Using ICT for diarrhoea intervention in resource constrained environments : a case study of Narok County in Kenya

Abstract

Diseases are the major causes of mortality worldwide with developing countries having the highest disease prevalence. Diarrhoea is one of the major diseases worldwide and especially in poor countries with its victims being mostly children below the age of five years. Diarrhoea is most prevalent in rural areas of poor countries which is due to poor awareness about the disease. Effective use of ICTs can greatly enhance health information dessimination and consequently improve disease awareness. The aim of this study was to reduce diarrhoea prevalence by raising awareness using suitable technologies in the context environment. The study was based in Narok County, one of the counties in Kenya with most of the people living in the rural areas. The county has high diarrhoea prevalence due to low levels of awareness which is attributed to use of ineffective strategies and technologies in dissemination of health information. A control and an experimental group from two similar sub-locations were identified for the study. Purpose sampling technique was used in data collection. The study was quantitative conducted in three parts concurrently. Part one was a retrospective chart review of dispensary records of children under the age of five years who suffered from diarrhoea. Part two consisted of a pre-test post-test experimental study of 175 mothers with children below the age of five years from each group.The experimental study was a diarrhoea intervention through awareness on children below the age of five years through their mothers who are the caregivers. A structured questionnaire was used to collect data during this phase. Part three conducted concurrently with parts one and two was a cross sectional survey on community health volunteers. The study established that the previously used strategies and technologies had failed because they were not suitable for the area. Mobile phones were identified as the most pervasive and preferred technology in the area for diarrhoea information dissemination. A mobile phone-based system was developed and used in diarrhoea intervention through awareness. Diarrhoea education voice messages were sent through the system to the mothers in the experimental group for three months but not to the control group. The system was unique in that it used mobile phones, which is the most pervasive technology in the area, the messages were in voice and in the Maasai language which is the local language. This allowed the illiterate to benefit from the intervention. The system allowed interaction between the participants and the system and the system allowed participants in emergency situations to contact a health worker. The intervention caused an improvement in diarrhoea awareness in the experimental group from 42.69% to 87.10% which was significant (effect size= 0.81) but there was no significant change in the control group (p>0.999). On diarrhoea prevention practices, there was a significant improvement from 36.9% to 73.0% in the experimental group (effect size=0.643) however there was no significant change in the control group (p=0.526). Diarrhoea prevalence significantly reduced from 28% to 19.6% in the experimental group (p=0.002) but there was no significant change in the control group (p=0.557). Using the data collected during the study, a diarrhoea intervention framework for resource constrained environments that integrates use of suitable technology in the context environment in diarrhoea intervention was developed. The framework addresses diarrhoea intervention from the awareness point of view because high diarrhoea prevalence is associated to low diarrhoea awareness. The framework can also be adopted in interventions of other diseases that can be prevented by creating awareness. The study concluded that when the right technology for the context environment is used to raise diarrhoea awareness, the awareness increases which leads to improved diarrhoea prevention practices and consequently to reduced diarrhoea prevalence.