ANALYSIS OF THE BURDEN OF POTENTIALLY WATER-RELATED
DISEASES TO THE COMMUNITIES TREATED BY THE NGUUNI
HEALTH CLINIC, KIEMBENI, MOMBASA AND THE OUTREACH
STATIONS AT VIKWATANI, MITEDI AND KIMBUNGA
LAURA JEFFERIES
MEDICAL ELECTIVE PROJECT 2010
Haller (The Haller Foundation) is a registered UK Charity, No.1101725 and a registered NGO in the Republic of Kenya
PO Box 65809, London EC3P 3FG
t 020 3023 4080
e info@haller.org.uk
www.haller.org.uk
1
Aim:




Analysis of data supplied by Dr R Haller from the Nguuni Health Clinic.
o Look for potential relationships between rainfall and disease occurrence when
considering the burden of potentially water-related diseases (malaria,
schistosomiasis, typhoid/salmonella, helminthiasis and diarrhoeal disease and
dysentery)
Analyse the disease burden as a percentage of morbidity in patients seen in the clinics where
data available.
Visit the clinic and the outreach stations to assess their functions.
Explore patient education targets based upon my findings.
First impressions:




Vikwatani outreach station:
o I was shown around Vikwatani by a community member who explained the water
supplies to me.
o I learnt that people’s main water supplies are leaking pipes appearing as
puddles/surface water and 2 damns built by the Baobab Trust.
o Not much rain had fallen and the two damns were close to empty; the water was
green and sludgy.
o I could not see any signs of snails suggesting either damn as a source for the
schistosomiasis cases arising in this area.
o I was advised that not many people treat the water they collect from the leaking
pipes or the damns.
Nguuni clinic:
o Malaria diagnosis and treatment – although most people with symptoms of malaria
are diagnosed microbiologically, some are treated for malaria on clinical suspicion
alone or in combination with a negative blood film. In the UK I observed that
patients returning to the UK with a fever from countries where malaria is endemic
were tested for parasitaemia using a blood film. Tests were repeated up to 4 times
to ensure the correct exclusion of malaria as a diagnosis. I do not think this option is
viable in a setting here however, I do think considerations need to be made to
improve malaria testing and treatment, especially in the outreach clinics.
o Many conditions such as diarrhoeal disease and upper respiratory tract infections
are treated with antibiotics when the infections may not be bacterial but viral.
Mitedi outreach station:
o I attended the Mtedi outreach clinic once. The rains prevented us from reaching the
area but we stopped at a known point on the main road and people came to us.
o There was equipment needed for the clinic that was not brought with us. Such as
weighing scales, a thermometer and an oto/oroscope. These pieces of equipment
are essential for the correct and efficient diagnosis of patients and making do
without, e.g. by assessing for fever clinically, was not accurate or ideal for patient
care.
Kimbunga outreach staion:
o A local lady helped to organise the patients who needed to be seen and to collect
payment. This was well organised and ran very smoothly.
Haller (The Haller Foundation) is a registered UK Charity, No.1101725 and a registered NGO in the Republic of Kenya
PO Box 65809, London EC3P 3FG
t 020 3023 4080
e info@haller.org.uk
www.haller.org.uk
2
o
Lennox took the opportunity to educate attending patients about the importance of
taking treatment for malaria without delay to limit morbidity and mortality.
Analysis of clinic statistics:
Displayed below are a number of graphs that depict various diseases in an attempt to distinguish
relationships between disease occurrence and the average rainfall (statistics taken from the BBC
weather website). The use of average rainfall levels is not an ideal comparison due to the natural
variation of the precipitation levels and the timing variations each year. I acknowledge that it would
be better to compare them to rainfall statistics that were more accurate to the areas under analysis.
MALARIA BURDEN (% OF TOTAL PATIENTS) AT NGUUNI CLINIC AND THE 3 OUTREACH CLINICS
AGAINST AVERAGE RAINFALL LEVELS IN MOMBASA, KENYA
35
30
25
Average rainfall (cm)
20
15
Malaria burden 2008 (% of total
patients)
10
Malaria burden 2009 (% of total
patients)
5
Malaria burden 2010 (% of total
patients)
0
Haller (The Haller Foundation) is a registered UK Charity, No.1101725 and a registered NGO in the Republic of Kenya
PO Box 65809, London EC3P 3FG
t 020 3023 4080
e info@haller.org.uk
www.haller.org.uk
3
MALARIA TRENDS SEEN AT NGUUNI CLINIC AND THE 3 OUTREACH CLINICS, JANUARY 2008 – MARCH
2010
35
30
25
20
Malaria burden 2008 (% of total
patients)
15
Malaria burden 2009 (% of total
patients)
10
Malaria burden 2010 (% of total
patients)
5
0
60
50
40
Average rainfall in
Mombasa (cm)
30
Malaria burden 2008 (% of
total patients)
20
10
Malaria burden 2009
(percent of total patients)
0
Malaria burden 2010 (% of
total patients)
The above line graph shows that the 2008 levels of malaria rose after the long rainy season as did
the 2009 levels; the former to a lesser extent.
The data used to compile the above graphs have a number of flaws that I wish to note:
Haller (The Haller Foundation) is a registered UK Charity, No.1101725 and a registered NGO in the Republic of Kenya
PO Box 65809, London EC3P 3FG
t 020 3023 4080
e info@haller.org.uk
www.haller.org.uk
4



Clinic and laboratory data is unavailable for the months of January, February and December
2009;
Post-April 2009 the data is based on lab diagnostics whilst pre-April 2009 figures reflect the
clinical suspicion of malaria therefore, pre- April 2009, the figures may over-estimate the
burden of disease in the areas served by the clinic and outreach stations.
Laboratory data for August 2009 was incomplete therefore I have used the clinic statistics
for this particular month.
SCHISTOSOMIASIS BURDEN IN PATIENTS ATTENDING NGUUNI HEALTH CLINIC AND THE OUTREACH
CLINICS (MARCH 2009 – MARCH 2010) AGAINST AVERAGE RAINFALL IN MOMBASA, KENYA:
4
3.5
3
2.5
2
Average rainfall for Mombasa
(m)
1.5
Schistosomiasis burden (% of
total patients)
1
0.5
Mar-10
Feb-10
Jan-10
Dec-09
Nov-09
Oct-09
Sep-09
Aug-09
Jul-09
Jun-09
May-09
Apr-09
Mar-09
0
Haller (The Haller Foundation) is a registered UK Charity, No.1101725 and a registered NGO in the Republic of Kenya
PO Box 65809, London EC3P 3FG
t 020 3023 4080
e info@haller.org.uk
www.haller.org.uk
5
4
3.5
3
2.5
Schistosomiasis burden (%
of total patients)
2
1.5
Average rainfall in
Mombasa (m)
1
0.5
Mar-10
Feb-10
Jan-10
Dec-09
Nov-09
Oct-09
Sep-09
Aug-09
Jul-09
Jun-09
May-09
Apr-09
Mar-09
0
Once again the same flaws in the data exist as for the malaria statistics. The above two graphs
appear to show that schistosomiasis incidence and average rainfall are linked; that an increase in
rainfall heralds an increase in the number of cases of schistosomiasis found within these
communities. Whether this demonstrates coincidence, or a change in the nature of water collection
between seasons, is difficult to say with any certainty. It is however, an interesting relationship to
note and one that if echoed this coming year (2010) will need investigation into why this relationship
exists. The nature of schistosomiasis colonisation means that a patient may have contracted the
parasite quite some time ago. It is therefore difficult to trace where the patient contracted the
parasite.
Haller (The Haller Foundation) is a registered UK Charity, No.1101725 and a registered NGO in the Republic of Kenya
PO Box 65809, London EC3P 3FG
t 020 3023 4080
e info@haller.org.uk
www.haller.org.uk
6
DIARRHOEAL DISEASE/DYSENTRY BURDEN AND RELATIONSHIP WITH RAINFALL:
Again, the data for diarrhoeal disease is missing for January, February and December 2009 however,
in this instance, all the data available was taken from the clinic reports instead of the laboratory
reports. Some of the diarrhoeal disease/dysentery may have been caused by poor water or food
sanitation resulting in parasite and/or bacterial infections however, a certain percentage of disease
will be attributable to viral infections.
Below are two graphs showing the incidence of diarrhoeal disease/dysentery in patients under 5
years and those over 5 years. Children are commonly affected by viral gastroenteritis and this may
reflect a significant part of the incidence of diarrhoeal in under 5s. Without stool cultures and full
blood counts I can only speculate as to the causative factors behind these cases.
35
30
25
20
Average rainfall in Mombasa
(cm)
15
Diarrhoeal disease/dysentry
burden (% of total patients)
10
5
Mar-10
Jan-10
Nov-09
Sep-09
Jul-09
May-09
Mar-09
Jan-09
Nov-08
Sep-08
Jul-08
May-08
Mar-08
Jan-08
0
Haller (The Haller Foundation) is a registered UK Charity, No.1101725 and a registered NGO in the Republic of Kenya
PO Box 65809, London EC3P 3FG
t 020 3023 4080
e info@haller.org.uk
www.haller.org.uk
7
DIARRHOEAL DISEASE/DYSTENTRY BURDEN IN PATIENTS UNDER 5 YEARS AND PATIENTS OVER 5
YEARS RELATED TO AVERAGE MONTHLY MOMBASA RAINFALL LEVELS:
35
30
25
Average rainfall in Mombasa
(cm)
20
Diarrhoeal disease/dysentry
burden (% of total patients
under 5 years)
15
10
Diarrhoeal disease/dysentry
burden (% of total patients
over 5 years)
5
Mar-10
Jan-10
Nov-09
Sep-09
Jul-09
May-09
Mar-09
Jan-09
Nov-08
Sep-08
Jul-08
May-08
Mar-08
Jan-08
0
As you can see form the above graph, the diarrhoeal disease/dysentery rates in the under 5s seem
to show a relationship to the rainfall in 2008 and the early part of 2009. However, this does not
seem to be so much the latter part of 2009 and into 2010; although it is debatable that a rough
pattern can be seen. A concomitant rise in disease incidence and rainfall levels may demonstrate
contamination of water sources during the rainy seasons. It is also possible that people’s water
collection behaviour changes during the rainy season and this causes the changes seen.
I would like to note the higher disease burden within the under 5 year cohort. Some of this may be
due to viral causes as previously stated and as stated previously also, it is difficult to comment with
any certainty on the causative pathogens without further microbiological and biochemical testing.
It would be very interesting to know the division of diarrhoeal disease by causative organism e.g.
bacteria, viruses and parasites. For this to be determined, facilities not present in the laboratory at
this time are required. When this equipment is available I think it would be beneficial to conduct a
study to determine the causative diarrhoeal organisms in patients treated by the clinic, providing
benefit for patient treatment and for epidemiological benefit. Once the contributing factors are
known it will be possible to target them with authority.
Haller (The Haller Foundation) is a registered UK Charity, No.1101725 and a registered NGO in the Republic of Kenya
PO Box 65809, London EC3P 3FG
t 020 3023 4080
e info@haller.org.uk
www.haller.org.uk
8
Number of patients seen at Nguuni,
Vikwatani, Mtedi and Kimbunga Health
Clinics, January 2008 - March 2010
1600
1400
1200
1000
800
600
400
200
0
MONTHLY DISEASE BURDEN IN THE PATIENTS SEEN AT THE CLINIC AND THE
OUTREACH STATIONS
I wanted to look at the disease burden affecting patients attending the Nguuni and outreach clinics. I
feel this will enable the clinical team to target their education programme to have the greatest
impact for the communities’ health.
Each pie chart (below) is based on a month’s worth of data and demonstrates the morbidity of
patients seen in clinic. The morbidity figures are sometimes higher than the total monthly number of
patients attending the clinics as some patients present with more than one health problem.
Therefore I have designed these pie charts not to show morbidity associated with a particular
disease as a percentage of the total morbidity seen in the clinic within a month.
I found it difficult to decide which aspects of the data to use in order to give me meaningful and
transparent results for analysis. For example, for malaria, I have diagnostic data from the laboratory
as well as cases of clinical malaria from the clinic data. One would think that the laboratory data
would be more reliable however some patients are treated for malaria infections despite having a
negative test (clinical suspicion of malaria remains high) and others may present to Nguuni for a
malaria test but get treatment for the disease elsewhere. To create a system that is comparable on a
month-by-month basis I used the data of malaria cases from the clinic throughout (apart from
schistosomiasis statistics that are diagnosed in the lab after March 2009). Studies have been
conducted that demonstrate the incidence of malaria based on a clinical diagnosis to be much higher
than those based on blood film diagnosis. Thus the number of cases of malaria noted in the clinic
data may be an overestimation of the true values of the parasite infection. By using the clinic data all
the way through however, I hope to at least provide a system of comparable data.
Another problem arose when I considered that the laboratory data and clinic data does not match
for other diseases. For example, the incidence of intestinal worms in the clinic data is higher than the
Haller (The Haller Foundation) is a registered UK Charity, No.1101725 and a registered NGO in the Republic of Kenya
PO Box 65809, London EC3P 3FG
t 020 3023 4080
e info@haller.org.uk
www.haller.org.uk
9
incidence in the laboratory data. This is because some diagnoses can be made in the clinic from the
patient’s medical history alone without the need for microscopic identification from the patient’s
faeces. This same problem exists for diarrhoeal disease/dysentery. As noted above, I have no way of
knowing the causative organisms for the diseases seen. Also of note is that respiratory tract diseases
are not sub-divided to show the different conditions that are occurring within the populations
served.
For each month I have produced 3 pie charts. One to show the morbidity affecting patients under 5
years of age, one to show the morbidity affecting patients over 5 years of age and one to show the
combination of the two as a total burden of disease seen in the clinics within the month.
Burden of disease as a percentage of morbidity in patients under 5
years at Nguunni Clinic and the 3 outreach clinics, January 2008
Burns Other
Eye infections
Chicken
pox
1% 3%
4%
1%
Intestinal worms
6%
Diarrhoeal disease
2%
Malaria
34%
Other respiratory
disease
30%
Skin disease
13%
Pneumonia
6%
Haller (The Haller Foundation) is a registered UK Charity, No.1101725 and a registered NGO in the Republic of Kenya
PO Box 65809, London EC3P 3FG
t 020 3023 4080
e info@haller.org.uk
www.haller.org.uk
10
Burden of disease as a percentage of morbidity in patients over 5
years at Nguunni Clinic and the 3 outreach clinics, January 2008
Mental disorders
2%
Dental Sore throat
4%
disorders
6%
Diseases of the
circulatory system
9%
Malaria
23%
Urinary tract
infections
6%
Sexually
transmitted
infections
3%
Rheumatism and
Skin disease
28%
musculoskeletal
9% Ear infections
Chicken pox
2%infections
Eye
0%
2% Dysentry
Pneumonia
Schistosomiasis Intestinal worms 0% Diarrhoea
2%
0%
3%
2%
Other
respiratory
disease
1%
Burden of disease as a percentage of morbidity in all patients seen
at the Nguuni clinic and the 3 outreach clinics, January 2008
Urinary tract
infections
Diseases of the Dental disorders
4%
circulatory system
2%
5%
Sexually
Mental disorders
transmitted
1%
infections Rheumatism and
2%
musculoskeletal
5%
Eye
infections
2%
Sore throat
4%
Malaria
26%
Chicken pox
1%
Ear infections
1%
Schistosomiasis
0%
Other respiratory
Intestinal worms
disease
3%
20%
Dysentry
0%
Diarrhoea
3%
Skin disease
21%
Pneumonia
3%
Haller (The Haller Foundation) is a registered UK Charity, No.1101725 and a registered NGO in the Republic of Kenya
PO Box 65809, London EC3P 3FG
t 020 3023 4080
Burns
1%
e info@haller.org.uk
www.haller.org.uk
11
Disease burden as a percentage of morbidity in patients under 5
years at the Nguuni clinic and the 3 outreach clinics, February 2008
Ear infections
4%
Chicken pox
Other
1%
1%
Eye infections
2%
Malaria
19%
Skin disease
16%
Pneumonia
12%
Diarrhoea/dysentry
8%
Intestinal worms
4%
Other respiratory
disease
33%
Burden of disease as a percentage of morbidity in patients over 5
years seen at Nguuni clinic and the 3 outreach clinics, February 2008
Mental disorder
1%
Dental disorder Maternal child Other
4%Family planning
1%
Antenatal health
1%
1%
Rheumatism and Sore throat
1%
4% Bites
musculoskeletal
7%
Poisoning
1%
1%
Malaria
17%
Diseases of
circulatory system
3%
Urinary tract
infections
4%
Sexually
transmitted
Anaemia
infections
2%
8%
Chicken pox
1% Ear infections
1%
Eye
Schistosomiasis
infections Intestinal worms
0% Diarrhoea
2%
1%
1%
Skin disease
22%
Pneumonia
16%
Dysentry
1%
Other respiratory
disease
1%
Haller (The Haller Foundation) is a registered UK Charity, No.1101725 and a registered NGO in the Republic of Kenya
PO Box 65809, London EC3P 3FG
t 020 3023 4080
e info@haller.org.uk
www.haller.org.uk
12
Disease burden as a percentage of morbidity for all patients seen at
the Nguuni clinic and the 3 outreach clinics, February 2008
Poisoning
0%
Diseases of
circulatory
system
2%
Bites
0%
Rheumatism and
musculoskeletal
4%
Urinary tract
infections
2% Anaemia
Sexually
1%
transmitted
infections Chicken pox
5%
1%
Ear
infections
2%
Eye infections
2%
Schistosomiasis
Dysentry
0%
0%
Intestinal worms
2%
Dental disorder Maternal
Other
0%
child
2%
Sore
health
Mental Antenatal
Family planning
throat
0%
disorder
1%
2%
0%
0%
Malaria
16%
Skin disease
18%
Other respiratory
disease
30%
Diarrhoea
3%
Pneumonia
5%
Burden of disease as a percentage of morbidity in all patients under
5 years seen at the Nguuni clinic and the 3 outreach clinics, March
2008
Chicken pox
Ear infections
Eye infections
2%
0%
3%
Other
3%
Dysentry
0%
Schistosomiasis
0%
Intestinal worms
1%
Malaria
22%
Diarrhoea
8%
Other respiratory
disease
37%
Skin disease
21%
Pneumonia
3%
Haller (The Haller Foundation) is a registered UK Charity, No.1101725 and a registered NGO in the Republic of Kenya
PO Box 65809, London EC3P 3FG
t 020 3023 4080
e info@haller.org.uk
www.haller.org.uk
13
Burden of disease as a percentage of morbidity in patients over 5
years of age seen at the Nguuni clinic and the 3 outreach clinics,
March 2008
Sore throat
2%
Rheumatism,
musculoskeletal
18%
Dental disorders
4%
Other
8%
Malaria
14%
Skin disease
4%
Pneumonia
2%
Diseases of the
circulatory system
3%
Other respiratory
disease
21%
Urinary tract
infections
5%
Diarrhoea
4%
Sexually
transmitted
infections
6%
Anaemia
3%
Chicken pox
0% Eye Schistosomiasis
Ear infections
0%
infections
1%
3%
Dysentry
1%
Intestinal worms
1%
Burden of disease as a percentage of morbidity in all patients seen
at the Nguuni clinic and the 3 outreach clinics, March 2008
Dental disorder
Sore throat 2%
Rheumatism,
1%
Other
musculoskeletal
5%
10%
Diseases of
the
circulatory
system
Sexually Urinary
2%
transmitted tract
infections infection
3%
s
3%
Chicken pox Anaemia
1%
0%
Eye infections
3%
Ear infections
2%
Dysentry
0%
Schistosomiasis
Intestinal
Diarrhoea
0%
worms
5%
1%
Malaria
15%
Skin disease
21%
Other respiratory
disease
25%
Pneumonia
1%
Haller (The Haller Foundation) is a registered UK Charity, No.1101725 and a registered NGO in the Republic of Kenya
PO Box 65809, London EC3P 3FG
t 020 3023 4080
e info@haller.org.uk
www.haller.org.uk
14
Burden of disease as a percentage of morbidity in patients under 5
years of age seen at the Nguuni Clinic and the 3 outreach clinics,
April 2008
Other
Ear infections
Anaemia
Sore throat
3%
1%Chicken pox
1%
2%
Burns
1%
Schistosomiasis
Eye
1%
0%
infections
2%
Intestinal worms
Malaria
4%
Dysentry
22%
0%
Diarrhoea
13%
Skin disease
16%
Other respiratory
disease
32%
Pneumonia
2%
Burden of disease as a percentage of morbidity in patients over 5
years of age seen at the Nguuni Clinic and the 3 outreach clinics,
Poisoning
April 2008
2%
Dental disorders
1%
Rheumatism,
musculoskeletal
12%
Antenatal checks
2%
Other
5%
Diseases of the
circulatory system
3% Urinary tract
Malaria
13%
Skin disease
30%
infections
6%
Sexually
transmitted
Sore throat
Other
infections
2%
respiratory
3%
Burns Anaemia
disease
Ear infections
1%
2%
12%
1%
Eye infections
Intestinal
Pneumonia
2% Schistosomiasis worms Dysentry
Diarrhoea
0%
0%
0%
2%
2%
Haller (The Haller Foundation) is a registered UK Charity, No.1101725 and a registered NGO in the Republic of Kenya
PO Box 65809, London EC3P 3FG
t 020 3023 4080
e info@haller.org.uk
www.haller.org.uk
15
Burden of disease as a percentage of morbidity in all patients seen
at Nguuni Clinic and the 3 outreach clinics, April 2008
Rheumatism,
musculoskeletal
7%
Urinary tract
infections
3%
Antenatal checks
1%
Chicken pox
0%
Poisoning
Diseases of the
Dental 1%
circulatory
disorders
system
1%
2%
Sexually
transmitted
infections
Sore throat
2%
2% Burns
Anaemia
1%
1%
Ear infections
1% Eye infections
2%
Intestinal
worms
Dysentry
3%
0%
Other
4%
Malaria
17%
Skin disease
24%
Other respiratory
disease
20%
Diarrhoea
6%
Pneumonia
1%
Burden of disease as a percentage of morbidity in patients under 5
years of age seen at the Nguuni Clinic and the 3 outreach clinics,
May 2008
Eye infections
1% Ear infections
Intestinal worms
7%
1%
Other
7%
Malaria
17%
Skin disease
10%
Pneumonia
0%
Diarrhoea
21%
Other respiratory
disease
36%
Haller (The Haller Foundation) is a registered UK Charity, No.1101725 and a registered NGO in the Republic of Kenya
PO Box 65809, London EC3P 3FG
t 020 3023 4080
e info@haller.org.uk
www.haller.org.uk
16
Burden of disease as a percentage of morbidity in patients over 5
years of age at the Nguuni Clinic and the 3 outreach clinics, May
2008
BurnsSore Other
0%throat 3%
1%
Malaria
13%
Rheumatism,
Dental disorders
musculoskeletal
14%
Diseases of the 2%
circulatory system Chicken
pox
3%
0%
Urinary
Sexually
tract
transmitted
Anaemia
diseases
diseases
3%
1%
Ear 4%
Other
infections
respiratory
Intestinal
worms
1%
disease
2%
Eye infections
14%
Diarrhoea Dysentry
2%
1%
3%
Skin disease
32%
Burden of disease as a percentage of morbidity in all patients seen
at the Nguuni Clinic and the 3 outreach clinics, May 2008
Burns Sore throat
Rheumatism,
1%
Diseases of the musculoskeletal 0%
circulatory system
9%
Other
2%
5%
Dental disorders
1%
Urinary tract
Malaria
14%
diseases Chicken pox
2%
0%
Sexually
Anaemia
transmitted
3%
diseases
Ear infections
0%
1%
Eye infections
2%
Skin disease
25%
Diarrhoea
9%
Intestinal worms
4%
Dysentry
1%
Other respiratory
disease
21%
Haller (The Haller Foundation) is a registered UK Charity, No.1101725 and a registered NGO in the Republic of Kenya
PO Box 65809, London EC3P 3FG
t 020 3023 4080
e info@haller.org.uk
www.haller.org.uk
17
Burden of disease as a percentage of morbidity in patients under 5
years of age seen at the Nguuni Clinic and the 3 outreach clinics,
June 2008
Anaemia
Ear infections
Burns
1%
Chicken pox 0%
0%
0%
Eye infections
2%
Other
3%
Malaria
19%
Intestinal worms
6%
Diarrhoea
14%
Skin disease
13%
Other respiratory
disease
42%
Burden of disease as a percentage of morbidity in patients over 5
years of age at the Nguuni Clinic and the 3 outreach clinics, June
2008
Anaemia
Sexually
1%
transmitted
Chicken pox
infections
1%
2%
Ear infections
1%
Intestinal worms
3%
Diarrhoea
2%
Urinary tract
diseases
3%
Eye infections
1%
Malaria
17%
Other respiratory
disease
31%
Skin disease
38%
Pneumonia
0%
Haller (The Haller Foundation) is a registered UK Charity, No.1101725 and a registered NGO in the Republic of Kenya
PO Box 65809, London EC3P 3FG
t 020 3023 4080
e info@haller.org.uk
www.haller.org.uk
18
Burden of disease as a percentage of morbidity in all patients seen
at Nguuni Clinic and the 3 outreach clinics, June 2008
Mental disorder
0%
Diseases of the
circulatory system
1%
Urinary tract Sexualy
diseases transmitted
1%
diseases
Rheumatism,
Other
musculoskeletal
2%
Sore
throat
6%
1%
Dental disorder
1%
7%
Chicken pox
0%
Anaemia
0%
Diarrhoea
6%
Ear infections
1%
Eye infections
1%
Malaria
23%
Burns
0%
Intestinal
worms
3%
Skin disease
19%
Other respiratory
disease
26%
Pneumonia
0%
Burden of disease as a percentage of morbidity in patients under 5
years of age seen at the Nguuni Clinic and the 3 outreach clinics,
July 2008
Other
Intestinal worms Eye
Ear infections
1%
infections
4%
1% 2%
Diarrhoeal disease
4%
Malaria
21%
Other respiratory
disease
50%
Skin disease
9%
Pneumonia
8%
Haller (The Haller Foundation) is a registered UK Charity, No.1101725 and a registered NGO in the Republic of Kenya
PO Box 65809, London EC3P 3FG
t 020 3023 4080
e info@haller.org.uk
www.haller.org.uk
19
Burden of disease as a percentage of morbidity in patients over 5
years of age seen at the Nguuni Clinic and the 3 outreach clinics,
July 2008
Sexually
transmitted
diseases
1%
Anaemia
1%
Rheumatism,
musculoskeletal
Chicken Dental
7%
Other
pox disorders
4%
0%
2%
Urinary tract Diseases of the Sore throat
2%
infections circulatory system
1%
3%
Malaria
20%
Eye infections Ear infections
1%
0%
Intestinal worms
Dysentry
2%
Diarrhoeal
0%
disease
2%
Skin disease
19%
Respiratory
disease
35%
Burden of disease as a percentage of morbidity in all patients seen
at the Nguuni Clinic and the 3 outreach clinics, July 2008
Urinary tract Chicken pox Rheumatism,
musculoskeletal
infections
0%
2%
Sexually Diseases of4% Sore
transmitted
Dental throat
the
Eye infections Anaemia
diseases circulatory
1% Other
disorders
1%
3%
0%1%
1%
Ear system
Intestinal worms infections 1%
3%
1%
Diarrhoeal disease
3%
Dysentry
0%
Other respiratory
disease
40%
Malaria
20%
Skin disease
15%
Pneumonia
3%
Haller (The Haller Foundation) is a registered UK Charity, No.1101725 and a registered NGO in the Republic of Kenya
PO Box 65809, London EC3P 3FG
t 020 3023 4080
e info@haller.org.uk
www.haller.org.uk
20
Burden of disease as a percentage of the morbidity seen in patients
under 5 years of age seen at the Nguuni Clinic and the 3 outreach
clinics, August 2008
Ear infections
2%
Chicken pox
Eye infections 0%
2%
Intestinal worms
5% Diarrhoea
Anaemia
0%
Other
3%
Malaria
17%
5%
Skin disease
14%
Other respiratory
disease
49%
Pneumonia
3%
Burden of disease as a percentage of morbidity of patients over 5
years seen at the Nguuni Clinic and the 3 outreach clinics, August
2008
Urinary tract
infections
3%
Sexually
transmitted
diseases
1%
Sore throat
Rheumatism, 3%
musculoskeletal
Dental disorders
Other
6%
0%
Burns 3%
0%
Diseases of the
circulatory system
3%
Anaemia
1%
Malaria
17%
Chicken pox
0%
Ear
infections
1%
Skin disease
25%
Eye infections
1%
Diarrhoeal
Intestinal worms
disease
2%
3%
Other respiratory
disease
30%
Haller (The Haller Foundation) is a registered UK Charity, No.1101725 and a registered NGO in the Republic of Kenya
PO Box 65809, London EC3P 3FG
t 020 3023 4080
e info@haller.org.uk
www.haller.org.uk
21
Burden of disease as a percentage of morbidity in all patients seen
at the Nguuni Clinic and the 3 outreach clinics, August 2008
Diseases of the
Sore
Sexually
circulatory
throat
transmitted
Rheumatism,
Urinary system
2%
diseases
musculoskeletal
tract
2%
Chicken
pox
1%
4%
0% Ear infection
s
infections
2%
1%
Eye infections
2%
Burns Other Dental
3%
0%
disorders
0%
Malaria
17%
Intestinal worms
3%
Diarrhoeal diseases
4%
Skin disease
21%
Other respiratory
diseases
37%
Pneumonia
1%
Burden of disease as a percentage of morbidity in patients under 5
years of age seen at the Nguuni Clinic and the 3 outreach clinics,
September 2008
Other
Ear infections
Anaemia
4% Eye infections 1% 2%
Intestinal worms 3%
3%
Malaria
17%
Diarrhoeal disease
9%
Skin disease
14%
Other respiratory
disease
45%
Pneumonia
2%
Haller (The Haller Foundation) is a registered UK Charity, No.1101725 and a registered NGO in the Republic of Kenya
PO Box 65809, London EC3P 3FG
t 020 3023 4080
e info@haller.org.uk
www.haller.org.uk
22
Burden of disease as a percentage of morbidity in patients over 5
years seen at the Nguuni Clinic and the 3 outreach clinics,
September 2008
Sexually
transmitted
infections
3%
Chicken pox Diseases of the
2%
circulatory system
4%
Urinary tract
infections
2% Burns
0%
Sore throat
4%
Poisoning
0%
Dental disorders
1%
Other
6%
Malaria
11%
Rheuatism,
musculoskeletal
8%
Skin diseases
26%
Ear infections
1%
Eye infections Diarrhoeal
disease
1%
1%
Intestinal
worms
1%
Other respiratory
disease
29%
Pneumonia
1%
Burden of disease as a percentage of morbidity in all patients seen
at the Nguuni Clinic and the 3 outreach clinics, September 2008
Dental
Diseases of the
Poisoning Rheumatism,
disorders
musculoskeletal
circulatory system
0%
1%
5%
2%
Other
Urinary tract Sore throat
Burns
4%
infections
2%
Anaemia
0%
1%
2%
Sexually
transmitted
Chicken pox
diseases
1%
Ear infections 2%
Eye infections
2%
Malaria
13%
2%
Intestinal worms
2%
Skin disease
21%
Diarrhoeal disease
4%
Other respiratory
disease
35%
Haller (The Haller Foundation) is a registered UK Charity, No.1101725 and a registered NGO in the Republic of Kenya
PO Box 65809, London EC3P 3FG
t 020 3023 4080
e info@haller.org.uk
www.haller.org.uk
23
Pneumonia
1%
Burden of disease as a percentage of morbidity in patients under 5
years of age seen at the Nguuni Clinic and the 3 outreach clinics,
October 2008
Ear infections
2%
Eye infections
2%
Anaemia
Chicken
1%
pox
2%
Burns
Sore throat
0%
1%
Other
0%
Intestinal worms
3%
Diarrhoeal disease
7%
Malaria
20%
Skin disease
10%
Other respiratory
disease
49%
Pneumonia
3%
Burden of disease as a percentage of morbidity in patients over 5
years of age seen at the Nguuni Clinic and the 3 outreach clinics,
October 2008
Dental disorders
1%
Burns
0%
Diseases of the
Rheumatism,
circulatory
musculoskeletal
system
9%
Urinary tract
3%
infections
4%
Sexually
Chicken pox
transmitted
1%
diseases
1%
Anaemia
2%
Sore throat
3%
Other
3%
Malaria
17%
Other
respiratory
disease
20%
Ear infections
1%
Intestinal worms
Eye infections
2%
1%
Diarrhoeal disease
3%
Skin disease
27%
Pneumonia
0%
Haller (The Haller Foundation) is a registered UK Charity, No.1101725 and a registered NGO in the Republic of Kenya
PO Box 65809, London EC3P 3FG
t 020 3023 4080
e info@haller.org.uk
www.haller.org.uk
24
Burden of disease as a percentage of morbidity seen in all patients
at the Nguuni clinic and the 3 outreach clinics, October 2008
Chicken
Urinary tract pox
infections
2%
2%
Sexually
transmitted
Eardiseases
infections0%
1%
Rheumatism,
Diseases of the musculoskeletal
circulatory Dental 5%
system disorders
Burns
2%
1%
0%
Sore throat
2%
Other
2%
Malaria
18%
Anaemia
2%
Eye infections
2%
Intestinal worms
3%
Diarrhoeal disease
5%
Skin disease
20%
Other respiratory
disease
32%
Pneumonia
1%
Burden of disease as a percentage of morbidity in patients under 5
years of age seen at the Nguuni Clinic and the 3 outreach clinics,
November 2008
Urinary
Ear infections tract
3%
infection
Eye infections
s
5%
1%
Intestinal worms
Chicken
pox Burns
2% 0%
Other
2%
Malaria
19%
4%
Diarrhoeal disease
8%
Skin disease
8%
Other respiratory
disease
45%
Pneumonia
3%
Haller (The Haller Foundation) is a registered UK Charity, No.1101725 and a registered NGO in the Republic of Kenya
PO Box 65809, London EC3P 3FG
t 020 3023 4080
e info@haller.org.uk
www.haller.org.uk
25
Burden of disease as a percentage of morbidity in patients over 5
years of ageseen at the Nguuni Clinic and the 3 outreach clinics,
November 2008
Sore throat
Rheumatism,
1% Other
musculoskeletal
Poisoning Burns 2%
11%
0%
0%
Dental
disorders
Malaria
1%
11%
Diseases of the
circulatory system
4%
Chicken pox
3%
Urinary tract
infections
3%
Skin disease
28%
Sexually
transmitted
Anaemia
diseases
3%
2%
Ear infections
1%Intestinal worms
4% Dysentry
Eye infections
1%
Diarrhoeal disease
2%
3%
Other
respiratory
disease
18%
Pneumonia
1%
Burden of disease as a percentage of morbidity in all patients seen
at the Nguuni Clinic and the 3 outreach clinics, November 2008
Rheumatism, Burns
musculoskeletal 0%
7%
Poisoning
0%
Other
Diseases of the
2%
circulatory
Sore
throat
Dental
system
Urinary tract
1%
disorders
3%
infections
1%
2%
Chicken pox
Malaria
3% Sexually
14%
Anaemia
transmitted
Ear
2%
diseases
infections
1%
2%
Skin disease
Eye infections
21%
3%
Intestinal worms Dysentry
1%
4%
Diarrhoeal disease
4%
Other respiratory
disease
28%
Pneumonia
2%
Haller (The Haller Foundation) is a registered UK Charity, No.1101725 and a registered NGO in the Republic of Kenya
PO Box 65809, London EC3P 3FG
t 020 3023 4080
e info@haller.org.uk
www.haller.org.uk
26
Burden of disease as a percentage of morbidity in patients under 5
years seen at the Nguuni Clinic and the 3 outreach clinics, December
2008
Chicken pox
2%
Eye infections Other
4%
1%
Intestinal worms
6%
Diarrhoeal disease
5%
Malaria
18%
Other respiratory
disease
47%
Skin
disease
13%
Pneumonia
4%
Burden of disease as a percentage of morbidity in patients over 5
years seen at the Nguuni Clinic and the 3 outreach clinics, Decmber
2008
Sore throat Other
Burns
4%
Rheumatism, 1%0%
musculoskeletal
Dental disorders
13%
2%
Malaria
Diseases of the
18%
circulatory system
2%
Urinary tract
Sexually
infections
transmitted
2%
Skin disease
infections
20%
Anaemia Ear infections
2%
1%
2%
Other respiratory
Eye infections
disease
2% Diarrhoeal disease
Pneumonia
25%
0%
Intestinal 3%
worms
3%
Haller (The Haller Foundation) is a registered UK Charity, No.1101725 and a registered NGO in the Republic of Kenya
PO Box 65809, London EC3P 3FG
t 020 3023 4080
e info@haller.org.uk
www.haller.org.uk
27
Burden of disease as a percentage of morbidity in all patients seen
at the Nguuni Clinic and the 3 outreach clinics, December 2008
Chicken
Dental
pox
disorders
Urinary tract
Rheumatism, 1%
1%
infections
musculoskeletal
Sore throat
2%
8%
Sexually
1% Other
transmitted
Diseases of the
Burns 3%
diseases
circulatory system
0%
1%
1%
Anaemia
Malaria
Eye infections 1%
18%
Ear infections
3%
1%
Intestinal worms
Skin disease
4%
17%
Diarrhoeal disease
Other respiratory
4%
disease
Pneumonia
33%
2%
Burden of disease as a percentage of morbidity in patients under 5
years of age seen at the Nguuni Clinic and the 3 outreach clinics,
March 2009
Eye infections
Chicken pox
Ear infections
2%
1%
3%
Intestinal
worms
11%
Malaria
20%
Diarrhoeal disease
11%
Skin disease
13%
Other respiratory
disease
36%
Pneumonia
3%
Haller (The Haller Foundation) is a registered UK Charity, No.1101725 and a registered NGO in the Republic of Kenya
PO Box 65809, London EC3P 3FG
t 020 3023 4080
e info@haller.org.uk
www.haller.org.uk
28
Burden of disease as a percentage of morbidity in patients over 5
years of age seen at the Nguuni Clinic and the 3 outreach clinics,
March 2009
Sore throat
3%
Dental disorders
Diseases of the
1%
circulatory system Rheumatism,
Other
Urinary tract
5%
2%
infections
musculoskeletal
Sexually
1%
8%
transmitted
diseases
Malaria
1%
18%
AnaemiaEar
0%
infections
Eye infections
0%
0%
Skin disease
Intestinal worms
17%
9%
Other
Diarrhoeal
disease respiratory
disease
12%
23%
Burden of disease as a percentage of morbidity in all patients seen
at the Nguuni Clinic and the 3 outreach clinics, March 2009
Ear
infections
1%
Diseases of the Dental
Sexually
circulatory disorders
Other
transmitted
system
Rheumatism, 0%
1%
diseases
3%
musculoskeletal
Sore
0%
5%
throat
2%
Anaemia Urinary tract
0%
Chicken pox
infections
0%
1%
Eye infections
1%
Malaria
18%
Intestinal worms
9%
Diarrhoeal
Other
disease
respiratory
17%
disease
26%
Skin
disease
15%
Haller (The Haller Foundation) is a registered UK Charity, No.1101725 and a registered NGO in the Republic of Kenya
PO Box 65809, London EC3P 3FG
t 020 3023 4080
e info@haller.org.uk
www.haller.org.uk
29
Burden of disease as a percentage of morbidity in patients under 5
years of age seen at the Nguuni Clinic and the 3 outreach clinics,
April 2009
Ear infections
Urinary tract
1%
infections
Intestinal worms
Burns
0%
Anaemia
3%
0%
Eye
0% Other
infections
3%
1%
Diarrhoeal disease
9%
Malaria
33%
Other respiratory
disease
36%
Skin
disease
11%
Pneumonia
3%
Burden of disease as a percentage of morbidity of patients over 5
years of age seen at the Nguuni Clinic and the 3 outreach clinics,
April 2009
Rheumatism, Burns Sore Other
musculoskeletal 0% throat 5%
6%
4%
Diseases of the
circulatory
Urinary tract
system
infections
4%
6%
Malaria
22%
Anaemia
Sexually
1%
transmitted
Dysentry
Ear infections diseases
0%
3%
2%
Eye infectionsIntestinal
Other
worms
1%
respiratory
1%
Diarrhoeal disease
disease
3%
16%
Skin disease
26%
Haller (The Haller Foundation) is a registered UK Charity, No.1101725 and a registered NGO in the Republic of Kenya
PO Box 65809, London EC3P 3FG
t 020 3023 4080
e info@haller.org.uk
www.haller.org.uk
30
Burden of disease as a percentage of morbidity in all patients seen
at the Nguuni Clinic and the 3 outreach clinics, April 2009
Rheumatism,
musculoskeletal
4%
Sexually
transmitted
diseases
2%
Eye
infections
1%
Sore
throat
2%
Burns
0%
Diseases of the
circulatory system
2%
Urinary tract
infections
4%
Ear
Other
4%
infections Anaemia
1%
1%
Intestinal worms
2%
Malaria
26%
Dysentry
0%
Other respiratory
disease
24%
Skin disease
20%
Diarrhoeal
disease
5%
Pneumonia
1%
Burden of disease as a percentage of the morbidity in patients
under 5 years of age seen at the Nguuni Clinic and the 3 outreach
clinics, May 2009
Eye infections Ear infections Other
5%
3%
2%
Intestinal worms
9%
Malaria
31%
Diarrhoeal
disease
12%
Skin disease
10%
Other respiratory
disease
24%
Pneumonia
4%
Haller (The Haller Foundation) is a registered UK Charity, No.1101725 and a registered NGO in the Republic of Kenya
PO Box 65809, London EC3P 3FG
t 020 3023 4080
e info@haller.org.uk
www.haller.org.uk
31
Burden of disease as a percentage of the morbidity in patients over
5 years of age seen at the Nguuni Clinic and the 3 outreach clinics,
May 2009
Rheumatism,
musculskeletal
11%
Sore throat
6%
Diseases of the
circulatory
system
3%
Urinary tract
Malaria
22%
infections
6%
Anaemia
2%
Ear infections
3%
Skin disease
15%
Intestinal worms
7%
Other respiratory
disease
10%
Diarrhoeal disease
16%
Burden of disease as a percentage of morbidity in all patients seen
at the Nguuni Clinic and the 3 outreach clinics, May 2009
Rheumatism, Other
Urinary tract
musculskeletal 2%
infections
5% Sore throat
4%
4%
Diseases of the
circulatory system
2%
Ear infections Anaemia
3%
1%
Malaria
26%
Eye infections
1%
Intestinal worms
8%
Diarrhoeal
disease
14%
Other
respiratory
disease
16%
Skin disease
13%
Pneumonia
1%
Haller (The Haller Foundation) is a registered UK Charity, No.1101725 and a registered NGO in the Republic of Kenya
PO Box 65809, London EC3P 3FG
t 020 3023 4080
e info@haller.org.uk
www.haller.org.uk
32
Burden of disease as a percentage of the morbidity in patients
under 5 years of age seen at the Nguuni Clinic and the 3 outreach
clinics, June 2009
Neonatal sepsis
Other
2%
Chicken pox Burns
Amoebiasis 4%
1%
3%
Scabies 2%
Ear infections
2%
Anaemia
1%
3%
Malaria
24%
Eye infections
1%
Intestinal worms
8%
Skin disease
9%
Diarrhoeal
disease
10%
Other respiratory
disease
26%
Pneumonia
4%
Burden of disease as a percentage of morbidity in patients over 5
years of age seen at the Nguuni Clinic and the 3 outreach clinics,
June 2009
Amoebiasis
2% Other
Scabies
3%
2%
Peptic ulcer disease
10%
Sore throat
Malaria
Peuperal sepsis
3%
24%
1%
Poisoning Burns
Rheumatism,
1%
1%
musculoskeletal
4%
Skin disease
Dental disorders
7%
1%
Diseases of the Urinary tract
circulatory
infections
Pneumonia
Other respiratory
system
3%
3%
disease
Chicken 2%
Ear infections
16%
pox
1%
Sexually
2% transmitted
Dysentry
Intestinal
Eye
0%
diseases
worms
Anaemia
infections
Diarrhoeal
disease
1%
4%
2%
3%
5%
Haller (The Haller Foundation) is a registered UK Charity, No.1101725 and a registered NGO in the Republic of Kenya
PO Box 65809, London EC3P 3FG
t 020 3023 4080
e info@haller.org.uk
www.haller.org.uk
33
Burden of disease as a percentage of morbidity in all patients seen
at the Nguuni Clinic and the 3 outreach clinics, June 2009
Amoebiasis
11%
Other
3%
Scabies
2%
Sore throat
2%
Malaria
22%
Peptic ulcer disease
7%
Peuperal sepsis
Burns
0%
Poisoning
1%
Rheumatism,
1%
Other
Dental disorders
musculoskeletal
respiratory
1%
2%
disease
Chicken pox
Anaemia
18%
2%
1%
Diseases of Urinary
Ear infections
Dysentry
the
tract
1%
Sexually
Intestinal
0%
circulatory infection
Eye
transmitted
worms
Diarrhoeal disease
system
s
infections
5%
6%
1%diseases 2%
2%
0%
Skin disease
7%
Pneumonia
3%
Burden of disease as a percentage of morbidity in patients under 5
years of age seen at the Nguuni Clinic and the 3 outreach clinics,
July 2009
Scabies
Referral
Amoebiasis
2%
0%
1%
Neonatal sepsis
Chicken pox Dermatitis 2% Sore throat
1%
2%
1%
Burns
Other
Anaemia
1%
7%
1%
Eye infections
2%
Ear infections
1%
Intestinal worms
5%
Dysentry
1%
Diarrhoeal disease
6%
Malaria
25%
Other respiratory
disease
34%
Skin disease
6%
Pneumonia
2%
Haller (The Haller Foundation) is a registered UK Charity, No.1101725 and a registered NGO in the Republic of Kenya
PO Box 65809, London EC3P 3FG
t 020 3023 4080
e info@haller.org.uk
www.haller.org.uk
34
Burden of disease as a percentage of the morbidity in patients over
5 years of age seen at the Nguuni Clinic and the 3 outreach clinics,
July 2009
Schistosomiasis
1%
Sore throat
3%
Amoebiasis
Other
2%
Referral 4%
Mouth ulcer 0%
1%
Peptic ulcer disease
7%
Scabies
1%
Dermatitis
4%
Rheumatism,
musculoskeletal
3% Urinary
Diseases of the
circulatory system
Chicken pox tract
2%
infection
2%
Sexually
s
Eye infections
transmitted
3%
infections Ear
Intestinal 2%
1% infections worms Diarrhoeal disease
2%
4%
4%
Malaria
28%
Other respiratory
disease
24%
Pneumonia
4%
Burden of disease as a percentage of morbidity in all patients seen
at the Nguuni Clinic and the 3 outreach clinics, July 2009
Amoebiasis
1%
Mouth ulcer Sore
throat
0%
Dermatitis 2%
Other
3%
Referral
5%
Schistosomiasis
0%
1%
Scabies
1%
Rheumatism,
musculoskeletal
2%
Peptic ulcer
disease
Diseases of the
4%
circulatory system
Sexually
transmitted 1% Urinary tract
Chicken pox
infections
infections
1%
1%
0%
Ear infections
2%
Eye infections
2%
Diarrhoeal disease
5%
Intestinal worms
4%
Malaria
26%
Skin disease
6%
Other respiratory
disease
29%
Haller (The Haller Foundation) is a registered UK Charity, No.1101725 and a registered NGO in the Republic of Kenya
PO Box 65809, London EC3P 3FG
t 020 3023 4080
e info@haller.org.uk
www.haller.org.uk
35
Pneumonia
3%
Burden of disease as a percentage of morbidity in patients under 5
years of age seen at the Nguuni Clinic and the 3 outreach clinics,
August 2009
Neonatal sepsis
Anaemia
2%
3% Chicken pox
Ear infections
2%
2%
Other
9%
Eye infections
1%
Malaria
31%
Intestinal worms
9%
Dysentry
1%
Diarrhoeal
disease
9%
Respiratory tract
infections
25%
Skin disease
6%
Burden of disease as a percentage of morbidity in patients over 5
years of age seen at the Nguuni Clinic and the 3 outreach clinics,
August 2009
Other
9%
Hyperacidity
Pueperal sepsis
9%
1% Schistosomiasis
1%
Amoebiasis
2%
Malaria
21%
Sore throat
3%
Poisoning
Rheumatism,
0%
musculoskeletal
Dental
Other respiratory
4%
disorders
disease
0%
20%
Diseases of the
Chicken pox Anaemia
circulatory system
1%
0%
2%
Dysentry
Sexually Ear infections
0% Diarrhoeal
Urinary tract
2%
transmitted
disease
infections
diseases Eye infections Intestinal worms
4%
4%
0%
4%
1%
Haller (The Haller Foundation) is a registered UK Charity, No.1101725 and a registered NGO in the Republic of Kenya
PO Box 65809, London EC3P 3FG
t 020 3023 4080
e info@haller.org.uk
www.haller.org.uk
36
Skin disease
7%
Pneumonia
3%
Burden of disease as a percentage of morbidity in all patients seen
at the Nguuni Clinic and the 3 outreach clinics, August 2009
Neonatal Hyperacidity
sepsis
5%
Amoebiasis Schistosomiasis 1%
Pueperal
1%
1%
sepsis
Rheumatism,
Sore throat 1%
musculoskeletal
2%
Diseases of the
2%
Dental
Poisoning
circulatory system
disorders
0%
1%
0%
Chicken pox
Urinary tract
1%
infections Sexually
2% transmitted
diseases Ear infections
0%
2%
Anaemia
1%
Intestinal worms
Eye infections
6% Dysentry
1%
1%
Other
9%
Malaria
26%
Skin disease
6%
Other respiratory
disease
22%
Pneumonia
2%
Diarrhoeal disease
6%
Burden of disease as a percentage of morbidity in patients under 5
years of age seen at the Nguuni Clinic and the 3 outreach clinics,
September 2009
Neonatal
sepsis
1%
Sore
Burns throat
Urinary
tract
Anaemia
Other
1%
infections 1%
1%
15%
1%
Chicken pox
Ear infections 1%
1%
Eye
infections
Intestinal worms 1%
5%
Dysentry
Diarrhoeal
1%
disease
11%
Malaria
20%
Skin disease
9%
Respiratory tract
disease
31%
Haller (The Haller Foundation) is a registered UK Charity, No.1101725 and a registered NGO in the Republic of Kenya
PO Box 65809, London EC3P 3FG
t 020 3023 4080
e info@haller.org.uk
www.haller.org.uk
37
Burden of disease as a percentage of morbidity in patients over 5
years of age seen at the Nguuni Clinic and the 3 outreach clinics,
September 2009
Amoebiasis
1%
Schistosomiasis Hyperacidity
4%
1%
Pueperal sepsis
1%
Rheumatism,
musculoskeletal
2%
Dental disorders
0%
Other
14%
Sore throat
3%
Burns
0%
Poisoning
1%
Chicken pox
0%
Skin disease
10%
Other
respiratory
disease
17%
Anaemia
1%
Urinary tract Sexually
infections
Diseases
of the transmitted
circulatory1%
system diseases
1%
2%
Eye
Ear infections
infections
1%
1%
Malaria
23%
Intestinal
worms
8%
Dysentry
0%
Pneumonia
2%
Diarrhoeal
disease
6%
Burden of disease as a percentage of the morbidity in all patients
seen at the Nguuni Clinic and the 3 outreach clinics, September
2009
Hyperacidity
2%
Schistosomiasis
0% Sore
throat Pueperal
Dental
Neonatal
Burns
sepsis
2%
disorders
sepsis
Amoebiasis
0% Rheumatism,
1%
0% Chicken pox
1%
1%
musculoskeletal
Sexually
1%
1%
Urinary tract
Poisoning
transmitted
infections 0%
Diseases of the
diseases
1% Ear
circulatory
0%
Anaemia
infections
system
1%
1%
1% Eye infections
Intestinal worms
1%
7%
Dysentry
1%
Diarrhoeal disease
9%
Other
14%
Malaria
22%
Skin disease
10%
Other respiratory
disease
24%
Haller (The Haller Foundation) is a registered UK Charity, No.1101725 and a registered NGO in the Republic of Kenya
PO Box 65809, London EC3P 3FG
t 020 3023 4080
e info@haller.org.uk
www.haller.org.uk
38
Pneumonia
1%
Burden of disease as a percentage of morbidity in patients under 5
years of age seen at the Nguuni Clinic and the 3 outreach clinics,
October 2009 Malaria
Neonatal sepsis
2%
Sore throat
Burns
1%
Ear infections 0%
3%
Chicken pox
Eye
0%
infections
3%
Intestinal worms
3%
Diarrhoeal disease
4%
(positive
test)
8%
Other
14%
Malaria
(clinical)
16%
Skin disease
5%
Respiratory tract
disease
41%
Burden of disease as a percentage of morbidity in patients over 5
years of age seen at the Nguuni Clinic and the 3 outreach clinics,
October 2009
Hyperacidity
7%
Puerperal
Sore throat
sepsis
3% Amoebiasis
Burns
1%
1%
0%
Poisoning
Rheumatism,
Dental
0%
musculoskeletal
disorders Chicken pox
3%
1% Urinary tract
0%
Diseases of the
infections
circulatory
1% Anaemia
system
1%
3%
Sexually
transmitted Ear infections
1%
infections
Diarrhoeal
1%
disease
Eye
Intestinal worms
3%
infections
4%
1%
Schistosomiasis
0%
Other
10%
Malaria
(positive
test)
10%
Malaria
(clinical)
13%
Skin disease
6%
Other respiratory
disease
29%
Haller (The Haller Foundation) is a registered UK Charity, No.1101725 and a registered NGO in the Republic of Kenya
PO Box 65809, London EC3P 3FG
t 020 3023 4080
e info@haller.org.uk
www.haller.org.uk
39
Pneumonia
3%
Burden of disease as a percentage of morbidity in all patients seen
at the Nguuni Clinic and the 3 outreach clinics, October 2009
Schistosomiasis
0%
Neonatal
sepsis
Hyperacidity
1%
4%
Sore
Amoebiasis
Puerperal
throat
0%
Poisoning
sepsis
2%
Burns
0%
1%
Dental disorders 0% Rheumatism,
0% Chicken pox musculoskeletal
0%
2%Urinary tract
Sexually
Diseases of the
infections
circulatory
0%
Anaemia transmitted
infections
system
1%
0%
2%
Ear infections
2%
Eye infections
Diarrhoeal disease
2%
Intestinal worms 3%
Malaria (positive
test)
9%
Other
12%
Malaria
(clinical)
14%
Pneumonia
2%
Other respiratory
disease
34%
4%
Burden of disease as a percentage of morbidity in patients under 5
years of age seen at the Nguuni Clinic and the 3 outreach clinics,
November 2009
Chicken pox Neonatal Other
sepsis
5%
3%
Eye infections
Burns 3%
3%
Ear infections 0%
Malaria (positive
test)
9%
3%
Malaria
(clinical)
21%
Intestinal worms
8%
Diarrhoeal disease
5%
Respiratory tract
disease
38%
Skin disease
2%
Haller (The Haller Foundation) is a registered UK Charity, No.1101725 and a registered NGO in the Republic of Kenya
PO Box 65809, London EC3P 3FG
t 020 3023 4080
e info@haller.org.uk
Skin
disease
5%
www.haller.org.uk
40
Burden of disease as a percentage of morbidity in patients over 5
years of age seen at the Nguuni Clinic and the 3 outreach clinics,
November 2009
Malaria (positive
test)
8%
Hyperacidity
Other
11%
7%
Puerperal sepsis
Malaria
2%
Burns Amoebiasis
(clinical)
Schistosomiasis
0%
15%
1%
0%
Poisoning
Rheumatism,
1%
musculoskeletal
5%
Chicken pox
Other respiratory
1%
Dental disorders
tract disease
Ear infections
0%
20%
1%
Eye infections
Anaemia
Sexually
1%
1%
transmitted
Urinary tract
Intestinal Dysentry
Diseases ofdiseases
the
1%
infections
worms Diarrhoeal
1%
disease
circulatory system
3%
7%
1%
3%
Sore throat
2%
Skin disease
3%
Pneumonia
3%
Burden of disease as a percentage of morbidity in all patients seen
at the Nguuni Clinic and the 3 outreach clinics, November 2009
Schistosomiasis
0%
Hyperacidity
Sore Neonatal
7%
throat
sepsis
Poisoning
1%
1% Puerperal
0%
sepsis
Amoebiasis
1%
Rheumatism,
1%
musculoskeletal
Burns
3%
Chicken pox Dental 0%
disorders
2%
Ear infections
0%
2%
Eye infections Urinary Sexually
2%
tract transmitted
infection diseases
1%
s
Intestinal
2%
Anaemia
Diseases of the worms
1%
circulatory system 7%
2%
Dysentry
1%
Malaria (positive
test)
8%
Other
7%
Malaria (clinical)
17%
Skin disease
3%
Other respiratory
tract disease
26%
Diarrhoeal disease
3%
Haller (The Haller Foundation) is a registered UK Charity, No.1101725 and a registered NGO in the Republic of Kenya
PO Box 65809, London EC3P 3FG
t 020 3023 4080
e info@haller.org.uk
www.haller.org.uk
41
Pneumonia
2%
Data missing for December 2009.
Burden of disease as a percentage of morbidity in patients under 5
years of age seen at the Nguuni Clinic and the 3 outreach clinics,
Malaria
January 2010 (positive
Neonatal
sepsis
Ear infections Sore throat
4%
0%
Intestinal worms 2%
5%
Eye infections
0%
test)
9%
Other
9%
Malaria (clinical)
12%
Diarrhoeal disease
4%
Skin disease
7%
Pneumonia
2%
Other respiratory
disease
46%
Burden of disease as a percentage of morbidity in patients over 5
years of age seen at the Nguuni Clinic and the 3 outreach clinics,
January 2010
Puerperal sepsis Burns
2%
0%
Rheumatism,
musculoskeletal
7%
Malaria (positive
test)
9%
Other
10%
Malaria
(clinical)
11%
Skin disease
7%
Hyperacidity
11%
Pneumonia
4%
Other
respiratory
disease
16%
Sore throat
6%
Dental disorders
Chicken 1% Ear
pox
Diseases of the
Eye
Urinary tract Diarrhoeal disease
infections
Anaemia Intestinal
circulatory system 0%
infections
infections
1%
2%worms
2%
3%
3%
1%
5%
Sexually
transmitted
diseases
0%
Haller (The Haller Foundation) is a registered UK Charity, No.1101725 and a registered NGO in the Republic of Kenya
PO Box 65809, London EC3P 3FG
t 020 3023 4080
e info@haller.org.uk
www.haller.org.uk
42
Burden of disease as a percentage of morbidity in all patients seen
at the Nguuni Clinic and the 3 outreach clinics, January 2010
Puerperal
sepsis
Neonatal sepsis 1%
2%
Burns
0%
Rheumatism,
musculoskeletal
4%
Hyperacidity
7%
Sore throat
4%
Ear
Dental
pox
Diseases of the Chicken
infections
disorders
0%
circulatory system
1%
0%
2%
Eye
Sexually
Urinary
Anaemia
tract infections transmitted
2%
1%
diseases
infection
0% Diarrhoeal
s
Intestinal worms
disease
3%
4%
3%
Malaria (positive
test)
9%
Other
10%
Malaria
(clinical)
11%
Skin disease
7%
Pneumonia
3%
Other respiratory
disease
28%
Burden of disease as a percentage of morbidity in patients under 5
years of age seen at the Nguuni Clinic and the 3 outreach clinics,
February 2010
Neonatal sepsis Anaemia
1%
1% Burns
Dermatitis
1%
3%
Septic wounds
Other Malaria
Scabies
5%
7% (positive
1%
Ear
test)
Eye infections
infections
14%
Malaria
1%
1%
(clinical)
Helminthiasis
11%
4%
Diarrhoeal disease
4%
Other respiratory
tract disease
44%
Haller (The Haller Foundation) is a registered UK Charity, No.1101725 and a registered NGO in the Republic of Kenya
PO Box 65809, London EC3P 3FG
t 020 3023 4080
e info@haller.org.uk
www.haller.org.uk
43
Pneumonia
2%
Burden of disease as a percentage of morbidity in patients over 5
years of age seen at the Nguuni Clinic and the 3 outreach clinics,
January 2010
Typhoid Pueperal
sepsisReferral
0%
0%
1%
Ear infections
0%
Other
Threatened
Eye infections
9%
abortion
1%
Dermatitis
0%
5%
Diseas
Urinary tract
es of
infections
the
5%
blood Anaemia
2%
2%
Chicken pox
0%
Malaria
(positive
test)
17%
Malaria (clinical)
8%
Pneumonia
3%Other
respiratory
tract diseases
12%
Diarrhoeal disease
1%
Septic wounds
7%
Peptic ulcer disease
12%
Osteoarthritis
5%
Sore throat Schistosomiasis Amoebiasis
3%
1%
1%
Helminthiasis
6%
Burden of disease as a percentage of morbidity in all patients seen
at the Nguuni Clinic and the 3 outreach clinics, February 2010
Threatened
abortion
0%
Chicken pox Burns
Typhoid
0%
0%
0% Neonatal Pueperal
Eye
Scabies
sepsis
infections
0% sepsis
0%
1%
1%
Ear Referral
Diseases of the
infections 0%
blood
Other
1%
1%
8%
Dermatitis
4%
Urinary tract
infections Anaemia
3%
2%
Malaria
(positive
test)
15%
Septic wounds
6%
Pneumonia
3%
Other respiratory
tract disease
25%
Peptic ulcer disease
7%
Sore throat Osteoarthritis
3% Amoebiasis
2%
1%
Schistosomiasis Helminthiasis
Diarrhoeal disease
0%
5%
2%
Haller (The Haller Foundation) is a registered UK Charity, No.1101725 and a registered NGO in the Republic of Kenya
PO Box 65809, London EC3P 3FG
t 020 3023 4080
e info@haller.org.uk
Malaria (clinical)
9%
www.haller.org.uk
44
Burden of disease as a percentage of morbidity in patients under 5
years of age seen at the Nguuni Clinic and the 3 outreach clinics,
March 2010
Neonatal sepsis Malaria (positive
test)
2%
9%
Dermatitis
3%
Other
Septic wounds
5%
7%
Scabies
2%
Ear infections
2%
Malaria (clinical)
19%
Eye infections
7%
Helminthiasis
6%
Diarrhoeal disease
5%
Other respiratory
tract disease
30%
Pneumonia
3%
Burden of disease as a percentage of morbidity in patients over 5
years of age seen at the Nguuni Clinic and the 3 outreach clinics,
March 2010
Puerperal sepsis
Eye
Chicken pox
1%
Malaria (positive
infections
1%
test)
5% Threatened
Ear Thyphoid
7%
infections 0%
Diseases of the abortion
1%
blood
0%
Other
2%
8%
Malaria
Urinary tract
Dermatitis
(clinical)
infection
Pneumonia
3%
13%
3%
1%
Anaemia
1%
Other respiratory
Septic wounds
tract disease
5%
20%
Peptic ulcer
disease
13%
Diarrhoeal disease
3%
Sore
Osteoarthritis throat Schistosomiasis Amoebiasis Helminthiasis
1%
6%
0%
3%
4%
Haller (The Haller Foundation) is a registered UK Charity, No.1101725 and a registered NGO in the Republic of Kenya
PO Box 65809, London EC3P 3FG
t 020 3023 4080
e info@haller.org.uk
www.haller.org.uk
45
Burden of disease as a percentage of morbidity in all patients seen
at the Nguuni Clinic and the 3 outreach clinics, March 2010
Puerperal sepsis
0%
Eye
Chicken pox
infections
0%
6%
Neonatal
sepsis
Threatened
Malaria (positive
Ear Thyphoid
1%
abortion
test)
Dermatitis
infections 0%
0%
8%
Diseases
3%
1%
of the
Other
blood
7%
1% Scabies
Urinary tract
Malaria
1%
infection
(clinical)
Anaemia
1%
16%
1%
Septic wounds
6%
Other respiratory
tract disease
24%
Peptic ulcer disease
7%
Pneumonia
2%
Osteoarthritis Sore
throat
Amoebiasis
3%
2%
0%
Diarrhoeal
Schistosomiasis Helminthiasis disease
0%
5%
4%
Points to note regarding this data:
 I have recorded the group respiratory tract diseases all the way through despite some
months this group being titled respiratory tract ‘infections’ and others respiratory tract
‘diseases’. I have enquired about this and the difference in group name is merely to
distinguish pneumonia from other respiratory problems therefore this group contains
diseases such as upper respiratory tract infections as well as diseases such as asthma and
chronic obstructive pulmonary disease.
 N.B. The statement of a disease on a pie chart as 0% is an under estimation of the true
figure. This figure in the data has been entered as and then been rounded up or down
according to the decimal place, thus 0.4% will appear as 0% on the graph and 0.6% as 1%. I
have not included any morbidity data in the pie charts where there were no cases of that
problem in that particular month thus 0% always depicts true morbidity of more than 0%.
 There are changes in categories of disease throughout the last 3 years. For example ‘skin
disease’ is sometimes subdivided into, for example, dermatitis and scabies etc.
 ‘Poisoning’ means food poisoning.
Haller (The Haller Foundation) is a registered UK Charity, No.1101725 and a registered NGO in the Republic of Kenya
PO Box 65809, London EC3P 3FG
t 020 3023 4080
e info@haller.org.uk
www.haller.org.uk
46
Observations:
 Drug treatment of disease:
o My opinions are swayed by the way things are done in hospitals and clinics in
England. Although some of my considerations are obsolete here in Kenya, some are
of great importance and I list these below:
 Upper respiratory tract infections (URTIs)
 Many URTIs are viral in origin thus treating them all with antibiotics is
ineffective. This is both in terms of the treatment of the infectious pathogen
responsible as well as affecting people’s beliefs about drugs being necessary
to cure all disease.
 It seems that the standard treatment for URTIs at the clinic is
o Paracetamol (to reduce fever), antibiotics (if the clinicians
find evidence of the presence of a bacterial infection or are
worried about the development of a secondary bacterial
infection) and antihistamines.
 In most cases, paracetamol alone is likely to have just the same
benefit. I can see no reason for prescribing antihistamines unless the
rhinitis is allergic in origin. The antibiotics will not treat a viral
infection and although I understand it may treat a secondary
bacterial infection, if such an infection has not yet occurred people
are being treated for something they do not have. In outreach clinics
it can be difficult as people are far from medical help and must wait
a whole week if their condition deteriorates. However, I believe that
it is better to try to limit the overuse of antibiotics where possible
and instead to increase education of patients to enhance their
understanding of disease.
 Diarrhoeal disease with fever
 All cases I have seen of fever with diarrhoea +/- vomiting have been
treated either as malaria or as bacterial gastroenteritis. As with the
respiratory tract, many of these infections may be viral. It is difficult
to know without culturing facilities which infections are viral and
which are bacterial. I feel that the prescription of metronidazole for
the treatment of any diarrhoeal disease is not be the best option. I
am however, unsure what the answer is as situation and geography
make it difficult to treat disease by the book.
 Malaria
 Nearly all of the diagnoses of malaria in the outreach clinics are
made by clinical judgement alone. Eric told me that he was planning
to perform microscopic blood films out in the outreach stations but I
have not yet seen him do so.
 The cost of antimalarials such as quinine are higher than the cost of
a blood film test (50/=). By increasing testing it may be possible to
reduce the number of patients that need antimalarial treatment
thus in turn reducing the cost of antimalarials to the clinic.
 “Sexually transmitted” diseases
 When a patient comes into the clinic complaining of symptoms of a
sexually transmitted disease there is not the same investigation of
the patient as there is in the UK and the patient is often prescribed
Haller (The Haller Foundation) is a registered UK Charity, No.1101725 and a registered NGO in the Republic of Kenya
PO Box 65809, London EC3P 3FG
t 020 3023 4080
e info@haller.org.uk
www.haller.org.uk
47
treatment to cover all eventualities e.g. different antibiotics to cover
gonorrhoea, Chlamydia and bacterial vaginosis and anti-fungals to
cover Candida. High vaginal and cervical swab cultures would greatly
improve the clinicians ability to target and treat the pathogen
responsible. In doing so the drug costs necessary to treat would be
reduced.
Suggestions for the future:
 Design of a system to ensure accurate record keeping.
o Transparent system that can be accessed and understood with ease by anyone
 Monthly data reports to show the clinic’s work (design a template for their
use to ensure the same data is recorded each month)
 System to remain in the clinic for good patient record keeping that can be
accessed when the patient re-presents
o System to ensure the correct collection of funds from patients to be fed back into
the clinic’s accounts.
 I believe the clinic and the laboratory would benefit greatly from being able to perform
microscopy, culture and sensitivities (MC&S) on various samples from patients. Stool
cultures would be particularly useful to limit the use of expensive and unnecessary drug
treatment as would high vaginal and cervical swabs be useful in reducing drug costs in
treating potential sexually transmitted diseases.
 Consideration of the use of fast testing strips for the diagnosis of malaria in the field if blood
films are not going to be implemented imminently or reliably. I believe that this will reduce
the need for malaria treatment and thus decrease the antimalarial costs to the clinic.
 Hand hygiene at Nguuni and the outreach stations.
o Supply of soap for clinicians to be able to sanitise hands between patients in both
clinic rooms. At the moment there is no soap and only a limited supply of
antibacterial alcohol gel is available.
o Provision of soap in the toilets at Nguuni to encourage patients and children visiting
the library to adopt better hand hygiene.
 Education
o Patient-by-patient.
 Ask Lennox, Florence and Eric to adopt a system of educating patients whilst
they are in the consultation room and the laboratory on matters such as
how to take their medication, why medicine may not be indicated for them
and the importance of taking the whole course of treatment prescribed to
them.
o Before and after clinics.
 Designated subjects (I know that some of this is done already but more
organised teaching with visual aids may be useful)
 Water sanitation (especially for young children)
 Signs and symptoms of malaria
 Importance of mosquito nets
 Family planning
 Bacteria and viruses and the need for antibiotics
 Malnutrition
 HIV transmission and treatment
Haller (The Haller Foundation) is a registered UK Charity, No.1101725 and a registered NGO in the Republic of Kenya
PO Box 65809, London EC3P 3FG
t 020 3023 4080
e info@haller.org.uk
www.haller.org.uk
48



More organised approach to mobile unit.
o Equipment – weighing scales, thermometer, sphygmomanometer. These are
imperative to providing good and complete care of the patients and a clinic should
not be conducted in the field without them. They are easy to carry to the outreach
stations.
I think the plans for a reception to be built and for Michael to be dedicated to the
administration of the clinic will have a great impact on the viability of the clinic.
Although difficult at present, I think it would greatly benefit the clinic to employ a doctor to
help with the running of the clinic. A employee with a greater understanding of pathological
processes as well as good patient treatment would aid Lennox and Florence in treating
patients as well as improving their understanding of diseases and their treatments. I spoke
to Lennox about this and he feels he would benefit from the guidance of a doctor.
o Newly qualified doctors in government hospitals are paid on average 40,000Ksh
before tax. Many doctors leave the government system as this wage does not
increase a great deal and they can earn a lot more in the private sector. I am
therefore unsure of what salary it would take to entice a fully registered doctor to
work in the clinic.
Haller (The Haller Foundation) is a registered UK Charity, No.1101725 and a registered NGO in the Republic of Kenya
PO Box 65809, London EC3P 3FG
t 020 3023 4080
e info@haller.org.uk
www.haller.org.uk
49