Informal Settlements In Nairobi Research Articles

"I'll take them another day": A qualitative study exploring the socio-behavioral complexities of childhood vaccination in urban poor settlements.

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.

Ethnicity, social connectedness, and the rural-urban food continuum: Food security among urban informal settlement dwellers in Kenya

Rapid urbanization in developing countries is increasingly becoming an important development issue due to its negative effects on poverty and food insecurity in cities. This study investigated the determinants of the food insecurity gap among urban households living in informal settlements in Nairobi, Kenya, and the role of social connectedness and the rural-urban food continuum. Using panel data collected from 385 households using a two-stage cluster sample design, the study applied panel data regression and decomposition models to understand the factors affecting food insecurity access scores and weekly household food consumption expenditure. Descriptive results showed a score of 8.00 for the pooled sample on the household food access scale, with households from other regions having a lower score (7.94) than those from the Western region (8.32). 43 % of households from Western Kenya engaged in farming in rural areas (43 %) and had higher social connectedness (45 %) than households from other regions. The results indicate that dependency ratio, income, savings, social connectedness, rural visits, and dietary knowledge are significant factors impacting food security. Decomposition of levels and change in food insecurity revealed that endowments from the random effects model contributed to reducing the food insecurity gap between households originating from the Western region and those from other regions. The study highlights the importance of considering regional factors and promoting social connectedness and rural-urban linkages in addressing food insecurity in informal urban settlements.

‘Jobless corner campus’: an institutionalised idleness in Kibera, an informal settlement in Nairobi

ABSTRACT The article analyses the so-called institutional idleness observed taking place in Kibera, one of the largest informal settlements in Nairobi, Kenya. The study analyses the notion of idling – a stigmatic term that is internalised by the residents and follows the inhabitants’ reaction to the stigmatisation. Among the internalisation, another form of reaction to the stigmatisation has been identified, characterised by the involvement of the idleness in organisations formed by the residents. Such behaviour has been observed as being accompanied by a certain level of playfulness and irony resulting in what I term institutionalised idleness – a form of non-violent subversive resistance to the authoritative and disciplinary narratives of official institutions of the post-colonial state in Africa. Moreover, the study presents a spatial dimension of institutionalised idleness, allowing the residents of Kibera to secure their informal leisure spaces in the public space of the city, and to therefore challenge the normative thinking about urban living and perceptions of free time. The institutionalised idleness thus represents a strategy providing the inhabitants of informal settlements with wider recognition, however, without losing their safe space within the community.

Beyond a facility: A cross-sectional survey on WASH service levels and informal social accountability in childcare centres in Nairobi's informal settlements

Abstract Access to clean water, sanitation, and hygiene (WASH) services is crucial for a healthy start in life. Social accountability has a potential for enhancing WASH services in childcare centres. However, there are inadequate studies to understand how informal social accountability mechanisms contributes to WASH service provision. To address this gap, we conducted a cross-sectional survey in Korogocho and Viwandani informal settlements in Nairobi, Kenya, to explore the relationship between different levels of WASH services (ranging from basic to limited or nonexistent) and indicators of informal social accountability, including rewards, sanctions, voice, and responsiveness. We employed multinomial regression analysis, utilizing a robust error variance estimator to account for potential biases. Our findings revealed disparities in WASH service provision between the two studied areas, with childcare centres in Korogocho exhibiting higher access to basic WASH services compared to those in Viwandani. Our analysis also highlighted a significant association between informal social accountability mechanisms and the provision of WASH services. Notably, the sanction mechanism exhibited a correlation with all WASH services, suggesting its pivotal role in shaping service delivery outcomes. In light of these findings, it is imperative to prioritize efforts aimed at reinforcing social accountability mechanisms in WASH service delivery frameworks.

Maternal and Umbilical Cord Blood Lead Levels in Selected Informal Settlements in Nairobi, Kenya: A Cross-Sectional Study.

Maternal and Umbilical Cord Blood Lead Levels in Selected Informal Settlements in Nairobi, Kenya: A Cross-Sectional Study.

Predictors of Criminal Involvement by Teenagers Living in Informal Settlement in Nairobi, Kenya: A Case Study of Kibera Slum

Crime is a multifaceted phenomenon caused by a myriad of factors, including social, economic, and psychological factors. This study examined the predictors of criminal behaviour among teenagers in Kibera, Nairobi, Kenya. Kibera is the largest slums in Africa and is characterized by high poverty levels, high crime rates, unemployment rates, and limited access to basic amenities. The prevalence of crime in Kibera slum is marked by theft as the most reported crime and has drawn many teenagers into engaging in illegality as a way of earning a living. Notably, understanding these socio-economic and individual factors that contribute to teenage delinquency in Kibera is instructive in developing effective intervention and prevention strategies. This study was based on two objectives: examining the socio-economic factors and the individual-level factors that influence the adoption of criminal behaviour amongst teenagers in the Kibera slum. The strain theory was used to understand the relationship between the socio-economic and individual-level factors in the Kibera teenagers' context and the adoption of criminogenic behaviour. The case study design was adopted in which data was collected and analysed using qualitative methods. The data was collected from 19 participants, including teenagers, teachers, parents, guardians, and local administration officers. The sample was generated using purposive and snow-balling sampling with the questionnaire and focus group discussion used to collect the data. The study concluded that socio-economic factors influencing criminal behaviour amongst teenagers included access to education, economic instability, family dysfunction, peer pressure, community support, and school policies, while the individual-level factors included mental health issues, genetic variations, and prenatal and perinatal factors. The study recommended the establishment and implementation of programs to cater to economic impoverishment, educational access, role modelling, and mental health issues as necessary for tackling criminality amongst the teenagers in the Kibera slum

Risk for Severe Intimate Partner Violence in Nairobi's Informal Settlements: Tailoring the Danger Assessment to Kenya.

Understanding the risk for severe intimate partner violence (IPV) can help women and providers assess danger. The validated, widely used Danger Assessment (DA) developed for this purpose has not been tested in a low- and middle-income country (LMIC). We tailored the DA to Nairobi, Kenya, and prospectively evaluated baseline danger against severe IPV at 3-month follow-up. We used data from the myPlan Kenya trial conducted in 3 informal settlements in Nairobi, Kenya, from 2017 to 2018. DA items were refined through formative and pilot phases, yielding minor wording modifications. Quantitative analyses prospectively evaluated baseline DA against severe IPV at 3-month follow-up to understand the predictive effect of the (1) original 20-item DA, (2) 16-item Kenya-DA (highest relative risk ratios [RRR] with severe IPV), and (3) 16-item Kenya-DA weighted (weighting based on strength of RRRs). Diagnostic criteria, including C-statistics, sensitivity, specificity, receiver operating characteristic curve, and area under the curve, were examined; logistic regressions quantified the odds of each metric predicting severe IPV at follow-up. The original 20-item DA produced the highest specificity (75.41%) and lowest sensitivity (57.14%), resulting in the overall lowest C-statistic. Compared to the 16-item Kenya-DA, the Kenya-DA weighted produced slightly higher sensitivity (66.67% vs. 64.29%) and specificity (77.05% vs. 72.13%), resulting in the highest C-statistic (0.78 vs. 0.75). All versions successfully predicted severe IPV at 3-month follow-up (original DA: odds ratio [OR]=1.26, 95% confidence interval [CI]=1.12, 1.41, P<.001; Kenya-DA: OR=1.33, 95% CI=1.16, 1.53, P<.001; Kenya-DA weighted: OR=1.19, 95% CI=1.10, 1.28, P<.001). Several factors identified as homicide risk factors in other settings were not prospectively associated with severe IPV. Within a high-danger LMIC context, all 3 DA configurations performed well diagnostically. We recommend the 16-item Kenya-DA given the value for simplicity and field implementation, whereas the Kenya-DA weighted can add accuracy for research purposes.

Resilience Pathways of Informal Settlements in Nairobi: Stasis, Decline, Adaptation, and Transformation

Resilience Pathways of Informal Settlements in Nairobi: Stasis, Decline, Adaptation, and Transformation

MEASURING UNION FORMALIZATION FOR A NEW GENERATION OF FAMILY DEMOGRAPHY: A CASE STUDY FROM URBAN KENYA.

AbstractDespite repeated calls for improved measures of marriage as a process in sub‐Saharan Africa, large‐scale surveys continue to rely on static marital status. As a result, there is an incomplete understanding of the effects of marriage on outcomes of interest. We use qualitative and survey data from a longitudinal study of 1,203 young mothers residing in informal settlements of Nairobi, Kenya, to (1) describe the development of an innovative measure of union formalization (UF) defined as the steps through which a union attains social legitimacy; (2) compare UF with a conventional current marital status measure; (3) examine the distribution of UF steps across union history; and (4) examine the sequence and timing of pregnancy and childbearing within the UF process. We find UF steps indicative of both increasing individualization of marriage and the ongoing importance of kin involvement hold meaning. We demonstrate extensive heterogeneity in the sequence and extent of UF steps completed and interrogate the classification of premarital childbearing using sequence analysis. We argue that measuring UF is feasible and necessary for the next generation of family demography in Africa; UF measures facilitate understanding the linkages among family dynamics, health, and social stratification within the context of ongoing socioeconomic change.

The effect of COVID-19 pandemic on healthcare seeking in an urban informal settlement in Nairobi and a rural setting in western Kenya.

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.

Patterns and drivers of maternal personal exposure to PM2.5 in informal settlements in Nairobi, Kenya

Maternal PM2.5 exposures in informal settlements in Nairobi exceeded WHO air quality targets, with low-quality cooking fuel use identified as the most important non-ambient source.

Effect of post-discharge postnatal educational intervention on postnatal practices among low-income primiparas in Nairobi informal settlements, Kenya: a post-test quasi-experiment

Effect of post-discharge postnatal educational intervention on postnatal practices among low-income primiparas in Nairobi informal settlements, Kenya: a post-test quasi-experiment

A long and winding road of referrals: investigating the relationship between healthcare and integration for Nairobi's urban displaced

This article discusses what integration means in the context of forced displacement, focusing in particular on healthcare access of urban displaced people in Nairobi, Kenya. To do so, it uses a mixed dataset of survey data investigating health and healthcare access for displaced and host respondents in Nairobi's informal settlements Mathare and Kiambiu or Eastleigh South; key informant interviews with healthcare service providers working with displaced people; and finally a case study of a medical pathway taken by a displaced man living in a suburb to Nairobi. His journey demonstrates that documentation, information and language remain challenges specific to the displaced populations, and the importance of utilizing personal support networks, which will not be available to all patients. Notably, this patient's path to treatment brought him to clinics within Nairobi's informal settlements, where healthcare access is often inadequate for its own residents, including both locals and displaced. As such, it shows that where an integrated healthcare system falls short, it can be more beneficial for patients to navigate between the national system and support systems provided for urban refugees.

Teamwork in community health committees: a case study in two urban informal settlements

BackgroundCommunity health committees (CHCs) are mechanisms for community participation in decision-making and overseeing health services in several low-and middle-income countries (LMICs). There is little research that examines teamwork and internal team relationships between members of these committees in LMICs. We aimed to assess teamwork and factors that affected teamwork of CHCs in an urban slum setting in Nairobi, Kenya.MethodsUsing a qualitative case-study design, we explored teamwork of two CHCs based in two urban informal settlements in Nairobi. We used semi-structured interviews (n = 16) to explore the factors that influenced teamwork and triangulated responses using three group discussions (n = 14). We assessed the interpersonal and contextual factors that influenced teamwork using a framework for assessing teamwork of teams involved in delivering community health services.ResultsCommittee members perceived the relationships with each other as trusting and respectful. They had regular interaction with each other as friends, neighbors and lay health workers. CHC members looked to the Community Health Assistants (CHAs) as their supervisor and “boss”, despite CHAs being CHC members themselves. The lay-community members in both CHCs expressed different goals for the committee. Some viewed the committee as informal savings group and community-based organization, while others viewed the committee as a structure for supervising Community Health Promoters (CHPs). Some members doubled up as both CHPs and CHC members. Complaints of favoritism arose from CHC members who were not CHPs whenever CHC members who were CHPs received stipends after being assigned health promotion tasks in the community. Underlying factors such as influence by elites, power imbalances and capacity strengthening had an influence on teamwork in CHCs.ConclusionIn the absence of direction and support from the health system, CHCs morph into groups that prioritize the interests of the members. This redirects the teamwork that would have benefited community health services to other common interests of the team. Teamwork can be harnessed by strengthening the capacity of CHC members, CHAs, and health managers in team building and incorporating content on teamwork in the curriculum for training CHCs.

Sexual Assault Among Young Adolescents in Informal Settlements in Nairobi, Kenya: Findings from the IMPower and SOS Cluster-Randomized Controlled Trial.

Sexual assault is a global threat to adolescent health, but empowerment self-defense (ESD) interventions have shown promise for prevention. This study evaluated the joint implementation of agirls' ESD program and a concurrent boys' program, implemented via a cluster-randomized controlled trial in informal settlements of Nairobi, Kenya, from January 2016 to October 2018. Schools were randomized to the 12-h intervention or 2-h standard of care. Students were randomly sampled to complete surveys at baseline and again at 24months post-intervention. A total of 3263 girls, ages 10-14, who completed both baseline and follow-up surveys were analyzed; weights were adjusted for dropout. At follow-up, 5.9% (n = 194/3263) of girls reported having been raped in the prior 12months. Odds of reporting rape were not significantly different in the intervention versus SOC group (OR: 1.21; 95% CI (0.40, 5.21), p = 0.63). Secondary outcomes, social self-efficacy (OR: 1.08; 95% CI (0.95, 1.22), p = 0.22), emotional self-efficacy (OR 1.07; 95% CI (0.89, 1.29), p = 0.49), and academic self-efficacy (OR: 0.90; 95% CI (0.82, 1.00), p = 0.06) were not significantly different. Exploratory analyses of boys' victimization and perpetration are reported. This study improved on previous ESD studies in this setting with longitudinal follow-up of individuals and independent data collection. This study did not show an effect of the intervention on self-reported rape; findings should be interpreted cautiously due to limitations. Sexual assault rates are high in this young population, underscoring a dire need to implement and rigorously test sexual assault prevention interventions in this setting. The trial was registered with Clinical Trials.gov # NCT02771132. Version 3.1 registered on May 2017, first participant enrolled January 2017.

Effect of mentorship and a mHealth application in updating provider skills and knowledge in maternal and newborn care in two informal settlements of Nairobi

BackgroundChildren and women in urban informal settlements have fewer choices to access quality maternal and newborn health care. Many facilities serving these communities are under-resourced and staffed by fewer providers with limited access to skills updates. We sought to increase provider capacity by equipping them with skills to provide general and emergency obstetric and newborn care in 24 facilities serving two informal settlements in Nairobi. We present evidence of the combined effect of mentorship using facility-based mentors who demonstrate skills, support skills drills training, and provide practical feedback to mentees and a self-guided online learning platform with easily accessible EmONC information on providers’ smart phones.MethodsWe used mixed methods research with before and after cross-sectional provider surveys conducted at baseline and end line. During end line, 18 in-depth interviews were conducted with mentors and mentees who were exposed, and providers not exposed to the intervention to explore effectiveness and experience of the intervention on quality maternal health services.ResultsResults illustrated marked improvement from ability to identify antepartum hemorrhage (APH), postpartum hemorrhage (PPH), manage retained placenta, ability to identify and manage obstructed labour, Pre-Eclampsia and Eclampsia (PE/E), puerperal sepsis, and actions taken to manage conditions when they present. Overall, out of 95 elements examined there were statistically significant improvements of both individual scores and overall scores from 29/95 at baseline (30.5%) to 44.3/95 (46.6%) during end line representing a 16- percentage point increase (p > 0.001). These improvements were evident in public health facilities representing a 17.3% point increase (from 30.9% at baseline to 48.2% at end line, p > 0.001). Similarly, providers working in private facilities exhibited a 15.8% point increase in knowledge from 29.7% at baseline to 45.5% at end line (p = 0.0001).ConclusionThis study adds to the literature on building capacity of providers delivering Maternal and Newborn Health (MNH) services to women in informal settlements. The complex challenges of delivering MNH services in informal urban settings where communities have limited access require a comprehensive approach including ensuring access to supplies and basic equipment. Nevertheless, the combined effects of the self-guided online platform and mentorship reinforces EmONC knowledge and skills. This combined approach is more likely to improve provider competency, and skills as well as improving maternal and newborn health outcomes.

Adolescents’ experience of mistreatment and abuse during childbirth: a cross-sectional community survey in a low-income informal settlement in Nairobi, Kenya

BackgroundAdolescent girls in Africa have poorer maternal health outcomes than older women partly because they are less likely to access antenatal and facility-based delivery care. Mistreatment and abuse of adolescents...

Predictors of quality of childcare centers in low-income settings: findings from a cross-sectional study in two Nairobi slums.

Rapid urbanization and increased women's involvement in paid work have contributed to the upsurge of informal childcare centers, especially in low-income settings where quality is a major issue. However, there are limited data on the factors associated with the quality of childcare centers in informal settlements in Africa. We conducted a quantitative observation and questionnaire survey of 66 childcare centers to identify the factors associated with the quality of childcare services in two informal settlements (Korogocho and Viwandani) in Nairobi. The quality of the centers (outcome variable) was assessed using a locally developed tool. Data on center characteristics including type, size, location, length of operation, charges, and number of staff were collected. Center providers' knowledge, attitude, and practices (KAP) in childcare were assessed through a questionnaire, focusing on nurturing care and business management. Data were described using means and standard deviation or frequencies and percentages. Associations between quality center score (outcome variable) and other variables were examined using multivariable linear regression to identify potential predictors of the quality of the center environment. A total of 129 childcare centers were identified and categorized as home-based (n = 45), center-based (n = 14), school-based (n = 61), and church-based (n = 9). The number of home-based centers was particularly high in Viwandani (n = 40; 52%). Only 9% of home-based centers reported any external support and 20% had any training on early childhood development. Of the 129 centers, 66 had complete detailed assessment of predictors of quality reported here. Unadjusted linear regressions revealed associations between quality of childcare center and center providers' education level, type of center, support received, caregiver-child ratio, number of children in the center, and center providers' KAP score (p < 0.05). However, in the multivariable regression, only higher levels of center provider KAP ( = 0.51; 95% CI: 0.18, 0.84; p = 0.003) and center type ( = 8.68; 95% CI: 2.32, 15.04; p = 0.008) were significantly associated with center quality score. Our results show that center providers' knowledge and practices are a major driver of the quality of childcare centers in informal settlements in Nairobi. Interventions for improving the quality of childcare services in such settings should invest in equipping center providers with the necessary knowledge and skills through training and supportive supervision.

Financing Municipal Water and Sanitation Services in Nairobi's Informal Settlements

Abstract We test two ways to improve revenue collection efficiency for water and sanitation utilities: (i) face-to-face engagement between utility staff and customers and (ii) contract enforcement for service disconnection due to nonpayment in the form of transparent and credible disconnection notices. Engagement has no effect, while enforcement significantly increases payment. We find no effect on access to water, perceptions of the utility, relationships between tenants and property owners, or on tenant mental well-being nine months after the intervention. These results suggest that transparent contract enforcement was effective at improving revenue collection efficiency without incurring significant observed social or political costs.

Early detection of neurodevelopmental disorders in African children living in informal settlements in Nairobi

BackgroundChildren in low-income and middle-income countries (LMICs) are at a substantially increased risk of delayed physical, emotional and sociocognitive outcomes, with consequential neurodevelopmental disorders. Evidence based, cost-effective and culturally appropriate...