JOMO KENYATTA UNIVERSITY OF AGRICULTURE AND

TECHNOLOGY

SCHOOL OF HEALTH SCIENCES

DEPARTMENT OF PUBLIC HEALTH

A REPORT SUBMITTED IN FULFILMENT FOR THE COURSE IN THE FIELD

ATTACHMENT IN THE REQUIREMENT AWARD OF DEGREE IN PUBIC HEATH
URBAN TRAINING ATTACHMENT

PLACEMENT AREA: KAYOLE 1 HEATH CENTRE

COORDINATOR: DR.MAGU

SUPERVISOR: DR D.MOKAYA

STUDENT: PRISCILLA AKINYI OLUOCH

REGISTRATION NUMBER: HSH 211-0226/2016

PERIOD OF ATTACHMENT: SEPTEMBER-NOVEMBER 2019

 ACKNOWLEDGEMENT
The process of preparing this report benefited immensely from the support and guidance of
public health officer Ms.Jane for her insight and willingness to make me learn in every
activity that I did at Kayole 1 Health Centre, embakasi west sub-county public health office
and linkage to other departments within the hospital for the purpose of learning and
achieving my objectives.

Acknowledgment to public health department and JKUAT as a whole for designing a

learning program that involve field attachment which gives the trainees an opportunity to
correlate the class work/ theoretical learning to field practices for future preparation of our
profession.

I also acknowledge my family for the financial support throughout my practicum period and
especially for funding my education

Special thanks to God for his protection and also giving me good health throughout my
practicum period.

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 Table of Contents
ACKNOWLEDGEMENT .............................................................................................................. ii
ABSTRACT ................................................................................................................................... iv
INTRODUCTION .......................................................................................................................... 1
WORK EXPERIENCE ................................................................................................................... 3
ROUTINE ................................................................................................................................... 3
OFFICE ROUTINE ................................................................................................................. 3
MATERNAL AND CHILD HEALTH ................................................................................... 4
NUTRITION ........................................................................................................................... 8
COMMUNICABLE DISEASES ........................................................................................... 12
HEALTH EDUCATION AND PROMOTION .................................................................... 13
OCCUPATIONAL HEALTH AND SAFETY (OHS) .......................................................... 15
DISEASE SURVEILLANCE................................................................................................ 17
SCHOOL HEALTH AND SANITATION ........................................................................... 18
SOLID WASTE DISPOSAL................................................................................................. 19
LIQUID WASTE DISPOSAL............................................................................................... 20
MEAT INSPECTION............................................................................................................ 21
STAFF AND MY ANTICIPATION ........................................................................................ 26
COMMUNITY PARTICIPATION........................................................................................... 26
ISSUES AND PROBLEM ENCOUNTERED AND THEIR SOLUTION .............................. 27
EVALUATION OF THE PROJECT ............................................................................................ 29
RECOMMEDETION ................................................................................................................... 30
BIBLIOGRAPHY/ REFERENCE ................................................................................................ 31

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 ABSTRACT
My field attachment was conducted at Embakasi West sub-county, public health officeKayole 1
health centre, Nairobi County, from 16th.Sep-22ndNovember, 2019

During my practicum period,I learnt how various health-related issues are done to minimize the
risk exposure to different diseases and also how to manage different health related issues in-case
they occur so as to reduce the number individual affected by that problem.

I learnt some of the public health interventions done in Nairobi County to improve the county
sanitation profile and also reduce mortality rate from diseases of public health concern including;

The office routine on various duties of public health officers

Maternal and child health to help reduce the mortality and morbidity rates among the mothers
and children

Nutrition on various ways of managing malnutrition conditions among children, adolescent and
people with conditions such as malnourished HIV/AIDS patients

Communicable diseases and their prevention and control measure

Health education and promotion by giving various health talk to different target groups
according to their needs

Occupational health to assess and ascertain that the working environment for the workers is
conducive so as to reduce the morbidity and mortality rates

School health by inspecting and ascertaining that the learners and other workers are within
healthy and conducive learning and working environment respectively

Liquid and solid waste management to eliminate the breeding site of some microbes and also
prevent odor resulting from the waste by properly disposing waste

Meat inspection at slaughter house and butchery to inspect carcasses to be consumed by the
people so that they are not exposed to zoonotic diseases by condemning either whole infected
carcasses and visceral or by trimming the affected part

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 INTRODUCTION
Kayoe 1 health centre profile / history

Kayole 1 health centre is a local authority health centre located in kayole sub county,next to
kayole 1 primary school.The facility is operational as at October 2015.It operates from Monday
8.00Am to Friday,only Maternity works during weekends.

In kayole 1 health centre services rendered are free of charge and they include;

Child health services

Maternal child health services

Curative and diagnostic services

Special clinics eg,occupational and physiotherapy

Community health services

Disease surveillance and response to disease and environmental hazards

Heath education/promotion

Objectives of the host institution on medical services and public health and sanitation

 Eliminate communicable conditions in the county until they are not a major public health
concern.
 Reduce burden of violence and injuries by reducing morbidity and mortalities arising
from violence and injuries.
 Provide essential health services by ensuring services are affordable, equitable, accessible
and responsive to the residents of other counties.
 Minimize exposure to the health risk factors by strengthening health promotion in the
county

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Vision
Aspires to be a leader nationally in the provision of high quality services with dignity and
professionalism
Mission
Committed to courtesy and excellence in service delivery thus encourage clients to give feedback
on our services to enable us improve on quality of service delivery

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 WORK EXPERIENCE

ROUTINE

OFFICE ROUTINE
We were taken through office routine by Ms.Jane (PHO).
Public health officers can undertake different duties in various work places including;
a) At the Hospital,
 General hospital cleanliness / sanitation
 Inspecting the food stores, and incoming food stuffs, drug stores and drug to ensure that
expired drugs and other equipment are disposed off accordingly mortuary and its
equipment’s
 Vector, rodent and pest control within the hospital
 Disease surveillance especially those cases referred by the clinician such as measles and
taking the samples to national laboratory for confirmation tests
 Keeping records on reported cases and linking with other public health officers in the
field
b) Port
 Disease surveillance and screening within the frontier / port
 Responding to any health emergencies within and around the frontier / port
 Food safety measures for both the imports and the exports
 Vaccination of travellers and issuance of vaccination certificates
 Environmental sanitation within the port to control nuisances such as noises, dust, smoke,
or odor problems
 Vector / rodent control within the port
c) In the field (community)
 School inspection including Children deworming
 Defaulter trussing and isolation of contagious patients from the community
 Law enforcement by issuing notices such as statutory, not to use, expiry notices and
taking non complied individuals to court
 Disease surveillance and supplementary immunization

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  Health problem related Data collection , review and coming up with preventive measures
and giving priority to complains
 Health education and promotion
 Routine inspection of food premises and issuance of medical certificates to food handlers
 Networking with other relevant departments or ministry e.g. environmental, nutrition,
MCH, CCC, etc.

MATERNAL AND CHILD HEALTH

Maternal health is the health of women during pregnancy, child birth and the postpartum period.
It encompasses the health care dimension of family planning, preconception, prenatal and
postnatal care in order to ensure a positive and fulfilling experience in most cases and reduce
maternal morbidity and mortality in other cases.

Family planning

Family planning services are educational, comprehensive medical or social activities which
enable individuals, including minors to determine freely the number and spacing of their children
and to select the means by which this may be achieved. Family planning may involve
consideration of the number of children a woman wishes to have, including the choice to have no
children, as well as the age at which she wishes to have them. If sexually active, it may involve
the use contraception and other techniques to control the timing of reproduction such as sexuality
education, prevention and management of sexually transmitted infections, pre-conception
counseling and management and infertility management.

Methods of contraception

There are different methods of contraception available at kayole 1 hospital such as;

 Long- acting reversible contraception (LARC) which last for a long time:
i. Intra uterine device (IUD) ,in the uterus, that last for five to ten years
ii. The implant (in the upper left arm)that last for three or five years
 Hormonal contraception which uses hormones to prevent pregnancy e.g
i. Combined oral contraceptive pill (COC pill) and Progestrogen-only
contraceptives (POP). You take one pill each day

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 ii. The Depo Provera injection which is given as an injection on upper left arm every
three months
 Barrier methods which prevent the sperms from entering the vagina such as male, which
should be placed on erected penis, removed after ejaculation, and a new one used during
every sexually activities and female condom which can be used for up-to 8 hours
 Emergency contraception including emergency contraceptive pill (ECP) to be taken up
three days after unprotected sex for women of an average weight and copper IUD for
women who weigh more than 70 kg within 72 hours after having unprotected sex
 Fertility awareness which involve learning the signs of fertility in your menstrual cycle to
help you plan or avoid a pregnancy
 Permanent contraception (sterilization) which prevent all future pregnancies, very
difficult or impossible to reverse. They include vasectomy for male and tubal ligation

Preconception care

It a set of intervention that focus on health promotion and disease prevention in women of child
bearing age intended to improve the health status of a woman and that of her fetus/ newborn. Its
aims are; optimizing the woman’s health to minimize the risks during pregnancy outcomes, and
to provide information to make informed decisions about future reproduction.
Some of the issues discussed with the patients include; review of current and past medical
conditions and infectious diseases, prior immunizations, possible tetratogen exposure, genetic
issues, nutrition, domestic violence, smoking and alcohol use, substance abuse, psychosocial
issue and financial planning.
Daily use of folic acid 0.4 mg tablets recommended at least three months prior to conception
After a positive pregnancy test results, the client is advised regarding the immediate initiation of
folate and cessation of alcohol use and cigarette smoking.
For women planning to continue their pregnancy STIs including HIV Screening should be
deferred until initiation of prenatal care in order to avoid duplication of services
Women known to be type 1 and 2 diabetics who are seen for family planning services are
reminded of the importance of blood sugar control before pregnancy.
Women with risk factors should be referred for screening for type 1 and 2 diabetes before
becoming pregnant including client with; overweight or obesity, polycystic ovarian syndrome, a

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first degree relative with diabetes, a history of gestational diabetes or a pregnancy outcome
suspicious for type 2 diabetes such as baby born greater than nine pounds or unexplained
stillbirth
Prenatal care / antenatal care

It is type of preventive healthcare whose goal is to provide regular check-ups that allow doctors
or midwives to treat and prevent potential health problems throughout the course of the
pregnancy and to promote healthy lifestyles that benefit both mother and the child.

During check-ups, pregnant women receive medical information over maternal physiological
changes in pregnancy, biological changes, and prenatal nutrition including prenatal vitamins,
recommendations on management and healthy lifestyle changes, prenatal screening and
diagnosis which plays a role in reducing the frequency of maternal death, miscarriages, birth
defects, low birth weight, neonatal infection and other preventable health problems.

It is recommended that pregnant women should receive four antenatal visits to spot and treat
problems and given immunizations (tetanus vaccine)

Ultra sound is used for monitoring the pregnancy, diagnose pregnancy (unknown), check for
multiple fetuses, assess possible risks to the mother (e.g. miscarriage, blighted ovum, ectopic
pregnancy, or a molar pregnancy condition), check for fetal malformation, determine if an
intrauterine growth retardation condition exists, note the development of fetal body parts, check
the amniotic fluid and umbilical cord for possible problems and determine due date.
Physical examinations generally consist of;
 Collection of mother’s medical history
 Checking mothers’ blood pressure
 Taking mothers height and weight and calculating the BMI
 Pelvic examination
 Doppler fetal heart rate monitoring
 Mother’s blood and urine tests discussion with caregiver

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Postnatal care
Postpartum period refers to the first six weeks after the child birth. It is a period of adjustment
and healing for mothers. During postpartum period the mother is at risk for problems as
infections, hemorrhage, pregnancy-induced hypertension, and blood clot formation, the opening
up of incisions, breast problems and postpartum depression. Some of the services offered at the
hospital include;
 The new mother is given instructions on how to hygienically care for her perineal area.
She is encouraged to change her perineal pad frequently and to wash her hands
afterwards.
 Evaluate pulse, respiratory rate, and blood pressure every 15 minutes during the first hour
of postpartum, every 30 minutes for 2 hours, and then every 8 hours. Evaluate the
woman’s temperature at the first hour of postpartum and then every four hours for the
first 2-12 hours.
 Helping the woman to take a shower as soon as she is allowed to, while monitoring her
for lightheadedness
 Encourage adequate rest, a generous intake of nutrients and fluids
 Monitor the woman’s voiding and ensure the woman is not having the difficulty.
 Assessment of afterbirth pain/ discomfort the degree of pain and discomfort from
incision, laceration, and uterine cramping )
 Assessment of fundus by evaluating the height and consistency of fundus
 Assessing the color and the amount virginal discharge (lochia) by frequently removing
the pad and checking the flow of lochia after delivery
 Perineum Assessment of perineal area for an episiotomy or laceration repair

Child health
Child health, include physical, mental and social well-being.
The basic of keeping children healthy include;
 Offering the children healthy foods,
 Making sure they get enough sleep, and exercise
 Ensuring their safety
Some of the services offered regarding the child health at the hospital include;

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  Routine immunization of the children, giving vitamin A supplement and deworming
 Supplementary immunization in case of an outbreak of certain diseases (house to house
strategy)
 Regular check-ups for the child’s development by measuring their height and weight (at
CWC)
 Free treatment of any disease or condition for the children under the age of 5 years and
also they are seen for;
 Significant weight loss or gain
 Sleep problems or change in behavior
 Fever higher than 102
 Rashes or skin infection
 Frequent sore throats
 Breathing problems

NUTRITION
Nutrition is the science of food, nutrients and other substances therein, their action, interaction,
and their balance in relation to health and disease and the process by which the organism ingest,
digest, absorb, transport, utilize, and excrete food substances.
Nutrients, these are substances obtained from food and are used in the body to provide energy
and structural materials and to regulate growth, maintenance and repair of body tissue. They
include carbohydrates, protein, vitamins, minerals, fats and water.
Macro-nutrients These are nutrients needed by the body in large amounts and they include
carbohydrates, proteins and fats. They form the bulk of the diet and supply all the energy needed
by the body.
Micronutrients These are nutrients needed in small amounts for a variety of body functions and
processes. They include the vitamins and minerals
Essential nutrient, There are nutrients that must be obtained from food because the body cannot
make them/synthesize them in sufficient amounts to meet the body’s physiological needs.
Examples: All minerals and vitamins, nine out of twenty amino acids, linoleic and linolenic fatty
acids.

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Nutritional status Refers to the condition of health of an individual as influenced by the intake
and utilization of nutrients
Malnutrition Refers to any condition caused by an excess or deficient of energy or nutrient
intake or by an imbalance of nutrients. It is as a result of an imbalance between dietary intake
and requirements. There are single nutrient deficiencies, and imbalances of two or more required
nutrients.
Good/normal nutrition Refers to a sufficiency of nutrients intake that affords the highest level
of wellness i.e. maintains normal growth and development, normal reproduction, optimum
activity, resistance to infection, ability to repair body injury etc.
Under nutrition, Under-nutrition refers to a deficiency of energy or nutrients. Under nutrition
can be categorized as primary deficiency that is caused by lack of foods such as protein energy
malnutrition (PEM), kwashiorkor, marasmus, scurvy or as secondary deficiency that is caused
by something other than 4 such as presence of a disease such as measles. A diseases condition
reduces absorption, accelerates excretion or even causes destruction of nutrients. Excess alcohol
consumption and inborn errors of metabolism are also secondary causes of under nutrition.
Over nutrition Over-nutrition refers to excess intake of energy or other nutrients. It is common
among the affluent population and occurs mainly in the form of overweight and obesity and their
health related problems e.g. diabetes, hypertension etc.

Assessment of nutritional status

Nutritional assessment is the process of evaluating the nutritional status of an individual. It is the
process of estimating the nutritional position of an individual or group of people at a given point
in time. It provides an indicator of the adequacy of the balance between dietary intake and
metabolic requirements. Nutrition status assessment is carried out to discover facts useful in
guiding actions intended to improve nutrition and health. Four methods are available that can be
referred to as the 'ABCD' of nutritional status assessment. These are:
1. Anthropometry
Anthropometry is the measurement of body size, weight and proportions to evaluate nutritional
status. Various measurements are taken and compared to standards typical of the reference
population where deviations indicate abnormal nutritional status. The measurements commonly
used are:

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Weight
Changes in weight among young children can be a useful indicator of the general health and
well-being of the entire population. Weight is used to track growth or failure to grow in children.
Weight can be used together with age to compute the weight for age index that is used to
determine if one is underweight.
Height/Length
Height or length of children changes over time and is dependent on their nutrient intake and
utilization. The height measurement can be used in conjunction with the weight measurements to
compute the height for weight index which is an indicator for wasting. Height measurement can
also be used together with age to compute the height for age index, an indicator for stunting.
Mid upper arm circumference (MUAC)
These are rapid and effective measures that predict risks of death among children 12-59 months.
Skin fold thickness
This is a measure of indirectly estimating the percentage of body fat by measuring the thickness
of a double fold of skin and compressed subcutaneous adipose tissue on the triceps. The
measurement is taken using the skin fold calipers.
Head circumference
This is a measurement used for screening procedures to detect abnormalities of the head and
brain growth especially in the first year of life
Body Mass Index (BMI)
This is a useful tool when measuring an adult’s nutritional status. Weight and height
measurements are taken and used to compute the index.
BMI= Weight ( Kgs) /Height (m2)
The interpretation of BMI indices is as follows:
<18.5-underweight
18.5-24.9-normal weight for height
25-29.9-overweight
>30-obese
2. Biochemical assessment
This is a measurement of nutrients in blood, urine and other biological samples. Actual levels of
particular nutrients may be measured and expressed in relation to the expected normal values.

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Compared to other methods, biochemical assessment provides the most objective and
quantitative data on nutritional status. For example hair can be analyzed to determine zinc status,
urine to determine protein levels and blood for haemoglobin.
3. Clinical assessment
This entails the taking of medical history and physical examination to detect signs and symptoms
of deficiency or general malnutrition. It involves looking at the body and detecting changes in its
external appearance. For example changes in hair, face, eyes, lips, skin, teeth, gums, tongue can
be used determine the presence of nutritional deficiencies.
4. Dietary assessment
This involves the assessment of food consumption of a group of individuals over a period of
time. Data on foods consumed assists in the identification of nutrient intake. Interpretation of
dietary intake involves use of food consumption tables.
REMEDIES GIVEN AT THE HOSPITAL

CONDITION FOOD SUPPLEMENT AGE DURATION

GIVEN
Severe acute ready to use therapeutic 6-59 months 6-8 weeks
malnutrition (SAM) food (RUTF)-10-15 kg
Moderate acute Ready to use 6 months and 2-3 months
malnutrition (MAM) supplementary older
food(RUSF) in addition to
breast milk
Persistent diarrhea in F-75 MILK Under 5 years Hospitalization
SAM period (starter)
Severe acute F-100 Under 5 years Hospitalization
malnutrition period (catch-
up)
Malnutrition Fortified blended foods 5 years and WFP
above supplementary
feeding and
Mother and
child health
program

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COMMUNICABLE DISEASES
We were taken through and given some questions in form of an assignment on communicable
diseases.

Communicable disease is the one that spreads from one person to another through a variety of
ways including;
 Contact with blood and bodily fluids/ physical contact with infected person
 Contact with contaminated surfaces or objects
 Breathing in an airborne virus
 Being bitten by an insect
Determinate of communicable diseases

 Poverty
 Age
 Sex
 Lifestyle
 Diet / eating behaviors
 Health care services among the population affected
 The behavior and characteristics of people etc
Common communicable diseases
 Tuberculosis
 HIV/AIDS
 Cholera
 Typhoid
 Common cold
 Diarrheal diseases
 Influenza (flu)
 Chicken pox
 Urinary tract infection
 Brucellosis

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Emerging and re-emerging communicable diseases
Emerging diseases
Diseases that have not occurred in human before (this type of emergence is difficult to establish
and is probably rare)
Emerging diseases may have occurred previously but affected only a small number of people in
an isolated place. They include; HIV / AIDS, Ebola, hemorrhagic fever etc.
They have occurred throughout human history but have only recently been recognized as distinct
diseases due to an infectious agent e.g Lyme disease and gastric ulcer
Re-emerging diseases
These are diseases that were once major health issue/ problem globally or in a particular country
and then declined dramatically but are again becoming health problems for a significant
proportion of the population. They include malaria, tuberculosis, rabies, diphtheria, yellow fever
etc
Prevention and control measures of communicable diseases
 Treatment of communicable diseases
 Treatment and use of treated, clean and safe water
 Sewage treatment and proper disposal of waste
 Vaccination / immunization
 Implementation of standard, inspection plan and regulation of food preparation, handling
and distribution (food safety programs)
 Animal control program – inspecting animals for different zoonotic diseases,
vaccinations of dogs for rabies etc
 Vector rodent and pest control
 Public health organizations to enforce regulations ,provide public health services such as
vaccination programs, monitoring and reporting the incidence of a particular dise

HEALTH EDUCATION AND PROMOTION

Health education and promotion is a profession focusing on the behaviors, systems,
environments, and policies affecting health, at variety of levels. This profession requires
intensive specialized training encompassing the Biological, environmental, psychological, social,
physical and medical sciences.

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It involves the development of individual, group, institutional, community and systematic
strategies to improve health knowledge, attitudes, skills and behaviors which empower people to
take more control over their personal, community, and environmental health and wellbeing.
We were able to give health talk to various target groups as listed below according to their health
needs.
Health education and promotion strategies we used include
- Group education,
- Training and counseling
- Community development
- Environmental health and wellbeing
- Computerized educational materials development

Skills and Competences of Health Educator

We were able to;
- Assess individual and community needs
- Plan and develop health education Programs
- Implement health education programs
- Manage health education programs and personnel
- Organize and mobilize community for actions
- Advocate for health related issues
- Use a variety of education and training methods i.e. PET
- Print materials
Our Target groups
 Family planning clients
 Pregnant women at antenatal clinic
 Delivered and lactating mothers at maternity ward/ wards
 Parents with malnourished children at nutrition department
 Parents with sick children at MCH clinic
Health talk topics
 Preconceptual care and Family planning
 Focused antenatal care and its importance

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  Targeted postpartum care, and essential new born care
 Breast feeding and its importance
 Nutrition and importance of balanced diet
 Hand washing, personal hygiene and their importance

OCCUPATIONAL HEALTH AND SAFETY (OHS)

It is a multi-disciplinary field that is concern with the safety, health and welfare of people at
work-place and strongly focuses on primary prevention of hazard
It fosters a safe and healthy work place
PEST AND RODENT CONTROL
Pest control is the regulation or management of Pests, a member of the animal kingdom that
impacts adversely on human activities. The human response depends on the importance of the
damage done, and will range from tolerance, through deterrence and management, to attempts to
completely eradicate the pest.

In homes and urban environments, Mostly pests are rodents, birds, and insects. Another pest is
organisms that share the habitat with humans. They feed on and spoil possessions. Control of
these pests is attempted through exclusion, repulsion, physical removal or chemical means.

Integrated Pest Management has been implemented in most parts of the sub county

Among the various methods we advised local communities to use in regulating rodents include

Blocking Entrance Ways

For effective control of rodents, it is important to ensure that rats and mice have no way of
entering your home. Do a thorough inspection of your house, checking for cracks, crevices and
other openings. Sealing all gaps with an exterior-grade sealant, or cement whenever possible can
also be practiced. Large areas around pipes should be covered in mesh first, and then sealed with
cement. Metal panels at the bottom of wooden doors or windows can help prevent rodents from
chewing through. You should also cover ventilated areas with mesh.

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Prevent Exterior Access
Trees, weeds and overgrown vegetation can provide access to your home and serve as a food
source for rats and mice. For effective rodent control, keep trees trimmed, ensuring that no
branches are touching the outside of your home. Eliminate weeds and cut back grass and
vegetation, keeping it at low levels. Store outdoor items and firewood at least a few inches off of
the ground. If you have outdoor pets, try to schedule feedings during daylight and do not leave
food out overnight. To prevent rodents from accessing garbage, keep trash bags tightly sealed
and stored in garbage cans with lids. If you have excessive trouble with rats or mice, consider
using rock or concrete landscaping along the edges of your home to keep vegetation at a more
suitable distance.

Remove Inside Attractors

Sanitation is critical to rodent control. Rats require about 1 to 2 ounces of food per night and at
least double the amount of water. Mice require less food and do not require water daily. Do not
leave food out on the counter or in open storage. Put all food in airtight containers and keep it
stored in cabinets and pantries, or in the refrigerator. Throw garbage out nightly, clean crumbs
off of countertops and vacuum floors if necessary.

Rats and mice may enter other areas of the home as well. Rodents can nest in paper and
cardboard products. Do not store boxes on the floor and keep clutter to a minimum. In
bathrooms, ensure faucets are kept off and that there is no standing water on the floor.

Data Collection

The inability to generate reliable information needed to make decisions based on evidence is a
major obstacle to public health services. Public health decision-making is critically dependent on
the timely availability of sound data.
The critical elements in Health Information System (HIS) are usually to turn raw data into useful
form and extrapolate this through sector indicators outlined above. The main components are:-
• Data collection
• Data processing
• Data reporting
• Data dissemination and use.

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DATA COLLECTION TOOLS (REGISTERS)
1. MOH 710 A & B- Division of vaccine and immunization
2. MOH 705 A-Outpatients ≥5years
MOH 705 B-Outpatients ≤5years
3. MOH 711- Integrated program summary report form
4. MOH 717- Monthly service workload report for health facilities
5. MOH 105
6. TB Commodity Consumption
7. Lab Commodity Consumption
8. Disease Surveillance Report
9. Malaria Report
10. CDRR- Contraceptive Consumption Data Report Request form
11. MOH 731- NASCOP
12. CaCx
13. MOH 713-
14. ARV Consumption Report
15. SGBV
16. MOH 733A
17. MOH 734
18. MOH 718

DISEASE SURVEILLANCE
Disease surveillance is an epidemiological practice by which the spread of disease is monitored
in order to establish patterns of progression. Its main role is to predict, observe and minimize the
harm caused by outbreak, epidemic, and pandemic situations, as well as increase knowledge
about which factors contribute to such circumstances. A key part of modern disease surveillance
is the practice of disease case reporting.

Some of the departments and organizations involved in disease surveillance include; curative
department, livestock department, water supply department, NGO, county administration,
national health ministry, WHO, UNICEF, ETC

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The strategy used in diseases surveillance is called integrated disease surveillance and response
system (IDSR) which is designed for multi-disease surveillance of selected priority diseases or
conditions.it also links the community, health facility, district, and national levels. Allowing the
rational use of resources for disease control and prevention

More than 200 sentinel sites across the country ensure disease surveillance and early responses to
outbreaks of water-borne diseases (e.g. cholera), vector-borne (malaria) and vaccine preventable
diseases such as measles, and some other including watery diarrhea, meningitis, respiratory
infection and whooping cough

During my attachment period I was able to carry out various disease investigations under the
supervision of mrs.Ericah Ndege including;
 AFP case investigation during polio campaign but I didn’t find any case
 Measles case investigation which was reported by the clinician and we recorded the
details in MOH 502, took the sample to Kemri laboratory for laboratory test and the
results were negative
Disease surveillance process

 Responding to the cases by sending medical teams to conduct outbreak investigations and
rumors verification
 Data collection and analysis of diseases as at the health facility or the community by
person, time and place
 Treatment Centre or mobile clinics are set up in areas without access to health facilities
for response and case management
 Conducting community awareness intervention on preventive and control measure of the
disease to complement house to house case management

SCHOOL HEALTH AND SANITATION

It involves the inspection and certification of the school as a conducive learning and healthy
environment for the learners, tutor and other people within the compound

Was able to undertake the exercise in three schools under the supervision of Mr. Ezzrah after
which I wrote a report to each school.

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SOLID WASTE DISPOSAL
Solid waste is any discarded or abandoned materials, which can be solid, semi-solid, liquid or
containerized gaseous materials.

They include; waste tires, septage, scrap metal, latex paints, furniture and toys, garbage, empty
aerosol cans, paint cans, compressed gas cylinders etc.

Solid waste disposal

Hospital

 The wastes generated are usually disposed in different color coded bins lined with bin
liner and are mostly hazardous and therefore they are usually incinerated on daily basis

Household

 Most households dispose there waste in small waste bins or in the polythene bags which
are kept in their houses and later given to the garbage collector on weekly basis
 Some residents in flats they dispose their waste in big waste bins placed at a central place
(mostly ground floor) which is afterwards collected by the garbage collectors on weekly
basis
 Some of the households dispose their waste in waste pits which is later burnt
 Other dispose their waste especially used baby pampers and sanitary pads in the pit
latrines
Food premises
1. Waste produced from food premises is usually disposed in waste bins or in the polythene
bags which can either be sorted and the food remains given to animals (pigs and dogs)
and the remaining collected on daily basis by the garbage collectors
Day care
2. The waste generated mainly the food remains are either given to animals or collected by
garbage collectors and the used baby pampers disposed in bins or bags which are then
collected by the garbage collectors on weekly basis

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Market
3. The waste generated are mostly spoilage food stuffs which are kept in the bins or bags
and later disposed in waste pits which is then collected by the garbage collectors on
weekly basis
Garbage collectors
They dispose the collected waste at sub-county waste disposal point, where some waste such as
plastic bottles, glass bottles, cartons, food stuffs, etc are sorted by self-employed individuals who
sell them to re-cycling industry and the remaining waste is managed using mixed method of
waste management

LIQUID WASTE DISPOSAL

Liquid waste are liquids such as waste water, fats, oils, or grease (FOG), used oil, liquids, solids,
gases, or sludge and hazardous household liquids.

Liquid waste can be generated from;

1. Households; human waste, washing water, surplus drinks, cooking oil, pesticides,
cleaning liquids, etc

Disposal
 Pit latrines
 Washing sinks and latrines connected to manholes/ septic tanks

2. Industry; Industrial cooling waters (biocides, heat, slimes, silt), Industrial process
waters, Organic or biodegradable waste, including waste from abattoirs, creameries, and
ice cream manufacture, Organic or non-bio-degradable/difficult-to-treat waste
(pharmaceutical or pesticide manufacturing), Extreme pH waste (from acid/alkali
manufacturing, metal plating), Toxic waste (metal plating, cyanide production, pesticide
manufacturing, etc.), Solids and emulsions (paper manufacturing, foodstuffs, lubricating
and hydraulic oil manufacturing, etc.), Produced water from oil & natural gas production

Disposal
 Septic tanks
 Using water to minimize dust either produced within the industry or along murram roads

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 3. Storm water;
Disposal
 Directed to the river and stream

4. Rainfall water collected on roofs, yards, etc.

Disposal
 Directed to the septic tanks
 Used to flush the toilets.

MEAT INSPECTION
We were taken through slaughter house and meat inspection and hygiene at kiamaiko slaughter
house by vetinary officer.

Ante-mortem Inspection
Ante-mortem examination should be done within 24 hours of slaughter and repeated if slaughter
has been delayed over a day.
Principles of Judgment in Ante-Mortem Examination
 Fit for slaughter: Animals which are normal and free from any clinical signs of disease
should be s Unfit for slaughter: Highly emaciated, skin bound animals and those
affected with communicable infectious diseases like rabies etc. or diseases which cannot
be treated should be declared unfit for slaughter.
 Suspects: All suspected animals need further attention. Some animals with localized
condition and recovered cases should be passed for slaughter as suspect with instructions
for careful post-mortem examination.
 Detained animals: Some animals need to be detained for specified period of time for
treatment of disease or excretion of known toxic residues.
 Emergency slaughter: It is recommended in cases where the animal is in acute pain or is
suffering from a condition where any delay in slaughter would be contrary to the welfare
of animal. It is done under strict supervision so that there is no hazard to the consumer
health. Such condition could be recent injuries, recent fractures, tympany (bloat),
prolapse of uterus etc.

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Humane Slaughter of Food Animals
Humane slaughter avoids unnecessary pain and cruelty to food animals and ensures as complete
bleeding as possible. It also ensures speed of operation and safety of the personnel. Such
slaughter is preceded by stunning.
Stunning is any mechanical, electrical, chemical or other procedure which causes immediate loss
of consciousness which lasts until either the animal is killed or it recovers.
Sticking or Bleeding of the Animal
 It is important that bleeding should be done as soon as possible after stunning so as to
minimize the extravasation (leakage) of blood into the organs and musculature.
Bleeding can be done by any of the two methods:
1. After hoisting on the overhead rail, carotid arteries and jugular veins of both sides are
severed across the throat region, caudal to the larynx.
2. On the floor, skin is incised along the jugular furrow and carotid artery and jugular vein
of one side are severed. The knife is then passed to the chest severing the anterior a orta
and anterior vena cava. Sometimes, knife reaches too far in the chest puncturing the
pleura and the blood may be aspirated into the thoracic cavity..
Dressing of Slaughter Animal
 The carcass is conveyed by gravity or power driven along an overhead rail.
 Equipment such as brisket saw, hock cutter, hide puller, bone cutter etc. facilitate the
dressing.
 The process includes the opening of the carcass, flaying, evisceration, splitting,
inspection and dispatch.
1. Flaying: This is the removal of the hide and skin of cattle (buffalo), sheep and
goat.
2. Evisceration: Removal of the viscera from the carcass.
POST-MOTERM INSPECTION

 A routine post-mortem examination should be carried out as soon as possible after

carcass dressing is completed; beef and pork carcasses set rapidly and if inspection is
delayed, particularly in cold weather, the examination of the carcass lymph nodes is more
difficult.

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  The main purpose of post-mortem examination is to detect and eliminate abnormalities,
including contamination, thus ensuring that only meat fit for human consumption is
passed for food.
 Routine post-mortem examination determines the character and extent of disease lesions,
differentiating between:
 localized and generalized conditions (the former being less important)
 Acute, sub-acute and chronic conditions.
 An acute, active, spreading lesion is regarded very critically, but a healing one less so.
 The general disposition of the carcass, its organs, state of nutrition, any ante-mortem
report and the results of any necessary laboratory tests are all take into consideration in
making a final judgment.
 The color of the blood, its coagulation properties and the possible presence of foreign
bodies in it must be determined.
 Responsibility to the consumer must be upper most in the inspector’s mind. At the same
time there must be no unnecessary wasting of valuable meat.

Facilities for post-mortem inspection

 As far as the larger animals are concerned there are normally three main inspection areas;
head, viscera, carcass.

Post-mortem inspection procedure

 Involves
 visual examination,
 palpation of tissues and organs,
 incisions where necessary,
 use of the inspector’s sense of smell
 if indicated, laboratory tests.
Cattle
Inspection of carcass and its organs should proceed in the following order, though in countries
where bovine tuberculosis has been eradicated suitable modifications in the routine may
justifiably be made.

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Head
 An examination of the outer surface and eyes is followed by an inspection of the gums,
lips and tongue for foot-and-mouth disease, necrotic and other forms of stomatitis,
actinomycosis and actinobacillosis, the tongue being palpated from dorsum to tip for the
latter disease.
 Incisions of the internal and external masseters for Cysticercus bovis should be made
parallel with the lower jaw – in most cases the ventral surface of the base of the tongue is
also incised.
 After the tongue is dropped, routine incisions of the retropharyngeal, sub maxillary and
parotid lymph nodes should be made for tuberculosis lesions, abscesses and
actinobacillosis.
Lungs
 Visual examination, which should be followed by palpation, should be carried out for
evidence of: Pleurisy or pleuritis, pneumonia, tuberculosis, fascioliasis, hydatid cysts
 The bronchial and mediastinal lymph nodes should incised and the lung substance should
be exposed by a long, deep incision from the base to apex of each lung.

Heart
 The pericardium should be examined for evidence of pericarditis, hemorrhages etc.
 The heart ventricles are then incised and outer and inner surfaces observed, particular
attention being paid to the presence of petechial haemorrhages on the pericardium or
endocardium and to cysticerci and hydatid cysts and occasionally linguatulae in the
myocardium (Linguatula serrata, the so-called tongue worm, is a worm-like,
bloodsucking parasite).
 Alternatively, the heart may be everted after cutting through the inter-ventricular septum
and the ventricular wall.
Liver
 A visual examination with palpation should be made for: fatty change, actinobacillosis,
abscesses, telangiectasis. Parasitic infections as hydatid cysts, Cysticercus bovis,
fascioliasis or linguatulae and the larval stage of Oesophagostomum radiatum
 The portal lymph nodes and large bile duct should also be incised.

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Oesophagus, stomach and intestines
 Observe and if necessary palpate these organs.
 The serous surface may show evidence of tuberculosis or actinobacillosis, while the
anterior aspect of the reticulum may show evidence of penetration by a foreign body.
 Routine incision of the mesenteric lymph nodes should be made for tuberculosis or
linguatulae nodules.

Kidney
 The law requires kidney and renal lymph node inspection and enucleation

Spleen
 Visual examination, palpation and, if necessary, incision
 The surface and substance should be examined for; tuberculosis, anthrax, haematomata,
presence of infarcts

Carcass
 The cut surfaces of bone and muscle, carcass exterior, pleura, peritoneum and diaphragm
should be observed, attention being given to condition, efficiency of bleeding, colour,
cleanliness, odours and evidence of bruising and any other abnormalities.
 If necessary palpation and incision of parts may be indicated, e.g. triceps brachii muscle
for evidence Cysticercus bovis.
 The superficial inguinal, external and internal iliac, prepectoral and renal lymph nodes
should be observed and if necessary, palpated and incised.
 Where a systemic or generalized disease is suspected, in tuberculin reactors and where
tuberculosis lesions have been detected in the viscera, the main carcass lymph nodes must
be examined.
 The thoracic and abdominal cavities should be inspected for inflammation, abscesses,
actinobacillosis, mesothelioma (an aggressive cancer affecting the membrane lining of
the lungs and abdomen) or tuberculosis the diaphragm should be lifted, for tuberculosis
lesions may be hidden between the diaphragm and thoracic wall.

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SHEEP AND GOATS
 Sheep and goats require a less detailed inspection than cattle, calves and pigs.
 The carcass should be examined for satisfactory bleeding and setting, the lungs for
parasitic infections, especially hydatid cysts or nematodes and the liver for fascioliasis.

DECISION AT POST-MORTEM EXAMINATION

 The final judgment as to the action to be taken with a carcass or parts of a carcass is
based on the total evidence produced by; observation, palpation, incision, smell, any ante-
mortem signs, Results of any laboratory test, Rarely, but where appropriate, taste may be
employed.

STAFF AND MY ANTICIPATION

As a staff at kayole 1 hospital- public health office, I was able to participate in the following

 Attending community health meetings. I also attended some trainings and seminars
including the campaign against polio trainings.
 Attending to clients with health related issues. I was able to attend to people who visited
the office with complaints, for instance, some were reporting on pollution in certain areas
while others were seeking advice on how to go about certain challenges. I also
encouraged the HIV victims at the compressive care centre CCC at the hospital
 Assisting in report writing at the end of every inspection; I r with other staffs we were
able to write reports which were later submitted to the respective recipients after
inspections. We also wrote statutory notices and letters of closure to the non-complaints’
 Issuing of medical certificates to food handlers, this was given after the client had
undergone all the necessary tests and was certain of good health.

COMMUNITY PARTICIPATION
During the practicum the community was greatly involve in promoting public health and in
successful management of community health issues. They were involved directly or indirectly in
different areas though the following ways;

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Passive participation

Whereby, the community participated by being told what has been decided or already happened.

Participation by consultation

This is where the community participated by being consulted and answering questions. For
example, when investigating a community health problem I was able to inquire some information
from people around those areas which made my work and that of the other staffs easier.

Participation for material incentives

The community also participated by contributing resources such as labor in return for material
incentives.

Functional participation

People also participated by forming groups to meet predetermined project objectives. They were
also involved in decision making but any after, major decisions already been made by external
agents

Self-mobilization People participate by taking initiatives independently of external institutions to

change systems.

ISSUES AND PROBLEM ENCOUNTERED AND THEIR SOLUTION

The following were the problems that I was able to rule out during the attachment period. These
problems involve both the ones experience by people in the community as well as the health
workers

1. Resistance from some community members who were not willing to comply. For
instance, the house managers around the town who were letting wastewater and sewage
on the open lands were unwilling to cooperate and adapt to change by installing a sewer
line
2. Culture and traditions also posed a great challenge to working in the field. For example,
during the door to door vaccination program ; some people were too much in religion and
could not allow us to vaccinate their children since they believed in Gods protection

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3. Another challenge observed was the insufficient collection of solid waste; the role of the
municipal authorities that were once the main providers of the garbage collection services
has diminished with less than one percent households receiving services from the
municipal authorities. Payment collection remains the most common method of
collection.
4. In areas where waste collection were provided at a fee, there were some households
which could not pay for the services due to poverty , leading to an adoption of an
adoption of alternative disposal services. The alternatives included rivers, pits and
burning. This resulted to pollution of rivers and also air pollution due to the smoke
emitted when burning.
5. There was also a challenge with illegal disposal of waste, littering the community and
other people’s plots.
6. Overloading of waste collection vehicles lead to scattering or flowing out of waste during
transport, this contributed to more challenges in solid waste disposal.
7. Community’s lack of information was also another challenge. For example, some did not
know about family planning methods and the need to have consistent vaccination of
children which made it difficult to convince them.

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 EVALUATION OF THE PROJECT
The ten weeks attachment period was interesting and educative. I was able to learn a lot more in
the field in addition to what is taught in class. It also enabled me to apply the gained skills in
solving community health problems. Moreover, the theory taught in class was brought to reality
through practical activities. I achieved some of my objectives in the following ways:

 By sampling and testing water and food in the laboratories, I was able to add to my skills
as a health practitioner
 I was able to learn about report writing and could accurately write the reports
 I attended few court sessions and learnt how public health cases are handled
 Interaction with the staffs made me appreciate the importance of team spirit and also
develop cooperative attitude

Conclusion

The urban attachment practicum is important in expositing a trainee to the real public health
issues and should be encouraged for all public health students

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 RECOMMEDETION

Suggestions as to the best way to achieve goals of the organization

1. The organization should always involve the community at every stage of the project for
better outcome
2. The organization should educate the community on the use, management (maintenance)
of certain sanitation facilities
3. The organization should also educate the community on the importance of using a certain
facility through health education
4. The organization should work with CHEWS from different villages so as to achieve their
goals
5. The county government should construct sewerage system for proper disposal of liquid
waste
Weakness and proposition of the best way to overcome them
1. Exclusion of local communities in program implementation; all the communities should
be involved in program implementation so as to get good response from them by
accepting and being able to adopt the new practices and abandon the unhealthy hygiene
practices.

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 BIBLIOGRAPHY/ REFERENCE
1. Public health officer in-charge of disease surveillance Ms.Jane many thanks to you for
making sure I achieved various objectives and acquire the necessary skills in field
practical in disease surveillance , communicable diseases, health education and
promotion, occupational health and safety and school health.

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