Sustained utilization of safe drinking water and handwashing stations in Kenyan health facilities

Poor access to safe water and inadequate hygiene contribute substantially to the global diarrhea burden. In Nyanza Province, Kenya, 72% of the population lacks improved water sources and diarrhea is the second leading cause of death in infants less than 1 year old. To address this problem, from 2003-2008, CARE Kenya installed drinking water and handwashing stations (consisting of safe water storage containers with taps, bleach solution for water treatment, and soap) in 109 health facilities, educated health workers on water treatment and handwashing with soap, and encouraged them to teach this information to patients. From November-December 2008, we evaluated this program. We visited 30 randomly selected health facilities (6 hospitals, 10 health centers, and 14 dispensaries), made observations, and interviewed 164 health workers and 298 patients about water and hygiene. Of 30 facilities, 29 (97%) had water stations present; of these, 29 (100%) had water in containers. We confirmed through detection of residual chlorine in water stations, that 17 (59%) of 29 facilities had treated water. Of 164 health workers, 153 (93.3%) knew the correct dose of bleach solution for water treatment. Interviews with 298 patients indicated that health workers taught 134 (45%) about water treatment, 76 (26%) about safe water storage, and 116 (39%) about handwashing; 179 (60%) were taught at least one of the three topics. Use of water stations, water treatment, and patient training continued in most health facilities over 1-5 years, indicating potential sustainability of this intervention.