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Reaching vulnerable populations in Kenya’s cholera outbreak

Reaching vulnerable populations in Kenya’s cholera outbreak

31 March 2023 | Kenya

Nairobi ‒ Since October 2022, Kenya’s arid northern region has been affected by a cholera outbreak triggered by the impact of a prolonged and severe drought. The country has recorded more than 7800 cases and 122 deaths as of 26 March 2023.

Kenyan health authorities launched the country’s first-ever cholera vaccination drive in February to bolster outbreak control efforts and end the disease. The 10-day campaign, rolled out with support from World Health Organization (WHO), targeted 2.2 million people in four worst-affected counties. WHO has been working with the Kenyan authorities to ramp up disease surveillance, prevention and treatment, as well as community engagement and coordination with partners to improve sanitation and safe water provision. The Organization also disbursed US$6 million to kick-start emergency cholera responses in Kenya, Malawi and Mozambique.

India Zakaria lives close to Madogo Health Centre near the Tana River in eastern Kenya. She went to the centre to get vaccinated after her husband fell sick with cholera. “I believe he got infected from the river, which is our main water source, even though it is very polluted. For a whole week he could not take care of the family, but eventually he got well,” she said. “I heard about the campaign from a public announcement vehicle that was making the rounds in our area, and when I saw other people were getting vaccinated, I decided I should too.”

Communities in Garissa County, one of the cholera-affected regions, are widely dispersed across hard-to-reach areas. The role of local community leaders was pivotal in ensuring people turned out in large numbers at vaccination centres. “Our response to the outbreak has focused on community engagement and messaging, including a multi-sectoral approach to ensure religious and community leaders are involved at all levels,” said Ibrahim Mohamed, a health promotion officer for the Garissa County Department of Health and Sanitation Services.

In the village of Amares, local community leader Bule Mohamed ensured that people understood the purpose of the vaccine, which helped to alleviate hesitancy and build trust. “Together with other local leaders and WHO officials, we mobilized our community and we are happy that they have taken the vaccine,” he said.

The Ministry of Health also enlisted the help of volunteers who used loud hailers to encourage community members to turn up for vaccination. This was complemented by mobilization through the media and a toll-free hotline was also set up to provide further information and address concerns.

Vaccination teams went door-to-door to provide residents with the vaccine at home as well as setting up vaccination stations in schools, health centres, markets and other strategic public spaces. The campaign primarily targeted pastoral communities displaced by drought. Without access to clean water, sanitation and health facilities, these communities are particularly vulnerable to cholera. Infection is caused by the ingestion of contaminated food or water, with symptoms including acute watery diarrhoea, which can quickly lead to severe dehydration.

According to Dr Emmanuel Okunga, the head of the Division of Disease Surveillance and Response in Kenya’s Ministry of Health, the campaign ultimately managed to reach 99.2% of the target population by 21 February. “It has been very successful,” he said. “We are now monitoring the impact of the vaccine on the number of cases, and we have already seen a decline across the affected counties.”

WHO has supported Kenya’s response to the outbreak through the provision of over 2.2 million vaccines and nutritional supplements for about 12 000 under-five malnourished children. The Organization has also deployed 16 specialists across five severely affected counties to bolster disease surveillance and the coordination of outbreak prevention activities. “We must remember that the vaccine is not a magic bullet,” said Dr Julius Wekesa, WHO’s incident manager for the cholera outbreak in Kenya. “It must go hand in hand with the strengthening of water and sanitation interventions at all levels.”

In January WHO launched a regional appeal for US$178 million to prevent as well as respond to disease outbreaks in the greater Horn of Africa region. After five consecutive seasons of drought, projections are that below average rains in the current March‒May rainy season will result in over 48 million people being food insecure, including more than 5.4 million people in Kenya. This is expected to cause further disease outbreaks. “A food crisis is also a health crisis,” said Dr Abdourahmane Diallo, WHO Representative in Kenya. “Immediate global action is required to save lives in Kenya and the greater Horn of Africa.”

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