Browsing by Author "Akeyo, D."

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    Determinants of transitions in water and sanitation services in two urban slums of Nairobi: A multi-state modeling approach
    (Global Epidemiology, 2021) Iddi, S.; Akeyo, D.; Bagayoko, M.; Kiwuwa-Muyingo, S.; Chikozho, C.; Kadengye, D.T.
    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 Na tions, 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 gar bage 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.
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    Determinants of under-fve mortality in informal settlements in Nairobi, Kenya from 2002 to 2018
    (BMC Public Health, 2024) Iddi, S.; Akeyo, D.; Sanya, R.E.; Wamukoya, M.; Asiki, G.
    Background Childhood mortality persists as a significant public health challenge in low and middle-income countries and is uneven within countries, with poor communities such as urban informal settlements bearing the highest burden. There is limited literature from urban informal settlements on the risk factors of mortality. We assessed under-five mortality and associated risk factors from the period 2002 to 2018 in Nairobi urban informal settlements. Methods We used secondary data from the Nairobi Urban Health and Demographic Surveillance System (NUH DSS), a longitudinal surveillance platform that routinely collects individual and household-level data in two informal settlements (Viwandani and Korogocho) in Nairobi, Kenya. We used Kaplan-Meier curves to estimate overall survival and the Cox proportional hazard model with a frailty term to evaluate the impact of risk factors on survival time. Results Overall under-five survival rate was 96.8% and this improved from 82.6% (2002-2006) to 95% (2007-2012) and 98.4% (2012-2018). There was a reduced risk of mortality among children who had BCG vaccination, those born to a married mother or a mother not engaging in any income-generating activity (both from 2007 to 2011), children from singleton pregnancy, children born in Viwandani slum and ethnicity of the child. Conclusion Under-five mortality is still high in urban informal settlements. Targeted public health interventions such as vaccinations and interventions empowering women such as single mothers, those with multiple pregnancies, and more impoverished slums are needed to further reduce under-five mortality in urban informal settlements.