By Wandera Ojanji,Kenya

Her  10  month  old  baby  looked quite jovial, throwing smiles to anyone  who  showed   any interest.

But  in  quite  a  different  mood, J a c q u e l i n e ' s   m o t h e r ,   M e r c y Nasirumbi  looked  more  worried, almost  detached  at  what  was  going  on at the Eshikhuyu Clinic in Lurambi division, Kakamega District, Western Kenya, and for good reasons.

For  Nasirumbi,  this  was  a  routine clinic visit for her baby only that this time  round,  back  home,  her  eight- year old son was in bed, down with a  severe  bout  of  malaria.     For Jacqueline  whose  visit  had  no financial implications, Mercy needed money she   did  not  have  -  to  seek treatment for her son Joshua.

But  the  management  of malaria is compounded by other  life  thr eatening diseases  such  as  water borne diseases.

Although, the clinic offers treatment for  malaria  at  subsidized  rates  of about Ksh100  (US$ 1.5) per dose for children,  it  is  still  high  for  many parents  like  Nasirumbi,  with   no regular sources of income.

The  matter  is  further  aggravated  by the  high  incidence  of  malaria  in  the area,  particularly,  in  the  months  of April  to  June  and  September  to November, according to nurses at the Eshikhuyu.  Within  this  period,  they receive about 10,000 cases of malaria
per month compared to less than 200 cases in the other months.

But  the  management  of malaria is compounded by other  life  threatening diseases  such  as  water borne diseases.

Indeed,  it  was  only  last  week  that Nasirumbi used the little money she had  to  treat  her  third  born,  a daughter,  who  had  also  been  hit  by malaria.  “A  week  hardly  passes before  I  have  to  bring  one  of  my children  here  for  treatment  of malaria,” says the mother of six.

But  the  management  of  malaria  is c o m p o u n d e d   b y   o t h e r   l i f e   threatening  diseases  such  as  water borne  diseases.  More  seriously  HIV  and AIDS have taken a toll not only in Lurambi but also in the larger western region.

For  Auma  Opiyo,  also  on  a  routine  clinic  visit,  the  day  had  come  in handy. Her three month old son had had a running stomach over the last two  days.  She  would  cash  in  on  the free services then.

According  to  health  officials  in  the area, cases of acute watery diarrhoea are common in the region, a problem attributed  to  poor  sanitation  and hygiene  and  contamination  of
drinking water at the sources.

According  to  James  Gesami,  Kenya's assistant  Minister  for  Public  Health and  Sanitation,  there  is  a  need  for education  on  hygiene  as  well  as obtaining  using  clean  water  at  the clean  sources.

So far, Gesami said, the Ministry was working  on  improving  public  health through  activities  such  as  training v o l u n t e e r s   t o   w o r k   a l o n g s i d e community health workers for better health sensitisation.

However,  despite  the  sickness  of their  children  weighing  heavily  on their  minds,  Auma,  Nasirumbi  and many  other  residents  Eshikhuyu  like their other counterparts in the larger Lurambi Division of Kakamega District had something to smile about.

The Kenyan Ministry of Public Health and  Sanitation  in  collaboration  with V e s t e r g a a r d   F r a n d s e n ,   a n   international company specializing in complex  emergency  response  and disease  control  products,  and  CHF International,  had  just  launched  a
u n i q u e   I n t e g r a t e d   P r e v e n t i o n  Demonstration project - an important new approach to fighting m a l a r i a ,   d i a r r h o e a l   disease  and  HIV  among adult  men  and  women aged 15-49.

O n e   o f   t h e   u n i q u e   features of the campaign, dubbed  the  Integrated P r e v e n t i o n Demonstration (IPD), was  that  for  the  first  time, bednets  targeting  adults were part of an integrated public health campaign.

P r e v i o u s   i n t e g r a t e d  campaigns  that  included bednet  distribution  were coupled with child health interventions  such  as measles vaccinations and vitamin  A  supplement  and  reached only  the  most  vulnerable,  that  is, children  under  five,  says  Mikkel V e s t e r g a a r d   F r a n d s e n ,   C h i e f  Executive  Officer  of  Vestergaard
Frandsen  and  the  developer  of  the IPD concept.

He notes that the inclusion of adults contributes to the universal coverage  of  Long-Lasting  Insecticide-treated N e t s   ( L L I N s )   f o r   t h e   a t - r i s k   population,  which  was  called  for  by United  Nation's  Secretary  General  earlier this year.

He  says  there  is  a  cost  efficiency a t t a c h e d   t o   l o n g e r   l a s t i n g   interventions  as  repeat  costs  are eliminated.

Vestergaard  notes  that  by  designing LifeStraw®  Family  as  a  water purification  unit  with  a  three  year lifetime,  they  had  ensured  that  the major  components  of  basic  care package  are  without  the  need  for repeat  intervention  and  that  proper care  of  families  living  with  HIV  can now be rapidly scaled up.

Residents  of  Lurambi,  too  aware  of the  burden  of  malaria,  diarrhoeal disease  and  HIV  in  the  area  heartily welcomed the initiative. By the end of the  one-week  campaign  that  was jointly launched by the South-African music icon Yvonne Chaka Chaka, who is  also  the  United  Nations  Children Education  Fund  (UNICEF)  Goodwill Ambassador  and  Kenya's  Deputy Prime Minister and Minister for Local Government,  Musalia  Mudavadi, over  50,000  adults  participated, covering  nearly  every  adult  and family in the area.

This  was  way  above  the  targeted 40,000 residents to be provided with voluntary HIV counseling and testing services in the division, according Dr Oscar  Indakwa,  Kakamega  Central District Medical Officer of Health. All services were provided free of charge at 30 community-based delivery sites open from September 16-22, 2008.

Apart from providing the residents of Lurambi with the lifesaving facilities, the  project  also  provided  public health  and  policy  experts  with  important  information  on  the scalability  and  cost-effectiveness  of delivering a lifesaving care package to communities in similar settings, with intentions to replicate it across Kenya and throughout Africa.

Vestergaard states, “Lessons learned from this campaign will contribute to Kenya's national scale-up plan for HIV counseling  and  testing,  and  the Millennium Development Goals.”

The IPD campaign was designed to be replicated,  and  therefore  holds  the potential to reduce suffering and save lives far beyond the borders of Kenya.