Rapid feedback from household surveys in PHC planning: an example from Kenya

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Case management surveys were conducted in several districts in Kenya including 1) Kisumu Kakamega and Kisii which had received intense training and communication about the use of oral rehydration salts (ORS) 2) Nakuru which had had few activities related to use of ORS but has well-trained health workers and 3) Kwale and Kilifi where the Center for Diarrheal Disease (CDD) was just beginning its work. A cluster sampling technique was used to generate data on 23884 children <5 years old for analysis of simple rates and cross tabulations only. Results were made available within 4 weeks of field work completion in order to facilitate interventions. The results indicated that the incidence of diarrhea within a 2-week period ranged from 11.6% in Nakuru to 20.5% in Kisumu. Prevalence in the last 24 hours varied from 4.0% in Kisii to 7.7% in Kisumu. Less than half of the caretakers could prepare ORS correctly. ORS was given to 10.8% of the children with diarrhea in Kakamega and 29% in Nakuru. Recommended home fluids (RHF) especially maize gruel were the frequent choice of treatment rather than the sugar salt solution. The proportion of children receiving an increased fluid intake was low in all districts. Correct preparation of ORS was more prevalent in the areas where the CDD program was longstanding while greatest ORS use occurred in the district with trained health workers but with no followup activities. The lowest use of ORS or RHF treatment was in the areas where the CDD programming was just initiated. Most differences were not statistically significant. The results were discussed at the district level in plenary sessions and discussion groups and recommendations for program changes were made. It was decided that the emphasis should be on home fluids for treatment of diarrhea since ORS was not prepared correctly. Priority was to be given to development of home fluids such as cereal-based porridges. The authors conclude that survey data needs vary with the stage of program development. Early stages need data on the extent of a disease. Later information is needed on operational factors. Local survey activity generates useful data creates local interest in the program and trains local staff in field epidemiology. Program evaluation relies on household surveys and rapid data analysis and feedback are very important. The WHO case management prototype survey microcomputers and LOTUS 123 spreadsheet are a successful combination for speedy results