Adolescent sexual behaviour in Navrongo: Does family count?

Student Number: 0516329A - MSc research report - School of Public Health - Faculty of MedicineIn the face of diminishing traditional controls on adolescent sexual behaviour, parents are becoming the focal point of guidance on sexual issues. The main objective of the study is to establish if residing with one’s parents has any effect on one’s sexual behaviour among adolescents in the Kassena-Nankana District of Northern Ghana. A sample of 7056 adolescents aged between 10 and 24 years were interviewed between April and October 2003 while the 2004 household socio-economic data was used to generate a household wealth index. Females are less likely to have had sex (AOR 0.75; CI: 0.63; 0.88) and also less likely to initiate sex before age 16 (AOR 0.30; CI: 0.21; 0.43) compared to males. Living with one’s father only is associated with a 36% decrease in the likelihood of having had sex among males (AOR 0.64; CI: 0.42; 0.96) compared to living with both parents. Females living with neither parent were 76% more likely to have had sex than those living with both parents (AOR 1.76; CI: 1.21; 2.55). Discussion of sexual matters with parents increased the likelihood of initiating sex. Family structure is an important predictor of sexual behaviour among adolescents and therefore should be considered when designing and implementing interventions. Longitudinal and qualitative studies are recommende

Hunger and Food Insecurity in Nairobi's Slums: An assessment using IRT models'

Although linked to poverty as conditions reflecting inadequate access to resources to obtain food, issues such as hunger and food insecurity have seldom been recognized as important in urban settings. Overall, little is known about the prevalence and magnitude of hunger and food insecurity in most cities. Yet, in sub-Saharan Africa where the majority of urban dwellers live on less than one dollar a day, it is obvious a large proportion of the urban population must be satisfied with just one meal a day. This paper suggests using the one- and two-parameter item response theory (IRT) models to infer a reliable and valid measure of hunger and food insecurity relevant to low income urban settings, drawing evidence from the Nairobi Urban Health and Demographic Surveillance System (NUHDSS). The reliability and accuracy of the items are tested using both the Mokken Scale Analysis and the Cronbach test. The validity of the inferred household food insecurity measure is assessed by examining how it is associated with households? economic status. Results show that food insecurity is pervasive amongst slum dwellers in Nairobi. Only one household in five is food secure, and nearly half of all households are categorized as ?food insecure with both adult and child hunger?. Moreover, in line with what is known about household allocation of resources, evidence indicates that parents often forego food in order to prioritize their children. (229 words)Food insecurity; Hunger; Sub-Saharan Africa; Slum; Nairobi

Migration and sexual behaviour among youth in Nairobi’s slum areas

Migration remains an important event in the urbanization process. However, research evidence indicates that migration is associated with negative outcomes. For migrant youth, migration often coincides with leaving home and divesting of parental authority and controls. This study investigates migration as a determinant of risky sexual behaviours and the factors influencing the timing of first sex among migrant youth. We used data collected between 2006 and 2008 from youth aged 12-22 years living in two slums in Nairobi. We use Cox proportional hazards model for timing of first sex among migrants and logistic regression for determinants of risky sexual behaviour. Migration is important for number of sexual partners but not for sexual debut. The risk of initiating first sex soon after in-migration is higher for youth with problem behaviour. Among adolescents in Nairobi’s slums, migration is not associated with a higher risk of engaging in risky sexual behaviour. However, youth with problem behaviour face a higher risk of initiating sex soon after migration

Status report on the sexual and reproductive health of adolescents living in urban slums in Kenya

This report highlights the sexual and reproductive health (SRH) challenges faced by adolescents living in slums in Nairobi, Kenya, as well as the perceptions and strategies that adolescents adopt to deal with each of these challenges. The results point to the fact that there is a range of experiences among adolescents with regard to knowledge, attitudes, and behaviors. Age, education, and marital status were often strongly associated with certain adolescent sexual and reproductive health experiences, highlighting the fact that targeted programs are needed to reach adolescents with SRH services at different stages of need. Consistent and persistent poverty reduction strategies must be considered alongside SRH services; as well as holistic programs that consider the relationship between health and environment, to address the complex web of factors that contribute to SRH

Community perceptions of air pollution and related health risks in Nairobi Slums.

Abstract: Air pollution is among the leading global risks for mortality and responsible for increasing risk for chronic diseases. Community perceptions on exposure are critical in determining people's response and acceptance of related policies. Therefore, understanding people' perception is critical in informing the design of appropriate intervention measures. The aim of this paper was to establish levels and associations between perceived pollution and health risk perception among slum residents. A cross-sectional study of 5,317 individuals aged 35+ years was conducted in two slums of Nairobi. Association of perceived score and individual characteristics was assessed using linear regression. Spatial variation in the perceived levels was determined through hot spot analysis using ArcGIS. The average perceived air pollution level was higher among residents in Viwandani compared to those in Korogocho. Perceived air pollution level was positively associated with perceived health risks. The majority of respondents were exposed to air pollution in OPEN ACCESS Int. J. Environ. Res. Public Health 2013, 10 4852 their place of work with 66% exposed to at least two sources of air pollution. Less than 20% of the respondents in both areas mentioned sources related to indoor pollution. The perceived air pollution level and related health risks in the study community were low among the residents indicating the need for promoting awareness on air pollution sources and related health risks

Using a co-created transdisciplinary approach to explore the complexity of air pollution in informal settlements

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.Additional co-authors: Charlotte Waelde, Anna Walnycki, Megan Wainwright, Jana Wendler, and Mike Wilso

Monitoring of Health and Demographic Outcomes in Poor Urban Settlements: Evidence from the Nairobi Urban Health and Demographic Surveillance System

The Nairobi Urban Health and Demographic Surveillance System (NUHDSS) was set up in Korogocho and Viwandani slum settlements to provide a platform for investigating linkages between urban poverty, health, and demographic and other socioeconomic outcomes, and to facilitate the evaluation of interventions to improve the wellbeing of the urban poor. Data from the NUHDSS confirm the high level of population mobility in slum settlements, and also demonstrate that slum settlements are long-term homes for many people. Research and intervention programs should take account of the duality of slum residency. Consistent with the trends observed countrywide, the data show substantial improvements in measures of child mortality, while there has been limited decline in fertility in slum settlements. The NUHDSS experience has shown that it is feasible to set up and implement long-term health and demographic surveillance system in urban slum settlements and to generate vital data for guiding policy and actions aimed at improving the wellbeing of the urban poor

Developing a programme theory for a transdisciplinary research collaboration: Complex Urban Systems for Sustainability and Health

Background: Environmental improvement is a priority for urban sustainability and health and achieving it requires transformative change in cities. An approach to achieving such change is to bring together researchers, decision-makers, and public groups in the creation of research and use of scientific evidence. Methods: This article describes the development of a programme theory for Complex Urban Systems for Sustainability and Health (CUSSH), a four-year Wellcome-funded research collaboration which aims to improve capacity to guide transformational health and environmental changes in cities. Results: Drawing on ideas about complex systems, programme evaluation, and transdisciplinary learning, we describe how the programme is understood to “work” in terms of its anticipated processes and resulting changes. The programme theory describes a chain of outputs that ultimately leads to improvement in city sustainability and health (described in an ‘action model’), and the kinds of changes that we expect CUSSH should lead to in people, processes, policies, practices, and research (described in a ‘change model’). Conclusions: Our paper adds to a growing body of research on the process of developing a comprehensive understanding of a transdisciplinary, multiagency, multi-context programme. The programme theory was developed collaboratively over two years. It involved a participatory process to ensure that a broad range of perspectives were included, to contribute to shared understanding across a multidisciplinary team. Examining our approach allowed an appreciation of the benefits and challenges of developing a programme theory for a complex, transdisciplinary research collaboration. Benefits included the development of teamworking and shared understanding and the use of programme theory in guiding evaluation. Challenges included changing membership within a large group, reaching agreement on what the theory would be ‘about’, and the inherent unpredictability of complex initiatives

Air pollution in Nairobi slums : sources, levels and lay perceptions

Background Air quality in Africa has remained a relatively under-researched field. Most of the African population is dependent on biomass for cooking and heating, with most of the combustion happening in low efficiency stoves in unvented kitchens. The resulting high emissions are compounded by ingress from poor outdoor air in a context of poor emissions controls. The situation is dire in slum households where homes are crowded and space is limited, pushing households to cook in the same room that is used for sleeping. This study assessed the levels of particulate matter with aerodynamic diameter £ 2.5 microns (PM2.5) in slum households and people's perceptions of and attitudes towards air pollution and health risks of exposure in two slum areas, Viwandani and Korogocho, in the Nairobi city. Methods The study employed both qualitative and quantitative methods. For the quantitative study, we used structured questionnaires to collect data about the source of air pollution among adults aged 18 years and above and pregnant women residing in the two study communities. We used the DustTrak™ air samplers to monitor the indoor PM2.5 levels in selected households. We also collected data on community perceptions on air pollution, annoyance and associated health risks. We presented hotspot maps to portray the spatial distribution of perceptions on air pollution in the study areas. For the qualitative study, we conducted focus group discussions with adult community members. Groups were disaggregated by age to account for different languages used to communicate with the younger and older people. We analysed the qualitative data using thematic analysis. Results Household levels of PM2.5 varied widely across households and ranged from 1 to 12,369μg/m3 (SD=287.11). The household levels of PM2.5 levels were likely to exceed the WHO guidelines given the high levels observed in less than 24 hours of monitoring periods (on average 10.4 hours in Viwandani and 11.8 hours in Korogocho). Most of the respondents did not use ventilation use in the evening which coincided with the use of cookstove and lamp, mostly burning kerosene. The levels of PM2.5 varied by the type of fuels, with the highest emissions in households using kerosene for cooking and lighting. The PM2.5 levels spiked in the evenings and during periods of cooking using charcoal/wood. Despite these high levels, residents perceived indoor air to be less polluted compared with the outdoor air, possibly due to the presence of large sources of emissions near the communities such as dumpsites and industries. The community had mixed perceptions on the health impacts of air pollution, with respiratory illnesses perceived as the main consequence while vector or sanitation related diseases such as diarrhoea was also perceived to be related to air pollution. Conclusions With poor housing and reliance on dirty fuels, households in slums face potentially high levels of exposure to PM2.5 with dire implications on health. To address the poor perception on air pollution and knowledge gaps on the health effects of air pollution, education programs need to be developed and tailored. These programs should aim to provide residents with information on air quality and its impact on the health; what they can do as communities as well as empower them to reach out to government/stakeholders for action on outdoor sources of pollution such as emissions from dumpsites or industries. The government has a larger role in addressing some of the key pollution sources through policy formulation and strong implementation/enforcement

A Descriptive Assessment of Household Air Pollution in Rural Kitchens in Kenya

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