Integration of routine vaccination and hygiene interventions: a comparison of 2 strategies in Kenya.
BACKGROUND
Hygiene interventions reduce child mortality from diarrhea. Vaccination visits provide a platform for delivery of other health services but may overburden nurses. We compared 2 strategies to integrate hygiene interventions with vaccinations in Kenya's Homa Bay district, 1 using community workers to support nurses and 1 using nurses.


METHODS
Homa Bay was divided into 2 geographical areas, each with 9 clinics. Each area was randomly assigned to either the nurse or community-assisted strategy. At infant vaccination visits hygiene kits were distributed by the nurse or community member. Surveys pre- and post-intervention, measured hygiene indicators and vaccination coverage. Interviews and focus groups assessed acceptability.


RESULTS
Between April 2009 and March 2010, 39 158 hygiene kits were distributed. Both nurse and community-assisted strategies were well-accepted. Hygiene indicators improved similarly in nurse and community sites. However, residual chlorine in water changed in neither group. Vaccination coverage increased in urban areas. In rural areas coverage either remained unchanged or increased with 1 exception (13% third dose poliovirus vaccine decrease).


CONCLUSIONS
Distribution of hygiene products and education during vaccination visits was found to be feasible using both delivery strategies. Additional studies should consider assessing the use of community members to support integrated service delivery.
Global Immunization Division, Centers for Disease Control and Prevention, 1600 Clifton Rd, MS-A05, Atlanta, GA 30307, USA. tryman@cdc.gov
Tove K
TK
Ryman
Elizabeth C
EC
Briere
Emily
E
Cartwright
Karen
K
Schlanger
Kathleen A
KA
Wannemuehler
Elizabeth T
ET
Russo
Steve
S
Kola
Ibrahim
I
Sadumah
Benjamin L
BL
Nygren
Cliff
C
Ochieng
Robert
R
Quick
Margaret L
ML
Watkins
D000163:Acquired Immunodeficiency Syndrome / Q000517:prevention & control; D003153:Community Health Services; D019033:Delivery of Health Care, Integrated / Q000191:economics; D006801:Humans; D006920:Hygiene; D007630:Kenya; D011787:Quality of Health Care; D014611:Vaccination; D060753:Water Quality