Preventing Child Mortality: A Survey of Kenyan Families and Health Workers

Student Researcher: Nathan Combes
Location: Kenya

Every year, 800,000 children under the age of five die from diarrheal diseases. In Kenya, the mortality rate in 2010 was 38,800, a 30 percent increase from 2006.

Mortality from these diseases is cheaply prevented, and the Kenyan government guarantees free healthcare to children under five years of age. So why have government policies failed to prevent children from dying of diarrheal diseases?

One major reason for the high mortality rate is low usage of the gold standard of treatment: oral rehydration solution (ORS) and zinc. The most recent DHS in Kenya reports that ORS use is 40 percent, while zinc use is less than 1 percent. Given that treatment is free to patients under five years old, why is usage so low?

One explanation is that approximately half the dispensaries in Kenya are reported to be out of stock of ORS and other essential medicines. Another explanation is that citizen demand is too low.

A survey of rural Kenyans was used to collect data on residents' knowledge and beliefs regarding treatment options along with a simple experiment to test whether politician support of a particular treatment made residents more likely to adopt it. Community health care and dispensary workers were interviewed to determine what difficulties they faced in procuring supplies and if there were incentivizes to that would improve delivery of services. 

Results

The researcher conducted a 120-question survey of 1,006 residents in Kenya that included three survey experiments.

A core finding of the survey is that knowledge and usage of oral rehydration solution, the gold standard of treatment for childhood diarrhea, is very high in Western Kenya. Not only did the survey expose that childhood mortality from diarrhea is not caused by a failure of demand from citizens (as previously reported), but it pointed to other factors that potentially were the main obstacles to preventing childhood mortality from diarrhea in Kenya.

Many families opt not to visit dispensaries because they are hard to access. Even individuals who live near a dispensary may choose not to go there because they would wait a very long time in line to eventually receive substandard treatment. Respondents noted that dispensaries are often out-of-stock of essential medicines, including ORS. The summary of these conclusions is that citizens will use ORS and/or zinc when they are available, but that availability is abysmally low.

The survey also tested whether or not uptake of new medicines would increase if they were endorsed by female politicians rather than male politicians, in hopes of finding a way to increase citizen uptake. The results of this experi-
ment were null.