Gender differentials and old age survival in the Nairobi slums, Kenya

Abstract

This paper examines gender differentials in survival amongst older people (50+ years) in the Nairobi slums and to the best of our knowledge is the first study of its kind in an urban African setting. The results provide evidence contrary to the expected paradox of poorer self-rated health yet better survival amongst older women. Older women in the Nairobi slums have poorer self-rated health and poorer circumstances across other factors, including disability and socio-economic status. Further, older women in the slums do not have better survival. The conventional female advantage in mortality only becomes apparent after accounting for the cumulative influence of individual characteristics, social networks, health and socio-economic status, suggesting the female advantage in unadjusted old-age mortality does not apply to contexts where women experience significant disadvantage across multiple life domains. This highlights the urgent need to redress the support, status and opportunities available for women across the life course in contexts such as the Nairobi slums. In addition, a greater number of factors differentiate mortality risk amongst men than amongst women, suggesting inequality amongst slum dwelling older men and highlighting the need for gender sensitive interventions which account for the particular needs of both genders in old age.

Community Drivers Affecting Adherence to WHO Guidelines Against COVID-19 Amongst Rural Ugandan Market Vendors

“…A possible sex difference in vulnerability to COVID-19 needs to be given keen attention. An ongoing survey in urban slums of Kenya suggested that gender differences need to be looked into with regards to COVID-19 ( 16 ). A recent study confirmed the possible gender difference in curbing epidemics in informal settlements ( 15 ).…”

A comparative analysis of disability measures in Cameroonian surveys

“…In addition, the literature shows that men tend to have more complex situations due to their having a combination of disabilities that are more likely to generate activity restrictions [31]. To date, little is known about gender differences in disability in Africa, although recent studies have explored this issue and delivered mixed figures, depending on the context [32–34].…”

Coordinated support for local action: A modeling study of strategies to facilitate behavior adoption in urban poor communities of Liberia for sustained COVID-19 suppression

“…Drawing from data and observations during the Ebola outbreak in Liberia, cases living in slum communities were expected to have greater numbers of contacts, higher transmission rates due to nature of contacts amidst overcrowding, and to seek care after longer delays than those in less socioeconomically vulnerable settings (Distributions in Supplementary Material Tables 1-2). [30] In addition, based on gender-specific trends in aging, out-migration, and mortality in urban slum communities, [24] differential detection and proportions of symptomatic cases with severe disease were assumed between the subpopulations, as described below. Slum communities in Liberia are also characterized by a strong network of informal leaders who held roles in supervising active case finding efforts, conducted by peernominated community members and in coordination with national surveillance efforts, during the Ebola outbreak.…”

“…In particular, selective mortality among slumdwelling adults, combined with trends in out-migration among older adults, has been associated with a higher proportion of females in the 50+ slum-dwelling population in sub-Saharan Africa (SSA). [24] Given the age-dependent gender ratio for severe COVID-19 disease [25,26] --the disease state which most often triggers care-seeking [27] and, in turn, response activities --the concentration of the population in younger age groups and higher proportion female among old age groups could lead to significant undetected, and therefore unsupported, asymptomatic or mildly symptomatic disease in slum communities. This could be further compounded by the higher overall disease burden in slum communities, as mild disease may not be recognized as COVID-19 or perceived as an issue warranting action.…”