Extending Deworming to the Margins in Kenya

Parasitic worm infections disproportionately affect people living in poverty, especially those who are difficult to reach with mass drug administration. Evidence Action is committed to supporting innovations that enable treatment for all children at risk of worm infections regardless of their circumstances.

While programs such as Kenya’s National School-Based Deworming achieve high treatment coverage through the existing school infrastructure, sub-groups of children remain particularly difficult to reach. Hard-to-reach groups such as migrant children and children living in geographically remote areas are often at increased risk of parasitic worm infections due to factors including, frequently, poor sanitation infrastructure. Given the diverse needs of these groups, there is no one-size-fits-all solution. Here’s a look at some targeted strategies implemented in Kenya to improve coverage of hard-to-reach children over the past year.

Identifying hard-to-reach children in Kenya

Government officials involved in Kenya’s deworming program brought several populations of hard-to-reach children to our attention during county and sub-county training meetings, highlighting a need for additional support in reaching out to these communities. These populations included children living in nomadic pastoralist communities in Tana River county, as well as in remote fishing communities among the islands of Lake Victoria in Homa Bay county and in Lamu county, which borders Tana River county. Following the meetings, government officials shared lists of hard-to-reach schools in each county with the Evidence Action team. We used these lists to enable targeted support with the goal of improving coverage of hard-to-reach children.

What we did: Reaching children in nomadic pastoralist communities

Government officials identified over 300 children attending two mobile schools in nomadic pastoralist communities in Tana River county. Teachers at these schools migrate together with their communities and teach using blackboards, books, and other supplies carried by camels provided by the Ministry of Education’s National Council for Nomadic Education.

Since teachers are responsible for administering drugs to children, it is essential that they attend teacher training and that the government implementing team knows where they are on deworming day. We persistently tracked the migration patterns of these schools, investing additional time and resources into calling teachers to follow up on their progress preparing for deworming day and to ensure that they had received adequate drugs and program materials.

Nomadic pastoralist community members often have limited access to communications technologies. To address this challenge, the program used community announcements instead of its usual approach of radio campaigns to raise awareness about deworming and invite non-enrolled children to attend school on deworming day.

Further, food insecurity is prevalent among these communities and can contribute to higher rates of adverse events among children taking praziquantel for schistosomiasis. We worked with the Tana River County Director of Education to provide food for the children to consume with their deworming drugs.

What we did: Reaching children in remote fishing communities

Government officials identified just under 18,000 children attending schools in remote fishing communities in Homa Bay and Lamu counties. Recognizing the unique challenges that accompany deworming drug delivery in such areas, we encouraged the Government of Kenya to provide financial allowances for a few trainers to travel directly to teachers instead of bringing a large number of teachers inland to attend general training sessions.

Ministry of Health and Ministry of Education officials selected the trainers that traveled directly to teachers, and we worked with trainers’ supervisors to ensure that sufficient transport allowances were disbursed in a timely manner. The Government of Kenya provided the boats trainers used to travel to and from the remote island communities.

This approach was both more cost-effective and specialized to the training needs of teachers working in these remote communities.

What’s next?

We plan to use data collected from these communities to inform our future efforts to treat hard-to-reach children. Improving coverage of hard-to-reach populations requires constant recalibration, so we will continue working with our government partners to monitor hard-to-reach schools and update the list as conditions change. An up-to-date list will enable the program to target communities with specialized strategies to address their unique challenges. Treating hard-to-reach children requires additional resources and commitment. We will continue to regularly assess costs and work with the Government of Kenya to ensure that the most cost-effective approaches are used.

We are committed to improving coverage of hard-to-reach children across all of the school-based deworming programs we support. For instance, our team in Tripura state, India recently supported the government to treat migrant child workers through setting up deworming booths near brick kilns. Across program geographies, our teams continue to share experiences and learn from one another, and we are excited to use these lessons to inform our future efforts in ensuring all at-risk children receive the benefits of deworming.