Search

Abstract Background The connection between healthy housing status and health is well established. The quality of housing plays a significant role in infectious and non-communicable as well as vector-borne diseases. The global burden of disease attributable to housing is considerable with millions of deaths arising from diarrheal and respiratory diseases annually. In sub-Saharan Africa (SSA), the quality of housing remains poor although improvements have been documented. There is a general dearth of comparative analysis across several countries in the sub-region. We assess in this study, the association between healthy housing and child morbidity across six countries in SSA. Methods We use the Demographic and Health Survey (DHS) data for six countries where the most recent survey collected health outcome data on child diarrhoea, acute respiratory illness, and fever. The total sample size of 91,096 is used in the analysis (representing 15, 044 for Burkina Faso, 11, 732 for Cameroon, 5, 884 for Ghana, 20, 964 for Kenya, 33, 924 for Nigeria, and 3,548 for South Africa). The key exposure variable is healthy housing status. We control for various factors associated with the three childhood health outcomes. These include quality housing status, residency (rural/urban), age of the head of the household, mother’s education, mother’s BMI status, marital status, mother’s age, and religious status. Others include the child’s gender, age, whether the child is from multiple or single births, and breastfeeding status. Inferential analysis using survey-weighted logistic regression is employed. Results Our findings indicate that housing is an important determinant of the three outcomes investigated. Compared to unhealthier housing, healthy housing status was found to be associated with reduced odds of diarrhoea in Cameroon [Healthiest: aOR = 0.48, 95% CI, (0.32,0.71), healthier: aOR = 0.50, 95% CI,(0.35,0.70), Healthy: aOR = 0.60, 95% CI, (0.44,0.83), Unhealthy: aOR = 0.60, 95% CI, (0.44,0.81)], Kenya [Healthiest: aOR = 0.68, 95% CI, (0.52,0.87), Healtheir: aOR = 0.79, 95% CI, (0.63,0.98), Healthy: aOR = 0.76, 95% CI, (0.62,0.91)], South Africa[Healthy: aOR = 0.41, 95% CI, (0.18, 0.97)], and Nigeria [Healthiest: aOR = 0.48, 95% CI,(0.37,0.62), Healthier: aOR = 0.61, 95% CI,(0.50,0.74), Healthy: aOR = 0.71, 95%CI, (0.59,0.86), Unhealthy: aOR = 0.78, 95% CI, (0.67,0.91)], and reduced odds of Acute Respiratory Infection in Cameroon [Healthy: aOR = 0.72, 95% CI,(0.54,0.96)], Kenya [Healthiest: aOR = 0.66, 95% CI, (0.54,0.81), Healthier: aOR = 0.81, 95% CI, (0.69,0.95)], and Nigeria [Healthiest: aOR = 0.69, 95% CI, (0.56,0.85), Healthier: aOR = 0.72, 95% CI, (0.60,0.87), Healthy: aOR = 0.78, 95% CI, (0.66,0.92), Unhealthy: aOR = 0.80, 95% CI, (0.69,0.93)] while it was associated with increased odds in Burkina Faso [Healthiest: aOR = 2.45, 95% CI, (1.39,4.34), Healthy: aOR = 1.55, 95% CI, (1.09,2.20)] and South Africa [Healthy: aOR = 2.36 95% CI, (1.31, 4.25)]. In addition, healthy housing was significantly associated with reduced odds of fever among children in all countries except South Africa [Healthiest: aOR = 2.09, 95% CI, (1.02, 4.29)] where children living in the healthiest homes had more than double the odds of having fever. In addition, household-level factors such as the age of the household head, and place of residence were associated with the outcomes. Child-level factors such as breastfeeding status, age, and sex, and maternal-level factors such as education, age, marital status, body mass index (BMI), and religion were also associated with the outcomes. Conclusions The dissimilarity of findings across similar covariates and the multiple relations between healthy housing and under 5 morbidity patterns show unequivocally the heterogeneity that exists across African countries and the need to account for different contexts in efforts to seek an understanding of the role of healthy housing in child morbidity and general health outcomes.

Social accountability for water, sanitation and hygiene (WASH) services is a critical component to realising child rights to WASH services by the urban poor, more so in childcare centres. Despite the existence of discrete social accountability mechanisms (SAMs) in informal settlements, informal SAMs rarely form part of strategic approaches to addressing social accountability challenges in access to WASH services in childcare centres. The main objective of the study was to explore informal social accountability mechanisms for WASH in childcare centres in Korogocho and Viwandani informal settlements in Nairobi City County, Kenya. This qualitative study was an ethnography, where we administered governance diaries to 24 participants (parents and childcare managers) for 4 months. Data generated were analysed using a framework analysis derived from a principal-stewardship framework. Parents and centre managers, who are key actors for WASH services in childcare centres in informal settlements, relied on using informal SAMs. We identified three SAMs; (i) discretionary behaviours (rewards and sanctions, interpretation of rules and guidelines and peer mentorship); (ii) norms and values; and (iii) facilitative behaviours. The SAMs were interrelated and operated in synergy for access to WASH service by children in childcare centres. The SAMs for WASH used by parents and childcare owners in childcare centres encountered the following challenges; unrealistic expectations, negligence, conflicting expectations, conflicting agenda and administrative cultures, and tensions over performance standards and monitoring. Identified strategies for strengthening the SAMs included consistency in adhering to rules and guidelines for WASH service provision, and collaboration with strong WASH actors. Data from this study suggest it is valuable to examine and understand SAMs as this then offers clear pathways to mitigate problems and enact change in the WASH service delivery for improved global agenda of SDG 4 and SDG 6. Further, there is potential for joint advocacy for improved WASH services throughout the informal settlement. While SAMs are often conceptualised as a formal process or an intervention, this study shows that existing daily informal SAMs play an important role in promoting or maintaining WASH service delivery. Therefore, WASH stakeholders need to revisit, co-develop and evaluate informal SAMs for WASH service delivery.

Abstract We present novel co-created transdisciplinary research that uses arts and humanities methods to explore air pollution in an informal settlement (Mukuru) in Nairobi, Kenya. Air pollution is a well-documented major human health issue, but despite many air pollution reduction interventions designed to improve health, these are frequently ineffective. Often this is because they fail to account for local knowledge, cultural practices and priorities of the intended recipients. Designing solutions therefore requires in-depth exploration of relevant issues with stakeholders. Researchers worked collaboratively with local residents to develop a range of methods to explore understandings of air pollution including interviews, storytelling, participatory mapping and theatre. Together, we uncovered contrasting definitions of air pollution, differing perceptions of who was responsible for enacting solutions, and overall a view that air pollution cannot be seen in isolation from the other issues faced by settlement residents. The methods used also allowed us to communicate about the topic with a wide audience. While we acknowledge that this research approach is more time consuming than traditional approaches, we urge other researchers wishing to address multifactorial problems, such as air pollution to use a mixture of qualitative, participatory and creative methods to engage with a wide range of stakeholders to elicit new and unexpected understandings that may not otherwise emerge.

Efforts to ensure households transition to modern fuels are expected to reduce household air pollution. However, exposure to toxic particles and gases in fuel stacking households remains under-researched. We implemented a household survey to identify household energy sources and assess exposure to particulate matter with diameter of ≤5 microns (PM2.5), ≤10 microns (PM10) and select polluting gases (Sulfur Dioxide (SO2), Total Volatile Organic Compounds (TVOCs), Carbon Dioxide (CO2), Nitrogen Dioxide (NO2), Carbon Monoxide (CO)) in a rural community. Wood was the main cooking fuel in 94.2% (1615/1703) households with fuel stacking reported in 86.1% (1462/1703) of total households. Daily time-weighted average concentrations of PM2.5 and PM10 were beyond World Health Organization (WHO) limits in wood-using households (189.53 (Standard deviation (SD) = 268.80) µg/m3 and 592.38 (SD = 623) µg/m3, respectively) and Liquid Petroleum Gas (LPG) -using households (57.2 (SD = 53.6) µg/m3 and 189.86 (SD = 168) µg/m3, respectively). Only daily average CO and TVOC concentration in wood-using households exceeded recommended levels. Household socio-economic status, education level of the head of household, use of a separate kitchen and household size influenced household energy choices. Rural households using wood as the main cooking fuel are exposed to high levels of particulate matter, carbon monoxide and total volatile organic compounds. LPG-using households may not realize health benefits if stacking with polluting fuels is practiced.