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Abstract Background The government of Kenya is making plans to implement a social health insurance program by transforming the National Hospital Insurance Fund (NHIF) into a universal health coverage program. This paper examines the determinants associated with participation in the NHIF among residents of urban slums in Nairobi city. Methods The study used data from the Nairobi Urban Health and Demographic Surveillance System in two slums in Nairobi city, where a total of about 60,000 individuals living in approximately 23,000 households are under surveillance. Descriptive statistics and multivariate logistic regression analysis were used to describe the characteristics of the sample and to identify factors associated with participation in the NHIF program. Results Only 10% of the respondents were participating in the NHIF program, while less than 1% (0.8%) had private insurance coverage. The majority of the respondents (89%) did not have any type of insurance coverage. Females were more likely to participate in the NHIF program (OR = 2.4; p < 0.001), while respondents who were formerly in a union (OR = 0.5; p < 0.05) and who were never in a union (OR = 0.6; p < 0.05) were less likely to have public insurance coverage. Respondents working in the formal employment sector (OR = 4.1; p < 0.001) were more likely to be enrolled in the NHIF program compared to those in the informal sector. Membership in microfinance institutions such as savings and credit cooperative organizations (SACCOs) and community-based savings and credit groups were important determinants of access to health insurance. Conclusions The proportion of slum residents without any type of insurance is high, which underscores the need for a social health insurance program to ensure equitable access to health care among the poor and vulnerable segments of the population. As the Kenyan government moves toward transforming the NHIF into a universal health program, it is important to harness the unique opportunities offered by both the formal and informal microfinance institutions in improving health care capacity by considering them as viable financing options within a comprehensive national health financing policy framework.

Abstract Background Recent trends in global vaccination coverage have shown increases with most countries reaching 90% DTP3 coverage in 2008, although pockets of undervaccination continue to persist in parts of sub-Saharan Africa particularly in the urban slums. The objectives of this study were to determine the vaccination status of children aged between 12-23 months living in two slums of Nairobi and to identify the risk factors associated with incomplete vaccination. Methods The study was carried out as part of a longitudinal Maternal and Child Health study undertaken in Korogocho and Viwandani slums of Nairobi. These slums host the Nairobi Urban Health and Demographic Surveillance System (NUHDSS) run by the African Population and Health Research Centre (APHRC). All women from the NUHDSS area who gave birth since September 2006 were enrolled in the project and administered a questionnaire which asked about the vaccination history of their children. For the purpose of this study, we used data from 1848 children aged 12-23 months who were expected to have received all the WHO-recommended vaccinations. The vaccination details were collected during the first visit about four months after birth with follow-up visits repeated thereafter at four month intervals. Full vaccination was defined as receiving all the basic childhood vaccinations by the end of 24 months of life, whereas up-to-date (UTD) vaccination referred to receipt of BCG, OPV 1-3, DTP 1-3, and measles vaccinations within the first 12 months of life. All vaccination data were obtained from vaccination cards which were sighted during the household visit as well as by recall from mothers. Multivariate models were used to identify the risk factors associated with incomplete vaccination. Results Measles coverage was substantially lower than that for the other vaccines when determined using only vaccination cards or in addition to maternal recall. Up-to-date (UTD) coverage with all vaccinations at 12 months was 41.3% and 51.8% with and without the birth dose of OPV, respectively. Full vaccination coverage (57.5%) was higher than up-to-date coverage (51.8%) at 12 months overall, and in both slum settlements, using data from cards. Multivariate analysis showed that household assets and expenditure, ethnicity, place of delivery, mother's level of education, age and parity were all predictors of full vaccination among children living in the slums. Conclusions The findings show the extent to which children resident in slums are underserved with vaccination and indicate that service delivery of immunization services in the urban slums needs to be reassessed to ensure that all children are reached.

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 < 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. [ABSTRACT FROM AUTHOR]

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We sought to determine the spatial variation in the use of skilled providers during deliveries across Kenya and the relationship between distance to health facilities and the use of skilled delivery. We found that women who resided 5 km or less from the nearest health facility were more likely to use skilled care at delivery than women residing at greater distances, although the pattern of choice of health facility level for delivery differed at this distance. Outreach maternity services are urgently required in counties with remote communities in order to improve access to skilled attendants during deliveries in these areas. [ABSTRACT FROM PUBLISHER]

Background: Many studies have established a link between weather (primarily temperature) and daily mortality in developed countries. However, little is known about this relationship in urban populations in sub-Saharan Africa. Objectives: The objective of this study was to describe the relationship between daily weather and mortality in Nairobi, Kenya, and to evaluate this relationship with regard to cause of death, age, and sex. Methods: We utilized mortality data from the Nairobi Urban Health and Demographic Surveillance System and applied time-series models to study the relationship between daily weather and mortality for a population of approximately 60,000 during the period 2003-2008. We used a distributed lag approach to model the delayed effect of weather on mortality, stratified by cause of death, age, and sex. Results: Increasing temperatures (above 75th percentile) were significantly associated with mortality in children and non-communicable disease (NCD) deaths. We found all-cause mortality of shorter lag of same day and previous day to increase by 3.0% for a 1 degree decrease from the 25th percentile of 18°C (not statistically significant). Mortality among people aged 50+ and children aged below 5 years appeared most susceptible to cold compared to other age groups. Rainfall, in the lag period of 0-29 days, increased all-cause mortality in general, but was found strongest related to mortality among females. Low temperatures were associated with deaths due to acute infections, whereas rainfall was associated with all-cause pneumonia and NCD deaths. Conclusions: Increases in mortality were associated with both hot and cold weather as well as rainfall in Nairobi, but the relationship differed with regard to age, sex, and cause of death. Our findings indicate that weather-related mortality is a public health concern for the population in the informal settlements of Nairobi, Kenya, especially if current trends in climate change continue. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has affected Bangladesh's economic and social well-being in many ways. Slum dwellers, including day laborers, rickshaw pullers, CNG (Compressed Natural Gas) drivers, housemaids, hawkers, and street vendors, were the worst victims of this pandemic. Besides the voluntary organizations, the City Corporation (urban local government), instructed by the central government, took the initiative to distribute necessary food as well as financial assistance to the city dwellers to survive during the lockdown. The objective of this study is to identify the satisfaction level of slum dwellers with the assistance received from the City Corporation and obtain an idea of whether these supports were enough for them to maintain their livelihood. This is a mixed method research consisting of both qualitative and quantitative approaches. Researchers conducted a field survey in Sylhet City Corporation, in the northeastern part of Bangladesh, and collected primary data from one hundred and fifty-five respondents through a structured questionnaire along with an interview (semi-structured) schedule. Samples were selected by applying a multistage sampling technique. Researchers analyzed quantitative data using SPSS software and qualitative data using the thematic analysis method. Study findings reveal that nepotism, patron–client relation, corruption, unequal treatment, management flaws, low level of community engagement, political consideration, and lack of monitoring were the major issues in providing effective service delivery to slum dwellers during COVID-19. Citizen participation, well coordination, proper monitoring, impersonality, and good governance are indispensable for dealing with any crisis. [ABSTRACT FROM AUTHOR]

This paper investigates the relationship between parental education and child mortality in Madagascar. Until recently, most research linking parental education and child mortality had overlooked the case of Sub-Saharan Africa, despite the region having a high childhood mortality rate and a low association between parental education and child survival. Adopting a careful empirical strategy based on availability of schooling infrastructure and internal instruments, this paper contributes to the literature by analyzing the role of both the father's and mother's education as well as different educational levels. The results demonstrate that children's survival probabilities increase when they have a mother with at least primary schooling. Controlling for wealth reduces the effect of mothers' education by only one-third. In contrast, fathers' education does not play a significant role in child survival. HIGHLIGHTS Parental education is strongly associated with improvements in child health in many countries. Father's education is not a strong determinant of child survival in Madagascar. Higher levels of maternal education increase child survival in Madagascar. Wealth only accounts for one-third of the total effect of maternal education. Increasing education levels especially for women will likely reduce child mortality in future generations. [ABSTRACT FROM AUTHOR]

Overall, about 20 percent or 8.9 million women in Kenya have unmet family planning needs. The total fertility rate as of 2014 was 3.9 births per woman, which did not meet the Kenya National Population Policy for Sustainable Development target rate of 2.5, a rate that was set to help improve the health of women and entire communities. Working with the staff from Nikumbuke-Health by Motorbike (N-HbM), focus groups and in-depth interviews were conducted in June of 2013 in four rural villages of Southeastern Kenya to elucidate the determinants of reproductive health, including the beliefs and attitudes surrounding family planning, and how these translate into behaviors. The study results indicate that there is high knowledge of contraceptive methods among the women in the communities, but this knowledge does not necessarily translate to behavior or contraceptive use. Application of the Social Ecological Model identifies mediators associated with family planning behavior and suggests areas for interventions to meet the communities' unmet family planning needs at the intrapersonal, interpersonal, community, and societal levels. This article outlines the specific recommendations given to N-HbM to translate family planning beliefs and attitudes into behaviors, as well as discusses the global importance of designing family planning programs that improve the health of women and their communities. [ABSTRACT FROM AUTHOR]

Urban populations living in informal settlements are inherently vulnerable to climate change, as informal settlements are characterized by overcrowding, poor-quality housing, lack of basic infrastructure, and poverty. Nevertheless, evidence of the associations among weather or climate and health in these populations is lacking, which severely constrains the design of climate change and disaster risk reduction adaptation strategies. To help fill this gap, this paper is a guide for researchers working on climate and health in informal settlements that summarizes key epidemiological methods and study designs commonly used in environmental health research. We focus on designs that have modest data requirements and that have been used successfully in resource-poor settings. The final section of the paper gives an overview of the current state of evidence about climate change and weather hazards in urban areas, as this is one of the main concerns for policymakers. [ABSTRACT FROM AUTHOR]

Background: There is broad agreement that antenatal care (ANC) interventions, skilled attendance at birth and management of complications arising after delivery are key strategies that can tackle the high burden of maternal mortality in sub-Saharan Africa. In Kenya, utilisation rate of these services has remained low despite a government policy on free maternal care. The present study sought to understand what factors are leading to the low healthcare seeking during pregnancy, child birth and postnatal period in Siaya County in Kenya.Methods: Six Focus Group Discussions were conducted with 50 women attending ANC in 6 public primary healthcare facilities. Participants were drawn from a sample of 200 women who were eligible participants in a Conditional Cash Transfer project aimed at increasing utilization of healthcare services during pregnancy and postnatal period. Interviews were conducted at the health facilities, recorded, transcribed and analysed using thematic analysis.Results: Multiple factors beyond the commonly reported distance to health facility and lack of transportation and finances explained the low utilization of services. Emergent themes included a lack of understanding of the role of ANC beyond the treatment of regular ailments. Women with no complicated pregnancies therefore missed or went in late for the visits. A missed health visit contributed to future missed visits, not just for ANC but also for facility delivery and postnatal care. The underlying cause of this relationship was a fear of reprimand from the health staff and denial of care. The negative attitude of the health workers explained the pervasive fear expressed by the participants, as well as being on its own a reason for not making the visits. The effect was not just on the woman with the negative experience, but spiraled and affected the decision of other women and their social networks.Conclusions: The complexity of the barriers to healthcare visits implies that narrow focused solutions are unlikely to succeed. Instead, there should broad-based solutions that focus on the entire continuum of maternal care with a special focus on ANC. There is an urgent need to shift the negative attitude of healthcare workers towards their clients. [ABSTRACT FROM AUTHOR]