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SUPPORTING COMMUNITY SCHOOLS IN THE SLUMS OF NAIROBI

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The Health and Hygiene Programme

Over 55% of the population of Nairobi live in areas designated as slums, and this population is growing by around 6% a year.

Around 94% of slum dwellers do not have access to adequate sanitation, in fact, more people own a mobile phone than have access to a clean toilet. Open defecation or a bucket simply emptied into one of the many drains running between shacks, is common place.

Some people have access to a traditional pit toilet which is frequently no better than the alternative. Firstly, these toilets are never or seldom cleaned and disinfected so become

a breeding ground for harmful pathogens like bacteria that cause diarrhoea. Secondly, the faecal matter seeps into the ground infecting the water table and rivers with pathogens and toxic chemicals.

A further problem is that many residents of the slums are not aware of the health benefits of disinfecting toilets and washing hands. Then for those that do, water and soap are frequently too expensive for regular handwashing and disinfecting.

Water in the slums is sold in gerry cans delivered on bicycles. There is no way of knowing whether the water cans are washed regularly or whether the source of water is safe and clean.

Drains run between the shanties and are used to throw away everything including peels and human waste. The drains do not run freely and are in effect open sewers crawling with maggots and a perfect breeding ground for pathogen infestations.

In the rainy season, the drains flood spreading their unhygienic contents onto walkways and even in homes sometimes.

Compared to nearby affluent areas, poor health and illnesses abound. Water born illnesses and those that thrive on unhygienic conditions are prevalent.

Worms and diarrhoea are extremely common with devasting consequences.

A recent CDC report shows a prevalence rate of 80% for Soil Transmitted Helminths (worms) in one area of the Nairobi slums.

The WHO reports that 1 in 5 children dies from diarrhoea in the Nairobi slums by the age of 5.

Both diarrhoea and STHs are easy and cheap to treat with huge benefits for individuals and their society.

Treatment for worms is free through the WHO programme and extremely effective. A single tablet every 6 months keeps worms at bay.

The latest estimates indicate that more than 880 million children need treatment for these parasites.

PaR is a member of the STH Coalition.

Soil-Transmitted Helminths

Soil-transmitted helminth (STH) infections are among the most common infections worldwide and affect the poorest and most deprived communities most severely.

STHs can impair the nutritional status of those infected so severely as to cause permanent cognitive impairment or death.

STHs produce a wide range of symptoms like abdominal pain, diarrhoea, dysentery, malnutrition, anaemia, intestinal obstruction and rectal prolapse, and chronic intestinal blood loss.

Morbidity is directly related to worm burden: the greater the number of worms in the infected person, the greater will be the severity of disease.

Concomitant infections with other parasite species are frequent and may have additional effects on health and well-being.

STHs are transmitted by eggs present in human faeces which contaminate soil in areas where sanitation is poor like sub-saharan Africa where open defecation is still common and clean water is not available for personal hygiene.

The main species that infect people are the roundworm (Ascaris lumbricoides), the whipworm (Trichuris trichiura) and the hookworms (Necator americanus and Ancylostoma duodenale).

Treatment of STHs is simple. A tablet every 6 months keeps an individual free from worms. The medication is extremely effective and very safe.

In addition, treatment is free. Kenya receives the anthelminthic drug Albendazole free from GSK through the WHO. Nonetheless, deworming targets are not being met.

PaR treats all the pupils at its partner schools every 6 months with Albendazole. PaR is working towards treating siblings as well.

Education on health and hygiene along with the provision of adequate sanitation reduces transmission and reinfection by encouraging healthy behaviours.

PaR provides lessons on worms and the spread of disease, and how to combat them through good health and hygiene practice.

In addition, PaR provides soap and water for handwashing, disinfectant for cleaning, and is working on raising money for better and more toilets.

Sanitation

Sanitation provision in Nairobi is grossly deficient. Most people do not have access to a hygienic toilet, and large amounts of faecal waste are discharged to the environment without adequate treatment. Some people resort to "flying toilets" and open defecation which pose a serious health hazard.

The toilets that exist are predominantly latrines which are often emptied under unsanitary conditions and almost never cleaned let alone disinfected. A major problem with latrines is that they can pollute

underground water supplies as bacteria and dangerous chemicals seep from the latrine into the water table. They are cheap to build though, so remain popular.

Poor sanitation is a major factor in the infectious disease burden and quality of life. PaR thus seeks to provide a clean and hygienic environment to reduce the spread of disease.

PaR provides disinfectant for regular cleaning of school toilets and facilities. In addition, PaR funds water and soap so pupils and teachers can wash their hands regularly.

PaR also runs classes for pupils and teachers to teach the importance and benefits of habits like hand washing, in the fight against disease and the promotion of good health.

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