KISII UNIVERSITY

SCHOOL OF HEALTH SCIENCES

DEPARTMENT OF PUBLIC HEALTH

BACHELOR OF SCIENCE IN PUBLIC HEALTH

TITLE: ATTACHMENT AT MIGOSI SUB COUNTY HOSPITAL IN FULFILLMENT OF

THE
ACADEMIC REQUIREMENTS FOR THE AWARD OF THE DEGREE OF BACHELOR OF
SCIENCE IN PUBLIC HEALTH

ATTACHMENT PERIOD:4TH OCTOBER TO 23RD DECEMBER 2021

DEVELOPED BY:

NAME : FAITH ACHIENG

ADMISSION NUMBER : HE15/00050/19

EMAIL :faithachieng004@gmail.com

SIGNATURE : …………………………………………….

DATE : ……………………………………………
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TABLE OF CONTENT
DEDICATION ..................................................................................................................................................... iii
ACKNOWLEDGEMENT .....................................................................................................................................iv
LIST OF ABBREVIATION .................................................................................................................................. v
CHAPTER 1: INTRODUCTION ...................................................................................................................... - 1 -
1.1 Background of the facility/History ......................................................................................................... - 1 -
1.2 Objective, Vision and Mission of the facility ...................................................................................... - 1 -
1.3 Executive summary ............................................................................................................................ - 2 -
2.1 Maternal and child health care (MCH) ................................................................................................ - 4 -
2.1.1 Child Welfare Clinic (CWC) ............................................................................................................. - 4 -
2.1.2 Immunization .................................................................................................................................. - 4 -
2.1.3 Vaccine storage and cold chain management ..................................................................................... - 6 -
2.2 Antenatal Care (ANC) ........................................................................................................................ - 6 -

2.3 Postnatal care ..................................................................................................................................... - 9 -

2.4 HIV Exposed Infant Clinic (HEI)/ PMTCT ........................................................................................ - 9 -
2.5 Comprehensive Care Clinic (CCC) ..................................................................................................... - 9 -
2.6 Emerging issues in HIV ................................................................................................................... - 10 -
2.7 Nutrition Department ....................................................................................................................... - 11 -
2.8 Medical Laboratory department ........................................................................................................ - 13 -
2.9 Family planning department ............................................................................................................. - 14 -
2.10 Health records and information system department ........................................................................... - 16 -
2.11 Office Management .......................................................................................................................... - 16 -
CHAPTER THREE: COMMUNITY HEALTH ............................................................................................... - 17 -
3.1 Health levels, structures, system and service delivery ....................................................................... - 17 -
3.2 Levels of service delivery ................................................................................................................. - 18 -
3.3 Community diagnosis (CDx) ............................................................................................................ - 20 -
3.4 Community. Reporting Tools ........................................................................................................... - 21 -
3.5 Comprehensive School Health Programme ....................................................................................... - 22 - ..........
4.6 Hazardous Waste Management (HWM).......................................................................................................41
4.8 Pollution Prevention and Control..................................................................................................................44
CHAPTER FIVE: BUILT ENVIRONMENT AND HEALTH...............................................................................46

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 5.1 Design and Drawing of Building Plans.........................................................................................................46
5.2 Approval of Building plans...........................................................................................................................46
5.3 Drainage and Plumbing................................................................................................................................47
5.4 Regularization of building plans for compliance..........................................................................................50
5.5 Ventilation and Lighting...............................................................................................................................51
5.6 Issuance of Occupation Certificates..............................................................................................................52
5.7 Inspection for use/change of use...................................................................................................................53
5.8 Building Regulations, standards and codes...................................................................................................55
CHAPTER SIX: FOOD INSPECTION HYGIENE AND QUALITY CONTROL.................................................57
6.1 Routine inspection for Hygiene of food premises.........................................................................................57
6.2 Inspection of food premises for licensing.....................................................................................................60
6.3 Examination of food handlers.......................................................................................................................60
6.4 Food Sampling and Analysis........................................................................................................................61
6.5 Enforcement of Food laws............................................................................................................................63
6.6 Inspection of Meat and Meat Products..........................................................................................................65
6.7 Sugar Processing..........................................................................................................................................69
6.7.1 HACCP Application in Sugar Processing at Kibos Sugar Industry.........................................................69
CHAPTER SEVEN: GENERAL PUBLIC HEALTH.............................................................................................71
7.1 First Aid Basics and Emergency Care..........................................................................................................71
7.2 Casualty Management Procedures................................................................................................................72
7.3 Health Education and Promotion..................................................................................................................73
CONCLUSION AND RECOMMENDATIONS.....................................................................................................74
RECOMMENDATIONS........................................................................................................................................74
Bibliography............................................................................................................................................................76
APPENDICES.........................................................................................................................................................76

3.6 Nutrition/dietary assessment/survey ................................................................................................. - 24 -

3.7 Community health project/ Programme ............................................................................................ - 26 -
3.8 Entomology, pest, vector, vermin and parasites ................................................................................ - 27 -
CHAPTER FOUR: PUBLIC HEALTH ENGINEERING ................................................................................ - 29 -
4.1 Water supply and Quality control ..................................................................................................... - 29 -

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 4.2 Liquid Waste Management ............................................................................................................... - 33 -
4.3 Solid waste Management .................................................................................................................. - 34 -
4.4 Infection, Prevention and Control (IPC)............................................................................................ - 36 -
4.5 Conservancy Systems ....................................................................................................................... - 38 -

DECLARATION
I herebydeclare that this is my original work and was not initiated from anywhere,neither has it been

submitted to any other institution ,for the

d ofawar
any academic or professional qualification
.

SIGNATURE:……………………..

DATE:……………………………….

NAME:……………………………..

DEDICATION

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I dedicate this attachment report to my dad and siblings, the Kisumu Central Su b County PHO, Mr Philip

Adingo, Calvins Ochieng (PHO and my field supervisor ), CHAS , CHVS and any other individual of good

will who supported me by word or deed through my attachment period.

ACKNOWLEDGEMENT
First and foremost, I express my sincere gratitude to the Almighty God for leading me throughout the
entire period of my attachment program. The attachment period progressed well but this would have not
been possible without team work and cooperation with different stakeholders within the health sector
particularly in Migosi Sub County Hospital and Kisumu County Referral Hospital. I am happy to say and
thank The Kisumu County Public health officer headed by Jeremiah Ongwara and the Director of
preventive services, Dr. Fredric Oluoch for the warm welcome and acceptance to pursue the attachment
program in the county. I would also be pleased to thank the SCPHO, Mr Philip Adingo and the entire
public health staff at the sub county for their efforts and supervision of my activities during the
attachment period. I also acknowledge my immediate supervisor, Mr Calvins Ochieng who assisted me in
panning of activities, community entry and generally achievement of my objectives.

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Special regards go to Migosi Sub County Hospital headed by Mr. Robert Orina (the facility incharge) and
the nurse manager Ms. Everly Ouko and other staffs for effective cooperation provided by them. The
staff were friendly and willing to help me obtain the information I needed to achieve my objectives.
Finally, I would like to thank my family, relatives and friends for their support. Their support greatly
enabled me complete my attachment program.

LIST OF ABBREVIATION
AED Automated external defibrillator
ANC Antenatal clinic
ARV Antiretroviral Drugs
BOD Biochemical Oxygen demand
CBC Community Based Care
CCC Comprehensive Care Center
CHA Community health assistant
CHV Community Health Volunteer
CHEW Community Health Extension Worker

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CLTS Community Led -Total Sanitation
COD Chemical Oxygen Demand
CPR Cadiopulmonary resuscitation
HACCP Hazard Analysis Critical Control Points
IUCD Intra-uterine Contraceptive device
IPC Infection, Prevention and control
KCRH Kisumu County Referral Hospitals
KEPI Kenya Expanded Programme for Immunization
KISAT Kisumu Sewerage and Treatment Works
KIWASKO Kisumu Water and Sewarage Company
MCH Maternal and Child Health
MOH Ministry of Health
MUAC Mid Upper Arm Circumference
NGO Non-govermental Organization
NEMA National Environmental Management Authority
PMTCT Prevention of Mother to Child Transmission
PHO Public health officer
SCPHO Sub county public health officer
WASH Water, Sanitation and Hygiene

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CHAPTER 1: INTRODUCTION

1.1 Background of the facility/History

Migosi Sub-County Hospital is a government level 4 situated in Migosi Sub County location of Kisumu
County. The hospital is a government health facility in Kisumu County and is registered by the Ministry
of Health. The facility has a gazettement notice and operates for 24 hours and has a bed capacity of 25
though the official bed capacity is 42. The hospital has an estimate of 60 staff. The daily operation of the
hospital is overseen by Mr.Robert Orina who is the facility incharge and a clinical officer and the nurse
incharge Ms.Everlyne Ouko. The hospital offers outpatient services, laboratory, pharmacy, inpatient care,
reproductive health service, imaging services among others. The hospital personnel is governed by
hospital administrator and has a total of 20 nurses,9 registered clinical officers,4 laboratory technicians,3
pharmaceutical technologists,1 kitchen staff,14 casuals,1 radiographer,1 nutritionist,6 CHEW S,HTS
counselor and mentor mothers.

1.2 Objective, Vision and Mission of the facility

Vision: To develop misogi health center to be an efficient and high-quality care system that is accessible,
equitable and affordable for every Kenyan.

Mission: To transform the livelihood of the people of Kisumu County through responsive and

sustainability technologically driven evidence based and client centered health system for accelerated

attachment of highest standards of health. Core values professionalism Quality

Team work

Dignity

Objectives

To contribute towards the production of health inequalities and to provide the health impact and outcome
indicators.
To prevent maternal and child mortality.
To zero rate communicable diseases.
To provide health education.
To change health seeking behaviors.
Service offered
Attendance and customer care services

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Registration card provision
OPD card/health passbook
Consultation OPD
Emergency services
Special clinic/Consultation
Dispensing medicine
Routine vaccination /Immunization
Laboratory services
Maternity services
Radiological services Medical
legal service
1.3 Executive summary
The objective and purpose of the attachment program was for training in fulfillment of the academic
requirements for the award of the degree of Bachelor of Science in Public Health. The logbook contained
objectives that had to be achieved and outcome specified to its contents. I achieved my Objectives and
target through activities conducted in health facilities, community health units and other relevant sites as
described in the attachment log book. The core activities included: Hospital related experience,
Community Health, Public health Engineering, Built environment and health, Food Inspection, Hygiene
and Quality Control and General Public health.
Hospital related experience -Areas covered in this section are Maternal and child Health
Care(MCH),Growth monitoring and nutritional counselling.Immunization,Vaccine storage and cold chain
management, Antenatal care(ANC),Postnatal care, HIV/AIDS care/ARV administration, defaulter
followup, home based care for HIV patients, Nutrition support for HIV patients, Emerging issues in HIV,
nutrition therapy at the hospital for different category of patients, Laboratory work, family planning,
Health records and information system and office management.
Community health-Areas covered in this section are Identification of health structures, systems and
services, Community diagnosis (CDx), Community reporting tools, Comprehensive school health
programs, Nutrition/dietary assessment/Survey, Community health programs/projects and Identification
of pests, vermin, vectors of public health importance.
Public health Engineering-Areas covered in this section are; Water, hygiene and sanitation, Water
supply and Quality control, Liquid waste management, solid waste management, Infection, prevention

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and control, Conservancy systems, Hazardous waste management, Environmental inspection and
pollution prevention and Control.
Built Environment and health-Areas covered are design and drawing of building plans, Approval of
building plans, Drainage and plumbing,Regularization of building plans for compliance, Ventilation and
Lighting, inspection for use/change of use and Building regulations.
Food inspection, Hygiene and Quality Control-Areas Covered are Routine inspection of hygiene and
food premises, inspection of food premises for licensing, Examination of food handlers, Food sampling
and analysis, Inspection of meat and meat products, sugar processing, application of HACCP in sugar
production.
General Public health- Areas covered are first aids and health education and promotion.

CHAPTER TWO: HOSPITAL RELATED EXPERIENCE

2.1 Maternal and child health care (MCH)

2.1.1 Child Welfare Clinic (CWC)

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 I was involved in growth monitoring of under-five children at the CWC.The aim of growth monitoring is
to detect abnormal growth with an aim to improve nutrition, reduce risk of death or inadequate nutrition
to help educate caregivers if there is reason for special care or refer as appropriate. This is achieved
through weighing, Mid -Upper Circumference and height measurement of children during their monthly
visits at the clinic and/or during their visits when sick.

• Weight is measured and recorded for every month for the first year of life and every two months to
the age of five and plotted on a curve in the Mother and Child Handbook (MOH 216) so as to detect
any changes in child growth.
• Height or length is measured every six months to five years of age, it is measured to assess growth,
the greater the increase, the faster the child is growing.
• Mid Upper Circumference (MUAC) is measured every six months to five years of age. It helps to
screen so as to classify malnutrition, improve nutrition and educate caregivers if there is reason for
special care. It is a useful screen for malnutrition especially wasting.

These measurements are then plotted on a graph provided in the Mother and Child Handbook (MOH
216). Growth monitoring is important since it helps in early detection of cases of stunting, under-weight
and over-weight in children who are below five years.

I was later introduced to the reporting tools used at MCH by nurse Judith Ogao,the tools include:

• MOH 510 -children vaccination immunization permanent register.

• MOH 702 -immunization tally sheet.

2.1.2 Immunization
I learnt vaccine administration at the Child Welfare Clinic. The core objective of vaccine administration
is to control vaccine preventable diseases among children
Below is a table showing vaccine administration

VACCINE DISSEASE DOSE ROUTE OF TIME OF

PREVENTED ADMINISTRATION ADMINISTRATION
BCG TB 0.05mls Intra-dermal left fore At birth
arm

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OPV POLIO 2 drops Orally At birth, 6weeks,
10weeks,14weeks

IPV POLIO 0.5 mls Intramuscularly in the 14 weeks

Inactivated Polio Vaccine right outer thigh

ROTAVIRUS Rotavirus 1.5 mls orally 6weeks,10weeks

diarrhea

PENTAVALENT(Dpt- Diphtheria, 0.5Ml/3doses Intramuscular into 6weeks, 10 weeks, 14 weeks

Hepb-Hib) Pertussis, upper outer left thigh
Tetanus,
hepatitis
B,
Hemophilus
influenza type
B (pneumonia,
meningitis and
epiglottis)

Pneumococcal Pneumococcal, 0.5mls Intramuscular into 6weeks,10weekss,14weeks

severe form of right upper outer
pneumonia,
meningitis, thigh
invasive
disease, acute
otitis media

Measles Rubella (MR) Measles, 0.5m/s Subcutaneously into 6months,9 months,

Rubella right upper arm 18months
Yellow fever Yellow fever 0.5m/s Intra muscular left 9months
upper deltoid

• The children details were also taken into account by recording them in the immunization register.
The vaccines administered were also recorded in the integrated Immunization and logistics Summary.
• Deworming is also done to children under the age of 5 years. Albendazole is administered to boost
children immunity and thereby protecting them from chronic illness caused by worms. Albendazole or
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 deworming pills is given once every six months to all children of one year and above at a dosage of
200g for children between one to two years and 400g to children above two years.
• Vitamin A capsule is also administered once after every six months to children above six months at a
dosage of 100,000IU to children below one year and 200,000IU to children above one year. Vitamin
A capsule is important as it enables the body to perform various functions and is essential for good
healthy skin, good vision, cell growth and immune system.

2.1.3 Vaccine storage and cold chain management

Cold chain management is a process of maintaining vaccines in a potent state from the manufacturer to
the recipient (child, woman of child bearing age or adults). Vaccines lose their potency when they are
exposed to high temperatures, sunlight or freezing conditions depending on the types. The cold chain
equipment used at the facility are freezers/ Ice-line refrigerator and cold boxes. In the freezers, the
vaccines are arranged according to their sensitivity to heat.

I learnt how vaccines are stored. Vaccines are placed in shelves in order of sensitivity and packed leaving
about 5 cm space between the packets for air circulation. The upper cabinet is used for freezing icepacks.
A sticker is placed on the front side of the refrigerator to guide on the vaccine arrangement and
arrangement is observed at all times.

Temperature is monitored using cold chain temperature monitoring chart where the temperature of the
refrigerator is read twice daily and recorded. They ensure the temperature is between +20c to 80c.

2.2 Antenatal Care (ANC)

This is a personalized care provided to a pregnant woman which emphasizes on the woman’s overall
health, her preparation to child birth and readiness for complications that may arise during pregnancy or
at birth and health promotion on hygiene and nutrition.
At the ANC clinic, I was involved in; filling the maternal profile of pregnant women, taking their medical
and surgical history, previous pregnancy details, physical examination and filling their details on present
pregnancy table in the mother and child health handbook. This is done for pregnant during their first
ANC visit.

The history taken were: Name of the client, age, gravida, parity, height, weight, LMP, EDD, address and
telephone number.

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Medical and surgical history taken includes; cases of diabetes, tuberculosis, hypertension, blood
transfusion, any drug allergy and family history of twins.

Previous pregnancy details asked are; pregnancy order, year, number of times ANC attended, place of
delivery, maturity, duration of labour, type of delivery, birth weight, sex and outcome.

Physical examination; blood pressure, breasts, height and virginal examination such as discharge and
genital ulcer.

I also took part in palpation; this is examination of pregnant women by touch whereby I made them lie on
the bed and moved my hands down the abdomen and on the either side of the uterus. Palpation helps to
determine the fundal height, presentation, lie and foetal movement. Together with fellow attaches, we
calculated the maturity date by use of a gestation wheel (take current month minus the last month of their
menstrual period).

The recommended ANC visits should be at least four as enlisted below:

1st visit <16 weeks,

2nd visit 16-28 weeks,

3rd visit 28-32 weeks and

4th visit 32-40 weeks

The following gives a summary of other activities I did at the ANC Clinic

 Giving malaria prophylaxis, Sulfoxide Pyrimethamine (SP) for intermittent preventive treatment
(IPT).
 Tetanus toxoid vaccination for pregnant women to prevent Neonatal tetanus (NNT).
 Giving iron and folic acid tablets to pregnant women during their clinic visits.
 Educating pregnant women on care during pregnancy which includes eating plenty fruits and
vegetables, taking iron and folic acid tablets, drinking plenty of water at least 8 glasses a day,
sleeping under a long-lasting insecticidal net, adherence to ANC visit at least four times during
pregnancy and avoiding heavy work and resting more.
 Informing mothers on danger signs such as severe headache, vaginal bleeding, convulsion, fever,
paleness, reduced and no movement of the unborn baby during pregnancy and the need to visit the
health facility immediately the mother experiences the above signs.
 Record keeping at the ANC register.
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 Issue of long-lasting insecticidal nets to mothers at the ANC clinic
2.3 Postnatal care
Postnatal care is care given to both the mother and the baby from birth in order to reduce incidences of
complications and deaths as well as to promote the health of the mother and baby. The post-partum
period for the mother starts after the expulsion of the placenta up to 42 days (6 weeks) after delivery.

I participated in the following area within PNC clinic:

• Mother’s breast condition examination.

• Taking mothers’ blood pressure to confirm eclampsia.  Vaginal and pelvic examination.
• Checking baby’s umbilical cord.
• HIV testing for mother at 6 weeks and 6 months.
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• Giving guidelines for healthy living.
• Counselling on preferred family planning method.

2.4 HIV Exposed Infant Clinic (HEI)/ PMTCT

Major role of PMTCT (Prevention of Mother to Child Transmission) clinic and HIV Exposed Infant
Clinic is to identify HIV Exposed children and administer ARV Prophylaxis and CTX Prophylaxis with
an aim to achieve optimal viral suppression for the mother and infant and support optimal feeding
practices for the infant.

Nurse Susan Okode took us through maternal and infant antibody test to establish if the newly infants
were exposed. We found some infant serology to be positive while others were negative. The positive
ones indicated that the body is exposed. The HIV exposed infants are then tested; three DNA PCR tests
are done at 6weeks,6months and 12months respectively and the final antibody test is done at 18 months.

All HIV exposed infants are are given ARV Prophylaxis from birth composed of Nevirapine (NVP) for a
total of twelve weeks and Zidovudine (AZT) Prophylaxis for a total of six weeks. Cotrimoxazole (CTX)
Prophylaxis is given from six weeks of life until discharge from HEI follow up as per the dosage which is
adjusted as per the infant age and weight

2.5 Comprehensive Care Clinic (CCC)

Below are activities carried out in the CCC

Antiretroviral drugs administration: ARV drugs is administered to prevent HIV Virus from multiplying
and destroying infection fighting CD4 cells and to ensure people living with HIV live longer, healthier
and reduce the risk of HIV transmission. Drugs administered include; Abacivir, Zidovudine, Lamivudine,
Lopinavir, Ritonavir and Nevirapine. The dosage is adjusted as per the age and weighth .HIV patients are
therefore encouraged to adhere to the dose so as to reduce the viral load in their bodies.

Defaulter follow up and homebased care for HIV patients: defaulter follow up is done to those who
default treatment to ensure adherence of Antiretroviral drugs so as to prevent the body from becoming
resistant to medication. Homebased care is carried out to help people living with HIV/AIDS to to cope
with worries and fears by counselling them, advising them on the important food groups to take, how to
manage diarrhea and weight loss and on the importance of adherence to treatment.

2.6 Emerging issues in HIV

HIV/AIDS control and prevention strategy

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We made a visit to Railways Health Center where we learnt on HIV /AIDS control and prevention
strategies. Railways Health Centre had set up a tent where they offered free voluntary HIV/AIDS testing
services. I participated in the program and helped in carrying out the tests. The health workers at that tent
also offered pre-test counseling done before the HIV test and post-test counseling done after the test.
Details of the patients were entered into MOH 362 that is the HTS lab & referral and linkage register.
This strategy helped in prevention and control of HIV/AIDS because knowing one’s status is the first step
in prevention and control of HIV/AIDS.

In the prevention of mother to child transmission of HIV/AIDS they had a PMTCT department where
pregnant women were tested for HIV during their first ANC visit. They also administered antiretroviral
drugs to HIV positive mothers which helped in improving the mother’s health. Prophylaxis was
administered to lactating children in order to prevent the child from getting the infection. The mothers
were also counseled on the proper maternal nutrition that would have a marked impact on reducing the
transmission. Health workers also did follow up on defaulters.

Health workers at the hospital promoted the use of both female and male condoms by providing basic
information about condoms such as their effectiveness in prevention of HIV or other STDs. Availability
of condoms was made possible by being placed in accessible areas in the health facility.

Blood for transfusion was also screened routinely for HIV infection.

Health workers at Railways Health Centre educated the community members. I gave a health talk on
prevention of HIV/AIDS to patients at Railways health Centre.
2.7 Nutrition Department
The nutrition department deals with the feeding behaviours of the patients and the hospital staff.

Nutritional supplements and counselling are tailored specifically for different cohorts depending on their
prevailing health conditions. During my attachment at the nutrition department, I carried out the
following activities:

Nutrition Therapy for Severe Malnourished and Obese Infants

Children identified as having severe acute malnutrition and obesity after nutrition assessment at the Child
Welfare Clinic are directed to the nutritionist. Together with the nutritionist Mr Charles Otieno, we
explained the condition of the child to the caregiver, the child is then registered in the registration book
and also on an individual patient follow up card which helps in regular follow up of the child. For

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undernutrition, the child is given Ready to Eat Therapeutic food (RUTF) and the caregiver advised on
how to give RUTF. In addition to RUTF the under nourished children are given routine drugs which
include: Vitamin A, Folic Acid, Deworming and Iron. The caregiver is then advised on giving the baby
healthy foods. Follow up of the children is done which includes weakly follow up assess how the child is
taking the RUTF or any other complication the child may have If there is no complications, weekly
follow up services are continued which include; providing any routine drugs, providing weekly ration of
RUTF, making an appointment for the next weekly follow up and recording the information on the card
for obese infants the caregiver is advised on giving the infant healthy foods.

Maternal nutrition-good maternal nutrition is important as it makes it easier for them to conceive and to
meet the food needs of their bodies and that of the unborn baby and also prevents them from giving birth
to low weight babies and babies with health problems. I counselled pregnant mothers on how to eat
healthy during pregnancy and importance of good nutrition during pregnancy.

Maternal malnutrition can be classified into the following categories of BMI

Severely malnourished (BMI <16.0),

Moderately malnourished (BMI 16.0-16.9) and

Mild malnutrition (BMI 17.0-18.4)

Infant nutrition

Breast Feeding Infants

I encouraged the mothers to support and promote exclusive breastfeeding to around 6 months of age.

I also advised them to continue breastfeeding while introducing appropriate solid foods until 12 months
of age and beyond, for as long as the mother and child desire. For instance:

Between 0-6months: exclusive breastfeeding,

At 6month: at least 2-3 tablespoons of porridge or pureed food in each meal.

At 7 -8 months old- introduction of plant protein, vitamin and milk.

At 9-11 months-introduction of animal proteins.

At 9-12 months – introduction of general modified/ finished family meals.

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Mothers should maintain hygiene and cleanliness when giving complementary foods to the babies as
good hygiene is important to avoid diarrhoea and other illness. Macronutrients powders (MNP) is added
to complementary foods since children need vitamins and minerals to grow well, physically and mentally
and be strong to resist infections and diseases.

Infant is not receiving breast milk

If an infant is not breastfed or is partially breastfed, commercial infant formulas should be used as an
alternative to breast milk until 12 months of age. It is important to prepare and store foods correctly.

Nutrition for HIV patients

Proper nutrition for the HIV patients is important as it helps lay foundation for healthy thriving and
productivity of people living with HIV. Proper nutrition complemented by careful implementation of
antiretroviral drugs is essential in response to HIV and helps to manage HIV infection and side effects of
antiretroviral drug.

I advised newly enrolled patients living with HIV/AIDS on the necessary foods they required which
includes:

a) Foods high in protein, for body building purposes.

b) Food high in carbohydrates, for energy provision to the body for proper metabolism.
c) High immune boosting foods, i.e. fruits and vegetables.
d) Food rich in calories, to maintain lean muscles.
e) Omega 3 fatty acids, to lower blood triglycerides and reduce excess fats in the liver.
2.8 Medical Laboratory department
This is the department charged with carrying out all medical tests within the facility. It offers the following
tests: Blood smear for Malaria, Malaria rapid diagnostic test, Urinalysis, Stool microscopy for ova/cysts,
Salmonella antigen test, Haemoglobin estimation(hb),Random blood sugar(Rbs),Fasting blood
sugar(Fbs),Helicobacter Pylori(H.Pylori),Sputum for acid fast bacilli, Blood grouping, Rapid
Plasmaregan(RPR)/VDRL and Glucose tolerance test .

During the period I was attached in the laboratory, I carried out the following assignments:

Sample Collection

This entails the collection blood samples, urine (mainly taken during morning hours) and stool samples.
Blood samples are majorly collected for:
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  Malaria tests (both Rapid diagnostic test (RDT) and malaria parasite microscopy).
 Viral load analysis for people on antiretroviral.
 VDRL/RPR for syphilis tests.
 Blood grouping for ANC profiling.
 Haemoglobin estimation (Hb) for ANC profiling.
 Rhesus for ANC profiling.

Urine samples are mainly for urinalysis, pregnancy tests etc.

Laboratory tests

I carried out malaria tests for pregnant mothers on ANC clinic,Urinalysis for ANC mothers to check on
cases of urinary tract infections and Blood grouping,Hb,Rhesus and VDRL for pregnant mothers for the
purpose of ANC profiling.

Microscopic examination of malaria parasites Maintaining

high hygiene and safety standards

I achieved this by ensuring:

• Proper laboratory waste management and infection control by using appropriate waste bins.
• Proper waste segregation in the laboratory.
• Disinfecting used glass slides in jik and soapy water.

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 • Ensuring proper usage of PEP’s for example gloves

2.9 Family planning department

Family planning is a means of preventing pregnancy and risk of abortion when a pregnancy is unwanted.
Is also a means of preventing maternal mortality by reducing exposure to pregnancy and risks associated
with pregnancy.

In the family planning department, I was taken through different types of family planning methods and
how to administer by Nurse Martha Onger. Family planning methods are broadly classified into pills,
injectable contraceptive methods, implants, IUCDS, and non-hormonal methods.

Pills: we have combined oral contraceptives which are 28 pills and progastrin only pills. They work by
inhiting ovulation and thicken cervical mucus to prevent sperm entry.
Injectable contraceptive methods: we have Depoprovera given every three months. It comprises of a lot of
progesterone hormone and works by inhibiting ovulation and thickening cervical mucus.

Implants: examples are Norplant and Jadelle they are a long term method and is inserted in the left upper
arm below the skin.It works by interfering with the endometrium to inhibit implantation.

IUCDS (Intrauterine Contraceptive Device): these are small flexible devices made up copper metal and
plastics inserted in the uterus through the cervix. It works by inhibiting implantation and is a long-term
method as it lasts for 10 years.

Non- hormonal methods: Involves the use of male and female condoms, withdrawal which has 27%
failure and counting safe days for a person with regular periods.

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 Impla nt insertion at the family planning department.

2.10 Health records and information system department

The backbone of every health setup is up to date record keeping of every illness managed in the facility
and any other record that can be used in the evaluation of its performance. This department is headed by
the Health Records and Information Officer (HRIO) who is responsible for all health records in the
facility. I learnt of various reporting tools used which include the following:

a) MOH 705A-Outpatient Summary for doing summary of diseases of the under five years children
treated
in the facility;

b) the MOH 705B for the over five years children and Adults

c) MOH 204A (OP under-5 years) and

d) MOH 204B (OP over-5 years) register that I used to record clients once they came for treatment.

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Another important reporting tool in this department that I had an opportunity to learn and use is the
District Health Information System (DHIS) which is a software that consolidates all health records for all
the facilities within the sub county. Monthly data is keyed in this system which is automatically conveyed
to the county, national and internationally in WHO headquarters in Geneva, Switzerland. This system has
limited access and only those who have the rights can key in data and change the same. Through the help
of the HRIO, I was able to access the DHIS and retrieve a number of data as was required by other
departments within the facility or auditors.

2.11 Office Management

The objective on office management was met at the SCPHO office. Office management involved the
design, implementation, evaluation and maintenance of the process of work within an organization in
order to sustain and improve efficiency and productivity. The functions of office management included
employee management, event planning, internal communication, record keeping, report writing and
conflict resolution.

In order to do licensing planning, at the beginning of the year the staff that is PHOs sit down with the
SCPHO who is the office manager. They set specific finance targets for each ward to rise. The SCPHO
then coordinates and follows up to ensure the goals and objectives are met.

Proper records were kept through file keeping such as clearance forms for attachment. Files were kept
under safe custody so as to ensure confidentiality. Some of the records kept at the office included delivery
book (Used when serving a statutory notice), delivery note format and visitors’ note book among
others.The different types of reports at the SCPHO office were the collecting tools: source registers and
specifically the public health related ones including MOH 513, MOH 514, MOH 515, MOH 516, MOH
100 and MOH 708. MOH 708 was used by PHOs to report activities they’ve done during fieldwork such
as inspections.

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CHAPTER THREE: COMMUNITY HEALTH
3.1 Health levels, structures, system and service delivery
The community health extension worker in charge of Migosi Sub County Hospital Mr George Akuga
took me through the health systems, structures and services delivery. A health care system is a complex
of facilities, organization and trained personnel engaged in providing health care within an area. Good
service delivery is a vital element of any health system. In any well-functioning health system, the
network of service delivery should have the following key characteristics.
• Comprehensiveness: A comprehensive range of health services is provided, appropriate to the needs
of the target population, including preventive, curative, palliative, rehabilitative and health promotion
activities.
• Accessibility: Services are directly and permanently accessible with no undue barriers of cost,
language, culture, or geography.
• Coverage: Service delivery is designed so that all people in a defined target population are covered,
i.e. the sick and the healthy, all income groups and all social groups.
• Continuity: Service delivery is organized to provide an individual with continuity of care across the
network of services, health conditions, levels of care, and over the life-cycle
• Quality: Health services are of high quality, i.e. they are effective, safe, centered on the patient’s
needs and given in a timely fashion.
• Person-centeredness: Services are organized around the person, not the disease or the financing.
Users perceive health services to be responsive and acceptable to them.
• Coordination: Local area health service networks are actively coordinated, across types of provider,
types of care, levels of service delivery, and for both routine and emergency preparedness.
3.2 Levels of service delivery
According to the Kenya health sector strategic plan (2018-23), the following are the tiers of health care
services delivery in Kenya. Tier 1: community health services
This tier comprises of the Community health committees, CHVs who represent villages and
CHEWS/CHAs who represent a group of villages culminated into a community unit.
Roles of CHEWs/CHAs includes;
i) Acts as a link between the health Facility and the community ii)
Supervising the community health volunteers
iii) Updating of the community health chalk board (MOH 516) and Monthly CHEW summary(MOH
515) iv) Organize for community dialogue and action links v) Training of CHVs

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vi) Organization of health education and promotion activities at the community level
vii) Acts as resource for matters in the community unit viii) Identify common
illness at the community level

The CHVs play the following roles:

i) Conducting House hold registration and mapping
ii) Identification of common illness at the household or village level
iii) Conducting household assessments to identify health problems and defaulter tracing in matters
immunization, antiretroviral therapy uptake among other issues. iv) Conducting Health education at
the household/ village level v) Assisting in the Outpatient department-Reception

Tier2: Primary care services.

This tier comprises of dispensaries, health centers and maternity homes for both public and private
providers.
Dispensaries provides outpatient services for simple ailments. They are the first point of contact between
the patients and health care delivery personnel. Usually run by government and managed by registered or
enrolled nurses.
Health centers provide comprehensive primary care which includes preventive and basic curative services
to patients. Usually staffed with Clinical officers, nurses, Laboratory technologists, pharmacists and a
public health officer attached to it. Tier 3: County Referral Facilities
Comprises of all sub county hospitals, mission hospitals and private hospitals at the County level. This
hospital provides comprehensive medical and surgical services and also provides a higher quality
preventive and curative outpatient services. Migosi Sub County Hospital , my attachment station provides
the following services; Treatment services, immunization, maternal Child health Clinic; Antenatal and
postnatal care, Family planning, laboratory services, nutritional services, maternity services, outpatient
services,inpatient services, pharmacy services, public health services,radiological services,,medical legal
services and special clinic/consultation services.County hospitals provide specialized care including
intensive care and life support specialists’ consultation. Usually consists of medical personnel who are
specialized in a given medical field. These hospitals operate and managed by a given County. County
hospitals are usually managed by Medical supretendants/Administrators/Chief Executive Officers.

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Examples of County referral Hospitals in Kisumu are, Kisumu County referral and Jaramogi oginga
Odinga Teaching and Referral Hospitals.

Tier 4: National referral Facilities

National referral services; facilities that provide highly specialized services or complex health services
requiring more complex technology which are handled by highly skilled medical personnel.
Examples of National Referral hospitals in Kenya includes; Moi Teaching and Referral Hospital-Eldoret
and Kenyatta National and referral Hospital-Nairobi.

The management structure of Health in Kisumu County is illustrated below,

MINISTRY OF HEALTH
CHIEF OFFICER OF HEALTH
DIRECTOR OF MEDICAL SERVICES
DIRECTOR OF PREVENTIVE/PROMOTIVE SERVICES; DIRECTOR OF PUBLIC HEALTH
COUNTY MEDICAL OFFICER OF HEALTH
COUNTY PUBLIC HEALTH OFFICER
WORKS WITH: COUNTY DSC, COUNTY HEALTH PROMOTION, COUNTY WASH
CORDINATOR, COUNTY SCHOOL HEALTH CORDINATOR; among other officers.
County Nurse
County pharmacists
County laboratory technologists
County Nutritionist
County R.H coordinator
County HRIO
SUB-COUNTY PUBLIC OFFICERS
County medical engineer
County Ambulatory & Emergency services
SUB-COUNTIES MOH
WARD PUBLIC HEALTH OFFICERS
3.3 Community diagnosis (CDx)
According to WHO, Community diagnosis is the Qualitative and quantitative description of the health of
citizens and the factors which influence their health. It identifies problems, proposes areas of

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improvement and stimulates action. Mr. George Juma, the PHO in charge of the community unit guided
me through key methodology of Community diagnosis and included the following: i) Collecting
background information of the community ii) Setting of objectives iii) Developing of tools for data
collection iv) Community Entry v) Data collection
vi) Data processing, analysis and interpretation vii)
Dissemination of feedback
Using a designed Questionnaire, I assessed the water, sanitation and Hygiene aspects of Manyatta A
community unit where I focused on water supply, treatment & hand washing, latrine coverage and waste
management. 20 households were randomly selected for the diagnosis. Below were the findings:
• Water supply, treatment and hand washing

98% of the community members obtained their water from the well while 2% used tap water. 90% of
them treated their water and they used chlorine while 80% had hand washing stations in their homes.
• Latrine Coverage

95% of the residents had functional latrines, where simple pit latrines were the majority and some few
ventilated improved pit latrines. The 5% with no latrines affirmed that they used their neighbors’ latrines
and some defecated in the bush during the night.
• Waste management

98% of the households burnt their solid wastes in order to reduce their volumes while 100% of them
managed their liquid waste through open drains channeled to their farms. Lack of finances were a
challenge to a majority of them to construct appropriate waste disposal systems.
The following were the recommendations I made;
• The CHA and the CHVs were to conduct health education or sensitize the community members on the
importance of treating water before use and also to mobilize the residents to install hand washing
stations in their homes especially at the main gate and near their latrines or sanitary facilities.
• The CHA and the CHVs were to advocate on the importance of latrine used to ensure optimal usage.
This will help reduce the burden of fecal transmitted infections such as typhoid.
• Proper waste management techniques to be implemented at the household level in ways that won’t
create favorable environment or breeding grounds for vectors of disease.

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 3.4 Community. Reporting Tools MOH
100: Community referral form
MOH 513: Community health logbook
MOH 514: CHV monthly summary
MOH 515: CHEW monthly summary
MOH 516: Community health unit chalk board
MOH 517: Data in deworming
MOH 708: Public health services
Community Health Volunteer Tracking Tool

3.5 Comprehensive School Health Programme

Comprehensive school health programs ensure that school pupils and students are as healthy as possible
to enable them obtain maximum benefit of education with their learning environment kept safe and
conducive.
These programs can either be:
i) Curative ii) Preventive
In the preventive aspect, I together with the PHO in charge visited Kibos prison primary where we Used a
structured checklist and inspected the school environment and facilities, assessed adherence of the school
staff and pupils to Covid-19 protocols outlined by the Ministry of Health and disseminated key
information through a planned health education and promotion activity where we addressed key topics
relating to Covid-19 disease and safety of environment.
In matters of Covid-19, we checked on the mask usage for pupils, teachers and supporting staff;
Availability and adequacy of hand washing facilities stationed at strategic points, social distancing status
in classrooms and staffrooms, screening of pupils and teachers before entering the school and waste
disposal especially on used masks and other wastes. Kibos prison primary lacked sufficient thermo-guns
thereby causing a challenge in screening of temperatures at the gate/entrance, had adequate hand washing
station strategically located and appropriate waste disposal for used face masks. However, the school was
highly populated of about 1368 pupils and due to limited classrooms social distancing status was a great
challenge. Mask usage was 98%. We advised on the following:
i) The school to mobilize resources to create alternative areas of learning to ease overcrowding in
classrooms so as to address the social distance challenge.
ii) The importance of Mask usage and hand washing. Furthermore, we health educated the pupils and
teachers on steps of hand washing and how to wear and remove masks.
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iii) The school to ensure screening of pupils, teachers and support staff before entering the school
premises by purchasing more thermo guns. iv) The school to set aside an isolation room or a holding
room for suspects of the Covid-19 virus.

Other key areas checked on environmental safety were: i)

Availability, adequacy and state of sanitary facilities.
ii) General cleanliness of the school compound, classrooms, staffrooms and other areas used by pupils
and teachers.
iii) Ventilation and lighting of all rooms and sections of the school
iv) Waste disposal mechanisms
v) Cleanliness and hygiene of food preparation areas, where we checked on the sanitation of the kitchen
and medical examination certificates of the food handlers.

Others schools visited for COVID-19 assessment were:

Kibos Special secondary school
Kibos Hope Academy
Nyamonge Primary School
Wildor Academy.

In curative, I Participated in the National school-based deworming Programme for Soil transmitted
helminthes. According to studies, deworming children reduces school absenteeism by 25%, Children
persistently infected with worms are 13% less likely to be literate and deworming enables them grow and
stay healthy. Intestinal parasites have negative effects on health and education. On health, the parasites
often leads to malnutrition/anemia, Growth retardation, Diarrhea and vomiting, Intestinal obstruction,
Malabsorption and loss of appetite. Poor concentration, high absenteeism, high repetition and dropout
rates, poor academic performance are negative challenges these parasites can cause on education.
During the deworming day at Haven of Hope primary school and Obwolo primary, I supervised teachers
in administering Albendazole tablets (400g) to enrolled pupils and non-enrolled children. The program
targeted children aged 2-14 years, children enrolled in pre-primary and primary schools and children who
were not enrolled in school but were aged 2-14years.
The following was the procedure used:
i) We ensured that all children washed their hands before receiving the deworming medicines.
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ii) Gave one albendazole tablets to each child to chew.
iii) Recorded deworming on relevant tools used. For enrolled students we used MOH 517A-Intergrated
school health program Summary form/Class/Grade summary for enrolled children. For non-enrolled
children we used MOH 517B which is the integrated School health program form for non-enrolled
children.
iv) After deworming, we allowed the children to rest under a shade.

Other key tools used during the exercise were:

i) MOH 517C –Integrated School health programme Summary form (School Summary) which was to be
filled by the head teacher of respective schools. ii) MOH 517D – Integrated School health programme
summary form (Division/Ward summary). iii) MOH 517E – Integrated School health programme
Summary form (Sub-County summary)

After completion of the exercise, we health educated the Children/pupils on key ways to avoid infection
of the intestinal parasites;
i) Washing hands using soap and clean, safe water before and after eating food.
ii) Washing fruits and vegetables using clean, safe water before eating to get rid of eggs and larvae
iii) Wear shoes to prevent hook worms infection iv) Drinking clean and safe water
v) Avoid swimming/walking in contaminated rivers, dams or puddles/ rice fields etc.
vi) Use latrines/toilets; not bushes/Fields or ponds/rivers/puddles vii) Keep latrines and the
surrounding area clean viii) Wash hands with soap and clean, safe water after going to the
latrine/toilets ix) Keeping fingernails short and clean
3.6 Nutrition/dietary assessment/survey
I was deployed to Obunga clinic where I participated in nutritional and dietary assessment of Children,
lactating and pregnant mothers. Furthermore, I offered dietary counselling and extended key messages on
various food groups and the importance of balanced diet uptake. The purpose of nutritional assessment
includes; o To identify individuals or population groups at risk of becoming malnourished.
o To identify individuals or population groups who are malnourished o To develop health care programs
that meet the community needs which are defined by the assessment.
o To measure the effectiveness of the nutritional programs and interventions once initiated.

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Mr. Dancun Onyango, the Center Nutritionist took me through different methods used to assess
nutritional status of persons and included the following; Anthropometric, Clinical, Dietary evaluation and
biochemical/laboratory methods (ABCD). However anthropometric and dietary evaluation methods were
commonly used. Anthropometric methods included the measuring of body height, weight and proportions
and also checking the mid-arm circumference, head circumference, Head/chest ratio and Hip/waist ratio.
Tools used include MUAC tapes, weighing scales both for children and adults, BMI calculators, Height
boards for children, Food charts etc. Other tools for data storage and reference were, Facility daily
register for nutrition services, integrated management for acute malnutrition guidelines-Weight for
Length and the Clinic book-Height for Age.
I participated in measuring the BMI of mothers by taking their weight against the square of their heights.
The following were the BMI ranges and their interpretation on nutritional status.

BMI Nutritional Status

<18.5 Underweight
18.5-24.5 Healthy weight range
25-30 Overweight (Grade one obesity)
30-40 Obese (Grade two obesity) >40 Very obese (Grade 3 obesity)
I also measured mid-arm circumference of children and used the following interpretation scales;
MUAC measurements Nutritional status
6-10.9 Pictured red and denoted severely malnourished
11.12.5 Pictured yellow and denoted moderately malnourished
12.5 > Pictured green and used to denote normal
We also conducted dietary assessment by asking mothers the foods that they have consumed or what their
children have taken. To achieve this, we used a variety of methods including:
i) 24 hours dietary Recall-asked them to recall all foods and drinks taken in the previous 24 hours ii)
Food frequency charts-We gave mothers or the care givers lists of food items to indicate their intake in
the past days. This chart contained groups of foods i.e. fats and oils, bread and cereals, meat-fish-poultry,
vegetable and fruits. They were to determine the number of servings from each group and we compared
them to the minimum requirements needed for a balanced diet- a diet that provides all essential nutrients
in sufficient Quantity and in correct proportions to promote good health.

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We conducted practical demonstrations and health educated them on locally available foods and the
nutrients they contain and also meal planning-planning of diets which will provide all nutrients in
required amounts and proportions.
I identified various nutritional problems including Protein energy malnutrition, Anemia, diarrhea and
vitamin A deficiencies. On the prevention of various malnutrition disorders identified, I performed the
following:
i. Health educated them on the importance of good nutrition ii. Distributed supplements in relation to the
type of malnutrition; examples of supplements given included supplementary porridge flour, fortified
blended flour, plumpynut supplementation, oral rehydration salts solution.
iii. Encouraged mothers to undertake Exclusive breast feeding i.e. up to 6 months and beyond iv. Asked
mothers to embrace family planning to enhance birth spacing and therefore ensure proper planning of the
needs of their children.
v. Advised mothers to seek early diagnosis and conditions like diarrhea. I affirmed them on the
importance of having oral rehydration salts in the house to address issues of diarrhea among their
children.
3.7 Community health project/ Programme
Attached at Chiga Youth friendly Center, a center managed by ‘Make me Smile’ Non-governmental
Organization. The NGO majors on reproductive health drugs and substances abuse and gender-based
violence issues.
Under reproductive health, they:
• Provide contraceptives to youths aged between 10-30 years
• Offer sexual reproductive health talks with the aim of curbing teenage pregnancies 
Community Outreach activities on reproductive health

Under drugs and substances abuse, they:

Educate youths on the effects of drugs and their impacts to our economy.
Gender based violence is one that is directed at an individual based on his or her biological sex or gender
identity. Under Gender based violence, they identify types of GBV occurring and address them as
required. The following types of GBV were addressed;
1. Physical – Beating, punching, strangulation, attack with weapons
2. Sexual – Rape, defilement, sexual harassment and unwanted touching
3. Psychological- Mockery, insults threats, silent treatment

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4. Economic- Withholding financial resources, not allowing a partner to work, no control over financial
resources etc.
5. Harmful traditional practices-Female genital mutilation etc.
During my attachment at the NGO, I took part in the sensitization of the youths in the following aspects:
• Use of contraceptives and their importance.
• Challenges of different forms of contraceptives.
• Practically demonstrated to them how to wear condoms (Both male and female condoms) 
Advised girls on matters to do with teenage pregnancies and ways to reduce them.
• Taught girls on menstrual hygiene and ways to properly dispose sanitary pads.
• Youth empowerment on income generating activities to sustain themselves.
3.8 Entomology, pest, vector, vermin and parasites
Visited Kibos maximum prison and conducted inspection on the inmate chambers, kitchen, food stores
and the general hygiene of the prison. Based on my assessment the following were the pests and vectors
of public health importance that I identified;
i) Bedbugs-inmate chambers and clothing ii)
Cockroaches-The prison kitchen and food stores
iii) Mosquitoes-sleeping chambers
iv) Rodents- Rats were seen in the kitchen and food stores
v) Houseflies-sanitary rooms, kitchen vi) Lice-inmate
clothing and walls
I recommended the following;
i) Proper and regular washing of beddings and cloths of inmates to exterminate development of bed bugs
and lice
ii) Indoor residual spraying to control houseflies and mosquitoes
iii) Proper waste management especially in the kitchen section of the prison to eliminate cockroach iv)
Clearing of bushes and tall grass around the prison to eliminate breeding grounds for mosquitoes
v) Prison administration to ensure unblocking of drainage around the premises to prevent awful smell and
flies vi) Regular cleaning of sanitary rooms and toilets used by inmates and officers. vii) Proper
housekeeping procedures- Inmate team leader to ensure in mate chambers are clean.

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In a visit conducted at Kibos Special school boarding school, I inspected the boys’ and girls’ dormitory
where the house master and mistress complained of constant malaria cases brought about by mosquitoes.
I advised them to ensure that all the pupils sleep under LLTNs and to ensure that the environment around
the dormitories are kept clean especially the tall grass around them were to be cut off.
To prevent vectors and parasites around the school premises, the school administration:
i) Ensured regular indoor residual spraying of dormitories specially to control mosquitoes and bedbugs.
ii) Conducted daily inspection to ensure that dormitories have been cleaned and are kept in a sanitary
manner to prevent growth and development of vectors, pests and parasites.
I also visited the county officer incharge of Division of Vector Borne and Negleted Tropical disease
Kisumu ,Mr Edwin Lemojil, The public health officer helped me to familiarize with the four approaches
to vector control: environmental control, personal protection measures, biological control and chemical
control.

The common vectors in Kisumu central Sub County are: bedbugs, mosquitoes, cockroaches and rats. The
following chemicals are used for control:

• Bedbugs

Promax/delete/Bamako/methylated spirit.

• Mosquitoes

Fogging machines and Icon for mosquitoes.

Cockroaches
Green leaf powder.

The spraying and distribution of nets and control chemicals for example using the fogging machines is
done by CHVs. I participated in the spraying of bedbugs working closely and under the supervision of
the PHO in charge.

Pest and vector control is done to prevent spread of diseases from pests and vectors such as malaria and
plaque. Pests and vectors are also a nuisance to human beings and can cause damage of property. These
pests and vectors include insects and rodents.

They can be controlled through the following ways:

Fumigation
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 It is a method of pest control that fills an area with gaseous pesticides to suffocate or poison pests within.
This is done in rooms, aircraft and water vessels.

Clearing of vegetation and stagnant water

Bushy vegetation and stagnant water are breeding areas for insects such as mosquitoes and rodents.
Stagnant water is also a breeding are for snails that are vectors causing bilharzia.

Use of traps

Traps and baits are used to catch rodents. The traps are placed at places that rodents are so as to capture
them. Fly catchers are used to trap or catch flies.

Spraying

Spraying can be done in houses and bushes or marshy areas with stagnant water. Icon chemicals and
Morten doom are examples of the pesticides that can be used to spray.

Personal hygiene

Ensuring that one’s environs are tidy and clean is one of the fore line measures that one can undertake to
ensure prevention and eradication of pests such as Tunga penetra

CHAPTER FOUR: PUBLIC HEALTH ENGINEERING

4.1 Water supply and Quality control
This activity was achieved through a visit to Dunga water treatment plant to understand aspects of water
treatment and a briefing by the WASH coordinator on the procedure for collection of water samples from
different water sources and some key regulations and reforms of water sector. Furthermore, I participated
in the collection of water samples as illustrated by the coordinator. At Dunga water treatment plant, the
following procedure was employed;
Source Screening flocculation&coagulation Sedimentation filtration chlorination storage
distribution/supply.
i) Screening- Water from the source (Lake Victoria) is received through fine and course screens. Large
and small items are be trapped on the screen as the water passes through it.
ii) Flocculation and Coagulation-During coagulation, aluminum sulphate is added to the untreated water
this causes the tiny particles present to stick together or coagulate. This group of dirt particles then join to
form larger, heavier particles called flocs which are easier to remove through settling or filtration.

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iii) Sedimentation-At the sedimentation tanks, water moves slowly to allow the heavy floc particles to
settle to the bottom. The flocs that collect at the bottom of the tank is called sludge and is piped to the
drying lagoons.
iv) Filtration- Water then moves to the filtration chamber where filters are used to remove particles
within the water. This filters were made of layers of sand and gravel. Filtration helps to collect the
suspended impurities in water therefore enhancing the effectiveness of disinfection.
v) Disinfection/Chlorination- Water is disinfected before entering the distribution system therefore
making it amenable for disease causing microorganisms to be destroyed. Chlorine is used as a
disinfectant. After disinfected the treated water is then pumped to storage tanks after which distribution or
supply is done.

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Water treatment at Dunga Water Treatment Works.
Water sampling was done at the works before final supply of water by testing different parameters. Some
of the parameters analyzed during my visit were:
• Turbidity test-using a turbid meter to determine how clear the water is/Clarity of the water.
• PH test-to determine the alkalinity and the acidity of the water. PH meter was used.
• Chlorine test-to determine the residual choline in the water.

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 With the Supervision of the WASH Coordinator, I, together with other attachees and interns, sampled
water from different water sources in Orongo area where there was suspected cases of skin infections due
to the use of water from the River. We sampled water from River Obuso and a well in Manyatta slum.
Prior to the sampling is done, we prepared and sterilized our sample bottles in the following ways: i)
Cleaned and washed them, then rinsed with distilled water.
ii) Tied the neck of the bottles with an aluminum foil. The cover helped to protect the bottles from
contamination
iii) Sterilized the sample bottles in an autoclave- a strong heated container used for chemical reactions
and other process including steam sterilization. We autoclaved the bottles at 120 degrees for 20 minutes.
iv) After sterilization, we allowed the bottles to cool and then tighten their tops before we could partake
the water sampling.

During water sampling from River Obuso-Orongo, I first washed my hands thoroughly and carefully
undid the bottle cap, without touching the neck of the bottle to avoid possible contamination. By holding
the bottle at the base, I sub-merged it to a depth about 30 centimeters with the mouth facing slightly
upwards then scooped away the bottle after it was completely full. I then replaced the stopper carefully
without touching the neck of the bottle. I then transported the sample in a portable cooler to the
Government chemist within 24 hours.
During collection of sample from a well we used a weighted bottle where we attached a clean and a
washed stone to a sterilized container earlier prepared then attached the bottle to a longer length of clean
string around a stick and tied it onto the first piece used to attach the stone to the bottle. After we ensured
the bottle is secured we opened the bottle and lowered it into the well, weighted down by the stone and
assured that the bottle did not touch the side of the well we then immersed the bottle completely in the
water. When the bottle was full, we rewind the string attached and replaced the stopper of the bottle.

4.2 Liquid Waste Management

A visit was made to Kisumu Water and Sewerage Company (KIWASCO), a company that was
established through reforms that took place in the water sector nationally which based on the decision to
privatize essential services. The Company was established in July 2003 as an independent company after
the transformation of the water and sewerage department of the Kisumu Municipal Council. The core

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objective of KIWASCO is to make the water and sewerage services provision a commercial activity that
generates sufficient revenue to sustain its operations.
regulation of National authorities like KEBS and WARMA, KIWASCO must meet the stipulated
standards and assure the water supplied passes the quality assurance tests that are regularly undertaken by
KEBS.
Treatment process: KISAT receives waste water from households and industries via different regulated
channels allowing continuous flow of wastewater. The wastewater is first passed through a low velocity
screening chamber to removes suspended solids; and then pumped to the Grit chambers where sand or silt
are removed. In the grit chamber; there's a flume that measures the volume of the wastewater, afterwards
the water is directed to oil separator or the oil removal chamber that aids to remove oil from wastewater
using a density method.
The wastewater is then passed through primary chambers that are constantly churning and the sludge is
removed and channeled to the digesters; the sludge undergoes anaerobic decomposition for 28days in the
digesters. From primary sedimentation, the wastewater is pumped to the skimmers where scum is
collected, then to the water stickling filters in order to increase micro-organisms surface area catchment
(microorganisms break down complex organic materials like proteins and carbohydrates into simpler
nontoxic substances).
To improve the water stickling filters efficiency, it has a biofilm layers (aerobic layer, facultative layer
and anaerobic layer), and the water from the stickling filters is pumped to the secondary sedimentation
tanks where the scum is collected to hoppers. Water parameters like COD, BOD and others is checked
before discharge of the effluent to Lake Victoria. Effluent analysis is critical before final discharge to
enhance the safety of the receiving water body.
Key regulations that govern Liquid waste management include:
• Water Act, 2002
• Environmental management and Coordination Act, 1999  Public health act,
Cap 242

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 A photo of sludge drying beds at KISAT
4.3 Solid waste Management
This activity was conducted through a visit organized by my field supervisor where a dump site visit was
organized-Kisumu County Hospital dump site. According to the Environmental officer, Kisumu County
like many urban areas is grappling with increasing waste generation, overflowing dumpsites and pollution
and uncontrolled discarding of wastes. Sustainable solid waste management has remained elusive in the
City due to lack of adequate funding and skilled personnel besides poor public attitude towards waste
management. However, he added that planning measures in conjunction with concrete actions were to be
pursued to better ensure a more comprehensive and sustainable system for managing municipal waste in
Kisumu.
Solid Waste can be described as solid residues and end products of human physical activities. They are
unwanted remains discarded by the initial user or producer and therefore solid waste management

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involves managing the Generation, Collection, Sorting and Separation, storage, Transfer, and Disposal of
solid wastes.
Solid wastes can broadly be classified into; Domestic wastes. Industrial wastes, Trade wastes/commercial
wastes. Agricultural wastes. Debris, Junks, Hospital wastes/Health care wastes, Dead animals, Street
sweepings and Toxic wastes. The need to classify solid wastes helps to:
• Plan on waste storage at source.
• Plan on waste collection and transportation.
• Plan for proper waste disposal.
• To determines salvage potentiality.
• It assists in measuring the variations for future trends of refuse production.

At the Kisumu county hospital dumpsite, a majority of the wastes observed were health care associated
and were categorized as follows:
i) Infectious wastes-Including dressings, used gloves, ii) Non-infectious wastes- packaging materials,
boxes and cartons, plastics were observed. iii) Sharps-Sharps disposed (In the safety boxes) were
needles, scalpels, syringes among and broken slides.

The solid wastes from various departments at the hospital were brought and tied inside bin liners of
different color coding. Yellow liners carried infectious wastes, red liners carried highly infectious wastes
while black liners carried general wastes. The challenges of the dump site were:
• Was not gated/ fenced
• Was not manned or put under lock and key
At Migosi Sub county hospital, The solid wastes segregation is done at the source of production using
color coding technic whereby a bin lined with red biohazard polythene is used for highly infectious
waste, a bin lined with yellow biohazard polythene is used for infectious wastes, a black bin for general
wastes lined with black biohazard polythene/liner and safety boxes are for storing sharps.
The following SOPs are vital in Solid waste Management:
• Use of appropriate PPEs
• Fencing of dump sites and disposal sites
• Disposal sites should be located far away from utilities or residential areas
• Reuse, Reduce, Recycle

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 The following regulations or legislations helps to control Solid waste management;
i) Environmental management and coordination Act, 1999 ii) Public health act,
Cap 242 iii) Local Government Act Cap 265 iv) Pharmacy and Poisons Act
Cap496
v) Waste management regulations, 2007
vi) Radiation Act Cap 243 vii)
Factories Act Cap 514 viii)
Employment Act Cap 226.

ix) Building Code

x) Ministry of health Policy on Health care waste Management
xi) Ministry of Health-National standards and guidelines on injection safety and medical waste
management.
xii) Ministry of Health-Environmental sanitation and hygiene policy.
4.4 Infection, Prevention and Control (IPC)
Assessed IPC status of Kisumu County Refferal Hospital with the supervision from Mrs Wendy Kwanya
who is in charge of Infection,Prevention and Control based on the following Key components:  Health
Care waste Management
• Usage of PPEs
• Safety of medical practices
• Environmental control mechanisms e.g. Cleanliness and provision of adequate ventilation and
lighting
• Screening and Social distancing
• Post exposure Management
Health care waste management
Most of the wastes generated at the facility includes general wastes, sharps and anatomical wastes. These
wastes are segregated and disposed appropriately in different color-coded bins lined with bin liners of
specific colours.
Black lined bin-General wastes or non-infectious wastes e.g. discarded papers, packaging materials,
empty bottles, cans etc.
Yellow lined bin-Infectious wastes e.g. bandages, used cotton, used gloves and used gauzes

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Red lined bin-highly infectious wastes e.g. sputum containers, fluids from patients with highly infectious
diseases, anatomical parts etc.
Safety boxes- Used to dispose sharps. Sharps generated at the facility majorly included syringes, needles,
blades and sometimes broken glasses.
Usage of PPEs
All workers in the facility used PPEs when performing medical procedures and attending to patients. Due
to the COVID-19 pandemic, all patients and health workers were to be on face masks to prevent the
spread of the virus. Key PPEs observed included the following;
i) Gloves-To prevent contact with blood, body fluids, secretion and contaminated items. Also used
when waste picking is done .
ii) Mask, goggles and face masks-Protect mucous membranes of eyes, nose and mouth from contact with
blood, body fluids. Barrier to Covid-19 virus .
iii) Gowns-protects the skin from coming into contact with pathogens embedded in blood or body fluids
or contaminated surfaces. Hand washing Practices
Hand washing stations were placed at strategic areas of the facility including the main entrance and near
sanitary rooms. All patients and health staff were supposed to wash their hands with soap and running
water on arrival. Levels of hand washing observed included the following: i) Social Hand washing
Done by health care workers and patients on arrival at the facility, before and after handling food, after
toilet visiting and when hands are visibly soiled ii) Hygienic Hand washing
Done before coming into contact with patients, before and after invasive procedures and after contact
with blood.
iii) Surgical Hand washing
Done before and after conducting surgical procedures.
Safety of medical practices
Safe medical practices or procedures were upheld especially matters pertaining to injection safety. Safe
injection is one that is given using the appropriate equipment, does not harm the recipient or the provider
and does not result to generation of wastes that could be injurious. Unsafe injection often leads to the
transmission of nosocomial infections e.g. hepatitis B, C, HIV/AIDS, Tetanus and also can lead to drug
reactions and paralysis.
To enhance appropriate medical practices by staff, the facility in charge ensured; Adequate supply of
appropriate safety boxes and waste bins, Check expiry dates of drugs before administering to patients,
appropriate PPEs were used; no malpractices such as manipulating used sharps e.g. cutting of hypodermic
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 needles, passing of sharps from one health care worker to another, accidental switching of drugs and
reusing injection equipment.
Environmental control
Every morning before the commencement of activities, the facility was cleaned by a janitor employed.
Adequate ventilation and lighting was enhanced by ensuring all doors and windows are opened at
sufficient angles to enhance ample exchange of air and penetration of adequate light in the facility rooms.
Screening and social distancing
Screening was important as per the MOH guidelines on Covid-19. I participated in screening the health
staff, patients and MOH personnel coming into the facility using a modern thermo gun.
Persons whose temperatures came above 38 degrees Celsius were placed aside for further medical
scrutiny and isolation if required.
Social distancing of 1.5M apart was not adequately followed by the patients and staff and therefore a risk
to the spread of the virus. I requested the facility to construct a bigger waiting bay to reduce
overcrowding of patients at the OPD section.
Post exposure Management
PEP protocols were well documented and stuck on departmental walls at the health facility whereby in
case of an injury for instance, maybe, a breakdown of injection safety workers as well as patients were to
follow the stipulated procedures.
In a meeting at KCRH on HBIC key to Covid-19, I got to learn the significance of IPC in Covid-19 which
are;
• To enhance Quality care of patients and ensure safe environment
• Helps to reduce the risk of transmission of the virus  Reduce the rate of
infection.
4.5 Conservancy Systems
Conducted a study at Migosi community health unit and assessed the conservancy systems used, their
construction and suitability. Data collection methodology included the following:
 Review of tools; MOH 516, MOH 515
 MOH 516-Community unit summary board
 MOH 515-Monthly CHEW summary
 Screening of the community
 Observations
 Interviewing of key personnel such as CHAs and CHVs

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A majority had simple pit latrines while a few had ventilated improved pit latrines. The simple pit latrines
were mainly constructed as follows;
Slab-compacted murram/sand placed above jointed pieces of wood; others made of concrete
Superstructure-made of iron sheets nailed on wood; others made of mud and sticks
Roof- Iron sheets; few were thatched with grass
No vent pipes making the latrines prone to smell and fly nuisance
Although Simple pit latrines are easy to construct due to low capital requirement, they had the following
challenges:
• Smell and fly nuisance due to absence of a vent pipe  Short life and can easily get destroyed.
• Challenge on diarrheal diseases

Photo of a simple pit latrine at Adeta village-Migosi community unit

Key challenges on the conservancy systems in the area included the following:
• Swampy nature of the area created poor drainage of waters therefore predisposing the latrines to
destruction.

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 • A majority of households’ heads affirmed that high cost of constructing a modern latrine was a
challenge to them.
• Lack of man hole cover/squat hole cover
Based on the table above, Majority of the villages had a good number of households which did not have
functional latrines and was a detrimental to the health of the community in that these villages were at a
greater-risks in developing diarrheal diseases. With the help of the CHA, we called the CHVs for a
meeting and addressed the issue on latrine coverage. We taught them the importance of latrine usage and
why each household must have a latrine. They were then supposed to spread the message to the
households under their jurisdiction.

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40
4.6 Hazardous Waste Management (HWM)
At the County Environment Office, I learnt the roles they play in hazardous waste management.
They;
• Prohibit the import and export of hazardous waste without a valid permit granted by
NEMA
• Ensure proper disposal of expired and surplus chemicals and materials as well as
restricting and barring toxic substances
• Prohibit discharge of hazardous substances, chemicals and materials or oil in to the
County environs’ e.g. waters, land, air
• Ensure vehicles transporting hazardous substances are fully covered and licensed by
NEMA
• Ensure treatment plants, incinerators and waste disposal sites are licensed.

According to EMCA, 1999 regulations hazardous wastes are classified as follows:

i) Corrosive wastes ii) Carcinogenic wastes iii) Flammable wastes iv) Persistent
wastes v) Toxic wastes vi) Explosive wastes vii) Radioactive wastes

In a visit organized by my field supervisor to KCRH incinerator, I learnt about key facts of
incineration including purpose of incineration, preparation prior to start up of incineration and
different ways used to minimize emissions from the incinerator and also the challenges of
incineration. The incinerator is used to burn hazardous wastes especially sharps from various
health facilities around the County.

The incinerator operator, Mr. Mrefu gave the briefing and did demonstrations on the same.
The purpose of incineration are to reduce the volume of wastes and eliminate pathogens
present in the wastes and also to reduce air pollution. Prior to incineration the following are
ensured by the operator:
i) The hazardous medical waste should be dried if wet and should be placed in a
well-ventilated place.
ii) All tools and equipment are in working order iii) Wear protective clothing
such as hard gloves and aprons iv) Removal of ash from the incinerator and
disposed to the ash pit v) The area around the incinerator should be clean vi)
Weigh and record the waste vii) Avoid sorting or mixing the wastes

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 Measures employed to minimize emissions from the incineration includes: i) Rigorous
segregation of wastes ii) Ensure that the incinerator is in good working order and is clear of
excess soot iii) The incinerator should be pre-heated adequately and maintained at an
appropriate temperature iv) Adopt Quality control measures.

Challenges of KCH incinerator I observed includes:

a. The incinerator was not locked when not in use and was not fenced or restricted.
b. There wasn’t an ash pit leading to accumulation of ashes around the incinerator premises.
c. There was an improper segregation system prior to incineration
d. Inadequate supply of fuel e.g. diesel by the KCH administration therefore hampering the
incineration process.

i) At Migosi Sub County Hospital,The health care waste segregation is done at the source of
production using color coding technic whereby a bin lined with red biohazard polythene is
used for highly infectious waste, a bin lined with yellow biohazard polythene is used for
infectious wastes and safety boxes are for storing sharps. The highly infectious wastes
generated are divided into two i.e Pathological waste (used sputum containers, gauze and
cotton wool) ii) Anatomical waste (amputated body parts, placenta)
4.7 Environmental inspection
Environmental inspection is an investigation of a project, activity, premise, workplace etc. on
the level of compliance with environmental regulations or permits stipulated. The following
procedure is always used when conducting environmental inspection: i) Establishing a site
for inspection ii) Defining the scope of inspection
iii) Formation of inspection team and identification of a team leader
iv) Outline the inspection approach and methodology v)
Reviewing and customizing checklists
vi) Reviewing relevant documents e.g. stipulated regulations
vii) Ascertain ways of sample collection viii) Develop a
plan to be used once on site ix) Inform the owner of the
facility, workplace etc.
x) Inform the appropriate Regulatory authority e.g. NEMA xi)
Risk assessment

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xii) Conducting the actual inspection

With the Help of an Senior Environmental Officer Mr Wycliffe, I conducted an environmental

inspection on Ndugu construction company quarry located at Mamboleo, Kisumu.
During the inspection, I observed and addressed the following aspects;
i) Air pollution- air pollution was evident due to excavations works involved at the quarry.
This generated dusts. Furthermore, vehicle transporting debris or construction materials
produced gases and fumes generated through the combustion of diesel. I advised the site
manager to constantly sprinkle water on the excavation sites and provide with enforcement of
usage of appropriate PPEs to the quarry workers such as dust masks.
ii) Noise pollution- Noise pollution emanated from vehicles accessing the quarry site and
the excavation works which were mainly attributed to intense machine operations. High level
of noise often leads to hearing impairment which reduces workmanship and also affects their
finances due to treatment and medication.
To prevent adverse effects of noise pollution I advised on provision and enforcement of
appropriate PPEs to workers such as ear muffs. And also, to minimize transport of
construction materials. The manager was also supposed to sensitize drivers to avoid
unnecessary hooting or running of vehicle engines. Lastly, I addressed on the need for
compliance to environmental Management and Coordination (Noise and vibration pollution)
(control) Regulations, 2009. iii) Solid waste generation-Poor disposal of solid waste was
observed from the auxiliary facilities attached to the Quarry sites. These facilities were
eateries, food vending and other commercial activities. Based on this aspect I advised and did
the following:
• The Quarry site manager should procure and strategically place adequate solid collection
bins with a capacity for segregation.
• Created awareness on the best waste management practice among workers i.e. on the process
of solid waste collection, segregation and proper disposal.
• The site to comply with Environmental Management and coordination (Waste management)
Regulations, 2006.

The contents of the work inspection checklist were; PPEs provision and usage, Record of
maintenance of tools and equipment, Layout and environment of the quarry site, Emergency
procedures i.e. if written evacuation procedures and exits are displayed, potable fire

43
 extinguishers availability and maintenance, emergency and hazard signage; First aid facilities
near vicinity, general facilities, workers training on key aspects and storage of materials.
4.8 Pollution Prevention and Control
At the County Environment office (NEMA), I learnt their role in pollution prevention and
control. The office prevents different kinds of pollution by implementation of measures
stipulated in EMCA, 1999 regulations:
i) Water pollution prohibition: Restricting persons who apply any toxic, poison or other
pollutants or permits any person to dump or discharge such matter into aquatic environment
ii) Ensuring that effluents are discharged only into a sewerage system. This is to mean that
every owner or operator of a trade or industrial undertaking shall discharge their effluents
into the existing sewerage system and the authority issue effluent discharge license.
iii) Air pollution prevention- Ensure that no operator of a motor vehicle, train or air craft or
other similar conveyance shall operate in such a manner to cause air pollution that are in
contravention with emission standards.
iv) Ensure that no person discharges waste in such a manner so as to cause pollution to the
environment or ill health to any person.
v) Prohibits discharge of hazardous substances, chemicals, materials or oil into the
environment vi) Issue licenses to waste disposal sites, plant emissions and effluent discharges.
Noise Pollution
The office applies regulations meant to protect human health and environment from ill effects of
noise and vibrations. The provisions of the regulations include:
i) General prohibition of any loud, unreasonable, unnecessary or unusual noise or vibrations
that annoys, disturbs, injures or endangers comfort, health or safety of others and the
environment
ii) Controls excessive sounds from sound amplifying devises in buildings, vehicles and other
places

iii) Control of noise from hawkers, peddlers, touts and street preachers. The recommended
standards are 85dB for 8 hours, 88dB for 4 hours, 92dB for 2 hours and 94dB for 1 hour.

Noise levels and effects are tabulated below;

Noise Level Effects
0-60dB Standard
60-90dB Annoying
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Over 90dB Impairs or damages hearing
Air pollution
According to the environment officer, Air pollution is caused by air pollutants. Air pollutants
are materials present in the air that can have adverse effects on humans and the ecosystem.
Air pollutants can also be described as compounds present in the air that lowers its breathing
quality. These compounds may be found in two major forms;
i) Gaseous form. Including oxides of sulfur (SOx), Oxides of Nitrogen (NOx) and Carbon
monoxide. Sulphur oxides are mainly generated through industrial processes and burning of
fossil fuels. Nitrogen oxides are generated at high temperature combustion and carbon
monoxide is produced majorly due to incomplete combustion of fuel and vehicle exhaust. ii)
Particulate matter. This are toxic metals and organic compounds adsorbed or suspended in the
air originating from both anthropogenic activities. Examples of particulate matter include,
Polychlorobyphenyls (PCBs), Polyaromatic hydrocarbons (PAH), Lead (Pb) etc. Particulate
matter is always measured on their concentration and size of distribution

CHAPTER FIVE: BUILT ENVIRONMENT AND HEALTH

5.1 Design and Drawing of Building Plans
At Kisumu city physical planning department, I was taken through the design and drawing of
building plans by the City planner Mr Fred Misigo and participated in the drawing approvals
of residential and commercial buildings. According to the City planner, Design drawings are
used to:
• Communicate ideas about a developing design
• Investigate potential sites and assess options
• Develop the approved idea into a coherent and coordinated design,
• Communicate the developed design to other parties such as the local planning authority, the
building control body, contractors, suppliers etc.
• Record the ongoing changes of the completed construction.

Major design drawings are categorized as:

• Architectural drawing- done by an architect
• Structural drawing- Structural engineer
Design drawings are always prepared by a number of practitioners, such as; architects,
technicians and technologists, structural engineers, civil engineers, building services
engineers, interior designers, landscape designers, contractors, subcontractors etc. However,

45
they can interact in a way in that, some elements may first be designed by one individual or
organization and then taken on and developed by another.
During the development of design drawings, it is important to consider their purpose, what
information they are intended to convey and who they are intended to convey the
information. This therefore determines their format, content, size, and scale.
PHOs check the situation of sanitary facilities, size of rooms, drainage systems and ventilation
and lighting.
5.2 Approval of Building plans
I participated in the approval of a plan for a proposed residential apartment in Milimani and
learnt key aspects involved in the approval of building plans at the Kisumu City Planning
office. It’s a multi-disciplinary work involving several departments as listed below:
• Physical planning & Development control department
• Housing department
• Lands department
• Environment department and Engineers.
• Architect
• Fire department
• Public health
The above must check the structural plans and approve according to their stipulated
requirements and it takes approximately 30 days.
For Public health, the following factors were checked before approval;
• Ventilation – windows should be 10% of the floor in case of a residential area and 25% in
case of a factory set up.
• Drainage – drainage flow should be well indicated either towards a septic tank or sewer line
in the plan. Inspection chambers and manhole should also be well identifiable.  Lighting
system – Provision of natural lighting from window to ceiling
• Size of rooms
• Site of construction.
• Environmental effects and proposed use.
• Garbage collection

46
Sample of a structural plan approved for a proposed residential flat developmentMilimani.
5.3 Drainage and Plumbing
This activity was done at the Kisumu city Planning department where the objectives
stipulated were achieved through site visits for inspection of buildings’ drainage and briefing
by the City planner on key aspects pertaining drainage and plumbing. Drainage systems are
all piping within the private and public premises which conveys sewage, rain water or other
liquid waste to a point of disposal. Kisumu City uses both surface and sub-surface drains.
Surface drains remove water from the ground surface before infiltration while sub-surface
drains helps to drain the water in soil by the use of gravity.
Aims of building drainage includes the following:
• To drain away the liquid waste produced as quickly as possible so as to avoid nuisance.
• To prevent the entry of foul gases from the sewer line.
• To provide facilities for the quick removal of foul matter such as human excreta from the
water closets.
• To collect the sewage systematically for its further conveyance, treatment and disposal.
• To provide healthy and aesthetic environment in the building.
The principles of design and planning of a house or building drainage (Sound drainage) includes
the following:
• The house drain should contain enough number of traps at suitable points for efficient
functioning of it.
• The joints of sewers should be water tight.

47
• The lateral sewers should be laid at proper gradient so that they develop self-cleaning
velocity.
• The layout of house drainage system should permit easy cleaning and removal of
obstructions.
• The material of sewer should not absorb the sewage and should be provided to protect them
from external loads by earth cushioning.
• The possibilities of formation of air locks, siphonage, undue deposits etc. should be properly
studied and adequate remedies should be accommodated in the design to avoid them.
• The rain water from houses is collected from roofs and convey it to storm water drain
through catch basins or inlets.
• The sewage formed should be conveyed as early as possible after its formation.
• The size of lateral sewers should be such that they will not overflow at the time of maximum
discharge.

Drainage and plumbing aspects one of the major aspects checked by public health officers
during the approval of plans. Several site visitations were made to buildings around Kisumu
City such as SWAN center mall along Oginga Odinga streets and Yellow House residential
apartment-Kibos area to check on drainage and plumbing and also gave advice where
applicable. We observed the following points during the inspections:
i) The flow through the drains by checking the inspection chambers and gully traps ii) If
there were any damp spots in that they indicated leakages or blockages of plumbing systems.
iii) Emissions of bad smell especially from the sanitary systems. iv) Examinations of water
closets, flushing cisterns and traps.
v) Detailed survey of the entire drainage and plumbing systems of the building.

At Yellow house residential apartments,Kibos, two pipe system was used whereby soil water
and waste water were carried in a separate pipe system. Soil water/black water was channeled
to the septic tank while grey water was channeled to a Leach pit that was within the
Apartments’ premises. The Leach pit allowed water to slowly soak into the ground.
Overflows from the leach pit was observed thereby creating some awful smell. The common
tests used during the inspections included the air test and the smell test. For the air test, we
blew air into the drain after plugging the ends and then applied some soap solution. The
formation of bubbles indicated leakages while Smell Test, Air was mixed with some smelling
gas and is allowed to pass through the drainage pipes. Leakage joints or points are then

48
detected by smelling. Other tests used for inspection of drainage are, hydraulic or water test,
color water test and smoke tests.
The drainage materials were mainly of metallic and non-metallic and included earth wave,
fire clay, concrete, cast iron, glazed stone ware, pitch fibre, copper, lead, wrought iron and
PVC. The type of waste water or liquid conveyed determines the material of drainage pipe
used. For instance, the use of galvanized steel or iron as a conduit for drinking water can
cause a greater challenge in that water flow can be static or slow due to rust and internal
corrosions.
Plumbing systems observed were mainly of three types:
• Single stack system: In this system, the waste water from bathroom, kitchen, wash basin,
urinals etc. and human excreta from water closet is discharged through a single soil pipe
and this pipe acts as ventilating pipe.
• One pipe system: This is same as single stack system but in addition to this there is a
separate vent pipe connected to the fittings and the water seals are protected.
• Two pipe system: In this type of system, the soil pipe is connected to all water closets and
urinals and the other waste pipe is connected to bath, kitchen and wash basins etc. Both soil
pipe and vent pipes are separately ventilated by vent pipes. This system provides very
effective and trouble-free drainage though it’s a costly system.

The following aspects should be considered for optimal maintenance of Housing or building
drainage:
• The house drainage system should be properly maintained and cleaned at regular intervals
for its efficient working.
• Entry of undesired elements – The substances like sand, grit, decayed fruits, pieces of
cloth, leaves should not be allowed into the sewers or into sanitary fitments and should be
collected separately.
• The following points should be carefully noted
i) Flushing – In order to maintain the house drainage system in proper working order, it is
advisable to flush it once or twice a day to clear the system.
ii) Inspection – The various units of house or building drainage system should be inspected at
regular intervals and damaged pipes / washer of leaky taps should be replaced.
iii) Use of disinfectants – To maintain good sanitary conditions in the building appropriate
disinfectants should be used.

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5.4 Regularization of building plans for compliance
Regularization is the process of certifying building works that have been carried out without
building regulations approval. Inspection of buildings are normally done prior to the
achieving of regularization in that they determine whether or not the works complies with the
building regulations which may involve opening up of the works, carrying out tests, sampling
materials. I participated in the inspection of existing buildings around Manyatta, a peri-urban
settlement within the vicinity of Kisumu City where majority of buildings were not
constructed according to relevant approvals or building regulations. A visit was also made to
a condemned building. Building structures that were fit to be regularized were issued with
regularization certificates by the City physical planning office while those that fell below the
minimum acceptable standards had their owners address the structural defects that had been
identified. However, those found to be beyond rehabilitation were subjected to enforcement
action which included condemnation and demolition.
The following reasons rendered some buildings to be condemned during inspection;
i) Pose grave public emergency where the condition of the buildings were such as to cause
possible immediate loss of damage to persons or property. ii) The building has been vacant
and boarded up for a period of time, often more than 300 days. iii) Utilities had been
discontinued.
iv) The building was considered dilapidated, meaning that there are no specific hazards, but the
inspector has qualified it for condemnation.

The following certified copies were required for regularization:

i) Ownership documents such as title deeds, copy of land ownership/lease documents ii)
Copy of building plans both architectural and structural drawings and reports from
development consultants.
iii) Survey plans
iv) Approved fee payment receipts
The regularization procedure allows the Local Authority to consider appropriate works
carried out and completed without the submission of plans and giving of notice only for very
minor works. For any other works building control can request scaled plans be provided.
5.5 Ventilation and Lighting
Assessed ventilation and lighting status of Migosi Sub County Hospital Outpatient block and the
Maternity wing. Proper ventilation of buildings helps to:

50
i) Prevent unduly concentration of carbon (iv) oxide and moisture and the depletion of oxygen
content of the air therefore helping in satisfying the needs of the occupants ii) Helps to
prevent concentration of bacteria therefore inhibiting air borne contamination.
iii) Helps to maintain bodily heat balance iv)
Helps to remove products of combustion

According to the Public health act, Cap 242, Section 118(i); any dwelling or premises that is
so overcrowded as to be injurious or dangerous to the health of the in mates, or is dilapidated
or defective in ventilation and lighting…….is constituted to be a nuisance.
The following was my checklist during the inspection:
i) Types of ventilation and lighting provided e.g. Natural or artificial ii)
Capacity of the rooms in relation to the health care workers present. iii)
Number, situation and area of windows and to what extent they open.
iv) Number, position of doors and to what extent they communicate.
v) Layout and adequacy of passages-Checked for traffic and overcrowding vi)

Height of rooms. Rooms should be higher than a persons’ head.

vii) Adequacy of floor space. viii) Frequency of cleaning; state of

cleanliness of different sections.

ix) Ergonomics-How different departments are organized for efficiency of adequate ventilation
and lighting.

5.6 Issuance of Occupation Certificates.

In the company of the PHO in charge we inspected a newly completed building in Manyatta
near Magadi area. We checked on the actual layout of the buildings whether they matched
with the approved plans. We requested the owner of the building to present a copy of the
approved plans before starting the inspection. Site boundaries were marked and we were
satisfied that the construction was within the required distances from the site boundaries and
was in accordance with the approved plans. We checked the following other aspects;
• Building drainage- We checked if the drainage system was structurally sound (As
described on drainage and plumbing above) and whether the drainage system suited the
building.

51
• Plumbing –We ascertained that there was no cross connections between the water lines and
the sewer lines, and that there was no possible contamination of drinking supplies by waste
water.
• Structural Frame: The frame was of concrete blocks. The size and reinforcement of the
walls and ring beam were in accordance with the approved drawings/plan.
• Roof: We checked the roof plates and they were properly bolted to the ring beam and that
the rafters were connected to the plate by bolts or acceptable connectors. The roof structure
was constructed as designed.
• Floors: We checked the reinforcement of the floor to ascertain whether they conform to the
approved plans.
• Septic Tank and Disposal System – The design and construction of the septic tank was
carefully followed to ensure that they were in tandem to the drawings approved by the
physical planning unit.
The Procedure of issuance of occupational certificates to occupants of buildings is described
below;
i) Applications are made to the Municipality-Kisumu City; through the Secretary, Land Use
and Administration Committee, for a grant/approval of a parcel of land.
ii) The applicant obtains an application form (hard copy) from the Ministry, (Land Use and
Allocation Section) or downloads the same from their website.
iii) Complete the application from (hard copy or online) and return same accompanied with;
• The applicant tax clearance certificate (covering the past 3 years) or evidence of being
domiciled abroad where applicable;
• Passport photographs (3 copies required)
• Formal Letter addressed to the Executive Secretary  Four Passport Photographs with
white background.
• Evidence of payment of Income Tax.
• Current Development Levy.
• Survey Plan
• All payment receipts of Land Charges
• Vital Information Form
The applications are then considered by in charge who in turn make recommendations to the
Municipality for his approval.
If approved, plot(s) will be allocated to the applicant, subject to payment of the prescribed
fees as will be stated in the offer letter. These fees are usually required to be paid within a

52
period of not more than 90 days failing which the offer will lapse and the plot will be re-
allocated to some other deserving applicant(s). If the applicant pays within the stipulated time
limit,
Certificates of Occupancy will then be prepared and forwarded for the City Manager’s
signature. The certificate will then be due for collection.

5.7 Inspection for use/change of use

At Kisumu city physical planners’ office, I was taken through how change of use of buildings
are granted. Before then, inspection has to be conducted on the buildings to ensure that they
are fit for human habitation and that they meet minimum health requirements and hence
participated in the inspection of a residential apartment in Milimani, Kisumu City, which was
to be changed to a Restaurant/bar. During inspection, we checked on the general structure of
the building to ensure conformity with the approved plans. Other key aspects checked were
sanitary facilities, ventilation and lighting, water supply, waste management, accessibility and
general hygiene of the premises. The fact that Milimani sits on a residential zone the change
of use had the capacity to cause adverse effects to its neighborhood therefore an

Environmental impact assessment had to be conducted to come up with ways to mitigate the
effects because a restaurant/bar could lead to negative effects such as noise pollution
amongst others.
The following procedure is involved prior to granting of change of use;
i) Application is made to the physical planning department or head of development control
ii) Advertisement is made before inspection for change of use iii) Public participation and
opinion seeking are conducted
iv) Inspection is done to ensure that the building is fit to be changed to some other use
v) Increase or reduction of building can be done to fit the required usage

Change of use can be as follows;

• Agricultural to commercial use
• Commercial to agricultural use
• Residential to commercial use
• Commercial to residential use

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Change of use application from agricultural to commercial.

5.8 Building Regulations, standards and codes

At the Kisumu city department of physical planning I identified regulations and standards
relating to building approvals. This regulations and standards are culminated in various acts
of parliament and include the following: i) Public health Act, Cap 242 Part (ix) Sanitation
and Housing
-Section 126 (C) talks on how plans can be rejected, passed or retained
-Section 126 (A) contains by laws to buildings and sanitation as regards to buildings, works and
fittings
-Section 124 illustrates on demolition of unfit buildings
-Section 123 Examination of premises
ii) Physical Planning Act, Cap 286

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Section 20; Approval of Regional and
physical development plans

Section 22, Amendments of approved regional physical development plans

Section 27; Approval of local physical development plans
Section 31; how development application is done
Section 33; Approval of development application
iii) Building Code
Section 4: Application form for building plans
Section 5: Submission of plans
Section 7: Approval of plans
Section 10: Grounds for disapproval of plans
iv) Local government Regulations Cap 265

Section 177; Housing and advances of housing

v) National Construction Authority Regulations, 2014.

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CHAPTER SIX: FOOD INSPECTION HYGIENE AND QUALITY CONTROL
6.1 Routine inspection for Hygiene of food premises
According to Food, drugs and chemicals substances act, Cap 254 laws of Kenya, a premise
includes any building or tent together with the land on which the same is situated and any
adjoining land used in connection therewith, and includes any vehicle, conveyance or vessel.
Section 30 of the same act gives permission to public health officers to enter any premise
where food is prepared, preserved, packaged, stored or conveyed. This gives public health
officers the power of entry to initiate the inspection process. Reasons for inspection of food
premises includes:
a) Routine-Carried out for surveillance purposes to maintain a good state of health to the public
and ensure proper hygiene of the premises.
b) Following complains: Complains by the public on certain food premises would result to the
inspection of the premises.
c) Outbreak of disease or food borne illness-This usually results in the inspection as a way of
verifying etiology and control options

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d) Court order-Courts may require details of the premise in case of an issue in court pertaining
the premise in order to reach a reasonable conclusion.
e) Instructions- Inspections can be carried out by senior circulars given by the Ministry of
Health.

For any premises, the following shall be noted;

a) Type of the building e.g. permanent, semi-permanent etc.
b) State of repair of floor, walls, ceiling, roof etc.
c) Type of sanitary accommodation
d) Ventilation and lighting
e) Refuse disposal methods
f) Source of water and whether safe to use or not
g) Drainage patterns
During my attachment, in the company of the PHO in charge we conducted routine inspection
on various food premises around Kisumu market which included butcheries, eating houses,
bars, shops and the open-air market at its vicinity. The following were my checklists for the
premises;
a) Butchery
• Display box for viscera and plug; should be fly proof at all times of operation
• Meat safe which must be maintained clean and in sanitary condition
• Provision of a counter with a smooth washable table preferably made of Formica or a
smooth tile
• Cleanliness of the walls, floor and ceiling
• Equipment used should be in good sanitary state
• Food hygiene license
• Hygiene of the personnel, be medically examined and issued with a valid medical
examination certificate
b) Eating house/hotels
• Food safe/cabinet free of flies
• Tables made of good material easy for cleaning
• Wash hand basin with clean water and soap/hand washing equipment
• A clean and sanitary kitchen with ample space for all operations
• Food attendants to be medically examined
• Protective clothing e.g. apron worn by food attendants
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 • Proper drainage of liquid waste
• General cleanliness
• Food hygiene license
• Safety of water
c) Bar and Restaurants

• Counter to be provided
• Sanitary accommodation with specification of sexes
• Protective clothing by attendants and be medically examined
• Tables and chairs in good state
• General cleanliness

d) Shops & Supermarkets

• Provision of counter and shelves and be in good state

• State of the goods sold, checking expiry dates
• General cleanliness
• Valid trade license
e) Open air market inspection- Kisumu town and Migosi markets
The aim was to ensure food commodities sold were safe for human consumption, operations
do not hamper public health measures e.g. sanitation status. Market activities were not
supposed to create a degradation of public health standards and to ensure that all food vendors
at the market were checked for medical examination. Aspects of inspection of various foods
at the markets included:
• fruits and vegetables- appearance, color and gloss, flavor and texture, harmful
adulteration.
• Cereals-infestation of weevils, moths. rodents and insects, contamination with foreign
particles, dampness.
• Bottled foods-Labelling, check of expiry dates, Cleanliness of the container; leakages,
stains, rust etc. Tilting the bottle to check any foreign substance and also checked if the
seal is intact or not.
• Fish- Checked the condition of eyes, scales and flesh. For a fresh fish the eyes are full and
bright, flesh is firm, solid and elastic when pressed and does not pit when pressed with
fingers, Scales are full and firm, the abdominal cavity is clean and not discolored, gills are
clean, bright and not swollen.

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• packed foods-Presence of pests and dusts, Presence of foreign materials within the packed
food, Hezzling – separation of food contents, Dentations – signs of physical damage,
Slack can – where the contents are less than what’s labelled.

A premise inspected must be documented in a report.

The following are the contents of the report:
Section A: Introduction
• Address of the reporting officer
• Address of the receiving officer
• Title of the report
• Name and address of the Occupier
• Date and time of inspection
• Name and type of the business
• Type and aspect of the Buildings
• Situation and locality of the premises

Section B: Conditions and defects a)

Exterior

b) Interior
c) Personnel
d) General cleanliness

Section C: Conclusions
Section D: Recommendations
6.2 Inspection of food premises for licensing
The public health officer in charge and I conducted inspection to various food premises in
Adeta and Migosi markets including hotels and eateries, butcheries, liquor stores and bars
among others for Licensing. Food premises inspected for licensing are those that;
• Prepare food for human consumption
• Sell food for human consumption
• Display food for sale
Inspection of food premises for licensing is similar to routine inspections where aspects
checked or assessed are the same. During the inspections we checked on the general
cleanliness of the premises, states of structures such as floor, walls, roofs, ceiling etc.;

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ventilation and lighting, medical certificates for food handlers and provision of basic
amenities such as clean water availability, refuse waste disposal to enhance proper solid and
liquid waste management and availability/state of sanitary facilities. Those food premises that
met the requirements for licensing were licensed and those that did not meet the
requirements, we issued statutory notices, oral intimidation notices for them to meet the
standards. We conducted routine follow ups to ensure they comply.
6.3 Examination of food handlers
The public health officer in charge and I conducted routine inspections in various food
premises around Adeta and Migosi Markets to ascertain that all the food handlers were fit to
handle food. We summoned those without medical certificates to come to Migosi Sub County
Hospital where we referred them to the laboratory with a laboratory request form-MOH 227.
At Migosi hospital, I participated in issuance of laboratory request forms and the
examinations of food handlers from different food premises around Adeta and Migosi
markets through taking their specimen, analysis and interpretation of their test results.
Medical examination of food handlers helps:
• To ensure that all food handlers are not carriers of pathogens related to Foodborne disease
especially S. typhi/paratyphoid and V. cholera.
• To ensure that those who come directly or indirectly in contact with food are not likely to
contaminate the food.
• Limit the spread of food borne illness through ensuring that food handlers are fit to handle
food.

The following procedure is applied when acquiring a medical certificate by a food handler;
• The food handler is given a laboratory request by the public health office upon paying Ksh.
750 for the medical certificate. The food handler takes with him/her the dully filled request
form to the authorized government clinic/Medical center where the Medical
practitioner/Laboratory personnel validates the form.
• Performance of laboratory tests-I together with the laboratory technician at Migosi Sub
County Hospital Mr. George, performed medical examination to clients which focused on
the evaluation of symptoms and conducting tests. The following symptoms were checked;
Fever, Jaundice, Skin infections on hands, arms, face, Boils, septic fingers, Discharge from
eye, ear or gums/mouth. The following laboratory tests conducted were mainly Stool
analysis and Urinalysis. For stool analysis ova and cysts, worms and segments are checked
while urinalysis, Epithelial cells and trachomonas vaginitis are checked.

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• If no abnormality (For urine indicated as NAD-No abnormality detected and stool-No O/C
seen) were detected from the above tests conducted, the Laboratory personnel then
documents the results in the request form after which he hands over it to the PHO who then
issues the client with the medical examination certificate.
The completed and certified medical examination form is then supposed to be kept by the
food handler and a copy shall be retained by the public health officer. The medical
examination certificate is usually valid for 6 months upon which renewal is necessary.
6.4 Food Sampling and Analysis
The activity was carried out at the Government chemist in Kisumu. The scope of analysis by
the food laboratory includes the Farm level, Institution –Schools, hospitals and prisons etc.,
Production lines- food industries, Markets and Foods brought by the general public.
The key roles of the public analyst on food analysis includes the following:
• Analysis of food samples or items to ensure that the foods consumed by the public are
safe. The suspected food samples are generally brought in to ascertain whether they
predispose the public to harmful complication
• Analysis of Food items for licensing, helps to process imports and export health
certificates based on their results of foods brought for analysis.
• Recommend for mass destruction of food in the event that they do not fit the acceptable
standards.
• Helps in the dispensation of justice for instance in the case of food poisoning; the analyst
helps courts reach a reasonable judgment
Analysis of foods start after samples are brought to the analyst. The following parties can
bring the samples; Public health officers/practitioners: They bring the samples based on
Public outcry or outbreak of a food borne illness; Encounter of foods not befitting public
health standards during routine sampling or inspection and any instance of suspicion of food;
The police and The general public.
During sampling, samples collected should be a representative of the whole and that changes
of composition do not take place during collection. A predetermined procedure for selection
for selection, withdrawal, preservation and preparation of the sample is always adhered to.
Before analyzing food samples, The department checks on; the packaging of the food for
example checking the mark of quality to find out the counterfeit ones, Deception-ascertain
that the contents inside the food container match with what is described on the package and
labelling. I participated in the analysis of cereals where we checked Moisture content,
aflatoxin levels, insect infestation and pesticide residues.

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At the water Lab, the focus was on water and waste water analysis. Any person was allowed
to bring samples of water for analysis at a fee. The laboratory deals with the analysis of
Physicochemical, Bacteriological and Effluent parameters of water and waste waters.
Water from different sources were analyzed and during water sampling the water sample
collected should be a representation of the entire water body to enhance the appropriate
results. I observed physicochemical analysis of water being performed where hardness of
water, PH, ions present were tested. Bacteriological analysis helped check on Total coliforms
and Escherichia coli where membrane filtration technique was used. Effluent analysis
involved testing waste water from industries, homes and sewerage companies. The
parameters to be checked includes the following; BOD, COD, Oils and grease, Total
suspended solids, Total dissolved solids, Electrical conductivity.
Equipment identified at the water lab includes the following:
• E.D.T.A machine-used to test total hardness of water
• PH meter-Tests PH of water and waste water
• Turbid meter-Tests turbidity of water
• Conductivity meter-Tests Electrical conductivity, Total dissolved solids
Thermo reactors- Tests COD
• BOD sensor- Tests BOD
• Mechanical shakers- uses ionic selective electrode principle to tests Chloride,
Ammonium and fluoride ions.
Tools used during food sampling and analysis includes, sampling forms for sample
collection, request forms issued to the Public analyst when foods are brought for analysis,
Seizure form A which is used by the public health officer when bringing the food samples
he/she has seized and Destructions forms which ascertains that foods analyzed are not safe
and has to be destroyed. Sample receipt forms are also used when receiving the samples
brought.
6.5 Enforcement of Food laws
The public health officer in charge of food took me through various laws related to food, the
various tools of inspection used in food enforcement; how statutory notices are prepared,
delivered and served and also key steps that a public health officer applies when abating a
nuisance.
The food laws include the following:
The public health Act, Cap 242
Meat control Act Cap 356

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Food, drugs and chemical substances Act, Cap 254
Hotels and Restaurants Act, Cap 494
Liquor Licensing act, Cap 121 68
Alcohol drinks Control Act, 2010
Traditional liquor licensing Act, Cap 122
Manuals for food Quality Control
Food Inspection code
Codex alimentarious Commission Regulations
Building Code
Physical planning Act, Cap 286

The following are the tools of inspection used in the enforcement of food laws; a)
Med 240. Sampling form-Sample collection
b) Med 242. Seizure form A -seize and carry the consignment

c) Med 243. Seizure form B- seize and don’t carry the consignment, court order for destruction
of the consignment with a reason.
d) Med 246. Surrender form after seizure
e) Med 247. Application form to court for destruction
f) Voluntary surrender form/ Voluntary forfeiture form

g) Med 248. Application for Licensing form A(Used when importing food)
h) Med 249-Application for Licensing form B(Exporting food)
i) Export health certificate- A requirement when exporting food
j) Import health Certificate-A requirement for importing food
k) Medical examination form C-Given to food handlers to go for medical examination

l) Certificate of Medical Examination-Issued to medically fit food handlers

m) Statutory Notice- A legal document served to a nuisance author giving specifications on
what to do pertaining to the nuisance. (Section 119, Public health act Cap 242)

When preparing a statutory notice, the following key elements are included;
-The details of your office (Public health office)
-Details of the person served with the notice (Author)
-Salutation

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-Purpose of the notice.
-Details of the nuisance
-Signature
A statutory notice is delivered by taking 2 copies to the author; he/she signs the original copy
based on the date received the notice and signature, take to the office the signed copy and put
under lock and key to enhance future reference or used as evidence. A delivery book should
be used to ascertain that the author of nuisance received the notice. Key aspects of the
delivery book should include the name of the author, reference no. of the notice, his/her
signature. The notice can be served directly to the author or left at the door of the author or
with a person who resides with him/her if not available.
The steps below are used by the public health officer to abate a nuisance; Record the
complaint or the nuisance; Identify the author of nuisance; Inform the author of nuisance
verbally to remedy the nuisance; Have a mutual agreement on the time taken to rectify the
nuisance
If he/she fails; the public health officer serves him/her with an informal notice, if she doesn’t
comply the author is served with a statutory notice indicating the time supposed to rectify the
problem. If again he/she doesn’t comply a complaint is caused to court and the court will
issue a sermon to the author to appear before it and prosecution begins.
Types of notices and tools of inspections issued during my attachment;
• Oral Intimidation notices during routine food premises checks-Migosi location.
• Seizure forms A (Attached) -Issued when we seized goods from Boom mart
Supermarket in Migosi. A customer bought some Weetabix that were unwholesome
which affected her child.

6.6 Inspection of Meat and Meat Products

This activity was done at Mamboleo slaughter house under the supervision of the Veterinary
officer and the public health officer in charge of the slaughter house. The abattoir is of Halal
type run by the Kisumu county government. The major aims of meat inspection addressed
included:
• To ensure that apparently healthy, physiologically normal animals are slaughtered for human
consumption and that abnormal animals are separated and dealt with accordingly.
• To ensure that meat from animals is free from disease, wholesome and of no risk to human
health.

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Animals slaughtered at the abattoir are Cattle, goats, sheep and chicken. Once the animals are
brought to the abattoir, they are kept in holding areas where the ante-mortem
examination/observation is carried out. The aims of ante-mortem inspection are;
• To ensure that all animals are properly rested and that proper clinical information is obtained
which will assist in the disease diagnosis and judgment.
• To reduce contamination on the killing floor by separating the dirty animals and condemning
the diseased animals if required
• To ensure that injured animals or those with pain and suffering receive emergency slaughter
and that animals are treated humanely
• To identify reportable animal diseases to prevent killing floor contamination
• To identify sick animals and those treated with antibiotics and chemotherapeutic agents,
insecticides and pesticides
• To require and ensure the cleaning and disinfection of trucks used to transport livestock
Later the animals are taken to the lairage to rest for at least 12 hours (for those in good health
and qualify for slaughter) before slaughter and were not supposed to be fed 12 hours to
slaughtering time so as to avoid/reduce contamination with grass and also reduce chyme
contamination during evisceration, the examination is also done before animals are taken to
the stunning area in order to be sure they do not show any signs of disease. The following are
key processes and sections involved in the slaughter house.
Stunning section
The animals in the lairage that have been examined and are ready to be slaughtered are driven
to this area. Stunning is a humane way of killing that makes the animal unconscious and
experience less pain during the slaughtering and for bigger animals like cows it makes the
slaughtering
process easy. ; The cattle are stunned using captive bolt penetrated into the animal’s skull by
a stunning gun. Stunning is done in the stunning box. The goats and sheep were slaughtered
manually.
• Bleeding area
Once the animal has been stunned the neck is slit. Bleeding process allows the meat/carcasses to
have longer shelf life
• Dressing area
After the bleeding process is completed, the dead animal is cradled and hoisted to a dressing
hoist where flaying is done. Dressing is done carefully to avoid skin and hides damage and
also to avoid the viscera content to contaminate the meat. The abattoir had adequate water

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supply for cleaning and reducing contamination. The evisceration is carried out and the offal
are removed and taken to separate room whereby they are cleaned and then sent back for
inspection. The carcass is then separated into two equal parts by a separating saw.
• Postmortem area
Assigned Veterinary officer inspects the carcass of the slaughtered animals (Post mortem
inspection) in three ways;
• Visualization,
• Palpation
• Making incisions at designated areas.
The two-half split carcass is hoisted to the inspection area where the post-mortem examination
is done. Post mortem examination involve the above methods at the specific parts of the carcass
e.g. The head, oral cavity, nasal cavity, lymph nodes, lungs, heart and liver. The post mortem
inspection examination focuses to check for abscess swelling, hemorrhages, enlargement, cyst
cercus bovis, liver flukes and any other abnormality and judgment is made depending on the
findings.
The major conditions that are visualized include jaundice, kidney stones, nephritis in the
kidney, Lungs are visualized for abscess and pneumonia, Livers are checked for liver flukes,
liver cirrhosis and hydatid disease, and the spleen checked for spleen enlargement and
abscess, and the heart for cysts.
Incision is made on the lymph nodes and the fluid portrayed should be clear, on the muscles
to check for the Cyst cercus bovis, lungs are palpated and opened up, liver incision are made
on the lobes one incision on right lobe and two on the left lobe, heart is incised to check for
blisters, tongue is incised to check for veins enlargement and also made on the lower part to
check for Cyst cercus bovis. Rejected offal and cut offs were placed on a separate container
and then thrown away on the condemnation tank.
After successful post mortem examination is done, inspected meat is stamped using a rolling
stamp and then forwarded to the dispatch area. The stamp affirms safety of the meat.
• Dispatch area or the transportation area
At this point the meat that has been inspected/examined and found to be fit for human
Consumption is therefore stamped and issued with certificate of dispatch to the butcheries
and are transported using well labeled meat containers with white paint and red labels written
MEAT.

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Various certificates issued includes the certificate of transportation of Carcass that shows
where the meat was slaughtered and the final destination, movement permit for movement of
given animals and No objection permit.
The above process of meat inspection at the abattoir incorporates the HACCP procedures.
HACCP is a key concept of meat inspection which involves the creation of conditions and
implementation of measures necessary to ensure the safety and suitability of meat at all stages
of the meat value chain. The HACCP procedures at the abattoir were evident in the following
aspects;
• Good agricultural practices: Farmers advised to keep their animals in good health before
taking to the slaughter house in that veterinary officers only received animals that are free
from diseases
• Good hygienic practices at the Abattoir:
Liarage: Animals showing signs of illness were isolated and removed from healthy animals,
ante mortem inspection diligently done to detect sick animals and animals were adequately
rested before slaughter for 12 hours.
Slaughter and Flaying: Slaughtering was done on hanging rails therefore reducing
contamination by regurgitation, slaughtering knife was frequently washed, head removed and
after skinning washed separately from the carcass, no hair or skin was left on the skinned
carcass, no excess blood appeared on the skin, contact of dirt from hides and skin was
avoided and the carcass was barred from contamination by dirty hooks, knives and protective
clothing worn by the slaughter house workers.
Evisceration: Viscera was not allowed to come in contact with floors, walls and stands
Carcass splitting and washing: splitting saws were adequately washed between each carcass
and the carcasses were washed using potable water
Post mortem: proper incision and palpation done to avoid contamination
Meat transportation: Clean meat containers that are licensed were checked. The meat containers
should be painted red and white.
Slaughter house workers: Were on protective clothing though not all of them had clean
clothing, Aprons and coats were white and light colored to detect dirtiness, washed their
hands, knives and equipment used (supposed to be sterilized using hot water) and were
medically examined after every 6 months to handle meat in the abattoir. Challenges
 Poor liquid waste management, Effluent from the floor of the slaughter house was not
properly drained.
Below is Meat inspection at mamboleo slaughter slab

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6.7 Sugar Processing
Together with other attachees we made a visit to Kibos Sugar and Allied industry which is a
sugar mill and factory located in Kisumu.
We were taken through step by step sugar processing process. The process involves:
Washing and Initial preparation-as soon as sugarcane arrive at the factory, they are washed
extensively. Washing occurs on belts that are sprayed with water. After washing, the
sugarcane is conveyed into the factory using belts. The sugarcane is crushed using a heavy
grooved crusher roller. The crushed sugarcane is then sprayed with hot water to swell the
plant cells in preparation for extraction.
Juice extraction-milling is used to extract the juice. A series of five mills compress the
sugarcane fibers and separates the juice from the bagasse. The juice is then collected in large
vats and the sugar concentration is measured.
Purification of juice-tall towers are used to purify and lighten the color of the juice. The
juice is introduced at the top of the tower ang sulfur dioxide rises up through the tower a
process called sulfidation. Carbonation is used to further separate the soluble non-sugar
materials from the sugar juice. The juice is heated to denature the protein content and mixed
with milk of lime. Carbon dioxide gas bubbles is introduced to lower alkalinity and
precipitate the carbonation, which is filtered to purify the juice.
Crystallization-a single -stage vacuum pan is used to evaporate the syrup until its saturated
with sugar crystals, a process called seeding.
Centrifugation-the sugar is retained in the lined centrifuge basket and spring water is used to
wash the crystals as they are centrifuged.
Drying and packaging-the damp sugar crystals are dried in large, hot air dryers, next the sugar
is gently tumbled through heated air in a granulator.
Finally, the sugar is packed for the consumers.

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6.7.1 HACCP Application in Sugar Processing at Kibos Sugar Industry
HACCP is a management system in which food safety is addressed through the analysis and
control of biological, chemical and physical hazards from raw material production,
procurement and handling, to manufacturing distribution and consumption of finished
product.
HACCP rule applied at the industry during production includes:

Specifications: There are written specifications for all ingredients, products and packaging
materials.
Production equipment: All equipment is constructed and installed according to sanitary
design principles. Preventive maintenance and calibration are established and documented.
Facility: It is located and constructed according to the sanitary design principles where there
is linear production flow and traffic control to minimize cross-contamination.
Supplier Control: Each supplier has effective food supply program.
Cleaning and Sanitation: All procedures for cleaning and of equipment are followed.
Personal Hygiene: All employees and other persons who enter the plant are required to
follow the requirements for personal hygiene.
Training: All employees receive documented training in personal hygiene, cleaning and
sanitation procedures, personal safety and their role in the HACCP program.
Chemical Control: Documented procedures are in place to assure the segregation and proper
use of non-food chemicals in the plant. These include cleaning chemicals or fumigants.
Storage: All raw materials and the final products are stored under sanitary conditions and the
proper environmental conditions such as temperature and humidity to assure their safety and
wholesomeness.
Pest Control: Effective pest control programs are in place.

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CHAPTER SEVEN: GENERAL PUBLIC HEALTH
7.1 First Aid Basics and Emergency Care
I attended first aids training at Kenya Red Cross Kisumu Branch where Joseph Omondi, who is
the first aids trainer, took us through different aspects of first aids.

First Aids is the initial assistance or treatment to a casualty for any injury or sudden illness
before the arrival of ambulance, doctor or qualified personnel so as to preserve life, prevent
casualty condition from getting worse and to promote recovery.

Basic life support sequence includes: Call 999 and ask for an ambulance if the person is
unresponsive and not breathing, perform thirty chest compressions, two rescue breathes,
continue CPR and as soon as AED arrives switch it on and follow instruction.

We also demonstrated ABCD-E-T of basic life support which includes:

A is airway care-the first action is to keep the airway open by lifting the chin.

B is breathing-once you are sure the airway is open, check whether the person is breathing or
not by listening for sounds of breathing and monitoring chest movement. If the person is
breathing, you put them in a recovery position. If the person is not breathing, you begin
rescue breathing until the chest rises.

C stands for circulation-once the person is breathing you check for circulation.

D stands for disability and brain and spinal cord damage-assess the person for any possible head
or spinal injuries.

E stands for exposure-expose the person to full attention by opening their clothes carefully
avoiding moving the body parts in case of an injury.

T stands for transfer-transfer your patient to the nearest health facility as quickly as possible.

EMERGENCY CARE: emergency care is needed when there is a deadly bleeding which
needs to be stopped or in case of cardiac arrest (the heart is no longer pumping blood). If CPR
is not performed; that person will die, performing CPR or AED could save life.

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7.2 Casualty Management Procedures
We were taken through casualty management procedure which includes: Triage, making an
action plan, assessing the situation, making the area safe, assessing the casualty, comfort and
reassurance(consent), emergency and getting help.

Triage is sorting of casualties based on the need of treatment, from immediate category to
delayed category.

Making an action plan involves making sure that that you have a fully equipped first aid box and
a list of important phone numbers.

Assessing the situation-assess the situation quickly and calmly, check whether you or the
casualties are in danger and if it is safe to approach them. Find out what caused the accident
or situation and how many casualties are there.

Make the area safe involves protecting you and other from danger. To prevent infection
between you and the casualties, you wash hands with soap and water and wearing disposable
latex free gloves to prevent touching of open wounds.

Comfort and assurance-introduce yourself to the casualty to help them gain trust and explain
to them the situation and what you are doing to them. After the consent you assess the
casualties using the three priorities referred to as ABC then use primary survey to deal with
any lifethreatening conditions. Survey involves exploring the scenario; what happened, if
there is any further danger, if you can cope, the number of casualties and identifying who
needs help first.

Lastly, arrange for help if needed. You can call 999 or 112 for an ambulance and give
important information such as the location of the accident, which emergency services are
required, what happened, casualties condition and the number of casualties.

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First Aids training at Kenya Red Cross Kisumu Branch

7.3 Health Education and Promotion

At Magadi primary school, with the Company of the PHO in charge, we health educated
students, teachers and support staff on Covid-19 prevention strategies. We advised them to:
1. Wash hands with soap and running water
2. Putting on masks
3. Keeping appropriate social distance preferably 1.5Meters from one another
4. Hand sanitizing
Apart from emphasizing on the strategies above, we taught them on how to wear face masks and
appropriate steps on hand washing.
Steps on Hand washing: -
I. Wet your hands with clean running water, turn off the tap and apply soap

II. Lather your hands while rubbing them together with soap. Lather the back of your hands,
between fingers and under the nails.
III. Scrub your hands for at least 20 seconds

IV. Rinse your hands using a clean towel/paper cloth or air dry them.

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Wearing and Removing of masks: Before demonstrating to pupils the steps to follow on
wearing and removing masks, I asked them critical questions like a. What are face masks?

b. Importance of putting on face masks?

CONCLUSION AND RECOMMENDATIONS

CONCLUSION

The attachment was a success, an excellent and a rewarding experience. I learnt a lot as far as
public health is concerned and therefore this attachment program has greatly impacted my
career aspect as a PHO.

During the program I faced few challenges such as:

Inadequate Funds: this became a challenge to me when it came to the activities that demanded
for field work especially those going to a far distance.

Competing tasks/duties from attachment supervisor: during the attachment period, I was
faced with competing tasks at some time.

Unfavorable climatic/weather condition: sometimes I was faced with a condition of unfair

weather condition mainly during the field activities.

RECOMMENDATIONS
Migosi Sub County Hospital
 There is need to involve more stakeholders majorly partners. This will ensure continued
cost effective and sustainable partnership which will assist in provision of high-quality
healthcare services.
 There is a need for the MOH to fast -track the supply of equipment and healthcare
commodities which would be adequate to cater for the entire population.
 It is very imperative for the facility to cooperate with the community to come up with
different packages and interventions to address health needs for the most at-risk population.

Public health department-Kisumu County

 Generate proper policies on solid and liquid waste management as well as sensitizing the
county residents on the same in order to minimize pollution and filthy environment
especially within the boundaries of the City.
 Conduct continuous health education and promotion as far as Covid-19 is concerned to
mitigate its spread and mortality rate.

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 The process of Solid waste management in Migosi Sub County should be given an upper
hand so as all the waste are taken care of particularly the household waste that were
indiscriminately dumped to the environment and also more skips and scarps be placed at
strategic locations with timely loading and offloading of wastes.

Bibliography

1. Public Health Act Cap 242.

2. Physical Planning act Cap 286.
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3. Building Code.
4. Food, Drugs and Chemical substances act Cap 254.
5. Meat Control act Cap 356.
6. Kenya health Sector Strategic Plan (2018-2023).
7.National guidelines for quality obstetrics and perinatal care: Ministry of Public Health and
sanitation and Ministry of Medical Services Page 286-291
8.Linking communities with the health system: The Kenya Essential Package for Health at
Level 1-A manual for Training Community Health Extension Workers. Ministry of Health
March 2007

APPENDICES

APPENDIX 1: NUTRITION TOOLS AT MIGOSI SUB COUNTY HOSPITAL

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APPENDIX 2: WATER SAMPLING AND ANALYSIS TOOLS AT THE GOVERNMENT
CHEMIST.

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APPENDIX 3: LIVER INSPECTION AT MAMBOLEO SLAUGHTER SLAB.

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APPENDIX 4: WATER SAMPLING AND ANALYSIS AT THE GOVERNMENT
CHEMIST.

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APPENDIX 5: HIV DEFAULTER FOLLOW UP FORM

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 BSC. PUBLIC HEALTH

RURAL ATTACHMENT WORK PLAN AT MIGOSI SUB-COUNTY HOSPITAL

WEE DATE OBJECTIVE ACTIVITY
K
1-2 4th to 8th  FIRST AID • Demonstrate Basic Life
October,202 Support and emergency
1 care/Casualty Management
Procedures
• Visit the OPD
• Health education and
promotion

2-3 11th to 22nd  HIV/AIDS • Visit CCC clinic

October,202 • Identify ARV and other

1 treatment administration
• Understand TB and HIV
Coinfection
• Carry out Defaulter Follow up
• Understand Nutritional
Support for HIV patients
• Understand Home Based Care
for HIV patients
• Identify Emerging issues in
HIV/AIDS
 MATERNAL
AND CHILD • Visit MCH
HEALTH CARE
 REPRODUCTIV • Visit chiga Youth friendly
center
E HEALTH

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4 25th to 29th  DRUGS AND  Identify commonly abused
SUBSTANCES drugs and their local
October,202
names Carry out health
1 ABUSE  promotion and education
among drug users.

 Visit Chiga youth friendly

centre

5 1st to 5th  COMMUNITY  Understand community based

November,2 HEALTH health care
021  Understand community units
(CUs) and community
participation.

 Understand community health

workers and their roles.

 Community diagnosis
6 8th to 12th  MEAT  Visit a slaughterhouse and
PATHOLOGY understand its
November,
requirement. Identify types
2021 AND  of animals slaughtered.
INSPECTION
 Briefly understand the
slaughtering process

Demonstrate both ante


mortem and post mortem
inspection.

7 15th to 19th  LABORATORY  Visit hospital Laboratory

November,2 WORK and understand the activities
021 in the
virology,microbiology,Bioche
mistry and Immunology
sections

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8 22nd to 26th  CONSERVANCY  Understand the conservancy
AND and drainage system of the
November,2
catchment area.
021 DRAINAGE
9 29th  NUTRITION • Understand the nutritional
November to  FOOD SCIENCE therapies at the hospital for the
3rd AND different categories of
TECHNOLOGY patients(Infants,Adolescents,
December,20
Adults,Elderly)
21
• Visit a food processing plant
• Understand the HACCP, food
safety and sanitation, and food
processing and preservation.

10 6TH TO 10TH  WATER SUPPLY • Visit a water treatment plant

December,20 AND QUALITY • Understand the process of
CONTROL water treatment.
21
• Understand solid and liquid
waste management

 BUILDING • Understand the role of Public

PLAN Health Officer in the
APPROVAL construction industry; building
sciences and material and
construction technology.

• Other aspects in building and

construction technology

11 13th to 17th  ENTOMOLOGY,  Participate in practical activities

PESTS AND such as Use of insecticides.
December
2021 RODENT
CONTROL

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  Understand the IVM and
rodent control strategies.

 Participate in ant jigger

campaigns.

12 20th to 24th  PREMISE  Conduct premise inspection

INSPECTION using the guidelines of the
December,20
Public Health Act, CAP 242,
21 and CAP 254.
 REPORT
WRITING

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