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Remba Island, Kenya
By Rotarian Jeremy Penner – Rotary E-Club One
Background
Remba Island is a small fishing island in Lake
Victoria, with a population that fluctuates between 4,500 and 8,000
(depending on season and local fish catch), of whom 10-15% are
children less than 5 years old.
Some people reside on the island
seasonally, some migrate through briefly, and a portion remains for
several years or more.
Most residents are Kenyan, but the
population also includes people from Uganda, Tanzania, and Somalia.
There are approximately 1,500 households on Remba. The main
economic activity is fishing.
The adult HIV prevalence is estimated to
be above 30%.
Because of the huge need for HIV services we
started going there once a week to run “mobile” clinics (carry the
staff, drugs, equipment, etc there and back each visit).
Without a health facility on the island
we used whatever space was available- for a while we ran the clinics
in a local hotel, using the beds as exam couches during the day,
then clearing them off to sleep on at night.
We even used a bar for a while- we
needed to finish clinic early before people started coming in to
drink.
And Remba is 1-3 hours from our main
island clinic using local boats (depending on weather).
Things have improved a bit since those earlier
days.
Thanks to generous private donors we
have built a health facility on the island, and when we put up staff
housing the government will post a nurse.
It will be a happy day when people can
receive basic essential health services on a daily basis, such as
immunizations, malaria prevention and treatment, and management of
diarrhea and pneumonia.
One of the major problems on Remba is safe
water.
Island residents depend on surface water
directly from Lake Victoria, which is grossly contaminated, for
drinking, cooking, and washing.
Consistent use of water treatment
methods is low.
The situation is made worse by
inadequate access to improved sanitation, with the majority of
residents defecating in open fields and beaches.
Water samples taken from 5 beaches where
people collect drinking water confirmed high levels of fecal
contamination, with average of 86.3 colony forming units (cfu) of E.
Coli per 100 mL (range 24.3-162.6 cfu/100mL).
Diarrhea is a major concern for
residents; it interferes with adults’ ability to fish and children’s
school attendance, and has associated mortality for young children.
Diarrhea is also a major concern for
public health officials, and was unaddressed before this
intervention.
Our HIV program could not address the water and
sanitation issues because of restrictions from our funding source,
but I had helped start a community empowerment organization in Kenya
(www.pamojapamoja.org) which had more freedom.
Funding for a water project came from
the same generous donors who built the health facility on the
island, and thanks to the efforts of Park Cities Rotary Club and the
Water and Sanitation Rotarian Action Group (WASRAG). We needed
an immediate intervention that would buy us time to plan, fundraise
for, and implement a long-term comprehensive solution addressing
water, sanitation, hygiene, health, and education (a true “Future
Visions” project in the making).
Intervention
Two water treatment devices were used:
LifeStraw Personal (LSP) and LifeStraw Family (LSF).
LSP is a plastic tube, 31 x 2.9 cm, with
a mouthpiece at one end and a water inlet at the other.
The user submerges the inlet into
untreated water and sucks on the mouthpiece like a straw; water
treatment takes place as the water passes through the device. LSP is
highly efficacious at reducing waterborne bacteria and viruses, but
not parasitic cysts.
The portability of LSP made it a
suitable option for fishermen to carry with them for use when on the
lake.
It has an operational lifespan of 700
liters (approximately 1 year of regular use).
LSF consists of a water intake bucket and a
purification cartridge, which are connected together by a 1 m long
rubber tube.
The bucket is hung high enough that the
rubber tube and purification cartridge can extend straight down.
Untreated water is poured into the
bucket, passes through a pre-filter in the bucket, flows down the
tube, and is treated as it flows through the purification cartridge.
There is an outlet tap at the bottom for
collecting the clean water.
LSF is highly efficacious at reducing
waterborne bacteria, viruses, and parasites.
It has an operational lifespan of 18,000
liters (at least 3 years of regular family use).
Many Rotarians may be familiar with
these filters as part of the “Shelter Boxes” distributed for
disaster relief.
Evaluation Design
Although the efficacy of the LifeStraw filters
had been previously demonstrated in highly controlled research
settings, we wanted to determine the effectiveness of using them in
this mode of rapid population-based distribution.
Specifically, we wanted to determine
usage of these devices after their novelty wore off, and evaluate
the impact this intervention had on diarrhea rates.
The results provide insight into the
expected impact of distribution-only interventions using LifeStraw
in similar setting.
We compared diarrhea rates before LifeStraw
distribution with rates after distribution, and since endemic
diarrhea rates often have seasonal variations it was critical to
assess the intervention over a full 12-month period.
We collected data at baseline, 4 months,
8 months, and 12 months.
Filter usage was measured at each
follow-up, allowing us to assess how usage changed with time.
Results
We found that people initially used the filters
well, but by the end of one year only 51% of households and
fishermen used their filters every time they drank water.
The household filters were too time
consuming because the water intake bucket was small and filter rate
slow, so it required constant refilling.
And many of the household filters
clogged up after several months of use.
The fishermen found that sucking water
up through the personal filters took a lot of effort and did not
provide enough water to quench the thirst that came with working
under the equatorial sun all day long.
Overall diarrhea rates dropped dramatically
over the year, and although we did not measure death rate, we are
sure that fewer children are dying on Remba because of this
intervention.
As expected, people who use the filters
consistently had much lower diarrhea rates than people who did not
(shown in the graph below).
Conclusions and Next Steps
The LifeStraw water filters worked well at
reducing diarrhea when people used them consistently, but usage
dropped off over the year.
There is also the issue of needing to
replace the filters every 1-3 years.
These filters seem best suited for
short-term interventions such as Shelter Boxes.
The next steps for Remba are already underway:
Pamoja (the community empowerment organization I am part of) has
helped form a Water, Sanitation, and Health (WASH) committee on
Remba.
The Kenyan Ministry of Health is on
board, as is the local community and leadership.
Through WASRAG’s network of experts, a
technical team will visit the island in January 2011 to work with
the WASH committee to design the best sustainable water and
sanitation solution for Remba, which will be rounded out with
improvements in health and education infrastructure.
Diarrhea Rates Based on Filter Usage |
I
moved to Kenya over 5 years ago to help start an HIV program
(www.faces-kenya.org) serving the rural poor in areas most affected
by HIV.
A
2-week filter distribution campaign was conduced in July 2009, with
LSP provided to each fisherman and LSF to each household.