Example 5: Kenya's National School-Based Deworming Program

Contributed by: Sarafina Kankam

JUSTIFY THE CHOICE OF THE PRIORITY PROBLEM/ GOAL TO BE ADDRESSED:

Around the world many adults and children are affected by parasitic worm infections. About 400 million school-age children are affected. A national mass fecal examination in Kenya determined that about five million (56.8%) children suffered from intestinal parasitic worm infections. Chronic worm infections damage children’s health and can result in conditions like malnutrition and anemia. This infection also leaves some children too sick to attend school. Studies have also shown that long-term worm infections negatively correlate with literacy rate. Children who are constantly infected with worms are about 13% less likely to be literate. Treatment is effective, simple, and inexpensive. The challenge is that diagnosing children is costly, so programs have decided to administer deworming drugs to all children since it is inexpensive. The goal of the Kenya National School-Based Deworming Program is to decrease the prevalence of worm infections by providing treatments to children at school and by offering educational resources addressing this issue.

FRAME THE PROBLEM OR GOAL TO BE ADDRESSED:

Too many school-aged children are affected with parasitic worm infections leading to many illnesses that may prevent children from attending school.

REVIEW THE NAMING AND FRAMING OF THE PROBLEM OR GOAL:

The main issue is that too many children are being affected by parasitic worm infections that can ultimately lead to the illness of children. This statement focuses specifically on the root condition, which is how a problem or goal should be framed. Note how the problem statement was not stated as, “The problem is children are being infected with parasitic worms because they are subject to illness due to the contamination of water and food resources in their communities”. The latter identifies potential components of an intervention.

Ask questions about the problem or goal to identify key behaviors, actors, and consequences:

Some behaviors (and actors) that contribute to the problem include:

• People consuming unsanitary water as a result of the lack of access to clean water.
• School aged children contracting Soil-Transmitted Helminthes (STHs) due to the lack of education about the various sources of worm infections.

The government has not fully implemented all of the policies that would ensure adequate water supply for its people. This analysis suggests the need for not only deworming efforts, but the implementation of programs to prevent the contraction of parasitic worms.

ANALYZE “ROOT CAUSES ” TO IDENTIFY THE ENVIRONMENTAL CONDITIONS AND RELATED BEHAVIORS THAT MIGHT CONTRIBUTE TO THE PROBLEM OR GOAL:

Too many school aged children are affected with parasitic worm infections leading to many illnesses which may prevent children from attending school.

• But, why? Because they are drinking unsanitary water.
• But, why? Because they cannot access clean water.
• But, why? Because of the lack of infrastructure to provide clean water.
• But, why? Because of the government’s failure to allocate funding to provide communities with safer resources and education about worm infections.
• But, why? Because the necessary resources and/or money are not readily available to address this issue.

Based on this analysis of root causes, some specific conditions/behaviors and related interventions that might contribute to improvement can be identified. These include: the need for the government to provide safer water for children and their communities by improving the infrastructure to provide clean water. Also, very few people are aware of the various ways they may contract worms. Government assistance programs should be implemented to provide communities with clean resources. A prevalent burden is that some of these areas simply do not have the funding available to combat this issue. Health officials should also educate all patients in their hospitals about this issue and encourage them to be cautious.

IDENTIFY RESTRAINING AND DRIVING FORCES THAT AFFECT THE ISSUE OR PROBLEM (CONDUCT A "FORCE FIELD ANAYSIS"):

Forces keeping the situation the same may include:

• People are unaware of the prevention of worm infections. There is a lack of health education about the importance of sanitation and soil pollution prevention.
• Communities are not being provided with sufficient resources because the government has not implemented policies to combat this issue.

Forces that are causing things to change may include:

• Research about parasitic worm infections and campaigns to treat the many people who are infected.
• The development of policies by the Kenyan government to provide adequate resources to aid in health, social, and economic development (these have not been implemented yet).

This Force Field Analysis aids in addressing the problem and allows us to build on the plans that are already being used to cause things to change.  We can also work on diminishing the barriers that play a role in keeping the situation the same.

FIND RELATIONSHIP BETWEEN THE COMMUNITY'S PROBLEMS AND GOALS:

The priority issue is to decrease the number of people, especially children, who are infected with parasitic worms. Studies have shown a positive effect of mass deworming in areas where the prevalence of worm infections is above 50%. The improved health status that results after deworming includes better productivity, enriched education performance, and increased life expectancy. The interrelationship between reducing incidences of infection and improving quality of life demonstrates the importance of ensuring adequate water supply and sanitation in Kenya.

Kenya National School-based Deworming Program: This program is supporting government action, whereby over 3.6 million children were dewormed in 2009 at a cost of $0.36 per child. The government is expanding the program to include additional at-risk schools.

Photo Courtesy of Deworm the World:
Primary school student receiving deworming tablet from teacher

For more information, read the Background Paper National Deworming Program: Kenya’s Experience for the 2011 World Conference on Social Determinants of Health.