately make you more able to arrive at personal decisions which may incorporate what you learn from the media. The research process The general purpose of research is to seek answers to a specific question or problem of interest, known as an ‘hypothesis'. Generally, researchers attempt to answer two main types of questions: 1) What is happening?; and 2) Why is it happening? To explore a particular research question, the researcher chooses a group of interest that they wish to investigate, known as a ‘population' (e.g., women with an eating disorder). Ideally, the researcher would like to study the entire population of interest, but normally this is not possible due to factors such as geography, time constraints and financial resources. Instead, the researcher chooses a subset of people to represent that larger population,