Exploring the complex relationship between women’s sanitation practices and household diarrhea in the slums of Nairobi: a cross-sectional study

Abstract

BackgroundDiarrheal disease kills over half a million people each year in sub-Saharan Africa; the majority are children under 5 years. About 58% of diarrhea cases are associated with poor water, sanitation, and hygiene—a critical issue for people living in informal settlements. In Kenya, 60% of Nairobi’s population lives in informal settlements; yet, there is a paucity of research exploring the relationship between water, sanitation and hygiene (WASH) conditions in these settlements and associated health outcomes.MethodsThe study examines characteristics of women’s WASH behaviors and environments as potential factors associated with household diarrhea in Mathare Valley Informal Settlement in Nairobi using cross-sectional survey data collected from 550 women.ResultsApproximately 17% of participants reported that at least one member of the household suffered from diarrhea in the previous 2 weeks—48% of the cases were children under five. Results from a logistic regression exploring factors associated with reports of household diarrhea suggest that women’s sanitation management strategies are associated with recent household diarrhea. Women who use toilets for defecation during the day, but rely on bags, buckets, or open defecation (OD) for urination during the day and for urination and defecation at night have over five time the odds of recent household diarrhea than women who use a toilet for all their sanitation needs. The odds of diarrhea were also higher for participants who walk up to 2 min to reach their toilets/sites for defecation and those who rely on water from taps inside buildings and plots. Odds were 62% lower for participants with clean toilets.ConclusionsFindings suggest that health targets to reduce the prevalence of diarrheal diseases in informal settlements may not be met unless particular attention is paid to the needs of women living in these environments.

Intimate partner violence: A key correlate of women’s physical and mental health in informal settlements in Nairobi, Kenya

“…Environmental factors. Research has shown that lack of access to water and sanitation may be associated with poor health outcomes for women in informal settlements [17,23,25,57,58]. Access to water and sanitation are also used as alternative or additional sociodemographic or wealth measures in these settlements [59,60].…”

COVID-19 related knowledge, attitudes, practices and needs of households in informal settlements in Nairobi, Kenya

“…(8) Slums are characterized by high population density, small informal dwellings, lack of access to clean water, multi-generational households, shared sanitation facilities among multiple households, a high level of both inter-and intra-social mixing within slums and other areas in Nairobi, transient residence, and poor health outcomes related to both poor environmental conditions and inability to pay for medical care. (9)(10)(11)(12)(13) Compared to the rest of Nairobi, slum dwellers have a higher overall mortality rate, (13) higher rates of mobility around Nairobi, (14) and the population is vulnerable to economic shocks, as most residents rely on income from the informal sector. As data suggest a bidirectional relationship between poverty and health exists in these slums, (13) the dual economic and health crises posed by COVID-19 will be particularly dire.…”

Handbook for Gender-Inclusive Urban Planning and Design

“…Since girls and women need to use toilets more often for urination and menstrual hygiene, they often suffer an additional cost burden when accessing pay-per-use toilets and latrines in informal settlements, as noted by Kwiringira et al, (2014) in Uganda. Consequently, they may go without drinking and relieving themselves for long periods of time, or use plastic bags and buckets when they cannot access a toilet, putting them and their families at greater risk of illness (Winter et al, 2019). For women and girls with disabilities these burdens are even more severe, due to physical mobility issues, social Girls and women also perform a number of caregiving tasks that carry severe health risks, often exacerbated by the built environment.…”