SWAP’s Research Department
Since March 2007, SWAP’s research department has been engaged in various research studies on public health in collaboration with local and international research partners. The research has been conducted in different counties of Western Kenya where there is high burden of disease. The main aim of the research department is to evaluate the health and economic impact of public health interventions, technologies and products. The department has an efficient pool of researchers that have technical expertise and experience in conducting baselines, surveillance, evaluations and feasibility studies. Through partnership and collaboration with various organizations, SWAP has published over 60 studies in peer reviewed international journals. These research findings have been instrumental in informing policies and implementation models worldwide. Internally, the research department has been helpful in modeling of implementation and evaluation of intervention impact. Research findings have been disseminated to the County Department of Health and Education, SWAP staff and the beneficiary communities through a community feedback mechanism. SWAP projects and interventions have been continuously adjusted to keep up with the changing trends and community needs. SWAP now outsources its research activities to various research partners. The water lab has become an essential asset to provide evidence when testing water, products and technologies. SWAP has diversified its research with studies on WASH and Waste Management, Early Childhood Development, Clean Cook Stoves, Maternal and Child Health, Menstrual Hygiene Management, Neglected tropical diseases Cholera, COVID-19 among others.
CURRENT RESEARCH STUDIES:
Achieving sustained early child development impacts at scale
This research project will involve a total of 1320 Kenyan mothers or other primary caretakers and their children aged 6-18 months from 66 total villages located across 3 sub counties in Kisumu and Vihiga County. The study will experimentally test the relative effectiveness and cost-effectiveness of two different delivery models for an ECD responsive parenting intervention. Delivery agents will be trained community health volunteers. The study is in collaboration with the University of Southern California and the National Early Childhood Network.
Our research questions are:
- Can an ECD responsive parenting curriculum be adapted to an mHealth platform and to the local cultural context to be accepted by beneficiaries and delivery agents?
- Are mHealth-based delivery models that partially substitute remote delivery for in-person meetings as effective as in-person delivery models in the short-term?
- Can a hybrid delivery model that combines mHealth and in-person delivery sustain early impacts in the longer-term better than a traditional in-person delivery model?
- Are cost-savings entailed in mHealth-based delivery models large enough to make them more cost-effective than in-person delivery models in the short- and medium-term?
- What are the key implementation processes that can make a delivery model that uses some remote mHealth-based delivery more scalable than traditional in-person delivery models?
Household Stored Drinking Water Quality study in Mugruk
This study addresses bacterial contamination of water intended for drinking in homes in Mugruk, where we established the Sola Maji; Solar Powered Water Disinfection Unit. The Household Stored Drinking Water Quality study is implemented by SWAP in collaboration with University of Illinois at Chicago and Jaramogi Odinga Oginga University of Science and Technology (JOOUST).
The study aims to;
- Characterize changes in levels of coli bacteria in water from the source, through treatment, household storage and use in Mugruk, Kisumu County in Kenya.
- Compare changes in coli levels during household storage as a function of water treatment method.
Monitoring evaluation and reduction of intestinal schistosomiasis and soil transmitted helminthiasis.
It’s a 5-year study supported by CDC whose focus is to determine schistosomiasis-associated liver morbidity and markers for monitoring and evaluation of morbidity, and a level of water, sanitation and hygiene (WASH) that correlates with more effective reduction in prevalence after mass drug administration (MDA) in a schistosomiasis (SCH) and soil-transmitted helminthiasis (STH) control program in endemic areas of western Kenya. The study has both cross sectional and longitudinal designs.
Markers for Monitoring and Evaluation of Schistosomiasis Control Program
This was a one-year study USAID funded whose objective was to generate sets of biological samples from persons with Schistosoma mansoni or S. haematobium infections that can be used for laboratory development and evaluation of new diagnostic tools for assessment of morbidity, monitoring and evaluation of ongoing control programs, and elimination and surveillance in Western Kenya. The study site was Homabay and Siaya counties respectively. The total number of participants enrolled were 1,279 in Homabay County and 290 in Siaya County. Study participants were adults aged 18 years and above. One objective had a longitudinal arm that saw study staff do follow ups at various intervals. Although the study ended in September 2022, follow up is ongoing.
Production, Distribution and Monitoring of Alcohol Based Hand Rub
SWAP received funding and support from CDC for the production of Alcohol Based Hand Rub using the WHO formulae. Production is done at the water lab. SWAP received approval from Kenya Bureau of standards in November 2020 and started the monthly distribution in January 2021 to 47 health care facilities in Nyando and Nyakach Sub-Counties.
Enhanced Preparedness and Response to communicable diseases in Kenya
SWAP continued with the production, distribution and monitoring of Alcohol Based Hand Rub (ABHR) in all the 47 public Health Care Facilities (HCF) in Nyando and Nyakach Sub Counties. During the intervention period, a total of 5,522 liters of ABHR was produced in the SWAP lab and 2,760 liters was distributed to the health facilities. Through community hotspot mapping, a total of 59 high-traffic locations were identified and continuous supply of WASH supplies maintained throughout the study intervention period. SWAP got approval from the Kenya Bureau of Standards (KEBS) to produce liquid soap and since then the production and distribution is going on. The study is in collaboration with Washington State University.
Building Blocks for Positive Community Health
STEMA is a disruptive research group promoting sustainability, health and wellbeing in low resource settings worldwide through community led research and action The study aims to develop tool kit and approaches that will bring the science of decision-making to the field of global health. This is being done through local community engagement in three regions in Kenya including Siaya County which represents rural settings, Nakuru County which represents an urban setting, and Baringo County which represents pastoral community. SWAP is implementing partner in Siaya county. Through mathematical modeling, STEMA is building a system to support decision-makers in identifying the most effective health interventions. The study is in three stages and so far, two stages have been accomplished and analysis is ongoing, plans are underway to continue with stage three in 2023.
Chlorine Generation at Healthcare Facilities
The STREAM Disinfectant Generator provides a continuous flow of disinfectant solution from common salt and electricity. The chlorine-based solution generated by the STREAM System complies with national and international guidelines for disinfecting surfaces, medical devices, and instruments. In 2021, SWAP received funding from Vox Impuls to train and install the STREAM disinfectant generators at 8 health care facilities in Kisumu County. The facilities have been producing up to 1,000 litres per month and distribute as well to other facilities. SWAP continued to give technical support. Ongoing research continued in 2022 to determine whether chlorine production in health care facilities using the STREAM disinfectant generator is feasible and practical.
WASH Infection, Prevention and Control (IPC) in HCF’s
This is a pilot study bringing together epidemiology and ethnographic research on Infection Prevention and Control in Health Care Facilities in Nyando and Nyakach Sub Counties. This study is done in collaboration with Durham University and Washington States University. Baseline data was collected in 4 health facilities. Introduction meetings to Kisumu County and Nyando and Nyakach Sub Counties Health Management meetings were done before the pilot. We conducted a workshop with IPC focal persons, In-charges of 4 health facilities and public health officers to share experiences and identify and prioritize gaps which needs addressing.
Covid-19 Waste Water Based Epidemiological Study.
This study is in collaboration with the University of Illinois at Chicago and entails the surveillance and prevalence of COVID-19 disease through the monitoring, testing by viral RNA (Ribonucleic Acid) extraction and amplification of the detected SARS-COV-2 (severe acute respiratory syndrome of Corona Virus Type 2) viral particles by qPCR (Quantitative Polymerase Chain Reaction) followed by subsequent genomic sequencing at the USAMRU/ Walter Reed Medical Institute. The target testing sites include hospitals, market centers, public transport sections, wastewater treatment plants and any other highly regarded hotspot area with the major sample type being waste water.
Covid-19 testing and risk stratification tool for decentralized care.
SWAP managed the Bill and Melinda Gates Foundation grant to enable piloting of and acceleration of evidence generation and demonstration of antenatal risk stratification and connected Antenatal Care (ANC) diagnostics in driving improved Maternal, Newborn and Child Health (MNCH) outcomes by bringing improved quality and accuracy of care and risk assessment for pregnant women in lower-level health facilities in Kisumu County. This project partnered with Kisumu County Department of Health, CHAMPS/ARC project and ILARA Health to pilot a package of innovative tools and services in an agile, iterative fashion to explore whether they can close the gap in provision of ANC during COVID-19, and perhaps even improve the overall resilience of the MNCH health system post-COVID. The differentiated ANC package involved 1. Stratifying pregnant women into high risk and low risk pregnancies, 2. Strengthening primary facilities to offer ANC profile using Point of care diagnostic devices and attend to women with low-risk pregnancy, and 3. Ensure women receive four in-person ANC contacts in health facilities with the remaining four contacts conducted through telemedicine or in the community.
The Solar Soaker is a basin of recycled plastic with a black plastic foil and a transparent plastic cover. The solar soaking process involves:
- dissolving the detergent in cold water
- submerging the laundry
- closing the basin with the cover
- leaving it to soak in the full sun
The key benefit is that the sun heats up the wash solution to the point where stains and dirt are removed without further need for hand washing, as the key active ingredients in the detergent work best at around 40°C. This temperature can be achieved in an hour in direct sunlight, but the device heats up effectively without direct sunlight. It uses the physical principles of a greenhouse to capture the heat of the sun.
SWAP participated in qualitative research on the Solar Soaker at 9 health facilities. Focus group discussion and laundry practices observations were done together with clinicians and other healthcare workers/casuals supporting laundry work in each facility. Experiments were conducted in the field at the health facilities laundry services area and also at SWAP lab.
Some of SWAP Research Staffs