Child Health and community Health
Human Immunodeficiency Virus is still a major health problem in developing countries. In Mbita Sub-county, the HIV prevalence stands at 25.3%. Compared with the younger age group (15–19 years), adults aged 30–34 years is 6.71 times more likely to be HIV-positive, and the estimated HIV-positive population among women is 1.43 times larger than among men. There is a homogeneous HIV distribution in the communities surrounding fishing villages .
There is a dearth of information on malaria endemicity in the islands of Lake Victoria in western Kenya. Single infections of Plasmodium falciparum (88.1%), P. malariae (3.96%) and P. ovale (0.79%) as well as multiple infections (7.14%) of these parasites were found on Rusinga Island. The overall malaria prevalence was 10.9%. The risk of contracting malaria was higher among dwellers of Rusinga West than Rusinga East locations. Parasite positivity was significantly associated with individuals who did not use malaria protective measures. Although current entomological interventions mainly target indoor environments, additional strategies should be considered to prevent outdoor transmission of malaria .
Schistosoma mansoni infection is a major cause of organomegaly and ultimately liver fibrosis in adults. Morbidity in pre-school-aged children is less defined, and they are currently not included in mass drug administration (MDA) programs for schistosomiasis control. The researchers’ report results of a study of the association of schistosomiasis with organomegaly in a convenience sample of 201 children under 7 years old in Rusinga, Kenya on two cross-sectional visits, before and after praziquantel treatment. The baseline prevalence of schistosomiasis by antibody and/or stool was 80.3%. Schistomiasis was associated with hepatomegaly and splenomegaly. The association with hepatomegaly persisted post treatment. Schistosomiasis was associated with morbidity in this cohort. Efforts to include young children in mass treatment campaigns should intensify .
Protection Child
Cases of child abuse are rampant in Rusinga Island. The unfortunate scenario is linked to various forms violence that women are subjected to, which comes in terms of verbal abuse, physical, and emotional abuse. Rusinga Island is a patriarchal community that is characterized by male dominance, and this gives the males the autonomy to abuse women, despite the existing fundamental law on human right protection. The violence women experience directly affects their children, either emotionally or physically. Children are sometimes forced to flee from homesteads with their mothers .
The issues of child labour are dominant at Rusinga Islands as children engage in fishing activities either by themselves or alongside their parents. The practice makes children stay away from schools, and this finally influences their performance and academic success in a negative way. Young boy’s fish by using hooks and lines as girls are engaged in cleaning the catch. They do the activity for meagre pay or merely consumption purposes.
Boda Boda operators and fishermen along the shores of Lake Victoria in Homa Bay are cashing in on the high poverty levels that characterize the region in an innovative way to cut short education dreams of students in both primary and secondary schools. A survey carried out in the county reveals that the riders and fishermen entice students by offering free rides and a promise to pay school fees for the young girls in exchange for casual sex . The 2015 National Adolescent and Youth Survey conducted by the National Council for Population and Development (NCPD) say riders offer to pay school fees for the young girls. Victims feel obliged when payback time arrives to trade in sex for the favours in addition to being offered cash for food and other education materials at the risk of becoming pregnant.
In Rusinga Island community’s culture, girls are married at an early age. From the study findings, more than half of the married women were aged 16-20 years. At this age they are not mature enough to take up the responsibility of being wives or effective mothers. The reason behind early marriage in the community is to enable women have many children when still young, and also the bride wealth paid can be used to educate the boy-child . Traditionally, value was placed on the number of children a man had, and it seems this community still upholds this tradition. The decision to be married was done with the permission of the fathers of the girls who had control over their daughters’ lives. Culturally, women were not supposed to participate in education or any development activities both in public and private spheres. Instead, they were to be married and become good home makers for their husbands. The cultural expectation and patterns are such that if highly educated, a girl may find it difficult to get a husband or be a good wife. The reason given for early marriage in this region is that at this time the girls are still virgin and clean and this has a bargaining power in terms of payment of bride wealth.
When girls marry when they are underage, they are bound to have a myriad of health issues. Being young means one cannot make rational decision on the number of children to have, and control over one’s reproduction. Young girls in a marriage are not aware of their reproductive health rights as this is information one gets through education in schools and colleges. But in Suba sub-County, as the study findings indicate the majority of these women do not even complete basic education. As such, they will forever remain in darkness unless the societal perception regarding early marriage of the girl-child changes. Early marriage denies the girl-child the right to education in the sub-County. The right to education is well established in international covenants.

Water, Sanitation and Environmental Conservation
People living on Rusinga face a multitude of problems. The island has suffered enormous environmental degradation, soil erosion and extended drought conditions in recent years leaving little productive land and few opportunities to make money other than through fishing . Furthermore, construction activities, deforestation, vegetation clearance and poorly planned infrastructure development has led to an increased abundance of mosquito larval habitats, notably those suitable for malaria-transmitting Anopheles .
Waste disposal equipment or dust-bin is lacking in nearly all households. Many residents of Rusinga Islands throw away waste outside their compounds . Some litters find their way to the lake, a practice that results in water pollution. Rusinga Island’s main source of drinking water is Lake Victoria. The unclean water is the cause of waterborne diseases that are decimating the population and heath of the island. Proper latrines are not available to the small community to replace the inadequate ones present, and the village is without means to safely deposit human waste. Kolunga Beach in Rusinga Island has one latrine facility for every 200 people. The growing problem of trash in the area offers a startling counter to the village’s complete void of trees, having been cut down to be used as cooking fuel
Education for Children
Rusinga Island, western Kenya has one public health centre, three government-run dispensaries and three private clinics . The public health centre and government-run dispensaries are poorly maintained by the county government. The health facilities lack adequate drugs and equipment. The private clinics, on the other hand, are expensive and some of them lack competent and well-trained health practitioners or physicians.
Suba sub-County has 88 primary schools and 17 secondary schools. However, it lacks school infrastructures such as classrooms and toilets . These hinder a number of school children from full participation in learning. The communities living there are too poor to construct classrooms. A few classrooms, however, have been constructed but they are semi-permanent structures of mud and grass thatch. These structures are easily destroyed especially in rainy or windy seasons. During harsh weather highland areas such as Gwassi, where rainfall is very heavy during the rainy seasons, some schools are completely destroyed and children have to attend neighbouring schools.
The poorly constructed schools do not appeal to young children due to the dangers that they harbor. Jiggers have been reported to infest the natural floors found in mud structures and dust, and it is a particular nuisance during dry spells. All these factors make school unappealing to children who then become more attracted to places that they perceive to be more comfortable outside school, for example, beaches and town centres . Some of the most cited problems which hinder children from full participation in school are books and stationary. Text books and stationery and other learning materials are key to classroom participation. Two government health centres serve Rusinga’s population; one in the north-eastern part of the Island and one in Mbita Township .
1.2 Strategic Response
In order to address the strategic issues, VFM will strive towards the following strategic goal and objectives.
1.2.1 Our Strategic Goal
By 2022 VFM will contribute to improved health, protection, participation and well-being of 2,328 most vulnerable children through direct programming.

1.2.1 Our Strategic Objectives
1) Improved equitable access to quality education
2) Improved nutrition for school going children
3) Improved access to quality healthcare
4) Greater access to social and Counselling services
5) Access to Dignified and Sustainable Livelihood and Resilience

1.2.3 Our Strategic Program Focus
VFM six programmatic areas of focus:
a) Improved equitable access to quality education: Interventions aim to make at helping every child under our care to achieve the highest educational standards that he or she possibly can.
b) Improved nutrition for school going children: Interventions aim at enhancing access to proper nutrition in order to enhance nutritional intake, improve enrollment rates and reduce absenteeism. This is geared toward improvement in school performance and higher transition rates.
c) Improved access to quality healthcare: Interventions are geared at strengthening the capacities of duty bearer to provide equitable, accessible and quality services as well as create demand by promoting health seeking behaviours. The interventions endeavour to create awareness and health education to all the target beneficiaries for better health outcomes.
d) Greater access to social and counselling services: Interventions aims at Promoting inter/intrapersonal relationships by providing psychological counselling services and behaviour change support to the children and youths in schools and out of school especially the orphans, expectants school girls and children whose rights have been violated.
e) Sustainable livelihood and Environmental conservation:

the overall objective of this is to promote participation of children, youth and adults in initiatives for adequate food and household income. Specifically the program aims to support communities increase farm production through adoption of good agricultural practices; sensitize and support community initiatives on soil conservation and agro-forestry; strengthen the capacity of communities to seek technical support and devolved funds from the government; strengthen the capacity of farmers to engage in market led production and value addition; and promote access to community based savings and lending opportunities

Hoshi, T., Fuji, Y., Nzou, S.M., Tanigawa, C., Kiche, I., Mwau ,M., et al. (2016). Spatial Distributions of HIV Infection in an Endemic Area of Western Kenya: Guiding Information for Localized HIV Control and Prevention. Retrieved from PLoS ONE 11(2): e0148636.

Olanga, E., Okombo, L., Irungu, L., & Mukabana, W. (2015). Parasites and vectors of malaria on Rusinga Island, Western Kenya. Journal of Biomedical.

Davis, S. et al., (2015). Morbidity Associated with Schistosomiasis Before and After Treatment in Young Children in Rusinga Island, Western Kenya. The American Society of Tropical Medicine and Hygiene

Anyango, M. (2013). Causes and Effects of Early Marriage on the Girl-Child in Suba Sub- County, Western Kenya. University of Nairobi

Onyango, W., Aagaard-Hansen J.,& Jensen B. (2010). The potential of schoolchildren as health change agents in rural western Kenya. Soc Sci Med, 61:1711–1722

Onyango, W., Aagaard-Hansen J.,& Jensen B. (2010). The potential of schoolchildren as health change agents in rural western Kenya. Soc Sci Med, 61:1711–1722

Hoshi, T., Fuji, Y., Nzou, S.M., Tanigawa, C., Kiche, I., Mwau ,M., et al. (2016). Spatial Distributions of HIV Infection in an Endemic Area of Western Kenya: Guiding Information for Localized HIV Control and Prevention. Retrieved from PLoS ONE 11(2): e0148636.

Hoshi, T., Fuji, Y., Nzou, S.M., Tanigawa, C., Kiche, I., Mwau ,M., et al. (2016). Spatial Distributions of HIV Infection in an Endemic Area of Western Kenya: Guiding Information for Localized HIV Control and Prevention. Retrieved from PLoS ONE 11(2): e0148636.

Anyango, M. (2013). Causes and Effects of Early Marriage on the Girl-Child in Suba Sub- County, Western Kenya. University of Nairobi

Vincent, C.C. (2012). Community health care practice in developing countries. Owerri: Springfield Publisher.

Davis, S. et al., (2015). Morbidity Associated with Schistosomiasis Before and After Treatment in Young Children in Rusinga Island, Western Kenya. The American Society of Tropical Medicine and Hygiene