Killing Kenyans, Saving UN Employees: it's a matter of priorities

I'm still trying to reconcile two claims from UNAIDS: the first is that 80% of HIV transmission is a result of heterosexual sex in African countries (in most non-African countries it's mainly a result of male to male anal sex and intravenous drug use). An estimated 18% of transmission in African countries is from mother to child. And only the remaining 2% is a result of unsafe health care.

The second claim is that "We in the UN system are unlikely to become infected [with HIV through contaminated blood] since the UN-system medical services take all the necessary precautions and use only new or sterilized equipment. Extra precautions should be taken, however, when on travel away from UN approved medical facilities, as the UN cannot ensure the safety of blood supplies or injection equipment obtained elsewhere."

Evidently, non-UN approved hospitals do not take all the necessary precautions to prevent accidental exposure to contaminated blood, nor can they be guaranteed to use new or sterilized equipment. The 2% figure estimated (and it is an estimate, no empirical data has ever been made available to support it) is so low, it can be assumed that only the kind of small clinics found in outlying areas would be responsible for much of it.

So why the need to warn UN employees? There is certainly no danger to them. Or, turning things around, why is there no need to warn Kenyans and other Africans? Most poor Kenyans will rarely see a doctor and much of the treatment they receive will be rushed, performed by badly trained, badly supervised, underequipped personnel, perhaps even people who know nothing about infection control.

Because many people working in health know little about infection control. Many health facilities have few infection control supplies, people who know how to use them or studies to find out if the little available is ever utilized. UN employees are probably in little danger when it comes to health care. But Kenyans face many dangers.

The latest Service Provision Assessment for Kenya (2010) is now available from the MeasureDHS website. This assesses the availability and quality of services from a representative sample of over 700 health facilities, ranging from regional hospitals to voluntary counselling and testing (VCT)acentres to dispensaries and small, rural clinics.

When it comes to infection control, the survey makes especially sorry reading. Only 80% of standalone VCT clinics have both soap and water. The figures for all other types of health facility are even lower, with only 30% or fewer hospitals, health centres and maternity facilities having such basic items.

While 93% of VCT clinics manage to have clean latex or sterile gloves, only two thirds of hospitals and health centres do, and less than 80% of materity facilities do. In fact, only 12% of hospitals have all the basic items needed for infection control. Again, the highest figure is from VCT clinics, where 66% 'make the grade'.

When it comes to supplies of items needed, fewer than 30% of facilities in all categories have all the items and none of the VCT clinics have all of them. It may not be so bad for only 14% of VCT clinics to have supplies of needles and syringes. But only 89% of hospitals, 86% of health centres and 93% of maternity facilities have them.

As for the disposal of contaminated waste, especially sharps, such as needles and scalpels, the majority of facilities don't even have the basics. Sterilization equipment is lacking in many and, even where it exists, there are often no people or equipment to ensure its use. Written guidelines or procedures are also missing in the majority of facilities.

As the Service Provision Assessment itself makes clear, the presence of trained personnel, equipment, guidelines or anything else gives no indication of whether infection control actually takes place, how often and to what extent. If there are any serious breeches, they are unlikely even to be logged, let alone investigated or addressed.

So it seems that UN employees probably do need to be warned. But if so, ordinary Kenyans and other Africans are in far greater danger than pampered foreigners who travel in air conditioned vehicles and have access to some of the best facilities and expertise in the world, and that's not just in health care, either.

Kenyans and other Africans need to be aware that the state of their health facilities is such that their safety from blood borne and other infections is most definitely not assured. Kenyan hospitals are shabby, understaffed and underequipped. It is not clear how much HIV (or other diseases) have been spread by health care procedures because the matter has never been investigated. But it is time to investigate now.