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The Safe Water and AIDS Project (SWAP), a non-governmental organization in western Kenya, opened kiosks run as businesses by community health promoters (CHPs) to increase access to health products among poor rural families. We conducted a baseline survey in 2014 before kiosks opened, and a post-intervention follow-up in 2016, enrolling 1,517 households with children 0.2 mg/ml) was similar from baseline to follow-up (7% vs. 8%, p = 0.57). The odds of reported diarrhea in children decreased from baseline to follow-up (odds ratios or OR: 0.77, 95% CI: 0.64–0.93) and households with detectable FCR had lower odds of diarrhea (OR: 0.53, 95% CI: 0.34–0.83). Focus group discussions with CHPs suggested that high product prices, lack of affordability, and expectations that products should be free contributed to low sales. In conclusion, modest reported increases in SWAP exposure and product sales in the target population were insufficient to impact health, but children in households confirmed to chlorinate their water had decreased diarrhea.

Abstract Background Exposure to household air pollutants released during cooking has been linked to numerous adverse health outcomes among residents of rural areas in low-income countries. Improved cookstoves are one of few available interventions, but achieving equity in cookstove access has been challenging. Therefore, innovative approaches are needed. To evaluate a project designed to motivate adoption of locally-produced, ceramic cookstoves (upesi jiko) in an impoverished, rural African population, we assessed the perceived benefits of the cookstoves (in monetary and time-savings terms), the rate of cookstove adoption, and the equity of adoption. Methods The project was conducted in 60 rural Kenyan villages in 2008 and 2009. Baseline (n = 1250) and follow-up (n = 293) surveys and a stove-tracking database were analyzed. Results At baseline, nearly all respondents used wood (95%) and firepits (99%) for cooking; 98% desired smoke reductions. Households with upesi jiko subsequently spent upesi jiko (20%) (p = 0.0002). There were no significant differences in the presence of children upesi jiko (48%) or three-stone stoves (49%) (p = 0.88); children 2–5 years of age were less common in households using upesi jiko versus three-stone stoves (46% and 69%, respectively) (p = 0.0001). Vendors installed 1,124 upesi jiko in 757 multi-family households in 18 months; 68% of these transactions involved incentives for vendors and purchasers. Relatively few (upesi jiko were installed in households of women in the youngest age quartile ( Conclusions Our strategy of training of local vendors, appropriate incentives, and product integration effectively accelerated cookstove adoption into a large number of households. The strategy also created opportunities to reinforce health messages and promote cookstoves sales and installation. However, the project’s overall success was diminished by inequitable and incomplete adoption by households with the lowest socioeconomic status and young children present. Additional evaluations of similar strategies will be needed to determine whether our strategy can be applied equitably elsewhere, and whether reductions in fuel use, household air pollution, and the incidence of respiratory diseases will follow adoption of improved cookstoves.

Background: Keeping girls in school offers them protection against early marriage, teen pregnancy, and sexual harms, and enhances social and economic equity. Studies report menstruation exacerbates school-drop out and poor attendance, although evidence is sparse. This study qualitatively examines the menstrual experiences of young adolescent schoolgirls. Methods and Findings: The study was conducted in Siaya County in rural western Kenya. A sample of 120 girls aged 14–16 years took part in 11 focus group discussions, which were analysed thematically. The data gathered were supplemented by information from six FGDs with parents and community members. Emergent themes were: lack of preparation for menarche; maturation and sexual vulnerability; menstruation as an illness; secrecy, fear and shame of leaking; coping with inadequate alternatives; paying for pads with sex; and problems with menstrual hygiene. Girls were unprepared and demonstrated poor reproductive knowledge, but devised practical methods to cope with menstrual difficulties, often alone. Parental and school support of menstrual needs is limited, and information sparse or inaccurate. Girls’ physical changes prompt boys and adults to target and brand girls as ripe for sexual activity including coercion and marriage. Girls admitted ‘others’ rather than themselves were absent from school during menstruation, due to physical symptoms or inadequate sanitary protection. They described difficulties engaging in class, due to fear of smelling and leakage, and subsequent teasing. Sanitary pads were valued but resource and time constraints result in prolonged use causing chafing. Improvised alternatives, including rags and grass, were prone to leak, caused soreness, and were perceived as harmful. Girls reported ‘other girls’ but not themselves participated in transactional sex to buy pads, and received pads from boyfriends. Conclusions: In the absence of parental and school support, girls cope, sometimes alone, with menarche in practical and sometimes hazardous ways. Emotional and physical support mechanisms need to be included within a package of measures to enable adolescent girls to reach their potential. [ABSTRACT FROM AUTHOR]