Fatal Injuries in the Slums of Nairobi and their Risk Factors: Results from a Matched Case-Control Study

Injuries contribute significantly to the rising morbidity and mortality attributable to non-communicable diseases in the developing world. Unfortunately, active injury surveillance is lacking in many developing countries, including Kenya. This study aims to describe and identify causes of and risk factors for fatal injuries in two slums in Nairobi city using a demographic surveillance system framework. The causes of death are determined using verbal autopsies. We used a nested case-control study design with all deaths from injuries between 2003 and 2005 as cases. Two controls were randomly selected from the non-injury deaths over the same period and individually matched to each case on age and sex. We used conditional logistic regression modeling to identity individual- and community-level factors associated with fatal injuries. Intentional injuries accounted for about 51% and unintentional injuries accounted for 49% of all injuries. Homicides accounted for 91% of intentional injuries and 47% of all injury-related deaths. Firearms (23%) and road traffic crashes (22%) were the leading single causes of deaths due to injuries. About 15% of injuries were due to substance intoxication, particularly alcohol, which in this community comes from illicit brews and is at times contaminated with methanol. Results suggest that in the pervasively unsafe and insecure environment that characterizes the urban slums, ethnicity, residence, and area level factors contribute significantly to the risk of injury-related mortality

Analysis of OpenStreetMap data quality at different stages of a participatory mapping process : evidence from slums in Africa and Asia

This paper examines OpenStreetMap data quality at different stages of a participatory mapping process in seven slums in Africa and Asia. Data were drawn from an OpenStreetMap-based participatory mapping process developed as part of a research project focusing on understanding inequalities in healthcare access of slum residents in the Global South. Descriptive statistics and qualitative analysis were employed to examine the following research question: What is the spatial data quality of collaborative remote mapping achieved by volunteer mappers in morphologically complex urban areas? Findings show that the completeness achieved by remote mapping largely depends on the morphology and characteristics of slums such as building density and rooftop architecture, varying from 84 in the best case, to zero in the most difficult site. The major scientific contribution of this study is to provide evidence on the spatial data quality of remotely mapped data through volunteer mapping efforts in morphologically complex urban areas such as slums; the results could provide insights into how much fieldwork would be needed in what level of complexity and to what extent the involvement of local volunteers in these efforts is required

Effect of HIV status on fertility intention and contraceptive use among women in nine sub-Saharan African countries: Evidence from Demographic and Health Surveys

Background: Expanding access to antiretroviral therapy (ART) means that HIV is no longer a death sentence. This change has implications for reproductive decisions and behaviors of HIV-infected individuals. Design: Using multiple rounds of biomarker data from Demographic and Health Surveys (2004–2012) in nine sub-Saharan African countries, we compare patterns of associations between HIV status and fertility intention and between current use of modern contraception and HIV status in the context of expanding ART coverage. Results: Generally, results show that knowledge of HIV status and proportion of women ever tested for HIV increased substantially between the two surveys for almost all countries. Whereas modern contraceptive use slightly increased, fertility intentions remained relatively stable, except for Rwanda, where they decreased. Results from the two surveys for the nine countries do however indicate that there is no clear consistent pattern of fertility intention and modern contraceptive use behavior by HIV status, with variations observed across countries. However, multivariate analyses show that for Rwanda and Zimbabwe women who were HIV positive, with knowledge of their status, had lower odds of wanting more children. Similarly only in Rwanda (both surveys) were HIV-positive women who knew their status more likely to be current users of contraception compared with women who were HIV negative. The reverse was observed for Zimbabwe. Conclusions: Generally, the results point to the fact that the assumption that reproductive intention and behavior of HIV-positive women will differ compared with that of HIV-negative women may only hold true to the extent that women know their HIV status. Continuous expansion of voluntary counseling and testing services and integration of HIV treatment and care services with reproductive health services are thus warranted

Burden of Reproductive Ill Health

This chapter presents the burden of global reproductive ill health and, where data permit, regional estimates for selected conditions. Ill healthrefers to morbid conditions such as infections and injury and to nonmorbid measures of reproductive health that directly contribute to adverse reproductive health outcomes, including unwanted pregnancies and violence against women. The chapter is organized into six subsections: unintended pregnancies, unsafe abortions, non-sexually transmitted reproductive tract infections (RTIs), infertility, violence against women, and female genital mutilation (FGM). Unintended pregnancies lead to unintended births and induced abortions. Unintended births often occur among young women who are emotionally and physiologically not mature, which has effects on the health of the mother, the pregnancy, and its outcome. Induced abortions in countries where the practice is illegal are often provided in unsafe environments and by untrained personnel, which contribute to the high maternal death from abortion complications. Sexually transmitted infections (STIs) of the reproductive tract receive attention in programming and research, but little attention is focused on other infections that affect fertility and increase the risk of transmission of other infections. Violence against women violates their rights, including limiting access to and use of prevention and treatment services in addition to physical injury and death. FGM causes bodily disfigurement and may present immediate surgical complications and long-term risk of poor reproductive outcomes, especially during delivery

'If you start thinking positively, you won't miss sex': narratives of sexual (in)activity among people living with HIV in Nairobi's informal settlements

Drawing on qualitative data, this paper examines narratives of sexual activity (or the lack thereof) among people living with HIV in two urban poor contexts in Kenya and the ways in which these narratives intersect with the discourse of a ubiquitous HIV-prevention strategy - the 'ABC' (Abstinence, Be Faithful, Condom Use) approach. The exploration of these narratives gives insight into the ways that the notions and meanings around sexual activity are informed and re-shaped by the experience of living with HIV in urban poor settings and into the complex ways in which the components of the ABC approach feature in the lives of PLHIV in these contexts. As the sexuality of people living with HIV in sub-Saharan Africa is an under-researched area, this paper sheds light on the realities of living with HIV in urban poor settings and illuminates the context that informs constructions of sexuality in this milie

Maternal mortality in the informal settlements of Nairobi city: what do we know?

Background: current estimates of maternal mortality ratios in Kenya are at least as high as 560 deaths per 100,000 live births. Given the pervasive poverty and lack of quality health services in slum areas, the maternal mortality situation in this setting can only be expected to be worse. With a functioning health care system, most maternal deaths are avoidable if complications are identified early. A major challenge to effective monitoring of maternal mortality in developing countries is the lack of reliable data since vital registration systems are either non-existent or under-utilized. In this paper, we estimated the burden and identified causes of maternal mortality in two slums of Nairobi City, Kenya.Methods: we used data from verbal autopsy interviews conducted on nearly all female deaths aged 15–49 years between January 2003 and December 2005 in two slum communities covered by the Nairobi Urban Health and Demographic Surveillance System (NUHDSS). In describing the distribution of maternal deaths by cause, we examined maternal and late maternal deaths according to the ICD-10 classification. Additionally we used data from a survey of health care facilities that serve residents living in the surveillance areas for 2004–2005 to examine causes of maternal death.Results: the maternal mortality ratio for the two Nairobi slums, for the period January 2003 to December 2005, was 706 maternal deaths per 100,000 live births. The major causes of maternal death were: abortion complications, hemorrhage, sepsis, eclampsia, and ruptured uterus. Only 21% of the 29 maternal deaths delivered or aborted with assistance of a health professional. The verbal autopsy tool seems to capture more abortion related deaths compared to health care facility records. Additionally, there were 22 late maternal deaths (maternal deaths between 42 days and one year of pregnancy termination) most of which were due to HIV/AIDS and anemia.Conclusion: maternal mortality ratio is high in the slum population of Nairobi City. The Demographic Surveillance System and verbal autopsy tool may provide the much needed data on maternal mortality and its causes in developing countries. There is urgent need to address the burden of unwanted pregnancies and unsafe abortions among the urban poor. There is also need to strengthen access to HIV services alongside maternal health services since HIV/AIDS is becoming a major indirect cause of maternal death