BMJ open

2044-60551482024Aug19BMJ openBMJ OpenLandscape analysis of the Kenyan policy on the treatment and prevention of diarrheal disease among under-5 children.e081906e081906e08190610.1136/bmjopen-2023-081906Diarrhoea remains a leading cause of morbidity and death among under-5 children in Kenya, despite multipronged policy and programme initiatives to increase access to treatment. This study interrogates the comprehensiveness and adequacy of Kenya's policies, frameworks and action plans for diarrheal management and prevention. The study seeks to identify policy and practice gaps that need to be filled to strengthen diarrhoea treatment and prevention among under-5 children in Kenya.Our study is a landscape analysis, which seeks to identify the gaps in the current Kenya diarrheal policy, frameworks and action plans. The critical questions included their comprehensiveness, the availability of elaborate treatment, management and prevention solutions, together with updatedness, building on evidence from extant literature on key pathways to infection relating to man-animal environmental interaction, which are critical in enteric infection prevention initiatives.We conducted an internet search of databases of Government of Kenya's Ministry of Health; relevant websites/publications of international organisations and groups (Centre for Disease Control and Prevention, UNICEF and WHO) and published and grey literature (Google searches, Google Scholar and PubMed).Included are publicly available key national diarrheal policy frameworks, plans, strategies, laws, institutional frameworks and operational guidelines that inform pertinent questions on the adequacy of policy and practice and preventive policy updates and actions. Further, peer-reviewed and grey literature on diarrheal morbidity and mortality and diarrheal prevention and management are included. The analysis excluded any information that was not referenced on the internet nor obtained from the internet.The review team extracted the key provisions of the policy guidelines guided by a checklist and questions around the adequacy of existing national policies in addressing the determinants, prevention and treatment interventions of enteric infections and diarrhoea among under-5 children in the country. The checklist covered Kenyan background and diarrhoea situation analysis, policy objectives, policy strategies and policy implementation.The analysis identified a corpus of strategies for the management of diarrhoea at multiple levels: health facilities, communities and households. The policies highlighted advocacy, health communication and social mobilisation, as well as logistics management and prevention strategies. However, the triangulation of evidence from the policy provisions and extant literature identified critical policy gaps in diarrhoea prevention and management in Kenya, particularly the lack of focus on zoonotic pathways to enteric infection, environment-pathogen linkages and operationalisation of the roles of social determinants of health and related services. The policy documents had limited focus on rapid diagnosis, vaccine development and deployment, together with weak funding commitment towards implementation and unclear pathways to funding responsibilities.Policies are central to guiding programmatic actions towards effective enteric and diarrhoea prevention and management measures in Kenya. This study shows the need for policy updates to reflect pathways to enteric infections not covered in the current policy guidelines. Further, there is a need to strengthen the treatment and management of infection through rapid diagnosis, vaccine development and deployment, and strong funding commitment towards implementation together with clear funding responsibilities. Together, these will be vital in strengthening the current policy provisions and addressing other pathways to the prevention of enteric infections relating to zoonotic, environment-pathogen linkages and social determinants of health in Kenya and other low-income and middle-income countries.NCT05322655.© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.MberuBlessingBPopulation Dynamics and Urbanization, African Population and Health Research Center, Nairobi, Kenya.Demography and Population Studies, University of the Witwatersrand Johannesburg School of Social Sciences, Johannesburg, South Africa.SimiyuSheillahS0000-0003-3069-8967Population Dynamics and Urbanization, African Population and Health Research Center, Nairobi, Kenya.GutemaFanta DFDDepartment of Occupational and Environmental Health, The University of Iowa College of Public Health, Iowa City, Iowa, USA.SewellDanielDDepartment of Biostatistics, The University of Iowa College of Public Health, Iowa City, Iowa, USA.BusieneiPhylis JPJ0000-0002-7719-7994Population Dynamics and Urbanization, African Population and Health Research Center, Nairobi, Kenya.TumwebazeInnocent KIK0000-0003-2364-4602Population Dynamics and Urbanization, African Population and Health Research Center, Nairobi, Kenya itumwebaze@aphrc.org.BakerKelly KKK0000-0002-3774-2628Department of Occupational and Environmental Health, The University of Iowa College of Public Health, Iowa City, Iowa, USA.Center for Climate Change and Health Equity, University at Buffalo, Buffalo, New York, USA.engClinicalTrials.govNCT05322655R01 TW011795TWFIC NIH HHSUnited StatesJournal ArticleReview20240819