Report for practical placement from 16th Jan to

3rd march 2017

Acknowledgement
The practical placement activities would not have been possible without
the help of many people. I would like to acknowledge the effort of my
supervisor Mr Ndirangu who guided me through the activities, My
family member who supported me financially to the end and the
Almighty God for enabling me reach this far.

Table of contents

Hygiene of food premise

Conservancy
Community mobilisation
Immunisation
Hospital sanitation/solid waste management
Meat inspection
Disease surveillance
others

Abstract

Introduction
The practical placement entails what is at the ground ,the roles of a
public health officer in action while the theory part guide us on what
will find on the field.

Objectives

Food and plant origin and beverages

Hygiene of food premise
Food quality control
Property inspection
Meat inspection and re-inspection
Conservancy and
Disease surveillance
Immunization
Vector control
Public health law enforcement
COMMUNITY MOBILIZATION
In Naivasha sub county, open defecation was still a challenge in some villages
due to overcrowding, poverty, ignorance and lack of knowledge though other
villages had been declared open defecation free (ODF).TO ensure that those
villages who were still practising open defecation are declared ODF, community
mobilization had to be done so that the villages are able to participate since
without their support this could be impossible.
To ensure effective community mobilization, my supervisor taught me
Community Led Total Sanitation (CLTS) which is an innovative methodology for
mobilizing communities to completely eliminate open defecation (OD).
Communities are facilitated to conduct their own appraisals and analysis of (OD)
and take action to become ODF (open defecation free).
CLTS is the strategy adopted by the Kenya Governments ministry of health to
achieve ODF in rural areas of Kenya. At the heart of CLTS lies the recognition that
merely providing toilets does not guarantee their use, nor results in improved
sanitation and hygiene, earlier approaches to sanitation prescribed high initial
standards and offered subsidies as an incentive. But this often led to uneven
adoption, problems with long term sustainability and only partial use. It also
created a culture of dependence on subsidies whereas open defecation and cycle
of faecal oral contamination continued to spread diseases.
In contrast CLTS focuses on behavioural change needed to ensure real and
sustainable improvements. Investing in community mobilization instead of
hardware, and shifting the focus from toilet construction for individual
households to the creation of open defecation free villages. By raising
awareness as long as even a minority continues to defecate in the open
everyone is at risk of disease. CLTS triggers the communitys desire for collective
change, propels people into action and encourages innovation, mutual support
and appropriate local solutions, thus leading to greater ownership and
sustainability.

KEY ELEMENT AND PROCESSES THAT WERE INVOLVED IN ODF INITIATIVE

THROUGH CLTS STRATEGY
To ensure that CLTS is implemented and works effectively, stages must be
followed and we discussed with my supervisor as follows;
STAGES OF IMPELEMENTATION
PROTOCAL 1: pre-triggering
Community entry which involves mobilization and setting triggering dates
Individuals with community mobilization skills and have understanding on the
community dynamics such as health promoters, health staff including CHVs and
CHEWs , WASH officers, community leaders, religious leaders, women and youth
leaders, persons with disability children and other emerging facilitators from the
community are considered for effective triggering.
PROTOCAL 2: triggering
It is a critical element of the CLTS strategy and has a bearing on the outcome to
a great extent.
1. Effective tools for triggering communities for behaviour change were as
follows:
Rapport building-
Social mapping this involved boundaries, landmarks, schools, households,
water point, OD sites, this map is drawn by the community themselves on the
ground with different colours and yellow representing OD.
Transect walk- also known as walk of shame which is conducted around the
community to see their faeces and shame them.
Shit calculation- this is basically calculating the amount of faeces they are
produce by the entire population in the community so as to trigger their minds to
see how serious the problem is.
i.e
Amount of shit per individual per day- 1kg
A village of 300 people-1kg *300=300kg shit everyday
Every week- 300kg*7 days=2100kg
One year-2100kg *52 weeks=109200
How many years have they been in the village?
Lets say 50 years:
109200 *50=5,460,000kg shit.
F diagram- was used to discuss hand washing, Reduction of flies and smell, and
solid waste.
The f stands for;
Flies, fluid, food, faeces and fingers
Medical expenses, loss of time, and unproductivity- this involved calculating all
expenses incurred as a results of diseases associated with OD.
Participatory community action plan towards ODF whereby community are left to
come up with their own solution.
Participatory community monitoring which involves setting follow up program
EVALUATION OF TRIGGERING PROCESS
To determine whether the triggering and facilitation process was effective, the
following is considered:
a) Participation level, high level of participation indicates effectiveness
b) Participatory community action plan, if the plan is developed, it indicates
effectiveness.
c) Triggered/ODF villages/ communities whereby large number indicates
effectiveness.
d) Level of participation of women and children whereby high level translate
to effectiveness.
e) High CLTS uptake in the prescribed period, ( 3 months)
f) Emergence of natural leaders/ ambassadors, active ODF committee, and
community solidarity.
PROTOCAL 3: definition of ODF
Stage 1: complying for ODF certification.
Key indicators
Non negotiable
No exposed human excreta within the community/ households (this means
complete absence of exposed faecal matter that can be access4d by houseflies,
whether in toilet facilities, chamber pots, surrounding bushes/ shrubs or refuse
dumps etc.)
All households have access to a toilet (individual or shared) which should not
facilitate faecal oral transmission.
The squat hole should be covered
The floor should be free of faeces and urine
Superstructure that provides privacy
All households have hand washing facility near the latrine with soap/ ash and
water
Continued use of toilet by households owner.
Desirable
Promote Use of ash being put over faeces in pit after defecation to prevent
contact of flies and smell.
Stage 2: post ODF
Key indicators

Schools/ health centre/ public places with functionality/ use of WASH facilities
(drinking water, hand washing, toilet for girls)

A system of maintenance of WASH facilities in schools in places with involvement

of community Education Committee (CEC), teachers and children

Safe storage/handling of drinking water and point of use water treatment (as
needed)-covered vessel with hand not dipped while taking out water)

Stage 3: a total sanitation environment

Key indicators

A system developed at community level by community to stop OD in/around

village (formation of sanitation and hygiene committee to oversee community
systems to stop OD are followed)

Village being visibly clean (no garbage, stagnant water, debris)

Safe storage/ handling of food (free from flies)

Personal hygiene

PROTOCAL 4: ODF third party certification

The reporting, verification and certification should be done by separate
bodies/agency to ensure reliability. Factors to be considered and suggestive
officials and agency that could carry out the specific functions are provided
below
Step 1: community self-assessment process (ODF reporting/claim)
The first step in the ODF certification process in an internal process of
community self-assessment. A community that has been triggered and believes
it has achieved ODF status according to the stipulated criteria, conducts a self-
assessment which is facilitated by the public health officers. Having assessed
that the community complies with the ODF requirements as defined above, the
community will claim for being declared ODF.
Step2: verification
Verification was undertaken through peer review process that was supervised by
sub county team. Verification was done within one month after the community
self-assessment yielded an ODF claim by a team of three persons drawn from
the: DPHO/SCPHO, Trained natural leaders and community leaders, and NGO
representative working in the area. Natural leaders and NGO representatives
were drawn out from ward other than the areas to which they belong to or work
for. This helped to avoid any conflict of interest and ensured objectivity.
Step 3: ODF CERTIFICATION
Certification was carried out by trained county level certification team
constituted at the county level and not directly involved in implementation
ensuring an element of objectivity. Certification
Was carried out two months after verification.
Quality control of certification
Quality of ODF certification was ensured by a random sample check of randomly
selected 10% of the villages certified by county level teams. This exercise was
carried out by independent institution /organizations that had previous
experience in sanitation- CLTS and had capacity in ODF certification. The
certification was to be notified only after the validation by quality assurance
had been carried out as above.
Recognition (at local level/regional level/national level)
Public celebration with local and outside guest
Billboards, flags
Involved media
Certificates were issued
NGOs and individuals including communities that were involved during
implementation were recognised through community felicitation in form of
certificates/ memento and not cash.
PROTOCOL 5: post ODF social mobilization and monitoring
This involved ensuring that the community received support even after
certification of ODF so that they would not revert to OD. Families who were using
shared toilets were motivated to have their own toilets and any family branching
out or new house constructed or additional population setting in, should also
conform to the ODF status.
The above mentioned objective were to be supported through following
objectives:
Follow up to ensure that the supply chain is strengthened in the areas where
triggering had been completed and it complimented to community level of
commitment.
Monitoring villages achieving post ODF indicators. This was to be done through
network of Community Health volunteers and may be linked to Health
Management Information System (HMIS)
Reorientation/ retraining of Health Volunteers to support the community in post
ODF stage and motivate them to adopt total sanitation.
Promote appropriate disposal system of solid and liquid waste.
Establish linkage with community initiative including those by other sectors such
as Community Health strategy. The solid waste disposal could be linked to
composting for improved agriculture or small farming.
Community Dialogue process could be used for monitoring post ODF
sustainability.
Counties could be motivated to assign periodic Sanitation Days across the
County for turning improved sanitation into a way of life and develop
performance contract that include the sustainability aspects of ODF.
MATERNAL AND CHILD HEALTH CLINIC (MCH)
Immunization being one of the objective I was supposed to cover, I was placed at
karagita health facility for a period of one week whereby I participated in the
following activities involved in child and maternal health.
Health promotion
I carried out Health education to individuals and groups at the waiting area on
various topic such as, hand washing, immunization, nutrition, family planning,
personal hygiene, cleanliness during food preparation and feeding process,
proper environmental sanitation, malaria control and other aspects concerning
primary health care.
Weight and height
Weighing is done every month to monitor growth of the child. It involved taking
the weight in kg using the baby scale and the height in cm using the height
board scale and recording them in the childs growth monitoring chart of children
within 0-5 years
History taking
It involved asking the mother about the childs general health status such as
feeding habits and examining the child physically, and listening to the mother if
she as any complains.
Checking immunization status
This involved looking at the childs growth monitoring chart and interpreting, the
childs immunization status and vaccinate as appropriate, providing vitamin A
supplement and deworming as appropriate.
Counselling
This involved discussing the finding with the mother and advising her as
appropriate depending on the status of her childs health as well as hers. Those
whose children were above 6 months were encouraged to continue infant
feeding up to 2 years as well as adhering to routine immunization and clinic
visits.
Recording information on each childs health card
It involved the childs particulars, health status, weight, nutritional status, any
treatment given, date of immunization and date of next visit.
IMMUNIZATION
since immunization is a broad activity, I revisited the entire objectives with the
help of my supervisors to ensure better understanding while participating in the
sessions at the health facility. We discussed and practically participated in the
following in karagita health centre;
TERMINOLOGIES USED IN IMMUNIZATION
Immunization-process of protecting or exempting one from a particular disease
Vaccination- introduction of vaccine into the body orally or through injection
Vaccine- it is special drug which stimulates the body to manufacture its own
antibodies.
Immunity- it is a state of being resistant to disease or foreign bodies
Antigen- any molecule capable of stimulating an immune response
Toxoid- it is a substance produced by microorganisms after which they are
treated or weakened by use of heat or chemicals not to cause a disease to an
individual.
Inoculation- the use of injection to introduce vaccines into the body.
Cold chain- is a system of maintaining vaccines in a potent state from the
manufacturer to the consumer or recipient.
Efficacy- it is the effectiveness of vaccines in its treatment.
Potency- it is measure of drug activity expressed in terms of amount required to
produce given intensity.
TARGET DISEASES FOR IMMUNIZATION
Tuberculosis
Poliomyelitis
Diphtheria
Whooping cough
Tetanus
Hepatitis B
Pneumococcal
Yellow fever
Meningococcal
Typhoid
Cholera
Rabies
Rota virus

TYPES OF IMMUNITY
Natural immunity
Artificial immunity
Herd immunity
Natural immunity
Natural active- body produces its own antibodies after exposure to particular
disease e.g. measles
Natural passive- passed from mother to child through placenta or breast milk.
Artificial immunity
Artificial active- antibodies are introduced into the body by vaccination.
Artificial passive- it is a short time immunity induced by introduction of
antibodies into the body. Normally used when a person has been exposed to
certain risk.
Herd immunity
This when over 80% of the people or children in a population have been
immunized that population is said to have herd immunity.
TYPES OF VACCINES

I. Live attenuated vaccines e.g. BCG, OPV, measles, yellow fever. Given
single short except OPV
II. Dead organism e.g. pertussis, typhoid, cholera, inactivated polio. They are
less effective and produce shorter period of immunity (given multiple
doses).
III. Toxoid prepared from extract of toxin from dead organisms e.g. tetanus
toxoid, diphtheria toxoid
METHODS OF VACCINE ADMINISTRATION
Orally
Intramuscular-at angle of 90 degrees
Intradermal-at angle of 15 degrees
Subcutaneous-at an angle of 45 degrees
TYPES OF VACCINES AND HOW TO ADMINISTER
BCG (Bacillus Calmete Guerin)
Effective against TB in children and protect against severe forms of TB e.g.
Millliary TB, meningitis TB. It comes in powder form and has diluent, one vial has
20 doses administered 0.05ml for age below one year and 0.01ml above one
year intradermaly, only once. Administered as follows; with the left hand, stretch
the skin with the index finger and thumb. Introduce needle upwards into the skin
keeping it as flat as possible so as to give it intradermaly. There should be no
bleeding.
Contraindication
I. Should not be given to a child with clinical symptoms of HIV/ AIDS.
II. Should be stored at temperature of +2 and +8 in refrigerator or vaccine
carrier.
III. Its potency last for 6 to 8 days after being diluted
IV. Very sensitive to light
V. Vaccine carrier should be placed in icepack with a dial thermometer
OPV (Oral Polio Vaccine)
It protect from poliomyelitis caused by 3 types of polio virus, brunhinde, laucing,
leon.
It is in liquid form and supplied trough small plastic bottles with a dropper.one
vial has 20 doses, one dose given to two (2 )children orally 2 drops each.
Types of OPV:
OPV birth dose which was administered btw 0 and 8 days.
OPV 1 given at 6 weeks
OPV 2 given at 10 weeks
OPV 3given at 14 weeks
IPV (inactivated polio vaccine) (injection)
Given at 14 weeks , on left upper thigh, 0.5ml dosage, single short dose
intramuscularly 90*
During campaign, 2 doses of OPV are given to all children under five years
regardless of how many they have had in the past.
Contraindication
Should be Stored at a temperature of +2 to +8 n can be frozen in regional and
central stores (requires storage for long time)
Very sensitive to heat and in MCH/ Facility was stored in the coldest part and
discarded after immunization.
Measles vaccine
Provided as powder with diluents in separate vial before it can be used, it must
be reconstituted with specific diluent supplied with vaccine. Stored at
temperature of +2 to+ 8(may be frozen for long term storage but not the
diluent).
One vial has 2- doses each 0.5 ml which is given at 6 months only when there is
measles outbreak (3 cases) in certain county and HIV exposed children. Normal
doses are given at 9 and 18 months, subcutaneously right upper arm (45)
Tetanus Toxoid vaccine
Protect against tetanus and neonatal tetanus. Provided as liquid in vials. It is
available in a number of different formulations. All the antenatal clients are
asked about number of tetanus toxoid injections they have received in their life
to date including those given after injuries and through schools. This forms part
of the 5TTs, if none given it starts as follows:
T.T.1 given to primagravida or on first contact
T.T.2- given not less than 4 weeks after T.T.1
T.T.3 Given during the 2nd pregnancy any time before 8 months of pregnancy
T.T.4- Given during 3rd pregnancy, any time before 8 months of pregnancy
T.T.4- Given during 4th pregnancy, gives protection for life.
Pentavalent vaccine
Protects against diphtheria, pertussis (whooping cough), tetanus, haemophilus
influenza type B, and hepatitis. One vial has two (2) doses 0.5ml each, given at
6, 10, and 14 weeks, intramuscular left outer thigh. The vaccine should be
refrigerated.
Rota virus vaccine
Given 1.5ml orally 1st dose at 6 weeks, 2nd dose at 10 weeks which should not
be administered later than 32 weeks of age.
Vitamin A supplements
Combined with immunization service for children given at 6 months for the first
dose (100, 000 IU) and subsequent doses (200,000 IU) at interval of 6 months.
Also given for treatment of measles and eye damage (xerophthalmia).
VACCINE MANAGEMENT
During routine immunization, the number of vaccine doses which were used were
generally higher than the number of children immunized, this excess doses
represented lost doses or vaccine wastage as a result various reasons such as:
I. Reminder of doses discarded with vials after immunization session
II. Doses outside the target
III. Doses spoilt for one reason or the other e.g VVM stage reached discard
point, break down in cold chain, frozen Pentavalent and T.T or removed
label
IV. Missing doses from vaccine stock ledger

This wastage can be explained further in two ways as below:

a) Wastage rate
b) Wastage factor
Wastage rate
This is taken into account in estimation of vaccine need and knowing it helps to
determine the wastage factor. Vaccine wastage rate are not standard and each
health facility must calculate its monthly vaccine wastage rates of antigen and
by the end of the year know the vaccine wastage. This is calculated as follows:
 Doses used-doses administered * 100
Doses used
NOTE
Doses used include vaccine administered and wasted doses
Doses administered are doses which have been received by the targeted group

Wastage factor
It is a multiplier used to order vaccines to cater for the targeted population and
wastage. The total number of vaccines supplied within given period is referred to
as 100% supply.
Calculation
100% supply = wastage factor
100% supply-wastage rate
CALCULATING VACCINE NEED FOR HEALTH FACILITY
Total annual vaccine doses are estimated by use of the following formula:
Target population* no of doses in the schedule* target coverage* wastage
factor=total annual dose
Note
Target coverage for health facility is 100% which is in line in reaching every child
in the catchment area.
CONTROLLING VACCINE STOCK
Controlling vaccine stock involved the following activities:
a. Receiving delivered vaccines and supplies
Vaccines are ordered from the manufacturer once a year and delivered every 3
months. They are later distributed to the regional stores for the county vaccine
manager to order for their respective health facilities.
At county stores, the staff has a main responsibility of receiving and issuing them
to the immunizing health facilities in the county.

b. Storage, transport and handling of vaccines

Vaccines are delicate biological products that lose their effectiveness through
heat exposure and it is not even possible to restore even if the vaccine is later
stored at the required temperature. The following tab le illustrate the time limit
of vaccine storage and required temperature.
MOST SENSITIVE
OPV
 Measles / yellow fever
BCG
TT
Pentavalent
LEAST SENSITIVE

Vaccines National up to w6 Subnational up to Peripheral up to 1

months( electricit 3 months month
y) ( electricity)
OPV/yellow fever -15 to - 25 +2 to +8
Measles -15 to -25 0r +2 to +8
BCG
Pentavalent
+2 to +8

TOOLS USED IN VACCINE MANAGEMENT

Vaccine order sheet
It helps in ensuring that the minimum and maximum stocking policy is adhered
to by the health facility when placing the order for vaccine, it has the following;
No of children immunized
Available stock
Ordered vaccines
Issue voucher (SSI)
It is government requisition form which is issued in two copies. The original is
recorded and filled by store manager while the other copy is meant for health
facility which serves as acknowledgement of receipt of vaccines and other
supplies.
Vaccine stock ledger
It is a management tool used in store for recording vaccine movement to or from
the refrigerator. They are kept with vaccines on the same premise. Every vaccine
transaction is recorded thus; received, issued and returned on individual row,
name of antigen, batch number, expiry date, balance in stock and remarks.
Vaccine physical stock taking
This means making a total count of quantities of vaccine in stock. The physical
stock covers all vaccine store and carried out every month before ordering the
supplies.
MORNITORING THE USE OF VACCINE
It involves;
Interpreting vaccine monitoring indicators
The tool for monitoring vaccine exposure to light and temperature are;
Vaccine Vial Monitors (VVM)-it is a label with heat sensitive material which
is placed on vaccine vial register cumulative heat exposure over time. The inner
square is made of heat sensitive material which is lighter colour than outer circle
at the starting point and becomes darker with exposure.
It is interpreted as follows;
Stage 1 very white- give or use
Stage 2 not very white and has small dots- use first
Stage 3 darker- discard
Stage 4 very dark-discard
3M Vaccine Cold Chain Monitor Card
This card must always be stored together with vaccine through the cold chain
system from the supplier to the clients.it detect cumulative heat exposure above
10 degrees. The explanation of what is required to be done is indicated on both
sides of this card.
Freeze Watch Indicator
It tells you when the vaccine has been exposed to freezing temperature. There
are two types of freeze watch indicators, one for the Pentavalent and another for
T.T. it is a small vial containing blue (Pentavalent) and red (T.T) alcohol which is
trapped inside a plastic bulbous tube with a white paper background. When
exposed to temperature below 4 more than one hour, the vial burst and releases
the coloured liquid staining the white paper background.
Fridge Tag (TAG)
This is a data logger that shows daily minimum temperature over a period of 30
days and the current temperature in fridge.
Shake Test
This is test used for testing suspected frozen vaccine vials by shaking it.it is
shaken vigorously for 10- 15 seconds then allowed to rest for 15- 30 minutes and
sedimentation rate is checked. If rate is faster and sediments formed at the
bottom of the vial, the sample has been damaged by freezing and the supervisor
should be notified.
Multi Dose Vial Policy (MDVP)
An opened multi dose vial is a vial containing several doses from which one or
more doses have been taken. To ensure optimal use of vaccine, WHO and UNICEF
issued directive authorizing the reuse of opened multi- dose vials of some liquid
vaccine such as polio, Pentavalent and TT under certain condition.
COLD CHAIN
It is a process of maintaining vaccine potent state from the manufacturer to the
recipient.
Manufacturer
National deport
Regional
Facility
Outreach
Cold chain equipment
They must meet the standard set by WHO and UNICEF for safe vaccine storage,
they include:
a) Cold room and freezer rooms
They are large rooms specifically constructed for storage of large quantities of
vaccines, they have two cooling units one running and one standby, a 24hour
temperature monitoring system with an alarm, a recorder and a backup
generator that will turn on automatically when the regular power is interrupted.
Cold rooms are found at national and regional level while freeze rooms are found
at national level. Freezers and ice lined refrigerators are used at central, regional
and county stores and sub county level.
b) Gas electric refrigerator
They are of 3 type used in the county: Sibir V170GE, RCW42 EG and RCW50EG
Sibir V170GE
Vaccines are placed in shelves in order of sensitivity with the most sensitive to
heat (OPV) being on the first shelve below the evaporator, TT and Pentavalent
being the most sensitive to freezing is placed on second last shelf from the
bottom. Vaccines are packed leaving a space of about 5cm in between the
packets for air circulation. The upper cabinet is used for freezing the icepacks.
RCW 42 EG
Designed for use at the service delivery point. It is operated either on electricity
or gas and has a top opening door. Trays of different colours are used to store
each type of vaccine and a sticker is pasted on the front side of the refrigerator
to guide the vaccine arrangement and management order must be observed at
all times. The arrangement is as follows;
TRAY COLOUR POSITION VACCINE
Purple Top Pneumococcal
Red Second Pentavalent
Orange Third Tetanus Toxoid
Yellow Fourth BCG
Green Fifth Measles/Yellow Fever
Blue Bottom Polio

RCW 50EG
This is similar to RCW42 EG but has a double vaccine carrying capacity. Suitable
for use at places with higher target population or Sub County deports.
c) Solar refrigerators
Used in areas with high sun intensity. They are suitable for use at service delivery
points and arrangement of vaccine is similar to that of RCW.
d) Cold box
They are used for transportation of vaccines and can also be used for temporary
storage when refrigerators break down. Its cold life varies depending on the type,
the number of openings and ambient temperature.
e) Vaccine carriers
Used for transportation of vaccines from regional stores to service delivery
points. The cold life in vaccine carrier is approximately 8 hours.
f) Icepacks
They are flat rectangular plastic container filled with water or gel. Used in
vaccine carriers, cold boxes or refrigerators to maintain temperature.it is
advisable to always have at least an extra set of icepack as a reserve while other
set are in use.
g) Thermometer
Different type of thermometer are used to monitor cold chain temperature, these
are the dial and alcohol thermometer. They indicate the safe operating ranges of
temperature between +2 to + 8 for refrigerators and -15 to 25 for freezers.

Conservancy
It was one of the objective that I was supposed to cover. My
supervisor help me go through the theory part of it, to ensure
that I got the concept well. This were some of the things we
looked at;

SITTING OF WELLS, BOREHOLES, PIT LATRINE AND OTHER

CONSERVANCY SYSTEMS
SITTING OF WELLS AND BOREHOLES
Optimum health cannot be achieved without safe source of water, boreholes and
wells being some of the water sources, their sitting determine how safe the
water will be. To ensure water is free from any form of contamination, various
factors must be considered before coming up with one. My supervisor taught me
various factors to be considered before we visited the sites where the borehole
were situated just to check the safety.
The factors that were considered are;
Environmental factors
Ground water flow direction
If the direction is known, it is best to place the well up-gradient from latrine so
that contamination moves away from the well. Since it may be difficult to know
the direction of flow but ground water in an unconfined aquifer tends to flow in
that the direction of the ground slopes and flows from a recharge area to a
discharge point, knowing this helps to locate a well uphill from a latrine than
downhill.
In the case of deep water table
If the water table is at least 5m below the bottom of the latrine, most
contamination will be removed before it reaches the ground water if;
There clay, silt, or fine sand between the bottom of the latrine and water table.
The well is located at least 15m from latrine.
Minimum safe separation distance in deep water table

Sediment type Depth to water table Minimum safe

separation distance
Clay, silt or fine sand 5m or more 15m or more
Medium sand 5m or more 15m or more
Coarse sand/gravel 10m or more 15m or more
Fractured rock 10m or more 15m or more

In the case of shallow water table

If the bottom of the latrine is at the water table or close to it, then disease
causing organism can get into the ground water. Fine grain soils can easily filter
out pathogen than coarse sand. The minimum safe separation distance is shorter
for finer grain soil than coarse soil.
Minimum safe separation distance in shallow water table

Sediment type Depth to water table Minimum safe

separation distance
Clay, silt or fine sand 0m 15m
Medium sand 0m 50m
Coarse sand/ gravel 0m 500m
Fractured rock 0m 500m

Surface water like streams, rivers and pond

This may contain biological, agricultural or industrial contamination so wells
should be located at least 15m away from them.
Flooding areas
Avoid areas that get flooded since people cannot get to well during times of high
water and well may be contaminated by floodwater overflowing and seeping into
well/ borehole.
Naturally occurring chemicals
Chemicals like boron and selenium can affect groundwater quality, so water
should be tasted in areas where this may be a problem.
Cultural factors
Proximity to where people live-convenience is very important factor to
consider when locating a well/ borehole. Studies have shown that when water
point is located less than 200m from home, people tend to use more water than
when the source is further away.
Sacred areas-one should find out if there are areas which are considered sacred
since it is wise to respect spiritual landscape of the area as viewed by those
who live there.
Cemetery- this is a sensitive cultural issue that must be considered.in some
places people have refused to drink water that comes from the ground because
people were buried in the ground.

Pest control
It was one of the objective I was supposed to cover. To ensure better
understanding of the subject, I had to revisit my theory part .my supervisor help
me through to ensure I got the concept. This are some of the things we revisited;

Vector and vermin control

A vector is an animal, bird or anthropoid which destroys farm, animals or food
and act as a nuisance. They also transmit diseases. Some of the examples
vectors and diseases they spread are;
VECTOR DIESEASES
Mosquito - malaria, yellow fever, rift valley fever
Houseflies - Trachoma, Diarrhoea, Typhoid, Cholera
Rat fleas - plaque
Bode lice - Typhus fever
Sand fly - kala ozar
Tsetse fly - Sleeping sickness
Bed bug - Typhus fever

Vermin-small animals or insect that harm people livestock, property or crops e.g.
rat, weevils, fleas, cockroaches etc.
Rodent-These are small warm blooded animals of a lower class .They have sharp
front continuously growing teeth .They act as a disease reservoir.

Control Measures
Clear bushes and grass around the compound to control rodents
Drain or parricide stagnant water
Fill water collecting sites with soil /stones /
Apply chemicals in significant water
Proper management of refuse
Build VIP latrines
Cement floor
Chemical application on refuses site
Spay /destroy ant hills
Ensure coverage of water tanks (mosquito proofing)
Indoor residual spraying
Use of insecticide treated net in boarding schools and at home
Use of traps /bait for cockroaches
Regular sprinkling of earthen classroom floor with water and sweeping
DISEASE SURVEILLANCE
This was one of the objective that I was supposed to cover. Mr Bowen who was in
charge of surveillance in the area assisted me learn and participate in disease
surveillance. To ensure better understanding he taught me epidemiology; this
were some of the things that we discussed;
Epidemiology-it is the study of the determinants and distribution of health,
diseases and injuries in human populations.
Concept basic to epidemiology
Host
Agent
Environment
Types of epidemiology
Descriptive
Analytical
Epidemiology deals with; distribution, frequency and occurrence of health related
events
Major areas of epidemiology
Clinical triage
Outbreak investigations
Disease surveillance
Types of disease surveillance
Active
Passive
Sentinel
Food and plant origin
Being one of the objectives I was supposed to cover, my supervisor took me in
naivas kubwa
Supermarket, he assisted me identify various vegetables, fruits and beverages.
Some of them were;
Grapes,uche mushrooms, stir fry, fresh strawberry fruits ,ben peter
sugarsnaps,ben peter snowpeas,fresh beans,ravaya,fresh karela,sweet
melon,capsium,red carbage,butter nut,beetroots,onion,brozioli and promulgates.