Population Dynamics and Urbanization, African Population and Health Research Center, Nairobi, Kenya.
Demography and Population Studies, University of the Witwatersrand Johannesburg School of Social Sciences, Johannesburg, South Africa.
BMJ Open. 2024 Aug 19;14(8):e081906. doi: 10.1136/bmjopen-2023-081906.
Diarrhoea remains a leading cause of morbidity and death among under-5 children in Kenya, despite multipronged policy and programme initiatives to increase access to treatment. This study interrogates the comprehensiveness and adequacy of Kenya's policies, frameworks and action plans for diarrheal management and prevention. The study seeks to identify policy and practice gaps that need to be filled to strengthen diarrhoea treatment and prevention among under-5 children in Kenya.
Our study is a landscape analysis, which seeks to identify the gaps in the current Kenya diarrheal policy, frameworks and action plans. The critical questions included their comprehensiveness, the availability of elaborate treatment, management and prevention solutions, together with updatedness, building on evidence from extant literature on key pathways to infection relating to man-animal environmental interaction, which are critical in enteric infection prevention initiatives.
We conducted an internet search of databases of Government of Kenya's Ministry of Health; relevant websites/publications of international organisations and groups (Centre for Disease Control and Prevention, UNICEF and WHO) and published and grey literature (Google searches, Google Scholar and PubMed).
Included are publicly available key national diarrheal policy frameworks, plans, strategies, laws, institutional frameworks and operational guidelines that inform pertinent questions on the adequacy of policy and practice and preventive policy updates and actions. Further, peer-reviewed and grey literature on diarrheal morbidity and mortality and diarrheal prevention and management are included. The analysis excluded any information that was not referenced on the internet nor obtained from the internet.
The review team extracted the key provisions of the policy guidelines guided by a checklist and questions around the adequacy of existing national policies in addressing the determinants, prevention and treatment interventions of enteric infections and diarrhoea among under-5 children in the country. The checklist covered Kenyan background and diarrhoea situation analysis, policy objectives, policy strategies and policy implementation.
The analysis identified a corpus of strategies for the management of diarrhoea at multiple levels: health facilities, communities and households. The policies highlighted advocacy, health communication and social mobilisation, as well as logistics management and prevention strategies. However, the triangulation of evidence from the policy provisions and extant literature identified critical policy gaps in diarrhoea prevention and management in Kenya, particularly the lack of focus on zoonotic pathways to enteric infection, environment-pathogen linkages and operationalisation of the roles of social determinants of health and related services. The policy documents had limited focus on rapid diagnosis, vaccine development and deployment, together with weak funding commitment towards implementation and unclear pathways to funding responsibilities.
Policies are central to guiding programmatic actions towards effective enteric and diarrhoea prevention and management measures in Kenya. This study shows the need for policy updates to reflect pathways to enteric infections not covered in the current policy guidelines. Further, there is a need to strengthen the treatment and management of infection through rapid diagnosis, vaccine development and deployment, and strong funding commitment towards implementation together with clear funding responsibilities. Together, these will be vital in strengthening the current policy provisions and addressing other pathways to the prevention of enteric infections relating to zoonotic, environment-pathogen linkages and social determinants of health in Kenya and other low-income and middle-income countries.
NCT05322655.
尽管采取了多方面的政策和计划举措来增加治疗机会，但在肯尼亚，腹泻仍然是导致 5 岁以下儿童发病和死亡的主要原因。本研究探讨了肯尼亚腹泻管理和预防政策、框架和行动计划的全面性和充分性。本研究旨在确定需要填补的政策和实践差距，以加强肯尼亚 5 岁以下儿童的腹泻治疗和预防。
我们的研究是一种景观分析，旨在确定当前肯尼亚腹泻政策、框架和行动计划中的差距。关键问题包括其全面性、详细治疗、管理和预防解决方案的可用性，以及更新情况，以现有文献中关于与人类-动物-环境相互作用相关的感染主要途径的证据为基础，这对于肠道感染预防措施至关重要。
我们对肯尼亚卫生部政府数据库、相关国际组织和团体（疾病控制和预防中心、儿基会和世卫组织）的网站/出版物以及已发表和灰色文献（谷歌搜索、谷歌学术和 PubMed）进行了互联网搜索。
包括公共可获得的关键国家腹泻政策框架、计划、战略、法律、机构框架和操作指南，这些指南提供了有关政策和实践以及预防政策更新和行动充分性的相关问题。此外，还包括腹泻发病率和死亡率以及腹泻预防和管理的同行评议和灰色文献。该分析排除了互联网上未引用或未从互联网上获取的任何信息。
审查小组根据核对表和现有国家政策在解决决定因素、预防和治疗 5 岁以下儿童肠道感染和腹泻方面的充分性方面的问题，提取政策指南的关键规定。核对表涵盖了肯尼亚的背景和腹泻情况分析、政策目标、政策策略和政策实施。
分析确定了在多个层面管理腹泻的一整套策略：卫生机构、社区和家庭。政策强调了宣传、卫生宣传和社会动员，以及后勤管理和预防策略。然而，从政策规定和现有文献中获得的证据的三角分析确定了肯尼亚腹泻预防和管理方面的关键政策差距，特别是缺乏对人畜共患病途径进入肠道感染、环境病原体联系以及社会决定因素和相关服务的作用的关注。政策文件对快速诊断、疫苗开发和部署的关注有限，以及对实施的资金承诺薄弱，资金责任途径不明确。
政策是指导肯尼亚有效预防和管理肠道和腹泻的计划行动的核心。本研究表明，需要更新政策以反映当前政策指南未涵盖的肠道感染途径。此外，需要通过快速诊断、疫苗开发和部署以及对实施的强有力资金承诺以及明确的资金责任来加强感染的治疗和管理。这些将对于加强当前政策规定以及解决与动物传染病、环境病原体联系以及肯尼亚和其他低收入和中等收入国家的健康社会决定因素有关的肠道感染预防的其他途径至关重要。
NCT05322655。
