Urban Slums In Nairobi Research Articles

Adolescents' dietary patterns, their drivers and association with double burden of malnutrition in adolescents: a cross-sectional study in Kenya's urban slums.

The double burden of malnutrition (DBM) during adolescence is associated with growth and developmental impairment and risk of non-communicable diseases. There is limited evidence on adolescent's dietary patterns (DPs), and how they contribute to DBM in urban low income contexts in sub Saharan Africa. This study assessed DPs of adolescents, their drivers and association with DBM in Kenya's urban slums. Anthropometric, socio-demographic and dietary-intake data were collected through a cross-sectional survey of 621 adolescents from three major urban slums in Nairobi, Kenya. DPs were derived using principal component analysis. Multinomial-logistic-regression was used to assess the association between the DPs, individual and environmental factors and DBM. Two DPs were identified: traditional DP (whole grains/cereals,rice, fruits, legumes/nuts, and water) and transitioning DP (refined cereals (maize/wheat), vegetables, meat, tea/coffee, sweet ultra-processed/deep fried snacks). Adolescents from Mathare (the largest slum) were more likely to adhere to the traditional DP (RRR = 3.43; 95% CI 1.85-6.37). Cultural background (Luo) had a positive association (RRR = 4.28; 95% CI 1.97-9.32), while longer residency in the slum (> 10years) had a negative association (RRR = 0.47; 95% CI0.25-0.90) with transitioning DP. The transitioning DP had a positive (non-linear) association with overweight/obesity in girls (RRR = 2.79; 95% CI 1.16-6.71). The DPs were not associated with thinness or stunting. The DPs indicate various stages of nutrition transition of adolescent diets, which are influenced by cultural background, neighbourhood and duration of stay in the slum. Transitioning DP may expose adolescents to the risks of overweight/obesity in the long-term.

Investigation of Oral Health in Children from Urban Slums of Nairobi, Kenya.

For children living in the urban slums of Nairobi (Kenya), primary health conditions are not guaranteed, and oral diseases add further concern at social and institutional levels beyond the general poverty conditions. This study aims at determining the factors that influence the oral health status of children living in Nairobi slums. A cross-sectional study on school-aged subjects was conducted in June 2022 in three urban slum areas of Nairobi through a pediatric dental screening. The PI (Plaque Index), CPITN (Community Periodontal Index of Treatment Needs), and dmft (decayed, missing, and filled teeth index-deciduous) were considered as primary outcomes of dental health. Multivariate statistical analysis, based on ordinal and zero-inflated negative binomial regression models, was conducted to identify determinants of the oral outcomes in a wide set of potential predictors. A sample of 359 children aged 2-17 was examined. The PI was significantly associated with age, the type of bite, and the use of a toothbrush. The CPITN is influenced by different types of malocclusions, abnormal frenulum, dental trauma, and fluorosis. Dietary habits were found to significantly impact the susceptibility to dental caries. Fluorosis and a dental visit in the last year were highlighted as risk and protective factors, respectively, against higher rates of caries. The oral health features of children living in Nairobi slums are differently affected by socio-demographic conditions, dietary habits, dental characteristics, and oral care practices.

Exposure to violence, adverse life events and the mental health of adolescent girls in Nairobi slums

IntroductionMental health problems rank among the leading causes of disability among young people globally. Young people growing up in urban slums are exposed to adverse childhood experiences, violence, and other adversities. There is limited research on how exposure to violence and adverse life events influence adolescents’ mental health in urban poor settings. This study examines the associations between exposure to violence, adverse life events and self-reported depression in the slums of Nairobi.MethodsThis study draws on data collected from 2106 adolescent girls aged 12–19 years who were interviewed in the third wave of the Adolescent Girls Initiative Kenya (AGI-K). Mental health was measured using the Patient Health Questionnaire (PHQ 9). Frequency distributions, bivariate chi-squared analysis and multi-variate regression models were computed to identify factors that are independently associated with depression.ResultsAbout 13.3% of girls had symptoms of depression based on PHQ 9, 22% reported physical or sexual violence in the past year and about 47% of girls reported exposure to adverse life events in the family in the past year. After adjusting for the effects of socio-demographic factors, exposure to physical violence (AOR = 2.926, 95% CI 2.175–3.936), sexual violence (AOR = 2.519, 95% CI 1.637–3.875), perception of neighborhood safety (AOR = 1.533, 95% CI 1.159–2.028) and experience of adverse life events (AOR = 1.326, 95% CI 1.002–1.753) were significantly associated with self-reported depression. The presence of social support moderated the relationship between violence and mental health by reducing the strength of the association between violence and mental health in this setting.ConclusionGiven the magnitude of violence victimisation, adverse life events and depressive symptoms, there is a need to design interventions that reduce exposure to violence and provide psychosocial support to adolescents exposed to adverse events in urban slums in Nairobi.

Demand and supply-side barriers and opportunities to enhance access to healthcare for urban poor populations in Kenya: a qualitative study

ObjectiveTo explore the barriers to and options for improving access to quality healthcare for the urban poor in Nairobi, Kenya.Design and participantsThis was a qualitative approach. In-depth interviews (n=12), focus...

Mothers' knowledge and practices on breastfeeding and complementary feeding in an urban slum area and rural area in Kenya: A cross-sectional interview study.

Maternal breastfeeding and complementary feeding knowledge is an important determinant of childrens' long-term health and development. This study aims to account for associations between knowledge and practices in Kenya and report the food consumption of children from birth to 18 months. In 2015 mother-child pairs were recruited from Mother-and-Child Health Centers; 415 in an urban slum in Nairobi and 364 in rural Machakos. Knowledge and practice scores were calculated from questionnaire variables and 24-h food frequency questionnaire. The associations of knowledge and practices were studied with regression analysis. Breastfeeding knowledge (Nairobi 6.3/9, Machakos 5.9/9) and practices (Nairobi 7.5/8, Machakos 7.2/8) were good in both areas. Complementary feeding knowledge was not as good (Nairobi 7.5/14, Machakos 7.1/14). Minimum meal frequency was reached by almost 80% of the children but dietary diversity was low (Nairobi 2.7 [SD 1.4], Machakos 2.4. [SD 1.3]). Only 27% of children in Nairobi and 13% in Machakos were fed a minimum acceptable diet. The complementary feeding knowledge score was associated only with minimum dietary diversity in Nairobi (OR: 1.29; 95% CI: 1.105-1.514). Infant and young child feeding knowledge and practices were on a similar level in both areas. Future interventions should focus on improving dietary diversity.

Determinants of transitions in water and sanitation services in two urban slums of Nairobi: A multi-state modeling approach

Access to improved water, sanitation, and hygiene (WASH) services at the household level remains a good strategy to improve the health and well-being of individuals. Informal settlements, such as urban slums, are at risk of the spread of diseases due to the relative lack of access to safe, clean drinking water and basic sanitation, as well as poor hygiene. Global initiatives, such as the Sustainable Development Goals (SDGs) adopted by the United Nations, are aimed at transitioning households and communities from unimproved to sustained improved states of WASH services. To deepen understanding of the time dynamics between states of WASH services in the Nairobi Urban and Demographic Surveillance System (NUHDSS), this study employs the multi-state transition model to assess the influence of potential risk factors on these transitions. Results indicated that study sites, wealth tertile, age of household head, poverty status, the ethnicity of household head, household ownership, and food security were associated with household transitions of WASH services. There was a lower probability for households to transition from unimproved to improved toilet services than the reverse transition, but a higher chance for households to transition from unimproved to improved water and garbage services. The estimated average time that households spent in the unimproved and improved states before transitioning were, respectively, 35 months and 9 months for toilet services, 7 months and 66 months for water services, and 16 months and 19 months for garbage services. Thus, households tend to remain longer in the unimproved state of toilet and garbage services, and when in the improved states, they transition back relatively faster compared to water services. In conclusion, sanitation services in Nairobi informal settings remain largely unsatisfactory as transitions to improved services are not sustained. It is therefore important for governments, policy-makers, and stakeholders to put in place policies and interventions targeting vulnerable households for improved and sustained WASH services.

Effectiveness of a brief psychoeducational intervention on postnatal depression in the slums, Nairobi: a longitudinal study.

Research has shown that postnatal depression (PND) is higher in low- and middle-income countries as compared to higher-income countries. Despite this, little is known about practical interventions in these poorly resourced countries. This research investigated the effectiveness of a brief, prophylactic and therapeutic psychoeducational intervention in a low-resourced community in Nairobi. Two closely similar Maternal and Child Health (MCH) clinics in urban slums in Nairobi were identified and randomly selected. A total of 567 mothers formed the study population. The experimental group (284) mothers received the intervention, which included psychoeducation on PND, coping skills, healthy way of mother/child interaction and infant stimulation in addition to routine treatment, while the control group (283) mothers received treatment as usual. Data was collected using a social-demographic questionnaire and the English version of Becks Depression Inventory (BDI) at baseline. At 6months, we reassessed both groups using BDI only. Within group comparison, the percentage reduction of depression was 35.6% among the experimental as compared to 2.3% in the control group. Between group comparison, the mean BDI depression score was significantly low in the experimental arm compared to the control arm at endline (p = 0.025). When all variables were adjusted, using a generalized linear model, BDI depression score reduction among the participants was significantly associated with the intervention (p = 0.040). A brief, psychoeducational intervention that targets the mother and her infant may reduce PND even in poorly resourced environments. Therefore, it can be integrated into existing MCH services.

Understanding wealth transitions among households in urban slums of Nairobi: A multi-state transition modelling approach

Disparities in wealth are socially undesirable and may result in economic inequalities that have destabilizing effects on communities. Globally, more than 700 million people who live in extreme poverty still struggle for the most basic human needs. It is important to note that poverty is not static as households and individuals may transition from one wealth state to another with the passage of time. As such, the examination of poverty levels at one point does not offer a sufficiently complete picture of the dynamics in states of wealth through the dimension of time. In this paper, we study transitions in wealth status of households in two informal settlements (slums) in Nairobi, Kenya from 2006 to 2015. We employed the multistate transition model to assess the influence of potential risk factors on wealth transitions for households in urban slums. The results of the analysis indicate that slum areas, age of the household head, ethnicity, gender, household ownership type, food security, and household size have an effect on at least one transition between wealth states. A considerable proportion of households still remain in the lowest and middle wealth states. Households were found to easily transition forward, from the lowest to the highest wealth state than the reverse transition. The estimated mean sojourn times for the lowest, middle and highest wealth tertile were approximately 10, 7, and 14 months, respectively. These highlights the need for interventions that reduce the time spent in the lowest and middle wealth tertile while ensuring retention of households in the highest tertile. Our findings underscore the need for policy options around the provision of economic opportunities with targeted attention to households in vulnerable settings.

Long‐Distance Mothering in Urban Kenya

AbstractObjectiveTo explore the long‐distance mothering strategies of migrant women living in urban slums in Nairobi, Kenya.BackgroundThroughout sub‐Saharan Africa, migration has had a profound influence on family life. As women's migration increases, particularly to urban slums, mothers may choose to live apart from children, fostering them to kin. Though fostering is common in many African countries, the unique characteristics of separation due to maternal migration may result in development of long‐distance mothering strategies to maintain mother–child relationships over time and space.MethodForty‐seven in‐depth interviews with mothers living in two Nairobi slums were analyzed to explore key strategies women use to maintain relationships with children who live elsewhere, examining the importance women place on sustaining relationships through financial and emotional support, and whether long‐distance mothering is sufficient.ResultsEfforts to maintain mother–child relationships over time and space are integral to many migrant women's understanding of themselves as mothers. Commitments to provide financially, as well as frequent communication and visits to ensure emotional well‐being of children, are described as key strategies to sustain relationships, whether separations are short term or permanent. For many mothers, however, these long‐distance efforts are viewed as insufficient forms of mothering, even in a context where child fostering is relatively normalized.ConclusionThese long‐distance strategies may reflect a more nuanced approach to fostering or greater flexibility in fostering arrangements when mothers migrate, where frequent contact and financial support play an important role in maintaining mother–child relationships rather than shifting emotional and financial care to foster parents.

Examining gender differences in adult mortality mediated by household poverty in two urban slums of Nairobi

In sub-Saharan Africa, adult mortality estimates mainly obtained from nationally representative surveys such as Demographic and Health Surveys show discrepancies in all-cause mortality between men and women. It is important to understand factors that explain these differences. Using data for adults aged ≥15 years from the Nairobi Urban Demographic Health Surveillance System (NUHDSS), this study assesses whether gender differences in all-cause mortality are mediated through household poverty. We used the generalised structural equation model, a unified framework that allows to calculate both direct and indirect effects of exposure on outcome. Results show that overall mortality rates in 151,865 individuals were 32.9 and 28.4 per 100 person years among men and women, respectively during median(IQR) follow-up of 7.3 (3.7, 10.6) years. The effects of gender on mortality decreased with age. We observed a male versus female aOR 1.39 [95% CI (1.25, 1.53)] which represents a higher odds of dying among men compared to women in the 15–35 age group, but lower odds of dying in the age group 35–60 years and >60 years, aOR 0.90 [95% CI (0.81, 0.99)], aOR 0.91 [95% CI (0.73, 1.12)], respectively. We estimated the direct effect of gender on mortality mediated through household poverty but the mediated effects were marginal.All estimates are adjusted for age, slum area, education level and ethnicity. In summary, differences in mortality between men and women decrease with age, and partly are mediated by household poverty. Given that differences in mortality between men and women who share the same household decreases with age, it is essential for future interventions aimed at reducing the gap in gender mortality particularly in older age groups, to consider other factors that interact with poverty.

Associated factors of pregnancy loss in two urban slums of Nairobi: A generalized estimation equations approach

Complications often arise during pregnancy leading to unfavorable pregnancy outcomes such as stillbirths, abortions/miscarriages, and neonatal losses placing a substantial burden on families, communities, and the health care system. In this study, we estimate pregnancy loss and identify associated factors that drive pregnancy loss among women in two urban slums in Nairobi. In order to estimate the population-level effects of risk factors on pregnancy loss, we use the generalized estimation equation (GEE), which also allows us to account for the clustering of deliveries within pregnant women. From 2003 to 2016, the rate of pregnancy loss was 16 per 1000 deliveries (7 per 1000 and 9 per 1000 for stillbirth and miscarriages, respectively). Pregnancy loss was 6% less likely among pregnant women in Viwandani as compared to Korogocho, for a unit increase in years while holding other factors constant [i.e adjusted odds ratio (AOR) of 0.9429, 95% confidence interval (CI) of (0.9006, 0.9872)]. In addition, the study found that for a unit change in gravidity, the odds of experiencing pregnancy loss was 16% less among women in the lowest wealth tertile compared to women in the highest wealth tertile. Also, the odds of pregnancy loss was 6% more for a unit increase in women's age [AOR: 0.8425; 95% CI: (0.7134, 0.9949)]. Currently married and previously married pregnant women were, respectively, thrice and twice more likely to lose pregnancy compared to never-married women [AOR: 3.0180; 95% CI: (1.6930, 5.3798)]. In conclusion, advanced maternal age and being married were found to be strongly associated with the risk of pregnancy loss. The association between pregnancy loss and wealth tertile depends on the level of gravidity of the women. Identification of risk factors associated with pregnancy loss in slum settings can aid in public health programming and designing interventions to ensure safer pregnancy for women. Further research is required to investigate possible hidden factors affecting pregnancy loss for women with higher gravidity in the highest household wealth tertiles.

Trends and determinants of health facility childbirth service utilization among mothers in urban slums of Nairobi, Kenya

High maternal mortality remains a challenge for the attainment of the third Sustainable Development Goal in Sub-Saharan Africa. In Kenya, maternal mortality ratio remains high at 362 deaths per 100,000 live births. Utilization of health facility childbirth services ensures safe birth and is vital for the reduction of maternal mortality. However, this can be greatly affected by socioeconomic and geographical inequalities. In this study, we assess the trends and determinants of health facility childbirth service utilization among women giving birth in the urban slums of Nairobi, Kenya. Data were obtained from the Nairobi Urban Health and Demographic Surveillance System (NUHDSS) comprising 19,469 births observed between 2003 and [19]. A logistic regression model, with parameter estimation using a generalized estimating equations (GEE) approach, was used to assess factors associated with health facility childbirth. About 81% of the births occurred at health facilities while 19% were occurring at home or outside a health facility. The results further indicated that, education, parity, and relationship to head of households were associated with health facility childbirth. Increasing awareness of the mothers about the benefits of health facility childbirth service utilization and the risks of home childbirth should be given extra attention by health practitioners during antenatal care visits.

Containing the High Incidence of COVID-19 in the Urban Slums of Nairobi: The Case of Kibera

Globally, urban slums (in most cases, informal settlements) have been hit badly by novel coronavirus (COVID-19). The reasons for this include the cramped living conditions that make social distancing impossible, and high levels of poverty and unemployment that make masks and clean water for hand washing unaffordable to many slum residents. This paper makes the case for upgrading Kibera, which is long overdue. The United Nations General Assembly endorsed the upgrading of urban slums as a priority Sustainable Development Goal in 2015. To win the war against coronavirus in Kibera, the Government should adopt a bottom-up approach, using the existing community leadership and youth groups, as opposed to a top-down approach. Given the increasing number of positive cases of coronavirus in Kibera, the Government must apply a selective lockdown, as it did in Eastleigh, Mandera and old town Mombasa. Winning the war in Kibera ultimately depends not only on Government efforts, but also on the commitments of local communities and individual residents.

Are Malnourished Children Hungry? Use of the International Complementary Feeding Assessment Tool (ICFET) to Describe Diet and Eating Behavior

Abstract Objectives Undernutrition risk increases when children transition to complementary feeding in lower/middle income countries. Our newly developed ICFET assesses feeding and eating behavior (FEB); we aimed to test its performance in different countries and assess FEB in wasted and healthy infants. Methods Healthy and malnourished children aged 6–24 months were sampled from child health and malnutrition clinics in urban slums in Nairobi, Kenya (n = 157), peri-urban Lahore, Pakistan (n = 108), rural Retalhuleu, Guatemala (n = 125) and playgroups in Glasgow, United Kingdom (UK, n = 97). Children were measured and parents surveyed using the ICFET, which comprises standardized questions on meal frequency and self-feeding, and 5-point scores for enthusiasm for eating (Avidity), food refusal (Avoidance) and Force-feeding. Results Of 487 children, mean (SD) age 14.2 (5.3) months, 77 (16%) were wasted (body mass index < −2SD). Complementary feeding started earliest in the UK, with 91% starting before 6 m, and latest in Pakistan, where 27% started ≥ 8 m. In 336 healthy weight children, median (Q1, Q3) Avidity was higher (3.67; 2.8–4.2) than Avoidance (2.0; 1.6–2.6); Kenyan children had highest avoidance (2.4; 1.8–3.0) and Pakistani children lowest avidity (2.2; 2–2.8). Force feeding was rare in the UK (17%) and Guatemala (15%), but common in Pakistan (76%) and Kenya (82%). In LMIC children, wasted infants had lower median Avidity (2.7) than healthy (3.5; P < 0.001), but similar Avoidance and Force-feeding. Healthy children were offered 3 (2–3) plated meals and 1 (0–3) energy dense snacks daily. Compared to healthy, wasted children had fewer meals (2; vs 3; P = 0.006) and more milk (3 vs 2; P = 0.016). Conclusions Malnourished children were less hungry and ate fewer meals, but still refused food. The ICFET identified between country variation in complementary feeding behavior. It will be valuable for the identification of poor feeding and eating practices and informing intervention. Funding Sources Scottish Funding Council (Global Challenges Research Fund).

Group Intervention for Adolescent Anxiety and Depression: Outcomes of a Randomized Trial with Adolescents in Kenya

Youth mental health interventions in low-resource communities may benefit from including empirically supported elements, using stigma-free content, and using trained lay-providers. We developed and evaluated such an intervention, targeting adolescent depression and anxiety in Kenya, where mental health care is limited by social stigma and a paucity of providers. Kenyan adolescents (N = 51, ages 14–17, 60.78% female) from a school in an urban slum in Nairobi with self-reported moderate-to-severe symptoms of depression or anxiety were randomized to the 4-week “Shamiri” (“thrive”) group intervention or a study skills control intervention of equal duration. The Shamiri intervention included growth mindset, gratitude, and value affirmation exercises. The content was delivered by recent high school graduates (ages 17–21, 60% male) trained as lay-providers. Participants met in school once-a-week in groups of 9–12 youths (average group size 10). Compared to the study-skills control, Shamiri produced greater reductions in adolescent depression symptoms (p = .038; d = .32) and anxiety symptoms (p = .039; d = .54) from baseline to 4-week follow-up, and greater improvements in academic performance (p = .034; d = .32) from the school-term before versus after the intervention. There were no effects on overall social support or perceived control, but the Shamiri group showed larger increases in perceived social support from friends (p = .028, d = .71). This appears to be the first report that a brief, lay-provider delivered, community-based intervention may reduce internalizing symptoms and improve academic outcomes in high-symptom adolescents in Sub-Saharan Africa. Larger replications with extended follow-ups will help gauge the strength and durability of these effects.

Secure land tenure for urban slum-dwellers: A conjoint experiment in Kenya

Until recently, improving land tenure security has been an integral part of slum upgrading initiatives aimed at improving living conditions in urban slums. However, there is limited empirical evidence on whether slum dwellers find housing options with improved tenure security preferable and whether they can afford such options. This study identifies the causal effects of improving land tenure security on slum dwellers' preferences and abilities to afford alternative, upgraded housing options. To this end, it employs a conjoint experiment embedded in a public opinion survey on a sample of 3,715 respondents from five urban slums in Nairobi and its outskirts. Our experiment has three main findings. First, slum dwellers prefer a more secure land tenure type rather than contested land when considering where to live, but this preference depends on the respondents' informal settlement, occupation, and stated reasons for living in the slum. Second, improvement of land tenure security has almost no influence on slum dwellers' abilities to afford upgraded housing options. Instead, the cost of rent is the most important factor determining affordability. Finally, slum dwellers' preferences and affordability frequently do not overlap. For instance, over half (56%) of the respondents who prefer the housing option with a more secure land tenure type—that is, land with clear ownership—over contested land are unable to afford it. Therefore, improving land tenure security alone will have limited success in helping slum dwellers transition to housing options with improved living conditions. Instead of one-size-fits-all land formalization policies aiming at improving land tenure security, policies should be designed specifically for each informal settlement to address its residents’ unique needs and interests.

Microbial Source Tracking Using 16S rRNA Amplicon Sequencing Identifies Evidence of Widespread Contamination from Young Children's Feces in an Urban Slum of Nairobi, Kenya.

Child exposure to fecal contamination remains common in low- and middle-income countries after sanitation interventions. Unsafe disposal of children's feces may contribute to this continued exposure, but its relative importance to domestic fecal contamination is not well understood. To address this gap, we interviewed and collected environmental samples (drinking water, caregiver hands, child hands, surfaces, soil, open drainage ditches, standing water, streams) from 40 households in Kibera, an urban slum in Nairobi, Kenya. To track young children's feces (<3 years old) separately from other human-associated fecal sources, we validated distance-based and Bayesian (SourceTracker) microbial source tracking methods using amplicon-based sequencing of the 16S rRNA gene. Contamination by young children's feces could be identified and distinguished separately from older child/adult feces with high sensitivity and specificity in water and soil. Among environmental samples, young children's feces were almost always identified as the dominant source of human fecal contamination inside households (hands, surfaces) whereas older children/adult feces were often identified as the dominant source outside households (standing water, streams, soil). Markers for young children's feces were also detected in standing water and streams, and markers for both fecal sources were equally likely to be dominant in open ditches. These results establish motivation for sanitation interventions that directly address child feces management.

Exposure to Outdoor Particles (PM2.5) and Associated Child Morbidity and Mortality in Socially Deprived Neighborhoods of Nairobi, Kenya

Exposure to air pollution is associated with adverse health outcomes. However, the health burden related to ambient outdoor air pollution in sub-Saharan Africa remains unclear. This study examined the relationship between exposure to outdoor air pollution and child health in urban slums of Nairobi, Kenya. We conducted a semi-ecological study among children under 5 years of age from two slum areas and exposure measurements of particulate matter (PM2.5) at the village level were aligned to data from a retrospective cohort study design. We used logistic and Poisson regression models to ascertain the associations between PM2.5 exposure level and child morbidity and mortality. Compared to those in low-pollution areas (PM2.5 &lt; 25 µg/m3), children in high-pollution areas (PM2.5 ≥ 25 µg/m3) were at significantly higher risk for morbidity in general (odds ratio (OR) = 1.25, 95% confidence interval (CI): 1.11–1.41) and, specifically, cough (OR = 1.38, 95% CI: 1.20–1.48). Exposure to high levels of pollution was associated with a high child mortality rate from all causes (IRR = 1.22, 95% CI: 1.08–1.39) and respiratory causes (IRR = 1.12, 95% CI: 0.88–1.42). The findings indicate that there are associated adverse health outcomes with air pollution in urban slums. Further research on air pollution health impact assessments in similar urban areas is required.

Sociodemographic and behavioural factors associated with body mass index among men and women in Nairobi slums: AWI-Gen Project

ABSTRACTBackground: Body mass index (BMI) is rising globally with a faster increase in urban areas in low- and middle-income countries. It is critical to identify modifiable risk factors for BMI to prevent the occurrence of associated health consequences.Objective: To investigate socio-demographic, behavioural and biological factors associated with BMI in Nairobi slums.Methods: In 2014-2015, a cross sectional study of men and women aged 40–60 years in Nairobi slums (Korogocho and Viwandani) was conducted. Data were collected on socio-demographic, behavioural and biological characteristics. Mean BMI, overweight and obesity were computed. Hierarchical multiple linear regression analysis was conducted separately for men and women to explore factors associated with BMI.Results: In total, 1942 study participants (54.4%, women) with a mean age (SD) of 48.3 (5.3) years and 48.8(5.6) years for women and men respectively were recruited. Mean BMI was higher among women than men (27.6 versus 22.8; p < 0.001). More women were overweight (30.9% versus 19.6%; p < 0.001) and obese (32.1% versus 5.1%; p < 0.001) than men. Among men, BMI was independently associated with wealth index, bread consumption and self-reported diabetes and was negatively associated with current tobacco smoking, HIV and TB infections. Among women, BMI was independently associated with wealth, current non-problematic drinking, and sedentary time, but was lower among other ethnicities compared to Kikuyu, among current smokers, women with longer sleep, and those with HIV infection and tuberculosis. Wealth index contributed the most variance in BMI among women and men (10.4%, 7.5%, respectively), but behavioural factors (7.4%) among men and biological factors (6.5%) among women accounted for most of the additional BMI variance.Conclusions: Adults aged 40–60 years in the urban slums of Nairobi have a high BMI associated with wealth. Bread consumption by men and sedentary life among women are the main risky behaviours that need urgent targeted interventions.

Support to Children’s Education in the Urban Slums of Nairobi: Community and Parents’ Perceptions with an Expanded Phase of an Education Intervention Program

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.