Expert reaction to strategies that can be implemented to contain spread of Delta variant in Western Kenya

Dr. John Masasabi Wekesa, Chief Medical and Health Systems Specialist

Behaviour change communication: “We need to invest inenhanced behavior change communication. Why? I agree with the Deputy Director of Africa CDC who said that we the people are the vaccines themselves. It means if we embrace all the public health measures and protocols that have been put in place, then we become vaccines. We are unlikely to get the disease; we are unlikely to spread it. We can achieve this through the community health volunteers; community health extension workers. These are basic public health officers like nurses. We need to engage all forms of media; religious leaders both Christians, Muslims and Hindus; and get into partnerships with the private sector, faith-based organization, youth groups to drive the behavior change messages.”

Strict enforcement of COVID-19 protocols: “There is need for strict enforcement of COVID-19 protocols or control measures such as washing hands, sanitizing, keeping social distance, restriction of movements, curfews, lockdowns where necessary, banning of mass gatherings especially political rallies, closure of restaurants, hotels and bars, among others, which we consider to be the super spreaders of the virus. This requires intergovernmental and intersectoral approach through the provincial administration format. Otherwise, if we leave the enforcement of the COVID-19 protocols for the Ministry of Health alone, we’ll not achieve much and the variant will certainly overwhelm the counties’ health systems with devastating consequences on the economy and people’s livelihoods.”

Vaccination: “The Ministry of Health national vaccination statistics show that the counties are not doing very well when it comes to COVID-19 vaccination. This is because currently, no county seems to have any county acquisition and deployment plan (CADP) at all. Most counties are still waiting for the Ministry of Health’s circular on vaccine deployment yet they already have the vaccines at the county level. There are some structural challenges that discourage many people from accessing the vaccines. For instance, people who are over 60 years are expected to travel over very long distances sometimes up to 40 kilometers for vaccines. How possible is that? We need to be more pro-active as leaders. Since counties have been doing vaccinations for polio, and they even have national vaccination days (NIDs), they can pro-actively leverage on that, instead of waiting for the circular from the Ministry of Health.

Let’s have robust and clear county acquisition and deployment plans for vaccines. This entails the scheduling, eligibility for vaccination, place to get vaccinated as well as the side effects and adverse reactions. These are things we need to be talking about and really push and make sure they come to the local tvs, community health volunteers, churches and this will go towards now creating demand for the vaccines.”

Vaccine hesitancy among health workers: “Hesitancy caused by myths and misconceptions about safety of vaccines is a major threat to the vaccination drive in country. For instance, a recent study done by Amref found that about 19% of health workers in the country did not want to be vaccinated. This forced the government to change tact. For example, the government organized a public event whereby the top political leadership of the country including governors, cabinet ministers and the president received their jabs in full glare of the media. This resulted in drastic change of attitude towards vaccines leading to increased uptake by the general population including health workers. We need to educate, train and equip our health workforce. Equip them with confidence to engage the community, so they are able to be on the frontline to tell them what is true and avoid myths.”

Diagnostic capacity: “We had what we call a facility readiness assessment done in June last year 2020. One of the areas we looked at is diagnostic capacity, which is very low. The affected counties need more health personnel, equipment and reagents. Most hospitals have run out of testing kits including level six hospitals. I know through donations, we are going to have one PCR machine in every county referral hospital. They have already landed in the country, there is ongoing training and installation of the PCR machines. The challenge is not the machine; the challenge will be the reagent. Reagents can be fairly expensive and availability can be a challenge and of course, other support tests. The county hospitals also need functional CT scans to be installed for complicated cases.”

Infrastructure and essential medicines: “My worry is that the infrastructure available, including bed capacity, piped oxygen and oxygen cylinders, in the isolation and treatment centers would not be able to handle the expected large number of severe disease cases caused by the Delta variant circulating in the region.

Medicines for COVID treatment are very expensive. If you stay in some high end hospitals in Nairobi for about 7 days and you’re on oxygen and you need those medications; you’re going to spend shs. 257,000 (actually 50% of your hospital bill). The bed is cheap but medicines are expensive. That is why we are agitating for universal health coverage.

The counties are being encouraged to promote intercounty referrals. For example, Kisumu county seems to have the best level 6 hospital in Western Kenya. The western counties can put their resources together and improve the facility in Kisumu to improve intercounty transfers instead of struggling to put up similar facilities in their counties. The other counties should focus on investing or creating centers of excellence in other areas not covered by the Kisumu hospital.

The referral strategy has four components. One, you can refer the patient himself physically. You can refer the specimen of the patient. You can refer the patient information, then they give you feedback , whereby, patient information can be in terms of radiology, whereby, you just take a scan and send there and somebody responds and you treat the patient. There are areas we need to address as counties not to rely on MOH.

Home based care: Due to inadequacy of COVID-19 facilities, we can’t cope if there is an upsurge of cases as a result of this new variant which is highly infectious. So what we need to do is that if people have no symptoms (asymptomatic), mild disease, no chronic illness and there is a separate well ventilated room to self-isolate, it is advisable that we put them in home based care. Here is the criteria for home based care. To start with, the patient should be stable enough. There should be caregivers and a separate bedroom and that is a tall order for most people, even in Nairobi. The patient should be assured of accessing adequate nutritious food and other amenities. In addition, the other members of the household must have access to personal protective equipment like masks or gloves. Thermometers should also be available to enable the patient to constantly monitor his or her temperature. We should invest in some of these basic things, instead of running for things like big ventilators which will only take care of a few patients.

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