Engagement of “Soul Sistaz” in participatory action research: Insights for developing ICT-based SRHR platforms tailored for African adolescents

Intimate partner violence (IPV) harms women physically, sexually, and psychologically. Safety strategies, or harm reduction techniques implemented by women undergoing recurrent violence, may help mitigate the negative health, economic, and social consequences of IPV. This study aimed to understand recommended and utilized safety strategies among three urban informal settlements in Nairobi, Kenya. Semi-structured key informant discussions (KIDs; n = 18) with community-based service providers and focus group discussions (FGDs; n = 49) with IPV survivors were conducted. All interviews were audio-recorded, transcribed, and translated verbatim from Swahili to English. Inductive thematic analysis was used to structure codes. Convergence matrices were used to analyze emergent strategies by data source (service providers vs. IPV survivors). Women preferred safety strategies that they could implement unassisted as first line of harm reduction. Strategies included removing stressors, proactive communication, avoidance behaviors, sexual and reproductive health (SRH), economic, leaving partner for safety, child safety, and securing personal property. Strategies recommended by service providers and utilized by IPV survivors differed, with clear divergence indicated for leaving the abusive relationship, SRH, and personal property strategies. Innovative strategies emerged from IPV survivors for safeguarding property. Similar to upper-income and other low and middle-income contexts, women experiencing IPV in urban informal settlements of Nairobi actively engage in behaviors to maximize safety and reduce harm to themselves and their families. Integration of strategies known to be helpful to women in these communities into community-based prevention and response is strongly encouraged. Increased synergy between recommended and implemented safety strategies can enhance programming and response efforts.

Prevalence of all epilepsies in urban informal settlements in Nairobi, Kenya: a two-stage population-based study

PurposePrevious research, largely from the Global North, reports high rates of common mental health disorders among women in the antenatal period, but there is paucity of such data in contexts like Kenya. This study investigated the prevalence and correlates of depressive and anxiety symptoms among pregnant women in an urban informal settlement in Kenya’s capital – Nairobi.MethodsAn analysis of baseline cross-sectional data from a pilot cluster randomized trial of an integrated early childhood development programme. Participants were pregnant women in their third pregnancy trimester (N = 249), residing in an urban informal settlement in Nairobi County. Mental health measures [(Patient health questionnaire (PHQ-9) and generalized anxiety disorder scale (GAD-7)] were administered alongside other sociodemographic, pregnancy, and health-related questionnaires. Linear regression analysis was performed to investigate correlates of antenatal depressive and anxiety symptoms.ResultsParticipant’s mean age was 27.5 years (SD = 5.6). The prevalence of antenatal depressive and anxiety symptoms was 26.9% (95%CI: 21.4–32.4) and 6.4% (95%CI: 3.4–9.4), based on the PHQ-9 and GAD-7 cut-off scores of ≥ 10 respectively. Being married was a significant correlate for decreased depressive and anxiety symptoms. Higher levels of education (secondary or tertiary), history of three or more previous pregnancies, and an experience of moderate-to-extreme pain were significant correlates for elevated depressive symptoms. Similarly, tertiary level of education, history of four or more previous pregnancies, and experiencing pain were significant correlates for elevated anxiety symptoms for the pregnant women. Participants reporting feeling unwell had significantly higher anxiety symptom scores.ConclusionIn this setting, correlates of antenatal depressive and anxiety symptoms cut across demographic, pregnancy and health-related factors with implications for targeted interventions. Findings point to the need for screening of depression and anxiety as part of routine antenatal care. Further research is needed to understand these contextual correlates.Trial registrationThis study was part of the integrated early childhood development pilot cluster randomised control trial, retrospectively registered in the Pan African Clinical Trial Registry on 26/03/2021, registration number PACTR202103514565914.

The COVID-19 pandemic caused widespread changes and disruptions to healthcare seeking behavior. There are limited studies on the effect of the COVID-19 pandemic on healthcare seeking patterns in low-and middle-income countries (LMICs), especially in settings with inequitable access to healthcare in rural and urban informal settlements. We investigated the effect of the COVID-19 pandemic on reported healthcare seeking at health facilities and chemists using morbidity data from participants in an ongoing population-based infectious disease surveillance platform in Asembo in Siaya County, a rural setting in western Kenya and Kibera, an urban informal settlement in Nairobi County. We described healthcare seeking patterns before (from 1st January 2016 to 12th March 2020) and during the pandemic (from 13th March 2020 to 31st August 2022) by gender and age for any reported illness and select clinical syndromes using frequencies and percentages. We used a generalized estimating equation with an exchangeable correlation structure to assess the effect of the pandemic on healthcare seeking adjusting for gender and age. Overall, there was a 19% (adjusted odds ratio, aOR: 0.81; 95% Confidence Interval, CI: 0.79-0.83) decline in odds of seeking healthcare at health facilities for any illness in Asembo during the pandemic, and a 30% (aOR: 0.70; 95% CI: 0.67-0.73) decline in Kibera. Similarly, there was a decline in seeking healthcare by clinical syndromes, e.g., for ARI, aOR: 0.76; 95% CI:0.73-0.79 in Asembo, and aOR: 0.68; 95% CI:0.64-0.72 in Kibera. The pandemic resulted in increased healthcare seeking at chemists (aOR: 1.23; 95% CI: 1.20-1.27 in Asembo, and aOR: 1.40; 95% CI: 1.35-1.46 in Kibera). This study highlights interruptions to healthcare seeking in resource-limited settings due to the COVID-19 pandemic. The pandemic resulted in a substantial decline in seeking care at health facilities, and an increase of the same at chemists.

Experience of care is typically measured through client exit surveys administered in the facility. Evidence suggests that such measures suffer from courtesy reporting bias whereby respondents do not accurately report on their experiences while in the facility. We explored the presence of courtesy bias by comparing women's reported experience of person-centred maternity care (PCMC) from facility-based client exit surveys to mobile phone-based surveys out of the facility in Nairobi and Lusaka's urban informal settlements. We randomly and independently sampled women in the facilities for either a facility-based survey (n = 233 in Lusaka and n = 112 in Nairobi) or a mobile phone-based survey (n = 203 in Lusaka and n = 300 in Nairobi) within one to two weeks of facility discharge. The questionnaire included a validated PCMC scale. After adjusting for differences in women's characteristics across groups, we compared PCMC scores between facility and phone-based samples. We ran multilevel linear regression models to assess PCMC by survey modality in each city. In both cities, over 70.0% of women were aged 20-34 years and were married, at least two thirds had secondary education, and over 95.0% were unaccompanied during labour/delivery. The overall PCMC score was 69.3% among women surveyed on the phone compared to 70.2% among those surveyed in the facility in Nairobi. In Lusaka, it was 57.5% on the phone compared to 56.8% in-facility. We found no statistically significant differences in PCMC scores between survey modalities in both cities, after adjusting for differences in women's characteristics. We did not detect significant courtesy reporting bias in PCMC in facility-based client exit surveys in the context of urban informal settlements in Nairobi and Lusaka. Experience of PCMC can be measured through in-facility client exit surveys or mobile phone surveys. However, it is critical to address challenges related to a mobile phone-based approach.

Studies in urban informal settlements show widespread inappropriate infant and young child feeding (IYCF) practices and high rates of food insecurity. This study assessed the association between household food security and IYCF practices in two urban informal settlements in Nairobi, Kenya. The study adopted a longitudinal design that involved a census sample of 1110 children less than 12 months of age and their mothers aged between 12 and 49 years. A questionnaire was used to collect information on: IYCF practices and household food security. Logistic regression was used to determine the association between food insecurity and IYFC practices. The findings showed high household food insecurity; only 19.5% of the households were food secure based on Household Insecurity Access Score. Infant feeding practices were inappropriate: 76% attained minimum meal frequency; 41% of the children attained a minimum dietary diversity; and 27% attained minimum acceptable diet. With the exception of the minimum meal frequency, infants living in food secure households were significantly more likely to achieve appropriate infant feeding practices than those in food insecure households: minimum meal frequency (adjusted odds ratio (AOR)=1.26, P=0.530); minimum dietary diversity (AOR=1.84, P=0.046) and minimum acceptable diet (AOR=2.35, P=0.008). The study adds to the existing body of knowledge by demonstrating an association between household food security and infant feeding practices in low-income settings. The findings imply that interventions aimed at improving infant feeding practices and ultimately nutritional status need to also focus on improving household food security.

ABSTRACTAn Escherichia coli strain (sequence type 636) was isolated from an adult residing in an urban informal settlement in Nairobi, Kenya, and was sequenced using the Illumina MiSeq platform. The draft genome was 5,075,726 bp, with a Col(BS512) plasmid plus aph(6)-Id, blaTEM-1B, and dfrA7 genes, which encode kanamycin, ampicillin, and trimethoprim resistance proteins, respectively.

ABSTRACT.Completion of vaccine doses is essential for robust immunity and long-term protection against specific diseases. This study aimed to investigate factors associated with the completion of multidose coronavirus disease 2019 (COVID-19) vaccines (MDVs) among adolescents and adults in two informal urban settlements in Nairobi, Kenya. We analyzed data from the Kenya Multisite Integrated Serosurveillance project. We defined completion of MDV as receiving an additional COVID-19 vaccine dose between weeks 6 and 8 after the first COVID-19 vaccination shot. We applied the modified Poisson regression model with robust standard errors to determine the factors that were independently associated with the completion of MDV. We analyzed data from 402 individuals aged 14–90 years and found that the completion rate for MDV was 85.3%. In the adjusted analysis, participants aged ≥60 years (adjusted prevalence risk ratio [aPR] 1.30, 95% CI 1.05–1.60) and those who recommended the COVID-19 vaccine to others (aPR 1.40, 95% CI 1.00–1.96) were significantly more likely to complete MDV. Individuals aged 25–59 years (aPR 1.22, 95% CI 0.99–1.50), those who perceived themselves as being at risk for COVID-19 (aPR 1.09, 95% CI 0.99–1.19), and those who had access to healthcare during the pandemic tended to have a higher completion of MDV. Overall, the MDV completion rate is relatively high; however, public health interventions should endeavor to target those being left behind such as younger individuals and those hesitant about vaccination.

Safeguarding challenges in global health research include sexual abuse and exploitation, physical and psychological abuse, financial exploitation and neglect. Intersecting individual identities (such as gender and age) shape vulnerability to...

Introduction Service delivery and representation in informal settlements often exhibit a hybrid governance system, encompassing both formal and informal mechanisms. While formal governance structures, such as municipal authorities, are typically emphasized, their absence or inadequacy does not equate to a governance void. Instead, a diverse array of non-state actors, including resident-led initiatives and local service providers, frequently step in to fill the service delivery gaps. These informal actors create a networked governance system through self-organization and collaboration, often responding to the immediate needs of residents. This research aims to uncover and document the nature and dynamics of these informal governance practices within informal settlements in Nairobi, Kenya. By acknowledging and understanding the contributions of these informal actors, we value them and move beyond viewing them as temporary aberrations or unintended consequences of state failure. Methodology This study employed qualitative research methodology, utilizing in-depth interviews with 36 informal service providers operating in the education, healthcare, water, sanitation, and solid waste management sectors. These service providers were selected based on their history of serving vulnerable populations, including older persons, persons with disabilities, and child-headed households, and had been operational for at least eight years. Additionally, four local leaders from two urban informal settlements in Nairobi, Kenya, were interviewed. Data from the transcribed interviews were analyzed using thematic framework analysis, informed by Ostrom’s framework of self-governance, which provides a conceptual lens for understanding the management of common pool resources. Results We identified key crosscutting informal governance strategies in service delivery, including clear boundaries, alignment with local needs, effective resource management, collaborative decision-making, monitoring, appropriate sanctions, conflict resolution, and external recognition. However, challenges such as poor accountability, inadequate leadership, lack of political will, and unclear policies hindered the effectiveness of these informal governance structures. To address these challenges, results uncovered the need to focus on enhancing accountability, strengthening leadership, fostering consensus, clarifying policies, and promoting inclusive participation in service delivery. Conclusion The intricate governance of basic services in informal settlements is largely driven by informal practices and structures. Strengthening these structures alongside recognizing and valuing them is key. By documenting, acknowledging and supporting these informal governance structures, we can create a more equitable and sustainable service delivery systems for residents of informal settlements in Nairobi and beyond.

Despite improvement over recent decades, childhood vaccination uptake remains a concern across countries. The World Health Organization observed that over 25 million children missed out on one or more vaccines in 2021, with urban poor and other marginalized groups being the most affected. Given the higher risk of disease transmission and vaccine-preventable diseases (VPD) outbreaks across densely populated urban slums, identifying effective interventions to improve childhood vaccination in this vulnerable population is crucial. This study explored the behavioral and social factors influencing childhood vaccination uptake in urban informal settlements in Nairobi, Kenya. A grounded theory approach was employed to develop a theoretical account of the socio-behavioral determinants of childhood vaccination. Five focus group discussions (FGDs) were conducted with purposively sampled caregivers of children under five years of age residing in informal settlements. The Theory of Planned Behavior guided the structuring of the FGD questions. An iterative process was used to analyze and identify emerging themes. Thirty-nine caregivers (median age 29 years) participated in the FGDs. From the analysis, four main thematic categories were derived. These included attitude factors such as perceived vaccine benefits, cultural beliefs, and emotional factors including parental love. Additionally, subjective norms, like fear of social judgment, and perceived behavioral control factors, such as self-control and gender-based influences, were identified. Furthermore, a number of practical factors, including the cost of vaccines and healthcare providers attitude, also affected the uptake of vaccination. Various social, behavioral, cultural, and contextual factors influence caregiver vaccination decisions in urban poor settings. Community-derived and context-specific approaches that address the complex interaction between socio-behavioral and other contextual factors need to be tested and applied to improve the timely uptake of childhood vaccinations among marginalized populations.

The objective of this paper is to examine the perceptions of community elders and parents on their roles regarding support to their children’s education. Data come from the qualitative component of a baseline survey conducted in Korogocho and Viwandani, two urban informal settlements in Nairobi, Kenya. Data were collected in April-May 2016 through in-depth interviews, key informant interviews and focus group discussions. Results demonstrated that community elders internalized their role as the face of government in their respective communities, and enforced the implementation of education policies on behalf of all children. The community leaders also saw as part of their role the need to encourage parents to be active participants in their children’s education. Female parents with boys in the program perceived that parental monitoring and follow-up was important to ensure that their children attended school, and completed work assigned by the teachers, more so in Korogocho. Overall, parents recognized the importance of the role they played in their children’s education. This is a good entry point as parental support will ensure the success and sustainability of the intervention to improve educational outcomes for children, which in turn will help their children navigate the challenging period that adolescence presents.

Cholera is a diarrhoeal disease caused by Vibrio cholerae (V. cholerae) bacterium, with strains belonging to serogroups 01 and 0139 causing a huge proportion of the disease. V. cholerae can contaminate drinking water sources and food through poor sanitation and hygiene. This study aimed to identify environmental routes of exposure to V. cholerae within Mukuru informal settlement in Nairobi. We collected nine types of environmental samples (drinking water, flood water, open drains, surface water, shaved ice, raw produce, street food, soil, and public latrine swabs) over 12 months. All samples were analysed for V. cholerae by culture and qPCR, then qPCR-positive samples were quantified using a V. cholerae DNA standard. Data about the frequency of contact with the environment was collected using behavioural surveys. Of the 803 samples collected, 28.5% were positive for V. cholerae by qPCR. However, none were positive for V. cholerae by culture. V. cholerae genes were detected in majority of the environmental water samples (79.3%), including open drains, flood water, and surface water, but were only detected in small proportions of other sample types. Vibrio-positive environmental water samples had higher mean V. cholerae concentrations [2490-3469 genome copies (gc) per millilitre (mL)] compared to drinking water samples (25.6 gc/mL). Combined with the behavioural data, exposure assessment showed that contact with surface water had the highest contribution to the total V. cholerae exposure among children while ingestion of municipal drinking water and street food and contact with surface water made substantial contributions to the total V. cholerae exposure for adults. Detection of V. cholerae in street food and drinking water indicates possible risk of exposure to toxigenic V. cholerae in this community. Exposure to V. cholerae through multiple pathways highlights the need to improve water and sanitation infrastructure, strengthen food hygiene practices, and roll out cholera vaccination.

BackgroundHumanitarian actors have long used the Sphere Handbook and its minimum standards to guide operational practice. The new revision attempts to update these standards partly to address urban crises that have challenged the humanitarian system. Yet, these indicators have never been based on a substantial body of evidence or data from the varied living standards found in cities or specifically informal settlements. This study aims to contextualize the Sphere standards for urban populations by comparing a sample of the revised key indicators to living standards in three urban informal settlements of Nairobi, Kenya, during a non-crisis period to examine their relevance and applicability, and discuss the implications.MethodsRetrospective analysis of data sourced from randomized household surveys of three informal settlements in Nairobi across a range of living standards including a convenience sample of Sphere metrics is quantitatively compared to the newly revised Sphere standards.ResultsThe results show that while some standards are met, many of the urban poor in these settlements live far below the prescribed minimum standards across many key sectors including water, sanitation, shelter, and food security. The data also reveal variations between and within individual informal settlements.ConclusionThe Sphere standards are not informed enough by informality and remain largely aspirational for some populations and consensus rather than evidence-based. The revised handbook has made significant strides in highlighting the need for contextualization, market approaches, and incorporating stakeholder input. The new Sphere standards must be placed into context for use in the new urban agenda realigning humanitarian actions towards more locally contextualized and driven practice.

BackgroundSub-Saharan Africa’s rapid urbanisation has led to the sprawling of urban informal settlements. The urban poorest women are more likely to experience worse health outcomes and poor treatment during childbirth....