Impact Of Community Health Promoters On Awareness Of A Rural Social Marketing Program, Purchase And Use Of Health Products, And Disease Risk, Kenya, 2014-2016

The Safe Water and AIDS Project (SWAP), a non-governmental organization in western Kenya, opened kiosks run as businesses by community health promoters (CHPs) to increase access to health products among poor rural families. We conducted a baseline survey in 2014 before kiosks opened, and a post-intervention follow-up in 2016, enrolling 1,517 households with children <18 months old. From baseline to follow-up, we observed increases in reported exposure to the SWAP program (3-11%, p = 0.01) and reported purchases of any SWAP product (3-10%, p < 0.01). The percent of households with confirmed water treatment (detectable free chlorine residual (FCR) >0.2 mg/ml) was similar from baseline to follow-up (7% vs. 8%, p = 0.57). The odds of reported diarrhea in children decreased from baseline to follow-up (odds ratios or OR: 0.77, 95% CI: 0.64-0.93) and households with detectable FCR had lower odds of diarrhea (OR: 0.53, 95% CI: 0.34-0.83). Focus group discussions with CHPs suggested that high product prices, lack of affordability, and expectations that products should be free contributed to low sales. In conclusion, modest reported increases in SWAP exposure and product sales in the target population were insufficient to impact health, but children in households confirmed to chlorinate their water had decreased diarrhea.