by Bill Snyder
Eleven years after two Vanderbilt University medical students established a health care organization in an impoverished area of Kenya, the death rate for children under 5 years old has been cut in half, according to researchers from Kenya and the Vanderbilt Institute for Global Health (VIGH).
Their findings, reported last month in the online science journal PLOS ONE, support the effectiveness of community-based models of health care delivery like that provided by the Lwala Community Alliance.
“A community-driven, integrated health organization that starts from individual households all the way to a large hospital, regardless of where it’s situated in the world, can have a profound impact on health outcomes,” said first author Joseph Starnes, MPH, a fifth-year MD/MPH student at Vanderbilt University School of Medicine.
Lwala is preparing to expand its current “catchment area” of about 30,000 people to cover hundreds of thousands over the next five years. “This is — in a lot of ways — an experiment,” said senior author Troy Moon, MD, MPH, a core VIGH faculty member. “Can they take this to scale?”
Brothers Milton and Fred Ochieng’ established the organization in 2007 while they were in medical school at Vanderbilt — first as a clinic and later including a community hospital — to bring desperately needed health services to their village, Lwala, in Migori County.
In this rural area adjacent to Lake Victoria, nearly one in five people is HIV-infected. Malaria and other infectious diseases are rampant and life-expectancy hovers just above 40 years.
From the beginning, Lwala’s agenda has been driven by its community. “We invite community members to give us their priorities and look back together to see what has worked well and what has not … and come up with suggestions for making improvements,” said managing director Julius Mbeya.
Traditional midwives are excluded from the Kenyan health care system, which is moving from home-based to hospital deliveries. But they’re an asset to Lwala, which recruits and trains them as community health care workers to help “transform the way health care is delivered to women and children,” Mbeya said.
Today more than 97 percent of women in the area deliver their babies in a health facility attended by a skilled clinician — up from just 26 percent a few years ago.
The current study, based on a community-wide survey conducted in 2017, sampled 1,362 children born after Jan. 1, 1999.
Analysis of the data revealed that prior to 2007, when Lwala was established, the “under-five” mortality rate in this group was nearly 105 deaths per 1,000 births. After 2007 the rate fell to 53 deaths per 1,000.
In the last five years it has dropped to just under 30 deaths per 1,000, well below national averages in Kenya, Starnes said.
The most common causes of death in the children under 5 were malaria, respiratory infection and anemia. Deceased children were more likely to have been born a twin or triplet or to women who’d previously delivered a child less than 18 months earlier.
They also were more likely to have been born during the rainy season, when infectious disease rates are higher and access to medical care is more difficult.
To encourage birth spacing, Lwala offers family planning services. “It’s really well established in the (scientific) literature that mothers who are able to space births more, their children will do better,” Starnes said.
The study shows “there are hundreds of children who are alive today because of this work,” added Executive Director Ash Rogers. “It just compels us to do more. Now that we know we’re a model that works it’s really a moral imperative.”
Crucial to Lwala’s success are the resources provided through its affiliation with Vanderbilt University and Vanderbilt University Medical Center, said Moon, an associate professor in the Division of Pediatric Infectious Diseases.
The ability to conduct surveys and in-depth program evaluations with a high degree of scientific rigor enables Lwala to determine more quickly and accurately what works — and what doesn’t.
Lwala is supported by several foundations and the Kenya government. It partners with Nashville-based Thistle Farms, The Morris Family Foundation, Blood:Water Mission and the Harpeth Hall girls’ school, with Tivity Health in Franklin, and with Hearne Dry Goods in Shreveport, Louisiana.
Bonnie Miller, MD, senior associate dean for Health Sciences Education at Vanderbilt, serves on the board of directors, as do co-founders Milton Ochieng’, MD, now a gastroenterologist in private practice outside St. Louis, and Fred Ochieng’, MD, a cardiovascular medicine fellow at St. Louis University.
What’s happening in Lwala can be achieved elsewhere, Rogers said. “African-American women in the United States die in childbirth at much higher rates than other women,” she said. “We’ve built a model in Kenya that has direct replicability in the U.S. and other developed countries.”
